Clause 2 — Extent and short title

Bill Presented — Sustainable Energy (Local Action) bill – in the House of Commons at 8:15 pm on 12th January 2010.

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Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health) 8:15 pm, 12th January 2010

I beg to move amendment 42, page 2, line 27, at end insert-

'(1A) The provisions of this Act come into force on whatever day the Secretary of State appoints by order made by statutory instrument.'.

The amendment would quite simply enable the Secretary of State to appoint the day on which the Act would come into force. It might be the same day that it receives Royal Assent, as I assume is the intention, or it might be another day. Will the commencement sections or other sections of the amended existing legislation require the Secretary of State to set out commencement provisions for the measures in the Bill? Can the Bill commence before the regulations in clause 1(4) are passed? That harks back to some of the other points that we have made about the rapidity with which we are having to consider the Bill without some of the necessary supporting documents, research and basis.

It is worth pointing out that this is the only piece of primary legislation sponsored by the Department since 1997 that includes no commencement provision, which reflects on the nature and provenance of the Bill. The reason for the amendment is that I wish to cause the Secretary of State and the Minister to pause for thought when it comes to putting it into action. I hope that just for a moment, they will contemplate what a mess has been occasioned by the desperation of a Prime Minister anxious to use the final moments of a Government and a Parliament to rush through legislation that appears to have been electorally driven.

We have looked as best we can at the Bill to scrutinise it carefully in the very limited time that we have had available. An important point is that we were up against the incredible tightness with which the money resolution was framed, which understandably and rightly excluded many amendments that we wanted to table. Many people outside this place wanted them tabled, because they have a great need to understand how the system will operate in practice and they need clarity and certainty. We are dealing not only with people who care but with people who have care needs, and there is no substitute for the clarity and the security that it occasions for people in that circumstance.

As Labour Members have made clear, and as the Minister has made clear in answers to me, the Government have assessed the funding only for two and a half years. We have had some discussion about that. That suggests that although the Bill is an interim measure, which is at odds with the fundamental point that it is meant to be consistent with the Green Paper, it has turned out to be something of a spatchcock of legislation squeezed into the end of this Parliament.

I am keen not to detain the Committee, because we have put on record many times our view about the litany of broken promises, from the then Prime Minister Tony Blair promising in 1997 to sort out social care all the way to today, 13 years later. I hope that the Minister will take the chance provided by the amendment to contemplate what many people have said about the Bill, which is that it has driven a coach and horses through the Green Paper process. I know that he resists that view, but it seems real among those who take the closest possible interest in these matters. Niall Dickson of the King's Fund, and shortly to be of the General Medical Council, said in response to the Prime Minister's announcement of the policy:

"The problem is these latest proposals seem to have been hastily put together and appear to cut across the options set out in the government's own Green Paper. After all, the government has only just finished consulting us on the very different proposals set out in that document."

The English Community Care Association said that

"it is unhelpful to have just one piece of the jigsaw".

The Association of British Insurers noted:

"It is regrettable that the Personal Care at Home Bill undermines the Government's own Social Care Green Paper", and the Equality and Human Rights Commission expressed the concerns that I set out when discussing the previous group of amendments. Lord Lipsey, who was famously a member of the royal commission on long-term care and is usually no enemy of the current Government, put it most clearly when he said:

"What has gone wrong is that in the middle of the consultation...the Prime Minister has declared" this Government policy.

The reason for this amendment is to give those hon. Members with a keen interest in how the Bill has been put together a chance to talk of their regret about how it has been done, not necessarily its objectives. Many of us agree with its objectives; the trouble is that it does not sit well in the context that we have all been working towards and the attempt to build a consensus. I hope that the Minister will come to recognise that there is a price to pay for political tribalism, given his reluctance to contemplate the merits of our home protection scheme. Taken together with the provisions in the Bill and other measures urged on me by Dr. Ladyman among others, that scheme could provide the whole picture, rather than just one piece of the jigsaw. That is why we have tabled the amendment. We do not want to see a postponement of implementation, but this Bill should be seen as part of a consensual process, as far as we can achieve that. In the absence of such a process, and with the Government taking such a tribal approach, we have had difficulty scrutinising the legislation. Its provenance is more electoral and party political than policy driven. The amendment would give the Government chance to pause and contemplate the fact that they should have set the Bill in a broader context. I invite those who think that it could have been handled better-perhaps as Lord Lipsey has suggested-to support the amendment.

