New Clause 17

Health and Social Care Bill – in a Public Bill Committee at 3:30 pm on 24th January 2008.

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Minimum guaranteed outcomes

‘(1) The appropriate authority shall by regulations make provision—

(a) specifying circumstances in which it will be necessary for a local authority to provide social care support (including any form of practical assistance and equipment) to a disabled person; and

(b) specifying the minimum outcomes each local authority shall secure for all disabled persons in exercising their duties under social care enactments.

(2) Without prejudice to the generality of subsection 1(b), minimum outcomes prescribed under that subsection shall include—

(a) ensuring freedom from physical risk;

(b) ensuring freedom from inhumane or degrading treatment;

(c) the full enjoyment of the right to personal development and to establish and maintain family and other social relationships;

(d) support for participation in the life of the community;

(e) support to participate in essential social and economic activities, and

(f) support to access an appropriate range of recreational and cultural activities.

(3) In this section—

“appropriate authority” means—

(c) in relation to England, the Secretary of State,

(d) in relation to Wales, the Welsh Ministers;

“social care enactments” include—

(i) Section 2 of the Chronically Sick and Disabled Persons Act 1970 (c. 44).

(ii) Section 4 of the Disabled Persons (Services, Consultation and Representation Act 1986 (c. 33).

(iii) Section 17 of the Children Act 1989 (c. 41).

(iv) Section 47 of the National Health Service and Community Care Act 1990 (c. 19).’.—[Sandra Gidley.]

Brought up, and read the First time.

Photo of Sandra Gidley Sandra Gidley Shadow Minister, Health

I beg to move, That the clause be read a Second time.

New clause 17 would end the post-code lottery in social care provision and ensure that every disabled person has a clear right to independent living support that meets basic human rights standards. The system  we have now means that the entitlement of disabled people to support for independent living varies considerably depending on where they live and whether they meet increasingly high thresholds to qualify for support.

Increasing hardship and exclusion for disabled people and their families and carers is resulting from under-investment in social care. We accept that investment is being made in health but there seems to be a lack of will to reform an outdated and antiquated system. Although there are some good things in the Bill, for example, the extension of direct payments, more could be done. This year, many more disabled and older people will be turned away by social services. [Interruption.]

Photo of Derek Conway Derek Conway Conservative, Old Bexley and Sidcup

Order. I am sorry to interrupt the hon. Lady, but there are three or four different conversations going on in the room, and the Official Reporter is having difficulty hearing what she is saying. Perhaps it would help if she could speak up a bit, and if members of the Committee could converse outside.

Photo of Sandra Gidley Sandra Gidley Shadow Minister, Health 3:45 pm, 24th January 2008

I do not feel that I should have to speak up. It is polite to listen.

This year, many more disabled and older people will be turned away by social services because they do not meet the threshold for support. If they are lucky, family and unpaid carers may step into the breach, at great cost to their health, employment opportunities and well-being, as we all know. Instead of rationing according to severity of need, which deprives some disabled people with moderate or low support needs of any help whatsoever, and increases the likelihood of more costly acute health and social care intervention further down the line, the new clause proposes an alternative approach. It would require local authorities to meet minimum outcomes in respect of disabled people regardless of the level of presenting need. That would maximise the opportunities for disabled people and maintain and extend their independence and well-being.

The minimum outcomes would be prescribed in regulations, and, given the import, there would be virtue in making them subject to the positive resolution procedure. Parliament should get the chance to debate fully and decide what a minimum level of support should be.

Examples of minimum outcomes are given in the new clause. They are based on core human rights standards as set out in the European convention on human rights: freedom from physical risk is based on article 2, which deals with the right to life; freedom from inhumane or degrading treatment is based on article 3; and the right to privacy and family life is based on article 8, which encompasses a positive obligation on states to support people in developing their personality and social relationships, and in participating in social, economic, cultural and leisure activities.

Organisations such as the Royal Association for Disability and Rehabilitation hear from many disabled people for whom those basic human rights are denied. Unless and until those rights receive clear statutory  underpinning, disabled people and their families will continue to experience daily hardship, exclusion and indignity.

We believe that local authorities are left to flout human rights standards because the Government have failed to spell out clearly what the positive obligations in the convention actually mean. They cannot simply be dismissed by reference to resource constraints, although I would point out that independent living support is frequently cheaper, better and more flexible than traditional support.

The new clause would underpin effective implementation of recommendation 4.4 of the Prime Minister’s strategy unit report, which is accepted as Government policy. That report on improving the life chances of disabled people said that there should be a new system in place by 2012 to deliver independent living. It should include provision for eligibility based on requirements arising from disabling barriers—for example, cash payments for taxis when public transport is inaccessible—and additional requirements associated with impairment. For example, voice-recognition software would enable someone to read text at home and work. Subsection (1)(a) is designed to implement that. The system should also include provision for security and certainty about what level of support is available. That would be implemented by subsection (1)(b).

