Care Bill [Lords]

Public Bill Committee, 16 January 2014.

Andrew Rosindell (Conservative, Romford)

The microphones are now working, so we can commence. We now continue our line-by-line scrutiny of the Bill.

Clause 17 - Assessment of financial resources

Liz Kendall (Labour, Leicester West)

I beg to move amendment 95, in clause 17, page 17, line 15, at end add—

‘(14) The regulations in subsection (7) are subject to the affirmative resolution procedure.’.

I do not know whether I am allowed to do this, Mr Rosindell, but I want to welcome the non-Members who are here today. I would love to know who they all are and where they are from. It is nice to see people listening to this important discussion.

I know that hon. Members may have wished to go to the funeral of Paul Goggins, which is taking place today. We are not there because we are fulfilling our duties on the Care Bill. Many hon. Members will know what a decent and good man he was. He began his career as a social worker in children’s services, and was a passionate campaigner and a good, honest and true man. I wanted to pay tribute to him on the record.

Norman Lamb (Liberal Democrat, North Norfolk)

I join the hon. Lady in what she said about Paul Goggins. He was a lovely man, and really nice to deal with. He was completely non-tribal and had clear principles that he was prepared to fight for. I had a meeting with him on an important issue, which was not of great public excitement and involved the care of people in prisons, but he was passionate about it. I had a high regard for him, and I agree with what the shadow Minister said.

Liz Kendall (Labour, Leicester West)

I am grateful to the Minister for his comments and I am glad that they are on the record.

Hon. Members will know that clause 17 is about how someone’s income, savings and assets are assessed to determine whether they qualify for financial support from their council to pay for their care. It is about the means test in social care. It enables the Government to make regulations on how and at what level that means test is set. Amendment 95 would ensure that the affirmative resolution procedure of both Houses of Parliament would be required for the regulations to become law, just as we proposed on Tuesday for the regulations on the cap on care costs. I want to talk about why the amendment is necessary and to make a few general comments about the means test.

How the means test works is critical in determining whether pensioners with a modest income and assets will benefit from the Government’s proposed changes to social care funding. Let us be clear: care for the poorest pensioners, if they are assessed as being eligible, is free. Better-off pensioners, particularly those with more expensive homes, will benefit most from the cap. The means test is the key issue for everyone in between—the squeezed middle, or older people who have worked hard, saved all their lives, bought a modest home and perhaps have a small second pension on top of their basic state pension.

Hon. Members may be aware that there are two means-test thresholds for residential care: a lower limit and an upper limit. The means test works in between those limits. At present, older people with income or assets, including their savings and home, worth less than the lower limit, which is currently £14,250, have their care paid for. Those with income or assets worth more than the upper threshold of £23,250 must pay for their care in full. Alongside introducing the cap on care costs, the Government are raising the upper means-test threshold to the equivalent of £118,000, as Andrew Dilnot recommended, but the lower level will remain roughly the same, although by 2016-17 it will be equivalent to around £17,000.

That move is welcome. Opposition Members have said that any cap on care costs is a step forward, and we recognise and welcome any move that ensures that more pensioners have help to pay for their care.

Jim Shannon (DUP, Strangford)

I want to go back a couple of steps to the hon. Lady’s comments about the fact that pensioners may be asset-rich and money-poor. Houses may have been in families for generations so people may have built up their assets, and that will restrict the benefits they receive. Is that the point the hon. Lady is trying to make?

Liz Kendall (Labour, Leicester West)

Yes, and I will explain why people who do not have much of an income but have a big asset and those on average incomes, perhaps with a basic state pension and a small second pension, will not receive any help from the rise in the upper threshold of the means test because of the way it works. I hope that the hon. Member for Strangford will bear with me because I want to put the matter on the record, complicated as it is.

On 11 February 2013, the Secretary of State for Health told the House of Commons that raising the upper threshold would

“for the first time, provide financial protection for those with modest wealth”.—[Official Report, 11 February 2013; Vol. 558, c. 593.]

The reality, because of the way in which the means test works, is very different. In the other place, Lord Lipsey, as so often, hit the nail on the head. He said that the reason it is a problem for people with modest incomes and modest assets is because of what is in fact

“a very nasty means test.”—[Official Report, House of Lords, 16 July 2013; Vol. 747, c. GC728.]

I hope the Committee will bear with me while I explain. Let us say that an elderly person with an average income—a basic state pension and the average amount of a small second pension—has assets or savings of about £100,000. I will use that figure partly for the sake of simplicity, but also to demonstrate that claiming that everyone with income or assets of up to £118,000 would get help simply is not the case. So, when they hit that £100,000, they might have spent down some of the costs of their care, but they have £100,000 left in their home. As they do now, councils will assess them under the means test. They take into account the pensioner’s actual income from their basic state pension and any second pension, and what is referred to as a notional income from their home.

The council assumes that for every £250 a pensioner has in their home, they have £1 of notional income, which, of course, they do not, but that is how the means test works. When we add together the average income of a single pensioner, which the DWP estimates at £256 a week, plus the notional income between the lower and upper level of the means test, the pensioner on an average income with assets or a home of £100,000 would be assessed as having a total income of £588 a week. Since the total income of £588 a week is far above the standard rate that a council would pay for a week’s stay in a care home in their area, which we know is £477 a week, the pensioner is deemed to have too much money to qualify for help to pay for their care.

I am not proposing at this stage that we change the means test. I am trying to explain that the means test is crucial for pensioners on modest means, but the way in which it works, even with raising the upper threshold, means that many will not qualify for any extra help. The Health Secretary should not be claiming that for the first time pensioners on modest incomes will be protected by raising the upper threshold, because that is not the case. Did the Minister look at trying to change the way in which the means test works so that it helps pensioners on average incomes with modest assets, or pensioners who might be asset-rich but income-poor?

I want to raise a couple of points—some of which I have mentioned before, because the issues are critical to the means test—about pensioners who do qualify for some help. I am sorry to ask the Minister again about attendance allowance, about which I am increasingly worried. Lord Lipsey said in the other place he had discovered that if a pensioner applied for help through the means test, they would lose their attendance allowance after the first four weeks. I think he was alerted to the issue by the older persons charity FirstStop, which said some people might be better off not asking for help under the means test, because they could lose £79 a week in the higher rate of attendance allowance. Will the Minister tell us whether that is the case? Would a pensioner lose their attendance allowance if they applied under the means test for support under the Government’s new proposals?

The tricky issue of top-ups was raised by Lord Lipsey in the other place. I want to pay tribute to him because he really knows his stuff. He has been very helpful in scrutinising the Bill. At the moment, if a council assesses that an older person’s needs can be met by paying, say, £400 a week for a care home, they and their family can choose for them to go to a more expensive care home that costs, say, £500 a week and pay the extra £100 from their own pocket. However, the older person would be legally prevented from paying the top-up. A family member could pay, but the older person could not. In reality, some councils apply that rule strictly and others do not, so it can be confusing. What happens if the older person wants to pay a bit more but his or her family do not have the money? If they give their family the extra £100 to pay the top-up, are they breaking the law?

As the care Minister will know, Lord Lipsey tabled an amendment in the other place to clarify the situation with top-ups. There are loads of top-ups going on, although everybody denies it. I raise this issue because more and more people will be assessed under the means test because the threshold is increasing. Older people who want to top up their help from the council so they can go into a slightly better home are not able to do so, and if they give the money to their family they may be acting illegally.

I believe that we should help people to contribute towards the cost of their care, if that is what they want. The top-up situation has always been confusing. I have not tabled again Lord Lipsey’s amendment, but it is important that the Minister addresses this issue. More and more people will be assessed under the means test, it is currently illegal for older people to pay a top-up and there is confusion in the system. What will the Government do about it?

These issues, as I have probably explained inadequately, are complicated. The means test relates to how the cap works and whether pensioners want to take out loans. Those details will be set out in regulations, which we are being asked to pass without proper scrutiny. We have asked for the regulations to be subject to the affirmative resolution procedure because Members should be allowed to scrutinise them properly. As the Minister knows, the means test is critical because it is about people with modest incomes and assets, and I genuinely think that it is key to making the Bill fair. It is about helping not only the poorest or the very rich, but everybody in between—the squeezed middle.

Norman Lamb (Liberal Democrat, North Norfolk)

Let me start by agreeing with the shadow Minister. This is a complicated issue, and it takes a while to get one’s head around it. The bottom line is that the extension of the means test is, as the shadow Minister said, in accordance with Andrew Dilnot’s recommendations. It will mean that about 35,000 more people get social care support from their local authority.

The hon. Lady is right that people who have assets of less than £118,000 will not get additional support because of the combination of their income and assets. I have said all the way through that it is incredibly important that we are clear about what the measure will and will not do, but its great value is that a whole load more people on modest means will get more help. The value of extending the means test is that self-evidently it will help. The 35,000 extra people who will get social care support are those who need it most. I am sure the shadow Minister agrees with that. She was generous in indicating that she supports the move, but the fact that the coalition Government are providing extra help with care costs for a load more people on modest means is incredibly positive, and is widely welcomed.