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Photo of Phil Hope Phil Hope Minister of State (the East Midlands), Regional Affairs, Minister of State (the East Midlands), Department of Health 8:45 pm, 12th January 2010

The reluctance of the Opposition to support this Bill was obvious on Second Reading and today. The amendment would require a commencement order before the Bill could come into force, and would be yet another obstacle to the provision of free personal care for those adults and older people with some of the highest needs. We want to help those people live independently in their own homes.

The hon. Gentleman talks about consensus. He holds out the hand of consensus, but in his other hand is the back-stabbing knife of the Conservatives' disgraceful and scaremongering petition on disability benefits for older people. That shows the two-faced attitude of the Opposition in applauding the Green Paper at the same time as opposing the Bill. It is discourteous when the Conservatives are running a petition on their website that seeks to scare vulnerable and anxious older people with assertions about disability and attendance allowances that are wholly untrue.

Although the Conservatives have been reluctant to support the Bill-describing it as anomalous and perverse, as they have done today-other people have welcomed it unreservedly. Imelda Redmond, chief executive of Carers UK, has said:

"Many families face crippling costs to pay for care, and this historic pledge to end the means test for those with the highest need could make a huge difference to their lives."

That is in stark contrast to the quotes cited by the hon. Gentleman.

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Photo of Phil Hope Phil Hope Minister of State (the East Midlands), Regional Affairs, Minister of State (the East Midlands), Department of Health

I will give way in one moment, but I was thrown quotes criticising the Bill, and I am going to throw back some quotes from stakeholders who support it.

The president of the Association of Directors of Adult Social Services, Jenny Owen, said of the Green Paper and the Bill:

"Today's announcement is an important and valued first step on that road", meaning the road to creating a national care service. Mike Padgham, chairman of UKHCA, said:

"We welcome the Prime Minister's high-level commitment to homecare and look forward to the detail of how people will be able to access free personal care. Home-based care is an excellent service which keeps many people out of hospital and...enables people to return to their communities quickly following hospital discharge."

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Photo of Stephen Dorrell Stephen Dorrell Conservative, Charnwood

The Minister has said several times that the Bill concentrates money on those with the greatest care need. Is that true? The resources are in fact being channelled to those with the greatest care needs that can be met at home, but those with the greatest care needs are those whose needs cannot be met at home. Their needs must be met in residential care, and for them the means-tested system will continue to operate.

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Photo of Phil Hope Phil Hope Minister of State (the East Midlands), Regional Affairs, Minister of State (the East Midlands), Department of Health

We go around the same arguments that we have been having all afternoon. The right hon. Gentleman fails to acknowledge the importance of supporting people independently in their homes, which I thought all parties accepted. The people with the highest needs are the people to whom we have given priority, as a step along the road to a national care service that will meet the needs of all older people-indeed, all adults over the age of 18-over the years to come. His party recognises that that is a huge challenge, and we are endeavouring to propose measures for it.

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Photo of Stephen Dorrell Stephen Dorrell Conservative, Charnwood

I am grateful to the Minister for his patience in giving way, but he again spoke about people with the highest care needs. We all agree that we should encourage as many people as possible to live at home and introduce a system to enable that-there is no argument about that. However, it is simply untrue that the Bill focuses resources on those with the highest care needs. Those who need residential care have the highest care needs, but the Bill does nothing for them.

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Photo of Phil Hope Phil Hope Minister of State (the East Midlands), Regional Affairs, Minister of State (the East Midlands), Department of Health

The right hon. Gentleman simply continues to dig himself into a bigger hole. The question before the House is this: do we support a Bill that will help those people living at home with the highest care needs-yes or no? To Labour Members, the answer is clear and unequivocal, but the Opposition have continually put forward obstacles, objections and amendments, and describe the Bill as perverse and anomalous.

As the Bill continues through Parliament, I will be clear in telling my constituents how proud I am that over 10 years, we have been developing and improving care services in this country. The Bill is one more step along the road to creating a comprehensive solution to the care needs of the people of this country. Amendment 42 would simply put another barrier in the way and we do not need it. No separate commencement order is needed and no other obstacle or hurdle is required: they would simply add more work and time to the process in general.

We do not intend the regulations to come into force within two months of Royal Assent, and that is acceptable. It is time for the games to stop and for the Conservatives to give the Bill unalloyed and clear support.