The new clause would help to create a social care system geared towards prevention and the achievement of beneficial social and economic outcomes in place of the dependency-oriented, increasingly threadbare safety net that exists today. I will concede that the Government want a debate about the future funding of social care, but it must be informed by a clear position on what we want social care to achieve. The Wanless review noted that the impact of current social spending on achieving the Government’s desired outcomes of promoting choice, independence and prevention is unclear. In fact, the review said that the evidence that does exist suggests that the social care system is falling short of those aims.

The economic and social benefits, and cost-effectiveness of independent living support, including the low-level support mentioned earlier, have been well documented in reports published by the Office for Disability Issues. Wanless estimated that an additional £3 billion now needs to be pumped into social care. Even if that investment is not forthcoming, whole-system reform as outlined in the Disabled Persons (Independent Living) Bill currently before the Lords—which includes provision for seamless support and individual budgets—would release major savings which could fund the provisions in the new clause.

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

I do not want to detain the Committee long. I have read the new clause very carefully. When something deals with guaranteed minimum outcomes for people with disability, I think that we are all genuinely very exercised as to whether it carries with it a thrust that we should follow.

The first issue I have is that it does not come with any costings. That has an effect. We have real issues about increasing the burden on local authorities at the very time when their finances are under increasing and continuing pressure, particularly in the area of social  care. The hon. Lady and I have regularly had quite serious disputes, both in Westminster Hall and at other times because of her confession that the free personal care promise made by her party, first in Scotland and then as part of their last national election campaign, was a lie. That was something she agreed and confirmed on the Floor of the House, and I have been regularly reassured that it is in order to use the word.

Indeed, she said that that was the way her party’s manifesto writers like to approach their whole manifesto, something with which I could not possibly disagree, and which I dare say the Minister would also find it very tempting to endorse. [Interruption.] The hon. Member for Leeds, North-West says he wants to go home. It seems quite extraordinary that he does not wish to vote this afternoon.

Photo of Greg Mulholland Greg Mulholland Shadow Minister (Health)

Just to say—and it has nothing to do with this debate, nor with the nonsense he is talking—that the reason I am not voting is that I have chosen not to vote on my own pay or allowances, and that is a point of principle.

Photo of Derek Conway Derek Conway Conservative, Old Bexley and Sidcup

Order. I am sure that the hon. Gentleman would not be tempted down that path. What he does on the Floor of the House is a matter for him later.

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

Indeed it is. I have never participated, and never wish to, but I shall be voting for the lower amount this evening.

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

Otherwise I would not be participating, because I think as a matter of principle it is not right that we should have anything to do with our own pay and conditions.

Photo of Derek Conway Derek Conway Conservative, Old Bexley and Sidcup

Order. We are not going to have a debate about Members’ pay in this Committee. We will stick to the new clause before the Committee.

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

I accept your ruling, Mr. Conway. The reason this was important—and it is important to place it on the record—is that we do not get many chances to scrutinise one another’s promises and proposals, and the Liberal Democrats were making a serious contribution to this. They have form, and the hon. Member for Romsey prayed in aid the approach that her party has taken to social care. She even prayed in aid the Wanless report. That has been prayed in aid by her party in the past when it promised free personal care—a promise that, in their most recent announcement, has been withdrawn as no longer being affordable. It is important to recognise that, in fairness to the hon. Lady, she was at least two if not three years ahead of her party in admitting that the policy was unsustainable and undeliverable—and indeed, was not delivered. On that basis, and on the basis of the fact that there is an absence of costings in new clause—I think the Minister will share that concern—there is an issue here about whether the promises in the new clause are deliverable in reality.

Photo of Ben Bradshaw Ben Bradshaw Minister of State (Regional Affairs) (South West), The Minister of State, Department of Health

I do not want to intrude on the private grief of the Liberal Democrat and Conservative parties, but I will defend the hon. Lady’s right—and indeed the right of any political party or hon. Member—to change her mind. Indeed, the Conservative party changed its mind on policies almost every day, so I do not see what point the hon. Gentleman is making.

I think that many of us have a great deal of sympathy for the sentiment expressed by the hon. Lady, but we have problems with the new clause for reasons I will briefly spell out. First, they would curtail the autonomy of local authorities in the provision of social care services and undermine their ability to deliver the services required by their population with the funding available to them. The Department of Health published “Fair access to care” guidance in 2002, which provides councils with a framework for setting their eligibility criteria based on individuals’ needs and associated risks to independence, and includes four eligibility bands: critical, substantial, moderate and low. When placing individuals in those bands, the guidance stresses that councils should not only identify immediate needs, but those that might increase for lack of timely help.

The second reason why we do not think that the new clause is desirable is that where fundamental reform of the social care system is needed, which is what the hon. Lady was really talking about, it ought to be considered as part of a coherent package. That is why the Government are developing the Green Paper to which she referred. It is an historic advance reflecting the fact that society is changing and will change even more in the future. Dignity and control for those who use the services and their families will be at the heart of the new system. The work on the Green Paper will consider the issues that she raised about eligibility. In the light of those remarks, I hope that she will withdraw the new clause.

