Committee (6th Day)

Part of Care Bill [HL] – in the House of Lords at 5:15 pm on 16th July 2013.

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Photo of Lord Warner Lord Warner Labour 5:15 pm, 16th July 2013

My Lords, I hesitate to intervene in the debate on Amendment 88Q but I feel under some obligation to share with the Committee some of the thinking of the Dilnot commission where we went into this issue and set out our views in our report. I declare my interest as a member of that commission. I suspect that what I am going to say may be thought of more advantageously by the Minister than by those who tabled the amendment; however, it is important that we consider these factors.

First, we made it very clear in the report that,

“we believe that those who develop a care and support need during their working life should be assessed in broadly the same way as an older person”.

We tried to create an architecture that was reasonably consistent between the needs of those of working age and older citizens. Secondly, when we were asked to undertake this assignment we were asked to consider the feasibility of introducing this and the affordability of the changes. We wrestled with this quite a lot in our deliberations but we concluded in recommendation 6 of the report:

“In the short term, we think it is reasonable for a minimum eligibility threshold to be set nationally at ‘substantial’ under the current system”.

Our concern in doing that was not just that we were mealy-mouthed stooges of the Treasury but the overwhelming amount of evidence given to us about underfunding of the adult social care system over a long period. We considered that and said in the report that it was seriously underfunded and that funding had failed to keep pace with demographic changes in people of working age and those who were not. We thought that the deficit had to be made good but that that was a matter for the Government of the day and would need cross-party consensus if improved funding for social care was to be maintained.

We were trying to be realists in saying where we could begin this scheme. We were not saying that the threshold would be set at substantial for ever but that if we had a hope in hell of getting these changes made—this issue has been around for 10 to 15 years and has not been resolved and we had achieved a reasonable consensus among all stakeholders and across the political spectrum—one of the key issues was that the recommendations should be affordable. Given the deficit funding, we could not see how in the short term you could end up with eligibility criteria that would be more generous than substantial, which is where, in reality, most local authorities had ended up, whatever the rights and wrongs of those kind of considerations. That is where we were. We wanted a consistent architecture between working age and non-working age; we wanted practical proposals that would be implementable in the reasonably short term and we recognised that there was a deficit in the funding that had to be made good before you could get this new set of arrangements off the ground and improve them over time.

The Government deserve a lot of credit for the way they have simply accepted our recommendation that the FACS system was opaque and totally misunderstood or not understood at all by most of the public. They have abandoned a banding system that was a poor servant to comprehensibility about the way the system operated. They have made a pretty good first shot at draft eligibility criteria in their draft regulations, moving away from that discredited banding system under FACS.

In that situation, it is very difficult to foresee circumstances in which we can go from where we are now into a new cap system which is consistent between working age and non-working age and make the leap beyond a national threshold of substantial. You could argue that as we are being brave and making this change, we should become braver. The argument against that approach is that we would raise expectations among a lot of people of working age or non-working age about what they will get when the financial reality at the local level is that they will not get it because there will not be the resources to deliver those services. That would be a cruel deception. The only way to break out of that is to say that we will take one particular group—those of working age—and deal with them differently in the eligibility criteria for meeting needs from the older age group. If we are going to keep consistency between those two age groups, we have to accept that at present it is very difficult to introduce this system with eligibility criteria that are substantially more generous than “substantial” under the present FACS system. I fully accept that that is not likely to be a popular view and that it will mean that some people will not get the services they need and may deserve, but—and this is a big but—if you look at the characteristics of this system, even if people do not get free services, they still get a guarantee of an assessment of their care needs and advice on how to meet those needs. That is a lot better than the circumstances that they are faced with under the current system.