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Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

This is slightly depressing. The Government have chosen to discuss what they regard as a prime ministerial flagship Bill for only one day on the Floor of the House. The Bill was put together at short notice and flies in the face of the processes that the Government had already set up through a Green Paper. All sorts of people outside this place, including those who give a lot of their time to caring for vulnerable people and the many people in the various categories of need, have grave concerns about it. There is a big question mark about the legitimacy of the Bill. We have properly asked questions about its compliance with the European convention on human rights and my right hon. Friend Mr. Dorrell rightly identified and reinforced those discrimination issues in his argument. However, after all that, we end up with the Minister somewhat charmlessly deciding that it is really rather an insult to subject the legislation that he is meant to be defending to scrutiny. Of course, the only way in which one can do that is by way of amendment-I dare say that that would be clear in the minds of most hon. Members. The fact that the Bill has been rushed out and is contrary to the run of the Green Paper means that many questions have to be asked.

In my introduction I simply proposed my amendment 42 and said how it is framed, so it hardly warranted the Minister's quite extraordinary rant. It is framed to allow the Committee an opportunity to test whether it feels that the process by which the Bill has come about, the time in which the consultation will take place-it will not finish until February-and the results of the assessment of that consultation, which will be important for so many people representing various stakeholder and constituency interests, have been sufficiently thought through and well framed for us to produce good legislation, which we can pass from this House to the other place to look at. We have set up a number of things that I hope those in the other place will find useful, as hooks for their discussions, so that their expertise can be brought to bear.

I hope that the record will show that, far from not being supporters of the Bill, we are indeed supporters of the Bill. We are also keen to ensure that it works for the purposes that it is intended to work and for the people for whom it is meant to work. That is why we have done what we had to do in this Committee stage. That is precisely why we are all sent here: to do our legislative duty. I am surprised that the Minister found that insulting and felt that it warranted his outrageous rant, which I thought was undignified and not worthy of the office that he is privileged to hold.

Therefore it is vital that we give the Government and the Secretary of State a chance to pause for thought. Has this Bill been sufficiently well framed, in its timing and for the process by which we are drawn to this place to scrutinise legislation? Is it sufficient for a Government simply to say, "We want it to happen; therefore it will happen"? Or, at this late stage in this Parliament, should we be doing our duty, by looking at the constituency that the Bill is meant to represent? The Minister has not given an adequate answer to why 2,000 people becoming net beneficiaries is a sufficient benefit, as opposed to the costs, to warrant the £500 million being pledged, not least because money is to be scraped from savings by local authorities-local authorities are meant to be serious providers; they are also meant to have the opportunity to save-from budgets that are often already pared down to the bone.

It behoves us to give the Committee an opportunity to express its opinion. Had the Minister chosen to take a slightly different route in responding to this debate, we might have been more amenable to building a consensual approach, but that does not seem to be on offer. The Committee should have the opportunity to register its distaste at how the Government have sought to treat us in dealing with the amendment and at the Minister's response. I therefore seek to press the amendment to a vote.

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Question put, That the amendment be made.

The Committee divided: Ayes 188, Noes 286.

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Division number 36 Bill Presented — Sustainable Energy (Local Action) bill — Clause 2 — Extent and short title

Aye: 188 MPs

No: 286 MPs

Ayes: A-Z by last name

Tellers

Nos: A-Z by last name

Tellers

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Question accordingly negatived.

Proceedings interrupted (Order, 14 December).

The Chairman put forthwith the Question necessary for the disposal of the business to be concluded at that time ( Standing Order No. 83D) .

Clause 2 ordered to stand part of the Bill.

The Deputy Speaker resumed the Chair.

Bill reported, without amendment.

Third Reading

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Photo of Phil Hope Phil Hope Minister of State (the East Midlands), Regional Affairs, Minister of State (the East Midlands), Department of Health 9:11 pm, 12th January 2010

I beg to move, That the Bill be now read the Third time.

This is a small Bill containing just one substantial clause, but, as has been remarked, it will have a great significance for thousands of the most vulnerable adults and older people in our constituencies. As was said, we know that social care needs a radical overhaul, and the Green Paper published last year reflects our commitment to taking decisive action. However, the promise of fundamental reform in the future must not prevent us from taking important measures here and now to help those with the greatest need living in their own homes.

The Bill means we can take action to reduce the unfairness and uncertainty that many people feel as their health worsens and their care needs grow. The Bill will provide support and financial relief to 400,000 older people with the greatest care needs, including those with conditions such as Parkinson's, dementia and motor neurone disease. Some 280,000 people who require high levels of intimate personal care on a day-to-day basis will now get these services for free in their own home. Many of them have faced the burden of paying large amounts of money for care as their conditions deteriorate, and this Bill will remove that millstone. In addition, a further 130,000 people will receive free reablement or rehabilitation to help them to recover their independence after a fall, bereavement or serious illness.