Photo of Sandra Gidley Sandra Gidley Shadow Minister, Health

I thank the Minister for his comments. The new clause was tabled in an attempt to start a debate on a slightly different approach. I take issue with his comments about curtailing the autonomy of local authorities. Many of us think that local authorities do not have the autonomy that they want, owing to budget pressures and being unable to raise taxation should they wish to in order to meet social care demands. They are forced increasingly to make very uncomfortable decisions—this goes across the political spectrum—to restrict the services that they can offer. We can only guess at the impact of that in the long run.

I shall not detain the Committee further by indulging in cheap cross-party banter. For once, I shall rise above it and beg to ask leave to withdraw the new clause.

Motion and clause, by leave, withdrawn.


That certain written evidence already reported to the House be appended to the proceedings of the Committee.—[Mr. Bradshaw.]

Question proposed, That the Chairman do report the Bill, as amended, to the House.

Photo of Derek Conway Derek Conway Conservative, Old Bexley and Sidcup

On behalf of myself, and Mr. Hood, I thank the Committee for their co-operation in the consideration of our proceedings. In particular, I thank the Clerks for ensuring that we considered the Bill in good order, the Official Report , and the Serjeant at Arms Department and the police officers for ensuring that our deliberations were kept in an orderly fashion.

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

On behalf of the official Opposition, I would like to take this opportunity to thank all those who participated in this Committee. Despite the fact that none of our amendments was adopted, for which we are sorry, we recognise that the Minister has undertaken not only to provide information—some of which he has already provided—but to think through some of the issues that we raised. We might genuinely expect to see that materialise on Report or at other later stages. As I said, although we are sorry that amendments have not been accepted and that we have been unable to secure the evidence that we are seeking on the provenance of the health in pregnancy grant, which is a serious point, we are confident that our deliberations will have helped to improve and clarify the Government’s intentions.

I pay tribute to the contributions of the hon. Members for Luton, North and for Tamworth, and obviously to the Liberal Democrat spokespersons. I also pay tribute to my hon. Friends the Members for Rugby and Kenilworth, for Tiverton and Honiton—she has much expertise—and for Preseli Pembrokeshire, who unfortunately has been detained on other parliamentary business. In particular I pay tribute to my co-Front Bench spokesperson, my hon. Friend the Member for Guildford for the way in which we have sought to hold the Government to account.

Before I pay tribute to you, Mr. Conway, and your co-Chairman, Mr. Hood, I would like to add my thanks to the Officers and the Official Report writers for their work during the consideration of this Bill. It may not be usual, but I want to pay tribute to my expert and very diligent researcher, Sam Barker, who has been very helpful to me during the course of these proceedings.

I conclude by thanking you, Mr. Conway, and your co-Chairman, Mr. Hood, for chairing these sittings in such a way that we have been able to efficiently dispatch matters almost to the minute.

Photo of Sandra Gidley Sandra Gidley Shadow Minister, Health 4:00 pm, 24th January 2008

Carrying on from where the hon. Member for Eddisbury left off, I would like to thank you, Mr. Conway, and your co-Chairman, Mr. Hood, for your light-touch chairmanship. We had slightly fractious moments this morning, but Mr. Hood dealt with them admirably and kept us on track so that we can all get home to our families this evening.

I would like to thank the Clerks for their great attention to detail and their support and advice, which was always forthcoming and well given. I would like to thank the Minister for being flexible at the beginning when we were trying to clarify what happens in evidence sessions. We appreciate that this is all still new and we have probably learned lessons from that. I think it is a shame that the Minister has resisted all amendments, but I take heart from the fact that he was sympathetic to some of them, so I hope that we might see some Government amendments on Report.

We have had some strange debates on occasion. We have heard about the Minister’s liking for organic coupling, which had us all wondering. The tenor of the debate has sometimes been characterised by a lack of hearing. We seem to have had some confusion over whether the Minister was regarding someone’s comments as iffy or sniffy. This morning, we had a slightly fractious moment when it was felt that an hon. Member had used the word “cheat” when in fact the word “cheap” had been used. I apologise if the bug that I have had has affected people’s hearing in some way, but it has provided some lighter moments to a Bill that has been quite hard going on occasions because of the amount of technical detail.

I finish by thanking the Hansard writers, the Officers of the House and the police officers—even when they get locked out.

Photo of Ben Bradshaw Ben Bradshaw Minister of State (Regional Affairs) (South West), The Minister of State, Department of Health

Thank you, Mr. Conway. I thank you and your co-Chairman, Mr. Hood, for your excellent chairing of this Committee. I would like to thank the Opposition for their careful and close scrutiny of the Bill. The Bill will emerge better from the scrutiny that it has received during the Committee process. I would like to thank the Whips, who have ensured that we were all here at the right times, my parliamentary private secretary and all other members of the Committee for the time and dedication that they have shown in both attending and contributing to our debates. I would also like to thank the Clerks, Committees attendants, Hansard, and the police. Last, but not least, I would like to thank my excellent officials who have served me and this Committee extremely well in helping to provide hon. Members with very timely information so that they have been able to debate issues rather than receiving details in letter form later. Although, some issues have had to be delivered in that form, my officials have done a really superb job of getting information to the Committee in a timely and efficient manner.

Question put and agreed to.

Bill, as amended, to be reported.

Committee rose at four minutes past Four o’clock.