She asked about the consideration given to changing the formula. The problem is that there would be a cost attached to that. I think Lord Lipsey put forward a proposition that involved changing the formula for converting capital into income. I will correct this if I am wrong, but I think that would cost around £100 million. The Government have to find that money; indeed, the Opposition have to find that money if they are to propose it. We think that the step we are taking is sustainable, affordable and helps the people who most need help but get none at the moment.

There is a sense at the moment—and has been for a long time—that if someone has over £23,000 they are on their own and lose everything and get no support at all. I am proud that this Government are finally addressing that great injustice. I think it will make a real difference to people.

On the specific point about attendance allowance, the way in which social care payments work can affect eligibility for certain state benefits, including attendance allowance. In designing the detail of the reforms, the Government are considering the interaction with the benefits system—the shadow Minister is right that it is complicated—to ensure that no one will be made worse off by these reforms. I repeat that many more people will be made better off by getting some support with their care costs, and that help will be targeted at those who need it most.

Liz Kendall (Labour, Leicester West)

How would the Minister guarantee that? If someone at the moment claims social care means-tested support, they lose their attendance allowance. How will he guarantee that if someone decides to do that, they will not lose their attendance allowance?

Norman Lamb (Liberal Democrat, North Norfolk)

The best answer I can give is that we are clear about what we want to ensure: that no one will be worse off. The design of how that works is still work in progress, but we will clarify the position as soon as we are able, both to the shadow Minister and to other hon. Members.

The shadow Minister also mentioned top-ups and whether an individual can top up. At the moment they cannot top up, although they can if somebody else can fund it. There is a legitimate concern of ensuring that someone who wants to top up is able to sustain that. Everyone would want to avoid someone taking on a financial commitment that they were not able to sustain, perhaps leading to a situation where they could not afford the particular care home they had chosen to go to. Those are really tricky issues and we want to ensure that we give that extra flexibility. We are looking at relaxing the rule, but we must ensure that there are still some protections for the vulnerable people I refer to.

Liz Kendall (Labour, Leicester West)

It is excellent that the Government are looking at relaxing the rule. That is something new. We are obviously right to be concerned about whether elderly people who start topping up will continue to have enough money to do so, and that they do not have to leave their care home. However, the same could be said for families. Families are topping up; that is legal, but what if they lost their job? What if their kids go off to university and they have to pay fees? That argument is not very good. Families are just as prone to terrible things happening if they are paying the top-up as older people. If the Minister is looking at relaxing the rule on top-ups, how will he do that? So that I can keep my eye out for regulations or consultations—it is quite hard to keep up—where will he do that?

Norman Lamb (Liberal Democrat, North Norfolk)

By way of divine intervention from my left—

Meg Munn (Labour, Sheffield, Heeley)

That is where divine intervention comes from.

Norman Lamb (Liberal Democrat, North Norfolk)

I have noted that comment and I am ignoring it.

Liz Kendall (Labour, Leicester West)

I think the Minister meant to say that he will let me know in a letter. Is that right?

Norman Lamb (Liberal Democrat, North Norfolk)

The shadow Minister helps me out. I will let her know in a letter.

The Bill has been widely praised for the manner in which it has been drafted. It is a model of co-production, as I have said before, consultation and positive joint working between the Government and stakeholders. It has been described as the most consultative process perhaps ever undertaken for legislation. This is a testament to our commitment to open working, and not something that will cease with the completion of primary legislation. That approach will continue through secondary legislation under the Bill. We will carry forward the approach in the regulations and statutory guidance that will underpin the Bill.

We have already committed that all new regulations made under part 1 will be subject to public consultation in advance of being laid before Parliament. That is in addition to the open and collaborative manner in which we are drafting those regulations and statutory guidance, even before consulting publicly. It means that stakeholders, members of the public, hon. Members, and anyone else will have the opportunity to comment on and influence all regulations and guidance. The amendment would require regulations made under clause 17(7), which are in relation to the carrying out of financial assessments, to be subject to affirmative resolution. We do not think that that is necessary.

The provisions in clause 17 will establish a single legal framework for financial assessments, underpinned by regulations and statutory guidance. This would build on and enable us to improve the current system. Our aim is to promote greater transparency and fairness by setting rules that prescribe a consistent approach to charging in similar circumstances, where appropriate, as well as allow scope for flexibility to respond to different local circumstances where necessary. For example, models of residential care and the implications for approaches to charging are relatively similar across the country. In particular, residential care will include accommodation, food, and utility costs, as well as personal care. We would therefore expect regulations to prescribe rules that require a consistent approach to determining charges by different local authorities, as they do now.

Key to delivering this approach will be that regulations are flexible enough to be kept updated. There are already regulations setting out how local authorities should financially assess people in residential care. Those regulations are a long-standing feature of the care and support system, and parts of them are revised, updated and laid annually. Reflecting this practice of regular revision, they are subject to negative resolution, something to which the hon. Member for Leicester West, although not then a Member of Parliament but a special adviser in the Department of Health, did not appear to object to any great extent.

Liz Kendall (Labour, Leicester West)

I was not allowed to speak, was I?

Andrew Rosindell (Conservative, Romford)

Order. Is the Minister giving way?

Norman Lamb (Liberal Democrat, North Norfolk)

I am giving way.

Liz Kendall (Labour, Leicester West)

All I would say is come off it. Just for the record, advisers working on policy are not allowed to speak about affirmative resolution procedures.

Norman Lamb (Liberal Democrat, North Norfolk)

I accept that very fair intervention. However, none of her colleagues in this place objected to negative resolutions, which we are simply continuing through this measure. Requiring affirmative resolution would be bureaucratic and unnecessarily time consuming. Given parliamentary timetables, this may mean adding several months to finalise regulations. In this case, where we intend for the regulations to be updated annually, it could seriously compromise the ability to keep provisions up to date, and to provide them to local government with sufficient notice in advance of implementation.

Liz Kendall (Labour, Leicester West)

I know what the Minister is going to say, but what I care about is the issue of someone who claims under the social care means test losing their attendance allowance. That will be about £87 a week when the measure comes in, given that the upper level now is £79. That is a lot of money for an unbelievably frail, elderly person—it is a lot of money for anyone. The Minister has said that under the regulations no one will be worse off, but how are we going to check that? How do we scrutinise whether what he says will happen? How will we vote to stop it if we think the Government have not done it properly? How will we do that? That is the main, serious thing that I am bothered about. The Minister has said that no one will be worse off, but I am not sure which regulations are meant, I am not sure when they will be introduced, and I do not know how the Government will do it. Will they fundamentally change the principle of the means test, or allow it not to apply to some people who claim under the means test? I do not know. It is completely confusing, but really important.

Norman Lamb (Liberal Democrat, North Norfolk)

I agree that it is important and that we need to get the detail right. The point I have tried to make is that we are intent on getting the detail right when the measure is first introduced. There is a long, collaborative, consultative process, with which we will include the detail of the attendance allowance impact. There will therefore be every opportunity, not only through parliamentary processes but through proper consultation beyond this place, to ensure that we get the detail absolutely right and achieve the objective we are all after, so that the hon. Lady and others—including myself—are satisfied before the regulations are laid before Parliament. I hope that reassures her.

In any case, from the perspective of public and stakeholder engagement, the additional process is completely unnecessary on an ongoing basis since, as I have said, we have already committed to consulting publicly on the first set of regulations. Moreover, the regulations will still be subject to the parliamentary negative procedure, so either House may force a debate in the usual manner.

No one can seriously doubt our commitment to consultation on the development of the Bill, and we have already committed to continue that with regulations and statutory guidance. The amendment would do nothing to improve the commitments we have already made.

Liz Kendall (Labour, Leicester West)

I would like the Minister to write to me to spell out exactly when the proposals are coming out, so that I can keep track of everything and the Opposition can be clear about what we are doing. This issue is complicated and the point I am most concerned about. If the Minister commits to that, I will withdraw the amendment. Finally, he has been clear in Committee that not everyone on modest means will have all their care free under £118,000, but perhaps he should have a word with the Secretary of State so that he does not make assertions that are not true.

Norman Lamb (Liberal Democrat, North Norfolk)

I talk regularly to the Secretary of State and I see no difficulty in that regard. I am also happy to write to the hon. Lady, because the bottom line is that we are after the same thing. I am not in any sense seeking to deceive anyone; I simply want to ensure that we get it right and do not have unintended consequences. I am happy to lay out the intended time scale for all the proposals, and to allow her to scrutinise it and keep up to date.

Jim Shannon (DUP, Strangford)

I realise it is the 11th hour for making an intervention, but I want clarification on the attendance allowance issue that the hon. Member for Leicester West brought to the Minister’s attention. The hon. Lady was seeking assurance that the attendance allowance would not be affected by the changes. The Minister agreed to look at that and to report back—I do not want to put words into his brief, but I think that was what he said. Will he clarify the attendance allowance issue? I personally do not want to see any changes for those with attendance allowance. The attendance allowance is there for a purpose, which is to help those who are disabled and need help. It therefore should not be affected and I seek clarification on that point.

