Report (2nd Day)

Part of Care Bill [HL] – in the House of Lords at 4:30 pm on 14th October 2013.

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Photo of Lord Patel Lord Patel Crossbench 4:30 pm, 14th October 2013

My Lords, I spoke about this issue when we debated the gracious Speech, at Second Reading and in Committee, when I supported the amendment put forward by the noble Lord, Lord Warner, and today I support Amendment 137. Every time we have debated this, the Minister has been sympathetic to the idea of providing free social care to those who are dying. When I think about this amendment, I think of a patient who has just been told of a diagnosis of terminal cancer, that their life will now last a few months at the most, and that medicine cannot offer much more than perhaps palliative care or treatment of some kind. Once the patient and the family have recovered from the shock, their immediate thoughts are, “Can I cope with my life—which will now be very short—at home, and what support can I get?”.

Currently, the means test for free social care can represent a barrier for those who wish to die at home. It makes it unaffordable for some, but it also means that the person may be passed between the local authority and the NHS while the two systems decide who is eligible for care and whether it should be free or means-tested. Government Amendment 57 is a demonstration of the Minister’s clear intention. He wishes to see this happen, and I thank him for moving this amendment, but it does not go far enough to achieve what I think he, too, wishes to achieve.

The second subsection in the new clause proposed by Amendment 137 is addressed, at least in part, by government Amendment 57. However, Amendment 57 does not introduce any new duties for local authorities. It highlights the existing ability of local authorities to regard the care and support needs of people at the end of life as urgent. In contrast, Amendment 137 allows the Government to introduce secondary legislation to require local authorities to regard the assessment of needs at the end of life as urgent. If the intention of the government amendment is to do that, is it clear enough? The final part of Amendment 137 relates to free social care at the end of life. Research suggests that the introduction of free social care at the end of life has broad-based support. I believe this will help to prevent expensive, unnecessary hospital admissions, prevent burdensome financial assessment during a difficult time and is an important part of giving people genuine choice at the end of life.

From the debates we have had I believe the Government, and particularly the noble Earl, are sympathetic to the idea of providing free social care for the terminally ill. The Government stated in the care and support White Paper that they see,

“much merit in providing free … social care … at the end of life”.

Indeed, they committed £1.8 million to collect the data necessary to assess the policy’s benefit through the palliative care funding review pilots. I recognise the importance of the PCFR pilots in providing data on how a system for funding end-of-life care can be implemented. When they launched the pilots the Government committed to introducing the new funding system in 2015, following the conclusion of the pilots in 2014.

I seek a firm commitment from the Government that they will make a decision by the end of this

Parliament on free social care at the end of life. Indeed, the Joint Committee on the draft Care and Support Bill called for free social care at the end of life to be introduced, “at the earliest opportunity”, and the Government had confirmed that the Care Bill provides a statutory framework to implement free social care at the end of life in the future.

There needs to be a firm commitment from the Government and a timetable for making a final decision and implementing the policy. Do the Government still support the principle of free social care at the end of life and giving patients the choice of dying at home? Are they confident that the pilots will be able to collect enough data to implement free social care at the end of life? What assessment have the Government made of the number of people who will be unable to die at home if this choice is not implemented by 2016? Finally, what assessment have they made of the savings for hospitals of enabling patients at the end of life to be cared for and die at home? I look forward to the noble Earl’s response.