The Bill is practical and will be financially manageable for councils. Indeed, many local authorities already offer some form of reablement support, which is helping them to use their resources more efficiently. Because of that, we have a running start on many of the financial and logistical hurdles that were discussed in Committee, including recruiting and paying for the additional work force required to honour the commitment. We are consulting widely on how the system will work and how people will be assessed. I want councils to have flexibility over how they resource the free personal care offer, while we ensure consistency across the country over who receives it.

Above all, the Bill supports a simple principle-one that I must have reiterated in every intervention on Mr. Dorrell-which is that we must do everything we can to help people to live as well as they can, for as long as they can and in their own homes. That is what people tell us they want and why the Bill focuses on providing personal care for those who live in their own home, including sheltered or supported accommodation. Let us remember that the Bill will not only benefit older people but support their family members, many of whom face the difficult task of looking after an elderly relative while also bringing up their own family and holding down a job. It will bring wider economic and social benefits for carers, as well as long-term savings for the taxpayer by preventing hospital admissions and reducing care costs down the line. In other words, the Bill makes sense financially, as well as morally.

Social care is changing across the country thanks to the £500 million that we have put into the transforming adult social care programme. Today's Bill is another big step forward and a vital bridge to the radical proposals for funding social care heralded in our recent Green Paper. This is a significant moment for the House. By passing this Bill, we can extend the promise of a fairer, more affordable and more sustainable care system in the future, and we can make an immediate difference, here and now, to our most vulnerable constituents, giving a hand up to those laid low by age and illness. I commend the Bill to the House.

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Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health) 9:14 pm, 12th January 2010

H.G. Wells famously once said:

"In England we have come to rely upon a comfortable time-lag of fifty years or a century intervening between the perception that something ought to be done and a serious attempt to do it."

Perhaps that is a little harsh, but we all remember Tony Blair's pledge at the 1997 Labour party conference that he would sort out social care, and yet now, nearing 13 years later, the Government are still dealing with only a relatively small part of the overall picture, of the demand that has been coming from all quarters for many years.

Broadly, we have had a good series of discussions this afternoon. Time constraints have, however, been placed on us by the Government's somewhat bizarre programming decisions. This is not a free-vote issue, and nor is it a matter of national security, so it is puzzling that we have been given only this brief opportunity of one day to cover all the remaining stages of the Bill on the Floor of the House, rather than having the fuller scrutiny it would have received with a longer Committee stage upstairs and potentially a full Report stage. Frankly, we have ended up little, if any, closer to the clarity we need on some issues, such as the true costs of this measure-not only the basis for many of the estimates, but the costs post-2012 and the potential costs if the estimates are wrong. We expressed sufficient doubts to raise some serious questions about that. The Government have given little hope to local council tax payers and service users, who are set to bear the brunt of any funding shortfall.

The potential legal loopholes in the Bill are very worrying for the added costs they would bring, such as in respect of care homes restructuring, residential care qualifying as "home", and, of course, the human rights implications of the measure, which we have rightly discussed at length. A number of questions remain about reablement: who will get it, whether it is carer-dependent, and whether the costings are accurate and who will pay if they are not. Most disturbingly, the Government have refused to budge on their position regarding people with palliative care needs, although the discussion we had on that gives us some grounds for optimism that the situation may improve.

The proportionality of this legislation remains in serious doubt. The benefit estimated-that word again-by the Government is only £190 million a year, less than a third of the cost. The measure impacts on only 279,000 people, of whom 166,000 already receive care for free. It makes a difference to only 110,635, fewer than 2.5 per cent. of what the Government have said are the 6 million people in England with care needs.

The Bill makes no attempt to allow the whole gamut of social care to be addressed in the future. The Government have our home protection scheme before them. They have made various criticisms, but none of them amounts to anything other than the usual political rhetoric. As we have made clear, that scheme only addresses residential care, but their policy addresses some very narrowly defined domiciliary care. One could seek to put those two together and build a more consensual approach to trying to plug all the gaps and address the whole waterfront, as it were, of social care. In that, one can see the prospect of an opportunity for an approach that is a little less adversarial than, sadly, we have experienced, particularly in terms of the last group of amendments, which was a shame.

The Government have done little to reassure us that they know the meaning of the word "free" in terms of public policy: "free" means that somebody else pays. In this instance, they are pledging to cut money. A number of budgets have been mentioned, and they have sought to give rebuttals. We will study very carefully the rebuttal put forward at the Dispatch Box on research budgets, such as those targeting diseases such as dementia and cancer. There has also been a pledge to cut some money from the NHS IT programme. As Ministers are aware, I have been ferreting around, using parliamentary questions to try to get some answers, but the Government have never come clean about what contractual break clauses there are in NHS IT, or in some other contracts to do with the supply of swine flue vaccine, which I know my hon. Friend Mr. Lansley, the shadow Secretary of State, looks forward to receiving in terms.