Norman Lamb (Liberal Democrat, North Norfolk)

I thank the hon. Gentleman for that intervention. I have been clear about our commitment that no one will be worse off as a result of this measure, and that is an incredibly important reassurance to people who are receiving the attendance allowance. As a result of the reform going through, as soon as it is introduced in 2016, 35,000 more people will straightaway receive payments for social care support from their local authority. They are the people who need it most and who are most challenged in terms of capital and income, and that is a crucial combination. For means-testing purposes, the contribution has been designed for a particular reason—to target support on people who need it most. That is what the change does. Thirty-five thousand people will receive support from their local authority for the first time. The additional guarantee is that we will ensure that no one is worse off in respect of the interplay between the attendance allowance and payments from the local authority. I will write to the hon. Member for Leicester West to keep her reassured.

Liz Kendall (Labour, Leicester West)

I am happy to withdraw my amendment, but I still have no idea how the Government will do it. I am sure that the Minister does not want anyone to be worse off, but either the Government will have to say, “You don’t lose your AA if you claim under the means test”, or they will have to fundamentally change the means test. I have not seen any detail about how that will be done and I am sceptical—to put it mildly—not about what the Minister wants to do, but about how on earth it will be done. The Government have to change fundamentally either the attendance allowance or the social care means test. I do not know how they will do it and I want that on the record. We need to see the detail. I am worried that we will not be able to scrutinise it, but let us see the letter from the Minister. On that basis, I beg to ask leave to withdraw the amendment.

Clause 18 - Duty to meet needs for care and support

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I beg to move amendment 40, in clause 18, page 17, line 32, after the first ‘adult’, insert

‘(or someone acting on the adult’s behalf if the adult lacks capacity to arrange for the provision of care)’.

Clause 18 provides a duty to meet eligible needs for care and support, and my amendment seeks to address an issue that was first raised during the Joint Committee’s consideration of the Bill. The issue that it addresses comes out of clause 18(4), which appears to put self-funders who lack the capacity to make decisions for themselves in a more disadvantaged position, relative to those who are also funding their own care, but still have a capacity to make decisions for themselves. The clause effectively allows for circumstances in which a person has the means to pay for their care and asks the local authority to arrange that care. If they have the capacity, they can ask the authority, but it is not clear that the situation is as straightforward when a person, under the mental capacity legislation, does not have that capacity.

The clause appears to work in this way: first, local authorities have a duty to meet eligible needs for people with assets below the financial limit under clause 18(2). Secondly, local authorities have a duty to meet eligible needs of people above the financial limit under clause 18(3), if they ask the local authority to provide or arrange the service. However, the problem is about people who have assets above the financial limit—in other words, they have the means to pay for it—but cannot ask for it to be arranged, because they lack the capacity. I believe, as did the Joint Committee, that the Bill should provide for a third party to make a request, which is what my amendment would insert into the legislation. We considered that issue in Committee—let me quote from the Committee’s report:

“We consider that it is wrong in principle to place a person with impaired mental capacity in such a disadvantaged position, and we put our concern to the Department of Health. In a note of 30 January the Department responded, stating that it ‘takes on board these comments, and will consider whether any changes are necessary. It is not the Government’s intention to create a disparity.’ We welcome this undertaking to look again at the drafting of this clause.”

We did not put that into bold, so it did not become a recommendation and therefore, there was no response in the published Government response to the Joint Committee’s recommendations. It was never made clear how the Government intended to address that disparity. My amendment is an opportunity for the Minister to indicate how the Government intend to do that and, I hope, to set out a course of action that will address the concerns that I and the Joint Committee have.

Norman Lamb (Liberal Democrat, North Norfolk)

I thank my hon. Friend for the opportunity to try to clarify this important point. It is absolutely our intention not to have any disparity, as he rightly pointed out.

Clause 18 allows people, even those with enough means to fund their own care and support, none the less to ask the local authority to arrange care and support on their behalf. This is an important and groundbreaking new right. This amendment seeks to clarify that where an adult lacks capacity to arrange their own care and support, someone is authorised to act on their behalf. That person is able to ask the local authority to arrange the adult’s care and support on behalf of the adult.

This is an important point. Where an adult lacks capacity, a friend or relation might act on their behalf, but the existing general law on mental capacity already allows for that situation. So we do not refer to an adult’s mental capacity in this part of the Bill, where it is merely to provide for a person authorised under the Mental Capacity Act 2005 to do something on that adult’s behalf. For a provision which hangs on an adult asking a local authority to do something, such as the provision in question, this applies equally where a person authorised under the Mental Capacity Act asks the local authority on that adult’s behalf. This is in line with general law on capacity, as provided for by the Mental Capacity Act.

We considered the exact issue that my right hon. Friend the Member for Sutton and Cheam raises through this amendment as we were drafting the Bill. We have been assured that the Bill, as drafted, achieves this, but to clarify our intention we stated in paragraph 123 of the explanatory notes that:

“Where the adult lacks capacity to make the request, it may be made by someone else acting on their behalf”.

As my right hon. Friend will be aware, explanatory notes can be taken into account for clarification if necessary. I hope that this reassures him and he feels able to withdraw his amendment.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I am grateful to the Minister. It is helpful to have that clarification on the record. I will take away his words and reflect further on the words in the explanatory notes as well. My concern is how this translates into practice and how we ensure that there is a clarity of understanding about the interaction between obligations on a local authority with regard to the Mental Capacity Act and the Care Act, as it will become. An inquiry is currently going on into the application and effective implementation of the Mental Capacity Act, which certainly calls into question whether or not that legislation is widely understood and applied. Will the Minister give us some reassurance about how we ensure that the guidance here properly reads across and translates into good training and practice?

Norman Lamb (Liberal Democrat, North Norfolk)

I gave evidence to the inquiry in the House of Lords on this point. In response to the concerns that my right hon. Friend raises, I want to stress that a lot more work needs to be done to embed the Mental Capacity Act in practice. I have a particular concern that there appear to be examples of people who lack capacity, who may be in an assessment and treatment centre, for whom there is no deprivation of liberty safeguard in place. The consequence is that that person is being held unlawfully, which has to be treated extremely seriously.

I am absolutely determined to ensure that that important Act, passed by the previous Government but widely welcomed, is enforced properly, so that for those deprived of their liberty, there are proper safeguards in place. We are not there yet, but it is an absolute priority for the CQC, when conducting inspections, to ensure that the legislation is properly enforced.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

As someone who agitated for that legislation and who served on its scrutiny Committee, I am anxious that lessons are learned, not least because that legislation set in law, for the first time, a set of principles governing best interests, which the inquiry has revealed have not always been faithfully understood and followed in practice. There are certain principles in this Bill regarding well-being, and it is important that we learn the lessons of how we embed them into practice.

I welcome what the Minister has had to say, and I beg to ask leave to withdraw the amendment.

Meg Munn (Labour, Sheffield, Heeley)

I wish to discuss how clause 18 interacts with clause 13 on the eligibility criteria, which we discussed earlier in the week.

The Minister did not respond to my concern about how the eligibility criteria section is written and how we interact with people’s needs. I fundamentally believe that it is important to take a holistic approach. The question I was asking was: would care needs at the lower level, which would not normally come into the eligibility criteria as written here, be met, where the care provided by informal carers—friends, family and so on—was dealing with eligible care needs?

It is not only me who has concerns. The Minister has talked about a much more preventative approach, which the measure would be. However, evidence from the College of Social Work—written evidence CB 09—raises that issue as well. The college says that proposals in the Bill

“offer more of the same in terms of focusing on care activities that are centred on essential tasks. Past evidence would suggest that this approach will never be able to fully address the full circumstances of a person’s life…the reality is that need is usually interpreted in the light of available resources.”

The Bill, which should take us well into the 21st century, is drafted as if we were still in the 20th. It does not recognise the growth of personalisation, which has led to a much more varied approach to meeting need. There is no straightforward correlation between the given level of need and the cost of meeting it, except that that is now being put into legislation in terms of what people might get by way of personal budgets, which we will discuss in the next few sittings.

Resources that may be appropriate to respond to an individual’s needs in one area may be insufficient in another. We need to consider how assessment and resource allocation can properly be separated. Not doing so will lead to care and support planning that does not meet needs as necessary to deliver independence and well-being.

I am grateful that the Minister confirmed that the explanatory notes are important. They say about subsection (7):

“When conducting the needs assessment and the eligibility determination, the local authority will assess the totality of the adult’s needs, regardless of whether a carer is currently meeting any of them…If a carer were to cease providing care and to stop meeting any eligible needs, this would trigger a review of the adult’s care and support plan, and may mean that the local authority is required to meet the needs. If the carer has needs for support, they should be entitled to an assessment in their own right, under clause 10, and may receive support to meet their eligible needs.”

Will subsection (7) still apply if the carer can no longer provide care for the mild to moderate needs, in order to continue providing care for the substantial needs? Excluding support of that kind does not sit with the idea of a preventive care system. There are two risks if we do not support carers by relieving them of the need to provide some more moderate care. First, the carer might be unable to continue caring, so that the person with needs might have to go into residential care or might have a much greater level of need for care to be purchased; secondly, the carer might need care in their own right.

We know from examples already given that many carers are elderly; often they are the spouse of the person being cared for. The effort of providing substantial care can put their health at risk. Unless we move towards a more holistic approach—one in which those with overall substantial needs have their lower-level needs, such as cleaning or sitting services, recognised as eligible for support, although standing alone they would not be—there is a risk that we shall double the burden.

