I want to raise the question of what direct payments buy, and I have some figures from an article that appeared in one of the papers. We have  already talked about our welcome for direct payments, and there is no doubt that empowering people and having them feel in control of the services that they receive is useful for not only the individual concerned, but service providers. However, the effect of individuals’ purchasing power can be quite profound, and the help that people will be buying will be in the form of a personal assistant or a home carer. It is very important that these changes do not have unintended consequences. The job of being a personal assistant or home carer must be kept viably attractive.

The danger is that cost cutting is turning the personal assistant or home carer role into that of a poorly paid dogsbody, and a job that not enough people are willing to do. We have seen this in the tourism industry. For some reason, we have a dislike of unskilled labour in service industries in this country. I do not remember the precise figures, but in central London there is unemployment of about 8 per cent. We are importing labour from eastern Europe and British people will not work in service industries here because it seems demeaning.

These direct payments must be sufficient to employ people of a sufficient calibre to give the care. The danger, particularly in any sort of work that involves going into people’s homes, is that if the status of that work is not high, not enough people are recruited and we get second-class care. While it is important that people are empowered and feel that they have ownership of the care that they receive, we do not want them to feel that they can receive only the very worst possible care that is available.