It was important to make sure it is recognised that the Government have not pledged to support this policy with money from the centre, other than some proportion of it. They are also relying on the efficiency savings they simply announce can be made from local government-a full quarter of a billion pounds.

Of course, I wish that the Government had taken the opportunity to look beyond the narrow confines of this particularly electorally inspired Bill, whose provenance was the Prime Minister's comments at the time of his Labour party conference last September. With the money resolution being as tight as it is, there was not the opportunity for them to undertake full and proper consideration, not least of our home protection scheme. We would have enjoyed having the opportunity to debate and propose that. However, that is how it is, and we recognise that it will be difficult to persuade this Government to do what we hope they will do, which is to bring together a number of us to try to find some way to deliver on the very legacy that the Secretary of State claims he is trying to secure.

The Secretary of State says that he seeks some "unstoppable momentum for legislation" in this area. It is impossible to know now whether the Bill will complete all its stages, given that it must go through the upper House and that we have no idea when the general election, which must come before June, will be called. Thus we cannot be sure whether this Bill is "unstoppable" or whether it represents "momentum"-we are not even sure that it will be legislation. What we do know is that establishing unstoppable momentum requires a degree of consensus. If the Government genuinely wish to take that approach, I would be more than happy to be asked to participate in such a discussion, as I dare say those from other Opposition parties would.

As the measure goes strongly against what the Government set out in their Green Paper, we have faced the difficulty of trying to understand how to place the Bill in the context of the wider reform that so many of us seek and know must be addressed-our political generation has no option but to do that. In our consideration of this Bill in the time available to us, we have faced particular difficulty in understanding the true evidence that lies behind it and the calculations of the costs. A lot of us, including many outside this place, have had desperate concerns about the thoroughness and robustness of the impact assessment, even when the Government have sought to reissue some of the numbers. None the less, we have tried to give the Bill reasonable scrutiny.

Interestingly, the Bill may face its biggest difficulty when it goes to another place. The Government may well have a tougher time of it there, where they have some noble "Friends"-I assume that that word still applies-in Lord Warner and Lord Lipsey who have certainly, in comments to date, been squaring up for something of a fight on this. Lord Lipsey has called the Bill a "gimmick" and said that it is

"bad policy but also a very bad way to do policy just to find a...highlight for your Labour Party conference speech."

Who knows, perhaps everything has changed in Lord Lipsey's mind after the apparently rousing call to arms by the "Mr. I'm a team player" Prime Minister at the parliamentary Labour party meeting last night-we will wait and see.

In advance of what might be considered in the other place, what matters is that we have done our very best to try to unearth what truly lies behind this Bill and how it will in fact be made to work, given that it is proclaimed to service the needs of some-only some, not all-of the most vulnerable in our country. I am grateful not only to you, Mr. Deputy Speaker, and to all those who have assisted us in going through the process of scrutinising this Bill, but particularly to my many Conservative colleagues who have taken the opportunity to contribute to this extremely well-informed and responsibly discussed debate on an important matter.

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Photo of Stephen Ladyman Stephen Ladyman Labour, South Thanet 9:23 pm, 12th January 2010

For a relatively small group of people across the country who are struggling at home with a high level of care need and who are worried about the cost of that and whether they can continue to live in their own home or will have to go into residential care, this Bill will transform their lives. We need to put things in context, as I have attempted to do all the way through these debates, by saying that that group is relatively small. That is why this Bill, despite being good and worthy of support, is only the next step in the reform of social care. It is not the first such step and it is important to emphasise that over the past 12 and a bit years many advances have been made in the provision of social care. One that the Opposition continually fail to mention is the fact that if someone goes into care and does not want to sell the family home that they have lived in, local authorities now have the money to put a charge on that home to pay the social care debts after that person's death. The reason why so many people still sell their family home against their will is that Conservative councils and, I have to say, Liberal Democrat councils all around the country forget to tell people about that benefit that is now available.

That is not the only social care reform. Extensive efforts have been made to upgrade the status of the social care work force, to qualify them, to ensure that the regulation of social care is fit for purpose and to ensure that appropriate training is available to people who work in social care. Measures have been taken to improve the methods of discharging people from hospitals so that there is no longer bed blocking and to ensure that social care provision is available for people in the community when they need to be discharged from hospital. Reablement schemes are available around the country and improvements have been made to the provision of services and to the integration of services between the NHS and social care. Efforts are also being made to extend the availability of telecare and of extra care accommodation. I remain disappointed by some of the comments made by the Opposition about extra care. If, as they say, they are approaching this Bill in an open-minded spirit and if they want to approach me, I will happily take them to see some extra care accommodation and to see the benefits that such care can provide to people.