Norman Lamb (Liberal Democrat, North Norfolk)

I thank the hon. Lady for those remarks, and apologise for not responding. I think I was trying to respond to so many points during that debate that I missed out the response to hers.

Assessment deals with all eligible needs. The care plan that is then developed deals with which of them will be met by the local authority. Prevention duties that can apply to everyone are relevant in this context. That means that if someone is found to have eligible needs the local authority can include lower-level support in the care plan. That is the key point that the hon. Lady was concerned about.

I now have a note that I have not seen before, but I shall read it and we shall see where we get to. It states that where a carer is meeting an adult’s needs the local authority will not be under a duty to meet those same needs; but it will have to identify those needs in the assessment and determine whether they would be eligible. That is to create an incentive to ensure that the local authority supports the carer to maintain their caring role.

I hope that that helps, but I think that it would also be helpful if I were to write a letter amplifying the points that the hon. Lady raised. They are important, and if I can assist all hon. Members by replying in substance to her concerns that will be of value.

It is essential for the care and support system that it should be clear when a local authority is required to meet people’s needs. The Government have therefore set out in the clause the conditions and circumstances that would entitle an adult to have their needs for care and support met.

Current legislation sets out numerous duties on local authorities to provide particular services in certain circumstances. That overlap and duplication is precisely what the Law Commission sought to abolish when recommending a single duty to meet eligible needs. Clause 18, however, does more than merely consolidate the law. It provides a general duty to meet needs, rather than specifying services to meet specific needs. That supports local authorities to provide flexible, personalised care and support.

I thought that the hon. Member for Sheffield, Heeley said that the Bill does not recognise the growth of personalisation. If she did say that, perhaps she would like to clarify that. I think it does. That is the heart of the legislation: the enshrining in legislation of the personal budget and the direct payment as well as the whole principle of well-being. I do not know whether she wants to clarify.

Meg Munn (Labour, Sheffield, Heeley)

The point I was making was that a rigid interpretation of clause 13 suggests that certain care needs are eligible and others are not. Someone can be given a budget to support their care needs and the personalisation in those budgets has been used often to help with shopping and other services, but those would not by themselves meet the substantial or moderate test—or whatever the Government end up with. My point is not that the Bill does not talk about personalisation overall, but, if that clause is interpreted in the way I describe, that would run counter to the thrust of the personalisation agenda.

Norman Lamb (Liberal Democrat, North Norfolk)

I totally take the point and I will write to the hon. Lady to amplify what I just said. The clause makes it as easy as possible for people to understand the circumstances in which they will be entitled to care and support.

First, a person’s needs must meet the eligibility criteria set out in regulations under clause 13. Secondly, the person must be ordinarily resident in the local authority’s area or, alternatively, be living in that area at the time but have no settled residence. That is to ensure that a single local authority can be identified as responsible for meeting that person’s needs.

Thirdly, the clause provides for the interaction of those two factors with charging and financial assessment. If the local authority does not charge for a type of care and support, or regulations provide that that is to be provided for free, there is a duty to meet needs regardless of the person’s finances. If the local authority does charge, the adult’s financial circumstances are taken into account. If the adult’s financial resources are below a financial limit—that will be set in regulations—the duty to meet their needs will be triggered. If the person’s finances are above that level, however, they will still be able to access local authority support.

The clause introduces a new duty whereby local authorities must arrange the care and support for people whose resources are above the financial limit but who ask for that. The new duty will ensure that all people with eligible needs, regardless of their finances, will have a right to the help of a local authority, which will ensure that no one goes without the care that they need. Furthermore, the clause stipulates that a local authority must meet the needs of a person who lacks capacity to arrange care for themselves and who also does not have someone authorised to do so on their behalf.

Finally, the clause makes provision for the impact of funding performance. It specifies that the local authority must meet an adult’s eligible care and support needs if that person’s care costs have reached the cap to be set out in regulations for the capped care costs system.

The clause is integral to the reformed system of care and support. It creates a clear framework for entitlement for people who need care and support. It was widely supported in the consultation on the draft Bill.

Clause 19 - Power to meet needs for care and support

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I beg to move amendment 53, in clause 19, page 18, line 28, leave out ‘may’ and insert ‘should’.

Andrew Rosindell (Conservative, Romford)

With this it will be convenient to discuss the following:

Amendment 54, in clause 19, page 18, line 28, after ‘needs’, insert ‘and their carer’s needs’.

New clause 12—End of life care—

‘Following consultation, the Secretary of State may make regulations establishing arrangements for terminally ill persons to—

(a) have their preference for place of death recorded by local health and social care services and for that preference to be implemented wherever practicable; and

(b) to be exempted from charges for adult social care necessary in order to allow them to die in their place of preference.’.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

As well as amendment 54, which is tabled in my name, I want to indicate my strong support for new clause 12, even though, owing to my lack of diligence, I did not get my name added to it. The Joint Committee on the draft Bill took evidence on the effects of clause 19, which sets out the power to meet needs. One of the issues raised by Marie Curie and a number of other charities that have an interest in provision of end-of-life care was the need for speed when a person is terminally ill and requires support, care, social care and so on. Speed is needed for their carers too.

The national bereavement survey, which this Government introduced—I think we now have the second survey—has produced some interesting information about how carers and families see their experience of bereavement. One of the things the first survey found was that around half of people die in hospital, despite the fact that only 2% actually stipulated that as their preference.

Other work by the National Audit Office found that for 40% of those who die in hospital, there was no clinical reason for them to be there. That is a human tragedy for the individual and the family that they find themselves trapped in a hospital, often the worst place to die.

It was therefore welcomed that the Government took on board the concerns that were expressed in the Joint Committee and that the Bill was amended in the Lords to give specific reference by way of example to terminal illness as a situation in which urgency should be the trump card when it comes to the behaviour of local authorities.

Access to timely services for a terminally ill person is absolutely critical. Amendment 53 does a very straightforward thing: it seeks to strengthen the language from “may” to “should”. To be honest, I think it should have been “shall”, but there we go. That probably means that the Minister can tell us something about my trying to introduce a whole new concept of “should” into the legislative landscape. Of course, the Minister might be tempted by that today. It would be a landmark Bill in so many more ways if we were to do that, because it would introduce “should” into law for the first time. I accept that probably my amendment in its drafting is technically deficient, but the issue behind it is a central one.

Liz Kendall (Labour, Leicester West)

Will the right hon. Gentleman confirm that when he was a Minister, the shadow Health Secretary, my and I wrote to him and the former Health Secretary, the right hon. Member for South Cambridgeshire (Mr Lansley), and proposed free social care at the end of life, and that we raised it in the cross-party talks? Why did he not take action at that stage?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

There are two points about that. First, I have been very careful not to discuss the nature of the conversations that we had in those cross-party talks. I will continue to hold to that, because until such time as I write my memoirs about that particular set of episodes—for my family’s benefit if for no one else’s—I do not think it appropriate to disclose that. On whether the hon. Lady and the shadow Health Secretary wrote to me and the right hon. Member for South Cambridgeshire, I do not have an instant recollection. I would need to refer to the papers—to use the phraseology of such circumstances—but I have no doubt that she and her right hon. Friend did write and pressed that case.

I guess the point we would have made in response was that at the time we were—as current Ministers are—grappling with the fact that a financial envelope was available to them, and there were disputes about how much the policy would cost to implement. That is one of the reasons why, in the care and support White Paper, we increased funding for the piloting of a per patient payment mechanism, so as to flush out how much it would cost. I suspect that would have been the essence of our reply, but without the benefit of a detailed study of the paperwork, I cannot be absolutely confident that that is what we said. My instinct is that that is probably along the lines of what we would have said. We understood that the case was being made by the Labour party at the time, and also by many charities, and that is why I was keen to include the commitment recognising the merit of the case for free social care at the end of life, as we did in the White Paper. Of course, in an ideal world I would have liked to have gone further and for the White Paper to have announced the policy commitment being delivered. When the Minister responds at the end of the debate, I look forward to what he may or may not say about that.

Amendment 53 aims to strengthen the language. In my view, this should be a “should” issue, not a “may”—it should not be discretionary. One thing we said in the White Paper was that as an interim step we would ensure that revisions were made to the guidance covering intermediate care and the transition—and to some degree handover—between health services and social care services. That issue is of sufficient concern that we wrote it into the White Paper, and it would be useful if the Minister could indicate where we are with that interim step of revising the guidance on intermediate care, so as to ensure that end-of-life care is front and centre when it comes to local authorities and their intermediate care obligations.

Amendment 54 would simply ensure that carers are not left out of the measure addressing urgency. Given that the Bill does something new by establishing parity of treatment and esteem between the recipient of a care or support service and their carers, it seems odd that that symmetry is not maintained in the clause. I argue that we should maintain that symmetry and ensure that the carer is not left behind. Words matter in legislation; they matter to those who read them and then decide how they should behave in their later practice. The absence of the word “carer” could subsequently be construed as meaning, “Well, we don’t have to rush to assess the carer or to make sure they are supported both during the last days of the individual for whom they are caring or during their subsequent bereavement.” I hope those issues will be addressed and perhaps the Minister will reassure me on that point.

Bill Esterson (Labour, Sefton Central)

I have a question about the impact on local authorities in areas to which significant numbers of people move either temporarily or longer term. The right hon. Gentleman will be aware that that is a particular issue in local authorities such as mine that have seaside areas to which people move. He suggests that the recipient local authority should be responsible, but how does he anticipate that that additional cost would be picked up? Is he aware that care costs being taken on by recipient local authorities is an existing issue?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I am grateful for the question. I do not know whether my answer will be sufficient, and I hope the hon. Gentleman has an opportunity to contribute and put his question to the Minister, too. The answer is in two parts. First, the Bill obviously provides for issues of ordinary residence, which is the test for determining which authority is obliged to meet the costs, and it contains new provisions for portability of assessments, and so on. If the move is temporary, the authority of ordinary residence from which an individual has moved would, as I understand, continue to be obliged to fund. If the move is permanent, once ordinary residence tests have been met, the receiving authority would have that responsibility—I hate the word “receiving”, but it gets to the essence of what I am talking about.

On the overall issue of funding, we have mechanisms to distribute resources for local authorities, which are partly related to the age and demographics of a population. To some extent, some areas attract more older people who are in receipt of care, and that will be met to some degree—adequately or not; it is an area of debate—over time. I take the point that there are clearly some areas where people go to live to receive their care, and it is important that the funding mechanisms try to reflect that.

New clause 12 was tabled by my hon. Friend the Member for Totnes, and I will not address it at length because I want her to set out her own thinking. I strongly support the new clause. Free social care at the end of life would be a significant benefit to families who are already going through uncertain times. The absence of such an arrangement means that, inevitably, there are cumbersome, bureaucratic hurdles that people have to get over at a time when, frankly, they want to focus on their loved one. It would be the humane thing to do and, in terms of how the system works, the right and pragmatic thing to get the right care, at the right time, in the right place.

I have one question that is not about the guidance—I have already asked the Minister about that—but about the electronic palliative care co-ordination system, and I hope that he can say more about it. The White Paper was very clear about the need to draw a link between those systems and social services providers, to ensure another way of helping join up the system. Will he tell us where that has got to? Specifically, is the technology now enabling links to be made between health providers and social care providers? With that, I commend my amendments to the Committee and look forward to the debate and the Minister’s response.

Sarah Newton (Conservative, Truro and Falmouth)

It is a pleasure to serve under your chairmanship, Mr Rosindell, and to support the right hon. Member for Sutton and Cheam in his amendment. He is quite right that individual words matter. Like many Members, I expect, I spend time speaking to schoolchildren about my work as a Member of Parliament. I say to them that we spend many hours in Committees such as this, where it can be incredibly important that we debate the meaning of a single word, because it could make a huge difference to people’s lives.

In the three years I have been here, I cannot think of a distinction that makes more difference to people’s lives than the one between “shall” and “should”. Like everybody else here, both in my personal life and my constituency work, I have come across cases where people have been enabled to have a really good death. Right at the end, their family and loved ones have been supported by excellent hospice care and community palliative care. They have been able to choose how and where they wanted to die, and have been as comfortable and pain-free as possible. That, of course, is what we want for ourselves and everyone.

Sadly and tragically, however, we have probably all experienced the opposite: situations in which there has been a dreadful breakdown in communication between the social care system and the health system, huge bun fights about who is responsible for what care, carers not coping, people not managing, and the person ending up in an acute care setting when they do not need or want to be there. That is not the death that anyone would want for themselves or anyone else. This little word and the spirit behind it will go a long way toward ensuring that the existing systems work to the benefit of people in the last stages of their lives, and their loved ones, so they can have the sort of death that we would hope everyone in our country could have.

I want to speak a little about free social care at the end of life. If the Government accept the change it will be a good stepping stone, but ultimately we need to move quickly to free social care at the end of life, because that will ensure that we can provide the sort of death that I know people want. I pay tribute to what the Government have done through a range of studies to move things forward, but I am slightly disappointed by the Opposition’s tone in trying to turn this into a party political issue. Many people in this party have been working for numerous years to make the case for free social care at the end of life, and have worked effectively with organisations such as Marie Curie Cancer Care, Macmillan Cancer Support, and others with an immense amount of expertise that do much good work to enable it to happen.

The Government have undertaken pilots, which I understand will conclude in March. They have committed to sharing the evidence from those pilots and, if the evidence supports the introduction of free social care at the end of life, to moving swiftly to implement it soon. In summing up this section of the debate, will the Minister reconfirm the Government’s commitment to those pilots? We also want him to agree to a round table meeting with me, all the stakeholders and charities we have spoken to, and Members who want to join that meeting, to tell us what it is hoped the pilots will achieve, and what the Government plan to do with the results of the pilots. Moving as soon as we can to a situation in which we have evidence to support free social care at the end of a life will be a massive step forward in enabling a good death in our country.

Sarah Wollaston (Conservative, Totnes)

I will speak about new clause 12. We have heard a lot about the lottery of catastrophic care costs, but there is one thing that is no lottery at all, and that is the absolute certainty that everyone in this room and everybody following this debate will come to the end of their life, and—more importantly to most people—that somebody they love will come to the end of their life. We know that most people want to be at home when they die and to die in dignity, but unfortunately less than a third of us have the opportunity to do that. The new clause would ensure that terminally ill persons were separately recognised in the Bill. I want to set out why that matters and to address two of the most important barriers to people having a good, dignified death, at home and surrounded by the people they love.

From my personal experience of 18 years of general practice, I know that one of the main reasons why people who were desperately keen to stay at home ended up being admitted to hospital is simply the sheer stress and physical difficulty of providing personal care needs for someone at the end of life at home. Very often, of course, the families affected have not adjusted over a period of time to becoming carers but are thrown into that situation, at a time of quite extraordinary personal stress, when they are having to face the prospect of losing the person they love. When all the factors come together—not just providing 24/7 care, but the intimate and demanding physical nature of that care—it becomes too much. With the best will in the world, the elastic can only stretch so far, particularly for someone who is a single carer, and that is the point at which, sadly, people have to be admitted to hospital.

That admission can sometimes feel to families like an admission of defeat. There is a sense of failure that carries on into their bereavement. It is important that we address that, because often it is not a failure on the family’s part: it is a failure on the part of health care and social care to work together at the critical point that is the end of life. It does not have to be that way.

Of course, there are continuing care assessments, but 97% of health care professionals and of the families affected agree that those assessments are inadequate, because of the bureaucracy and delay that are involved. Anybody who has been involved in the process will know that continuing care assessments do not work effectively at the very important point that is the end of life, when often rapid decisions need to be made.

As my right hon. Friend the Member for Sutton and Cheam pointed out, 40% of people in hospital at the end of their lives do not need to be there, so social care is critical. We cannot address the urgent need for people to be able to die at home without addressing the need for free and rapid access to social care at the end of life. As the shadow Minister has pointed out, despite the welcome rise in the eligibility threshold, a number of people will still miss out under the Bill; and those people will be at a time in their lives when there is great financial uncertainty. A carer might have to leave their job to provide end-of-life care. They might be asset rich but they are very likely to be cash-flow poor at what is a critical time in their lives.

That is why we must address the urgent need for free social care at the end of life. The period of time involved is short—although I understand that the definition of the time period for terminal care is six months, for most people it is much shorter. Of course, we need to address the issue of funding, but let us be clear: when people are admitted to a busy general hospital ward, in effect the taxpayer is paying more for worse care. We all recognise that the join-up between health and social care is the problem. The incentives are in the wrong place. There is a great incentive for hospitals to admit people and there is no financial incentive for local authorities to fund. Overall, we are all paying for worse care in the wrong place.

I welcome the palliative care funding formula, which is due to be revised by 2015, but the Minister will know that there are concerns that the timetable for revision could be slipping. We know that a choice review was due to start in 2013. I hope that the Minister can offer some clarity on that, because we need more certainty about the remit, who will be running it, what it will cover and, critically, what the proposed start date now is.

There is a danger, in a sense, because there are four reviews going on. Sometimes we risk losing the ability to see the wood for the trees. Whatever the reviews and pilots show, the one thing we are clear about is the fact that we are paying more for worse care, so I hope that we will have a definite commitment to introduce free rapid access to social care at the end of life for persons who are terminally ill. That needs a separate category because, although I accept that clause 14 could be argued to be an enabling clause, I do not think that it goes far enough. It sets out that certain conditions can be specified, but end of life covers every condition. It is possible that it will not be as enabling as the Minister feels it could be.

There are provisions under section 6 of the National Health Service Act 2006 that could also perhaps be interpreted as enabling, but they apply to health care, not to social care. That is why I hope the Minister will accept that it is right that we have a separate clause to cover such an extremely important issue. New clause 12 would still enable the Minister, rightly, to take account of the pilots, but it would also set out a clear intent to deal with the issue. I feel strongly that that is the right thing to do.