All the measures that have been put in place so far have been the first steps in improving social care provision in this country, but the Bill that we are discussing today is only the next step on that path. The biggest step of all remains in front of us: we need to fold all those measures together into the comprehensive social care package that we know we have to face up to. In my view, it will necessitate some form of co-payment and some method of bringing in extra resources from the population. I said on Second Reading that my preference would be a hypothecated inheritance tax, and I shall continue to reiterate that until somebody takes the idea seriously. Whether we use that solution or some other insurance-based solution, a solution will have to be found. We must find a solution to how we can get local councils to assess people's care to ensure that packages are portable and to agree on how they will be funded so that they are funded to the same level around the country. That will have major implications for localism and the role of local authorities in the future.

These are huge issues that will have to be addressed-and addressed they must be-but this Bill is nevertheless a valuable contribution to that process. It will radically transform the lives of that group of people with high levels of care needs who want to stay in their own homes. For that reason, this Bill is absolutely worthy of the House's support, but only with the caveat that we should all commit ourselves to taking the next step as soon as possible.

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Photo of Norman Lamb Norman Lamb Shadow Secretary of State for Health 9:28 pm, 12th January 2010

It is a pleasure to follow Dr. Ladyman. I absolutely agree with his last point: we must all commit ourselves to finding a sustainable, long-term solution that meets the needs of all those with care needs and not just the small group whom this Bill addresses.

Let me start by making it clear that there are two other points on which we all agree. I am sure that we all agree on the absolute importance of the idea that any reform should facilitate people's remaining in their own homes for as long as they can. For the group of people who will benefit from the Bill, that will clearly be the case. We must ensure that that principle is at the heart of the final reform that we achieve.

The second absolutely important principle, which this Bill addresses, is the value of reablement. The Bill recognises that at present we do not do reablement well enough. There are patches of good practice around the country where authorities have been able to demonstrate the enormous potential savings and, more importantly, the dramatic improvement in people's lives of committing properly to reablement. However, in too many parts of the country reablement is not provided well enough. At its best, the Bill provides an incentive to the system to ensure that reablement takes place. That is a good thing.

Following the debates today and on Second Reading we still have three core concerns, the first of which is affordability and sustainability, particularly given the trend towards an ageing population. We used to be attacked by the Government for our previous commitment to free personal care. Two years ago, we removed that commitment. I took a paper through our party conference, because I reached the conclusion that one could not, in reality, argue the case for free personal care given the demographic changes that we are witnessing. The Green Paper recognises that point, but the Bill shifts in that direction. That causes me real concern, because the cost of the duty to provide free care to the relevant group of people will keep rising.

The Government have set a cap on the amount that they will contribute, so the other potentially pernicious impact is that if the rest of the funding has to come from local authorities as the numbers continue to increase, something else will have to give. My fear is that, owing to this duty, other vulnerable people who benefit from care from local authorities on a discretionary basis will end up losing their care, or part of it. If the demand is higher than the impact assessment has concluded, the impact will again be on local authorities here and now, and the potential consequences could be very damaging.

Our second core concern is that the proposal is a partial solution. I think that everyone recognises that. The Government's case is that it is a bridge to reform, but as long as it remains the only reform to have happened, and until we have more comprehensive reform, it will have perverse consequences. As Mr. Dorrell has made very clear, it will provide an incentive for local authorities to push people into care homes. That is not a good thing, because it will change behaviour and will benefit one group of people but not another. Another perverse incentive was mentioned on Second Reading by the hon. Member for South Thanet-it will provide a disincentive to people who are considering insuring to protect themselves in old age.

Another danger, or consequence, of the fact that the proposal is a partial solution is the inherent unfairness in the Bill. Why should we choose to support and provide free care to one group of people-those with critical need who are cared for at home-but not another group who, through no fault of their own, end up having to have their critical needs met in care homes because they simply cannot be cared for at home? That is perverse. Why should one group benefit and not another? The Government have provided no answer to that.

Our third core concern is whether what is proposed would be the most effective use of public funds. The Green Paper strongly makes the case that in any reform we have a duty to ensure that we use public funds to the best possible effect to achieve the best outcome for all those who have care needs, but the Bill does not do that. The impact assessment confirms specifically that the group of elderly people who would benefit most from the proposal would be the wealthiest.

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Photo of Norman Lamb Norman Lamb Shadow Secretary of State for Health

The Secretary of State shakes his head, but the impact assessment makes that clear. At paragraph 5.21, it states:

"The recipients of free personal care are believed to fall into the bottom, 2nd and 3rd quintiles because even the wealthiest older people (who represent the main beneficiary group) are in the middle of the income distribution of society at large."

In other words, the wealthiest elderly people are not the wealthiest people in society, but they are the main beneficiaries of the Bill. I find it bizarre that a Labour Government should choose to use available public funds to benefit most the wealthiest older people, given that there are many others with acute care needs. The conclusion must be that that is not the best use of available public funds.

I am also concerned that the Bill has been oversold by the Government. The Minister again quoted a figure of 400,000 for the total number of people to benefit from free care, and that of course includes those who would benefit from reablement. However, when one looks at the number of new recipients of free care at home, the real figure is 110,000. The Government do not use that figure at all in their pronouncements.

The Government say that the Bill protects the care of those currently receiving free care, but it is hard to envisage circumstances in which those in critical need who are benefiting from care on a means-tested basis would lose that care. Therefore, it is somewhat disingenuous to argue that there is some great benefit for that group. The new recipients of free care will total just 110,000. As the hon. Member for South Thanet made clear, that is a relatively small group, compared with the total number of people with care needs who will have to be supported in any final reform of the system.

Finally, I find that it strains the use of language to describe this Bill as a bridge to reform. As a sceptic, the hon. Member for South Thanet made the best possible case for supporting the Bill but, whatever happens to it, we must all be committed to a more fundamental reform of the system. I think that we are all agreed on that.

I want to repeat the case that I made on Second Reading. In this pre-election period, there is a real and overwhelming need for all parties to put aside their differences and to join in a process charged specifically with building and achieving consensus on this matter. I know that that would be supported massively by those groups outside Parliament who represent people with real care needs. Such a consensus would have the benefit of facilitating reform in the next Parliament, and it would also put pressure on whoever wins the next election to ensure that reform takes place.

The hon. Member for South Thanet is absolutely right to say that the urgency of completing the reform process is overwhelming. We must not allow this Bill to delay that.

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Photo of Tom Clarke Tom Clarke Labour, Coatbridge, Chryston and Bellshill 9:38 pm, 12th January 2010

I think that I have listened to every speech and contribution made today, and I have found them extremely stimulating. Far from objecting to the Committee stage being taken on the Floor of this House, I take the view that we ought to do this much more often. I do not think that it takes away from the scrutiny performed in Committee upstairs, but I believe that people might get involved in what we do here to a greater extent if we had more of the transparency to which this Bill has been subjected today.

I welcome the Bill, and I also welcome the contributions made by the Minister of State, my hon. Friend Phil Hope. A few harsh things have been said about him, but I have many relatives in the steel industry down in his area and they will be supporting him. They do not say that he does not distinguish his post, because he so clearly does. I am sure that they are proud to have him as their Member of Parliament.

Briefly, I should like to thank the House for the involvement of people with learning disabilities. For all those who will benefit because they need personal care at home, the Bill is progressive, meaningful and welcome.

Although we heard threats about what might happen in another place, I hope that people such as Lord Morris and Lord Ashley and many others there will recognise the progressive nature of the Bill and will see that the Government and many organisations have welcomed the provisions. I believe that they will welcome the fact that at this stage in our Parliament we have given such prominence to something so profoundly important. I hope that that will be a beacon and a signal of the relevance that we give these matters in the next Parliament, when I expect to be speaking from the same spot.

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Photo of Stephen Dorrell Stephen Dorrell Conservative, Charnwood 9:40 pm, 12th January 2010

I begin a brief speech by congratulating the Minister on the way that he dealt with the Bill. He put the best gloss possible on it, as I have not the slightest doubt that the Bill was generated in No. 10 Downing street and imposed on his Department against its advice. I have been there, so I congratulate him on presenting a defence of what is, in policy terms, an indefensible measure.

I shall go through the three key arguments, which are in many ways similar to those set out by Norman Lamb, to which I do not believe the Minister responded adequately during the debate, despite his polished performance. The first is the argument about the convention on human rights. The policy justification that the Government have offered for the Bill does not stack up as a defence against the concern that they made explicit in the explanatory memorandum to the Bill. There remains a set of unanswered questions about the Bill.

My second set of concerns relate to the policy implications of the introduction of the group of people who will benefit from free social care. The Minister rightly said in his presentation that we should not let the best be the enemy of the good, that we must allow for incremental change and so on. I entirely agree with him about that, but it does not absolve the Government from the need to think about the policy implications of what they do today when projected forward to tomorrow.