The second issue that the new clause covers is forward planning. My right hon. Friend the Member for Sutton and Cheam has already referred to electronic palliative care co-ordination systems, but we know that a lack of forward planning is also one of the main factors leading to people dying not in the place of their choosing. We have worrying data from GP surveys that show that GPs themselves are sadly still hesitant about initiating discussions on the issue—often, as they say themselves, they lack confidence. Such discussions must happen; it is no good having professionals shying away from them. Once they recognise that someone is dying, it is critical that, across health and social care, a preference for a place of death is recorded.

There must also be better information sharing, because often the issue is that a locum doctor, perhaps, sees someone who is unsure about what their wishes are, or perhaps is not in a position to express their wishes clearly at that point. Having good, clear information shared across health and social care—with the patient’s consent in advance, of course—would make a real difference.

Previously in Committee, the Minister has stated that just because something is in a Bill does not mean that it will be put in place, but there is no doubt that it helps to drive change if an issue is clearly expressed in legislation as important. As I have said, the new clause would be an enabling measure. It does not seek to set out in stone, in detail, how things should be done; it would simply enable the Minister to ensure that arrangements are in place. That is critical.

I look forward to hearing the Minister’s response and hope that he will accept new clause 12. If he cannot, will he at least give a clear commitment that the Government will fund free social care at the end of life? Do the Government recognise the importance of that and the need to have systems in place for advanced planning? That would be an extraordinary step forward and make a real difference to everyone following this debate.

Jim Shannon (DUP, Strangford)

I want to add my support for the new clause tabled by the hon. Member for Totnes. She has presented the case well, based on her 18 years of knowledge as a GP and now as an elected representative. My support for the new clause comes from my experience as an elected representative in the House, as well as my experience before I was privileged to come here to represent the people of Strangford. I was a Member of the Northern Ireland Assembly for 12 years and a councillor for 26 years. My speech is entirely based on what my constituents have told me and their stories. The hon. Lady touchingly referred to some stories, and I would like to make some comments on the ones I have heard.

I strongly believe that people in their final weeks of life should have the choice to die in a preferred place of care—it is one of the things I am very much committed to—surrounded by the friends and family they need, at the time when they need them most. Some 93% of people would prefer to die at home or in a hospice, yet only 30% of people are able to do so. The majority continue to die in expensive hospital beds or in A and E departments, as the hon. Lady outlined.

Macmillan Cancer Support has been good to us in giving us background information and bullet points, as has the Motor Neurone Disease Association, the National Council for Palliative Care and Sue Ryder. All those organisations have sent us information, but I am particularly aware of what Macmillan’s research said, which was that

“36,400 cancer patients who die in hospital each year would prefer to die at home”,

where that is possible. I am conscious that, whenever we make a case for something, there will always be examples of where it is not possible. Dying at home is not possible in cases where the level of medical care is so great that the only place it can be given is in hospital, and I understand that. When we look at hospice care, I think immediately—many organisations offer great support and understanding at a difficult time for the individual and their family—of Marie Curie Cancer Care. It is able to offer a level of care in the hospice that it can perhaps not offer at home, because the individual needs to be in a hospice under medical supervision and able to have medical attention at short notice, should things deteriorate.

The hon. Lady reminded us that there is one thing in life that we are sure of, which is death, but the other thing we are sure of is taxes. We have death and taxes to deal with, although in this case we are dealing with the honest case of death.

To illustrate what I am saying about people staying at home, one of my good friends had motor neurone disease. In his last days, it was so important to him to be at home with his wife and his daughter. He was a rugby fan and he watched Ulster in a rugby match on a Friday night at home with his family. That gave him a quality of life that he would not have had, with great respect, in any other place, whether a hospital or a hospice. As a family they were rugby fanatics and were able to enjoy that occasion. He passed away at home, with his family, which is where he wanted to be.

Because of that case and many others, I support the new clause. The palliative care funding review suggested that the best way to achieve choice at the end of life is by removing the financial assessment and providing free social care at the end of life. In the care and support White Paper, the Government stated that they see “much merit” in that principle and committed £1.8 million to assessing its benefits through the palliative care funding review pilots. 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.

I am conscious that we are approaching the hour when we will have to stop, so I will quickly make these comments. It is vital that the key stakeholders commit themselves and say that it is important. In a Macmillan survey, 97% of health care professionals agreed that the complexity of social care needs assessments and the time it takes to complete them were barriers preventing patients from receiving appropriate social care at the end of life. Free social care at the end of life will help prevent expensive unnecessary hospital admissions and burdensome financial assessments during a difficult time and is an important part of giving people a genuine choice at the end of life.

I hate to mention money when discussing care and health, but we sometimes have to, because we are all restricted by budgets, within which we have to try to work. Electronic palliative care co-ordination systems, to which the right hon. Member for Sutton and Cheam referred, are estimated to have saved £133,200. The costs of implementing them are estimated to be £21,000 per 200,000 people a year, which represents a modest investment, especially when potential savings are taken into account. I firmly believe that patients should be able to have time at home with their families, which is why I wholeheartedly support the proposal of the hon. Member for Totnes and I hope that she presses it—unless, of course, the Minister responds and says, “Yes.”

Hugh Bayley (Labour, York Central)

I remind the Committee that with this we are discussing the following:

Amendment 54, in clause 19, page 18, line 28, after ‘needs’, insert ‘and their carer’s needs’.

New clause 12—End of life care—

‘Following consultation, the Secretary of State may make regulations establishing arrangements for terminally ill persons to—

(a) have their preference for place of death recorded by local health and social care services and for that preference to be implemented wherever practicable; and

(b) to be exempted from charges for adult social care necessary in order to allow them to die in their place of preference.’.

Bill Esterson (Labour, Sefton Central)

Welcome back, Mr Bayley. I want to make a few remarks on amendments 53 and 54, following on from the intervention I made earlier on the right hon. Member for Sutton and Cheam. One issue facing local authorities, including Sefton, arises when significant numbers of people move to a borough for residential care as self-funders, but the money runs out, so the question then arises as to who is then responsible for their continuing care. Clause 19 and in particular the amendments to it, are relevant because they appear to add to that pressure. Will the Minister address my concern about how funding will be dealt with for the local authority to which people have moved, when they are ordinarily resident somewhere else? Is there something in the explanatory notes that already deals with that? If not, how will he deal with the situation, because it appears to be one of the consequences of the right hon. Gentleman’s amendments?

My main remarks concern new clause 12, which I very much support, in the name of the hon. Member for Totnes and supported by my hon. Friend the Member for Easington. I went to visit my parents last night—I have mentioned them once or twice in debates already—and my dad is a fan of the hon. Lady, although his support for Tory Members of Parliament does not go much further than that. In this case, he is undoubtedly a fan and was appreciative of what she said in The Guardian yesterday. He mentioned it, as someone who is experiencing many of the issues to which she referred in her article. He is not alone in being appreciative of what she wrote; many people around the country must have been pleased to read it and would welcome the new clause. Clearly, there is great support for it.

My question for the Minister, which I mentioned on Second Reading, is about the definition of free social care at end of life. At what point does “end of life” become defined? I think that is my question. At what stage should free social care be brought in? I shall not say too much more, because I have tabled an amendment on that very question, which we will probably discuss when we come to the end of our deliberations.

The issue of free social care at the end of life is incredibly important for all the reasons given by other hon. Members. As the hon. Lady said, I hope that the Minister will find a way in his response if not to accept the amendment, to indicate how the Government will move forward on that incredibly important issue.

Liz Kendall (Labour, Leicester West)

Welcome back, Mr Bayley. I am delighted that we are having a proper discussion about this. It has been a pleasure to follow the thoughtful speeches of my hon. Friends and Government Members. I do believe that this is a cross-party issue and that all the parties are signed up to doing something about it. The question is how quickly we can get there. I say to the hon. Member for Truro and Falmouth that my comments to the right hon. Member for Sutton and Cheam were not political point-scoring, but to place on the record that Opposition Members really pressed this as part of the cross-party talks on social care. We really wanted to engage with this and make it happen.

Hon. Members will know that the first time there was even a strategy for end-of-life care was in 2008. It was led by Professor Sir Mike Richards, who at that stage was the cancer tsar and is now the chief inspector of hospitals. Mike has been a champion of this work to give people the choice of where they die. I want to make a slightly broader point based on what the hon. Member for Totnes said. We need to talk about dying in this country. We have never really had a public discussion about death and dying. I understand why. Nobody wants to think about it, but it comes to us all.

If I may digress, it is interesting what happens in other countries. The one that springs to my mind is Mexico, which has a day of the dead. There is a bigger, broader debate about dying. We rightly talk about how we keep people fit, healthy and living for as long as they can, but it is something that will come to us and we do not think about it until too late. It is about giving people a choice, but also about the awful issues of having to talk about money alongside it. Anybody who has been through this will know that it is the last thing they want to do and think about. Those who have experienced it themselves with constituents, families or friends, know they have to start raising all the difficult issues of power of attorney, money and all that. It is horrible, but it is important that it is done. I hope we are discussing a first step to a bigger, broader and more thoughtful conversation about these issues, so I am grateful that the hon. Lady specifically raised that point.