Last July the Government said clearly that we could not afford a solution on personal care that landed the cost on the taxpayer. That is in the Green Paper in a rather convoluted form, and the Minister confirmed today that that remains the Government's view, yet as a consequence of the Bill, a group of people is created in the middle of the social care requirement for whom that outcome is what the Government are now seeking to legislate-tax-funded free social care-not, as the Minister said several times in loose wording, for the most vulnerable, but for the second most vulnerable group.

The most vulnerable are those with critical care needs, who need residential care. Those are still subject to means-testing under the Government's intended solution. Below them in the hierarchy of need is the group that has been identified by the Prime Minister as the people who should benefit from free social care. Then there is the whole of the rest of the social care group. It is a golden rule of policy that if a group of people is created in the middle of a much larger group, all of whom benefit from broadly the same type of care with constantly changing requirements, the result is a change in behaviour.

What the Government have done is create a group of people-a very small group, when seen in the context of all those who benefit from social care-to whom they have offered the promise of free social care, which is precisely the policy solution that the Government, quite rightly in my view, ruled out in their Green Paper. By doing that, if the Bill reaches the statute book and is actioned next October, they will have created a huge policy problem for the evolution of social care policy in a way that is consistent with the principles rightly set out in the Green Paper last summer.

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Photo of Andy Burnham Andy Burnham The Secretary of State for Health

I am listening carefully to the right hon. Gentleman and I have great respect for the work that he did as Secretary of State for Health. Does he acknowledge, however, that the group of people he is identifying, with whom the Bill deals, have already been paying for their care out of their own pockets as their condition has deteriorated over the years? For that reason, the Bill is consistent with the reforms in which individuals pay something towards their own care, but do not have to bear the whole cost, which can in some cases be catastrophically high, as we know. The right hon. Gentleman seems to have no appreciation that these are people who will already have paid out a large amount towards the cost of their own care.

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Photo of Stephen Dorrell Stephen Dorrell Conservative, Charnwood

Of course I have an appreciation of that, but I would like the Secretary of State to consider how he is going to explain to that same group of people who have paid out under the current regime that they will get free personal care when they are in their own home, but, as their care needs become more exaggerated and they have to go into residential care, they will have to start paying again. How is he going to explain that to them? That will be the consequence of the policy prescription that he is introducing.

I have three concerns about the Bill, as I have said. The first is the human rights implication. The second is the implication for broader social care delivery of the introduction of free care for this group of people. The third echoes the question raised by my hon. Friend Mr. O'Brien and the hon. Member for North Norfolk: where is the money coming from? The Government say that this will involve £500 million, but I do not believe that. I certainly do not believe that it will be £500 million when the behavioural impact has been taken into account.

At a time of huge competition for resources, the Department has been landed with bad policy by the Prime Minister, which will lead to resources being channelled to a particular group of people. Those people are very deserving-I do not deny that. I accept that they will benefit, and that they have contributed substantially to their care. They will suddenly receive that care free for as long as they do not need to be in residential care. Of course they will be significant beneficiaries, but seen in the context of the pressure on resources that the Government of this country-whoever they are-will have to address, over not just the next six to 12 months but the next five years, this seems to be bad policy which has been made on the hoof and will have all kinds of long-term negative consequences that have not been thought through. I entirely agree with the criticisms of the Bill that have been articulated by Lord Lipsey, and I rest my case on his presentation of the case.

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Photo of Laura Moffatt Laura Moffatt Labour, Crawley 9:48 pm, 12th January 2010

I do not care where the Bill was born or who dreamt it up; I am just extremely glad that I have stuck with it, right from the early days of the consultation paper when I considered these matters with my constituents. My constituents do not care either; they are just very pleased that we are able to be here today, giving the Bill a Third Reading. They believe that this is the right thing to do.

It is easy to over-complicate the Bill. It is also easy to spend a whole day doing down its aims and objectives. We know, however, that it will benefit a significant number of people. Most of us-certainly those of us, on both sides of the House, who have taken a serious, forensic interest in the Bill from the word go-will completely understand that we would love to move straight to a national care system. Anyone who has worked in the care system, as I have, will know that that is our objective. I have to say, however, that the one true thing that the Bill does is send a clear signal to our constituents that this Government are very keen to ensure that people receive the care that they need, free at the point of use, with the reassurance that they will be able to live their lives out in their homes if that is what they want. And that is what they want.

Question put and agreed to.

Bill accordingly read the Third time and passed.

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