I also really want to pay tribute to the organisations who have relentlessly championed this issue of free social care at the end of life: Help the Hospices, Marie Curie Cancer Care, Macmillan Cancer Support, Sue Ryder and the National Council for Palliative Care. They have been champions, but they have also done some really good work in showing that, at the very least, they believe that this policy would be cost neutral, because it would reduce the more expensive hospital care that people have to receive by helping them to get out and stay at home.

I first got involved with this issue when I was director of the ambulance service network. We wanted to get involved with the national end-of-life care strategy because when that crisis point is reached in a family and they are worried about something that has happened to a person who is terminally ill and at home, they often pick up the phone to the ambulance, because if they dial 999 they are there. Ambulance services need to be involved because they need to know that if that person has a package of support that keeps them at home, all the different parts of the system need to be involved.

As I said, we are extremely supportive of this. We want to see quicker and faster progress. We raised this issue at the cross-party talks on social care, and my right hon. Friend the shadow Secretary of State for Health said in his party conference speech last year that in our policy review we are working on whole-person care, to put the right for people to have a choice about where they die at the heart of our plans.

My view is that if we had a single budget for health and social care, and budgeted not annually but for longer periods so that there was certainty and commitment, we could take account of some of the initial up-front costs. Having more time to plan would make that much easier, and we are working on that as part of our policy review. I look forward to hearing the Minister’s comments on how we can make sure that that happens, and happens quickly.

I have one further point, which is not just for this Committee. It would be useful for us all to work on a cross-party basis to raise the difficult issue of dying, and to think about how we can help families to get through what will always be a terribly difficult time.

Norman Lamb (Liberal Democrat, North Norfolk)

Welcome back, Mr Bayley.

As the shadow Minister said, if the truth be known, we probably all agree on this issue. We have a rather crazy situation at the moment, as the hon. Member for Strangford highlighted, in which we are spending bucketloads of money on caring for people in acute hospitals who do not want to be there. My experience of dealing with the difficult issue of the application of the Liverpool care pathway, and with the concerns expressed by some families about their experiences in hospital in some parts of the country, has highlighted the horror of what has happened too often in end-of-life care and why there is such an urgent need to improve it. We must do so wherever someone is when their life ends; but, critically, we must also respect people’s wishes about where they want to die. At the moment, because of the way in which the financial incentives work, hospitals are often under enormous pressure, with many frail elderly people in them, and too many of them dying in hospital when, as the hon. Member for Strangford said, they do not want to be there.

Until recently my wife worked for Cruse Bereavement Care. Hearing the stories of what a loved one has to cope with in bereavement, it is clear that a bad experience of a death lives with that person for the rest of their life. We have a heavy responsibility to think of the needs of those people as well as the needs of the dying person. I feel strongly about this issue and hope that we can achieve some real progress, which is what we all want.

I will first address amendments 53 and 54. I thank my right hon. Friend the Member for Sutton and Cheam for tabling them, and pay tribute to him for his work on end-of-life care when he was Minister, which set in train a lot of the important work that might ultimately result in an improvement in people’s rights and experience at the end of life. I know his commitment to achieving the best outcomes for people at the end of life is very much a continuing one.

My hon. Friend the Member for Truro and Falmouth raised concerns that I know have been brought to her attention by a number of groups, including Macmillan Cancer Support, and asked whether it might be possible to have a round-table meeting to discuss the critical issues. I would suggest that that should be once we have finished our work in Committee, but I would very much be up for that. It is important that we reassure those groups—I join the shadow Minister in paying tribute to the work that many of them have done—that the work is on track, and that we continue to involve them thoroughly in achieving the objectives we all seek. I am happy to agree to that proposition. If the shadow Minister would also like to turn up she is welcome. How about that for a spirit of openness? I can see that hon. Members are impressed.

Hugh Bayley (Labour, York Central)

So is the Chair.

Norman Lamb (Liberal Democrat, North Norfolk)

Excellent.

Grahame Morris (Labour, Easington)

I am grateful to the Minister for his characteristic generosity.

Norman Lamb (Liberal Democrat, North Norfolk)

What is coming?

Grahame Morris (Labour, Easington)

I promise there will be no devilishness. I know that we will have an opportunity later under clause 73 to consider end-of-life care, but will the Minister give an undertaking, given that there is consensus on the desirability of free end-of-life care, to bring forward some costing? We earlier heard some figures available from charities. If the cost is the stumbling block and it is cost neutral, surely there is an argument for taking it forward.

Norman Lamb (Liberal Democrat, North Norfolk)

I thank the hon. Gentleman for that intervention. I hope I can address the issues he raises as I develop my argument. We agree that when someone is terminally ill waiting for their care and support to be put in place can often be a highly distressing time. That is why we amended the Bill in the other place. I was determined that we should amend it to state explicitly that when people are terminally ill, local authorities are able to use their power to meet needs urgently, that is, without having first to carry out a financial assessment or make an eligibility determination.

However, we would be wary of agreeing to amendment 53, because use of the word “should” in this context would create legal uncertainty. I pay tribute to my right hon. Friend the Member for Sutton and Cheam for his attempt at legislative innovation but I think it is dangerous. That is the boring old lawyer in me.

Liz Kendall (Labour, Leicester West)

Are you a lawyer?

Norman Lamb (Liberal Democrat, North Norfolk)

I was. In legislation we tend either to require someone or some organisation to do something, when we use the term “shall”—shall do this or that—or we say “may”, which gives discretion. To say “should” leaves people in a no man’s land not quite knowing what it means. I think my right hon. Friend understands that point. He will no doubt remember it next time he drafts an amendment.

Nor would it be appropriate for there to be a duty, so it is just as well that he did not try to use the word “shall” because I would have rejected that as well.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

My hon. Friend is never boring and would not have been even when he was a lawyer. I am sure once someone is a lawyer they never cease to be one. He was coming on to explain why, if I had used the word “shall”, he would have rejected it. Will he please share with the Committee why he thinks it is inappropriate to be clear about the expectation of an obligation on local authorities to act in these circumstances?

Norman Lamb (Liberal Democrat, North Norfolk)

Ultimately, we all know where we want to get to. In the meantime, until we get there, we want to ensure that we apply the rules equitably.

Let me continue to make the argument. As I said, it would not be appropriate for there to be a duty to meet all needs at end of life urgently, as there are many instances where it would be appropriate first to carry out financial assessment and eligibility determination in the normal way. I want to change the rules, as does my right hon. Friend. It is important that there is clarity until then about how the existing system operates.

Turning to amendment 54, we do not consider it to be necessary. When a carer’s needs for support are deemed urgent it is usually as a result of the adult’s needs being urgent, and so usually that would be best remedied by providing care to the adult urgently, for which there is already provision in clause 19. Where it is clear that local authorities need to put in place support for a carer quickly, they should obviously do so. We would expect provisions in the Bill to be applied proportionately, so that there need not be a delay in providing the support carers need, especially in urgent circumstances. However, we do not think that an additional express provision in the Bill is necessary to ensure that. I understand the concern my right hon. Friend the Member for Sutton and Cheam expresses and I would want to avoid inadvertent neglect of the carer. I will reflect genuinely on what he has said and report back to him in due course.

Turning to new clause 12, tabled by my hon. Friend the Member for Totnes, the Government are committed to moving towards choice for all on how to have a decent and dignified death and where that should be. I am determined that we achieve that. A review this year will determine when such an offer of choice in end-of-life care can feasibly be introduced. I can provide guidance on the choice review which I think my hon. Friend raised. It will happen this year. A workshop in early February will scope the whole issue and it will involve the full range of experts and stakeholders. They will continue to be involved as the review progresses. But it will happen and be completed this year.

As I say, I am determined that we achieve the breakthrough and achieve what we are all after here in delivering choice at the end of life. Any offer will be introduced using existing legislative powers, namely the standing rules. One of the recommendations of the independent palliative care funding review was about free social care at the end of life. The Government have funded eight pilot sites to gather the information needed to develop a new system and to test the review’s recommendations, including its recommendation to provide free social care at the end of life. Other hon. Members have made the point that it feels clear, and indeed, work has been undertaken to demonstrate that it should be cost neutral. There is a cost attached to the fact that so many people are dying in hospital and we are not delivering what those people want.

Jim Shannon (DUP, Strangford)

I referred this morning to the figures supplied by Macmillan Cancer Support and I think the hon. Member for Easington referred to them too. I think it was £21,000 per 200,000 head of population as against a saving of £135,000. There was clearly a financial advantage to introduce what they were suggesting. Have the Minister and the Department had a chance to consider those figures? If not, perhaps we could have some feedback on that later.

Norman Lamb (Liberal Democrat, North Norfolk)

The Government have funded eight pilot sites to gather the information needed to develop a new system and to test the review’s recommendations, including the recommendation to provide free social care at the end of life. The pilots are gathering evidence over two years until March this year, and the Government will consider the evidence collected from the pilots before making any decisions on a new funding system, including whether to offer free social care at the end of life and the practicalities of doing so. The Government have already stated that they see the merit in removing the means test at the end of life, but that it is not right to make any decisions until the evidence from the pilots can be properly considered.

It is daft, it seems to me, to commission pilots but then to make decisions before getting the evidence from them. Let me tell my hon. Friend the Member for Totnes: I am determined that we do this. Obviously, I want to see the evidence and we have to be aware of the financial consequences, but I am determined that that will happen. The current situation is very hard to justify, particularly given that we are spending money on caring for people where they do not want to be.

Sarah Wollaston (Conservative, Totnes)

I thank the Minister for his words—I am pleased to hear that he is so committed. However, may I ask him for some clarification? When he says that he is determined to do this, does he mean the choice review? I think the words we would all like to hear are: implementing free social care at the end of life. I accept that the pilots have to guide the mechanisms for that, and no one expects him to set that out without seeing the evidence, but a firm commitment to introducing free social care at the end of life would really reassure everyone on the Committee.

Norman Lamb (Liberal Democrat, North Norfolk)

I have given my hon. Friend my personal assurance that I want us to do this. I am not in a position to commit the Government, but, as the responsible Minister—indeed, I have some degree of influence over the decision making—I am determined that we achieve that objective.

Just to be clear, it seems that the issues of choice and free care are inextricably linked. It is the financial incentives that currently mess around with and undermine proper choice at the end of life, and that is what has to be resolved. The choice review can achieve that important objective, but getting the mechanism right is inextricably linked to the outcome of the pilots. It is my clear objective, however, that we achieve this ambition.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

That is a helpful undertaking. Clearly, the independence of the system is key to unlocking the resource to deliver what will actually be more cost-effective and better end-of-life care. Given the commitment the Minister gave to my hon. Friend the Member for Truro and Falmouth about a round-table, could we dwell on this matter as part of that discussion?

Norman Lamb (Liberal Democrat, North Norfolk)

If it comes up, I am sure we ought to dwell on it.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Can it come up?

Norman Lamb (Liberal Democrat, North Norfolk)

I am sure that it can come up. As I say, these matters are linked and cannot be neatly separated out into two separate issues. Therefore, any sensible discussion should deal with all of these matters.

Nick Smith (Labour, Blaenau Gwent)

Will the Minister give way?

Norman Lamb (Liberal Democrat, North Norfolk)

May I finish this paragraph? I am being a bit more demanding now: it is not just the sentence, but the paragraph. However, I will of course allow interventions.

As with any new policy on choice in end-of-life care, any decision to remove the social care means test at the end of life can be introduced through secondary legislation under existing powers. Clause 14(6) provides powers to make regulations that prohibit local authorities from making charges in specific cases.

Nick Smith (Labour, Blaenau Gwent)

I am really pleased that the Minister is convinced by the merits of the argument. It is good that he is waiting for any evidence from the pilot, but earlier he talked about any possible implementation taking place through standing rules. I want to press him on that. What will the legislative framework be for bringing forward and introducing this important idea?

Norman Lamb (Liberal Democrat, North Norfolk)

My understanding is that the standing rules under the National Health Service Act 2006 allow for that, but I am happy to provide clarity by way of writing to hon. Members.

Sarah Newton (Conservative, Truro and Falmouth)

I am grateful for such a firm commitment to delivering free social care at the end of life. When we have our round-table meeting, it would be useful if we looked at the scope of the research and met with the researchers. I understand that they will be gathering that material until March and that the analysis will take a few months, but we need to understand how that was done, so that all stakeholders can contribute to our learning from that for the implementation.

Norman Lamb (Liberal Democrat, North Norfolk)

That seems to make sense. I am very nervous at the way hon. Members keep saying, “I am so pleased with this very clear commitment.” I am conscious that the officials are probably quaking in their boots at what I am saying.

Paragraph (a) of new clause 12 deals with the ability to register one’s interest, intentions and wishes towards the end of life. NHS England and Public Health England are supporting the expansion of electronic palliative care co-ordination systems—EPACs—by introducing a new information standard for local providers to build their own systems. In places where EPACs are already established, around 80% of people die in a place of their choice.

Giving a person the chance to have their say, and recording it, with the professionals abiding by those wishes, is a remarkable and powerful thing. It perhaps contradicts what I said earlier, but that seems to have been possible even within the existing rules and does not undermine the case for changing the rules. It is a remarkable fact that, with EPACs, 80% of people die in the place of their choice, whereas we know that about 50% of people in the country as a whole die in hospital, where most of them do not want to be.

NHS England has an ambition to increase national coverage from the current 30% to 70% by 2015, more than doubling the number of people who currently benefit from the system. That is a powerful driver for change. The question of whether legislation achieves things or whether there are other levers that can be used has been a continuing theme. Ultimately, it must be a mix of levers, but the fact that NHS England has committed to the objective of getting 70% national coverage is very powerful.

I hope that hon. Members, if not officials, are reassured by what I have said.

Bill Esterson (Labour, Sefton Central)

I asked several questions in my speech but I am not sure I have heard any answers. One was about the definition of “end of life” and how a decision might be taken. What is the Minister’s view of what constitutes the end of life? I also asked about people moving to an area.

Norman Lamb (Liberal Democrat, North Norfolk)

I apologise to the hon. Gentleman. I know he raised those matters and I intend to respond.

At what point the end of life becomes defined as such is precisely what we are considering through the palliative care funding pilots, so that we can understand how to implement it most effectively. The easiest way would be once a patient has been placed on a palliative care register. The question, of course, is when that should happen, but the hon. Gentleman highlights an incredibly important point that is under active review through the pilots.

The hon. Gentleman was concerned about areas that are enormously attractive—areas such as his—where people might go for the last period of their lives in a care or nursing home. They might be paying for it as self-funders, but in some cases the money runs out and then it becomes the financial responsibility of the local authority—I hope I have got his concern right. On the whole, such matters balance out across the country. I appreciate his assertion that there is a substantial in-flow, but the relative needs formula takes account of population and demographic differences between areas. We are considering such issues as we work on plans for implementing the reforms, including reviewing the relative needs formula. I hope he accepts that I acknowledge the need to look at the issue, and that we will do so. I hope I have said enough to encourage my right hon. and hon. Friends to withdraw their amendments.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I am grateful to the Minister for his full response, and I look forward to listening to the other contributions to get a sense of how others feel about it. I want to pick up two or three things from the debate and say something about the amendments in light of the Minister’s response.

I agree with the shadow Minister’s comments about Professor Sir Mike Richards. He played a series of roles within the NHS, and his contribution to cancer care is legendary. We inherited the end-of-life strategy from the previous Administration. As the Minister at the time, I took the view that it would be pointless to put it in the bin and start again because it is essential to have continuity.

I am particularly proud that this Administration delivered a national bereavement survey for the first time, because it gives us a great insight into the issue. It provides valuable information and intelligence, and enables us to drive improvement and reach our ambitions about people being able to die in a place of their choosing. The Minister’s comments about EPACs are encouraging, particularly on the ambition to reach 70% coverage. He talked about how different the areas covered by EPACs are, and he made a powerful case for driving that whole area forward.

When we have the round table, I hope the Minister will say more about guidance. In particular, I hope he will respond to my question about guidance on intermediate care, which he did not address in his response. Given that commitments on intermediate care were made in the White Paper, it would be good to know how that will be taken forward.

Norman Lamb (Liberal Democrat, North Norfolk)

I had intended to respond to my right hon. Friend’s question. I understand that the package of statutory guidance on the Bill will deal with intermediate care, and we will publish guidance for consultation in May.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I thought it might help the Minister to pick that up and it will be useful to explore that issue in those discussions. The Minister’s comment is very helpful.

The problem, as my hon. Friend the Member for Totnes said, is that we are paying more for worse care, and the Minister said that it is hard to justify the current situation. I am absolutely determined about this issue, and after the intervention of my hon. Friend the Member for Totnes, we know that we must deal with free social care because it is connected to issues such as choice, tariff reform and so on.

This has been a useful debate. For me, free social care is a means to an end. It will mean that people have the chance to choose where they die, and that their death is as dignified as possible. As the Minister said, families live with the experience of a poor death for the rest of their lives. I therefore urge the Minister to reflect carefully on the issue of carers. I am grateful for his comments, and given that he has undertaken to seriously consider that point, for technical drafting reasons I will withdraw the amendment.

Sarah Wollaston (Conservative, Totnes)

I thank the Minister for his response, and I would like to ask him a few questions. I accept that he feels that these matters are dealt with elsewhere, and that regulations can be introduced, but I want to take him back to the wording. It says “in specific cases” in the regulations. Can he reassure me that “specific cases” could include the broader category of terminally ill persons?

Norman Lamb (Liberal Democrat, North Norfolk)

I can reassure the hon. Lady about that.

Sarah Wollaston (Conservative, Totnes)

I thank the Minister; that is very reassuring. On his second point, he gave us reassuring news about the progress of EPACs. However, may I point out that the figure is up to 80%, but it is not 80% across the board? We must not be distracted. That 80% figure could risk people thinking that we are going to deal with it all through EPACs and that therefore other measures are unnecessary. That is an important clarification on those data.

Norman Lamb (Liberal Democrat, North Norfolk)

I am grateful to my hon. Friend for her clarification and I accept her point. I did say that I was not arguing that the figure undermined the case for reform.

Sarah Wollaston (Conservative, Totnes)

I accept that, but I thought it was an important clarification to put on the record.

There is also the fact that we have four reviews ongoing in this area—or one about to start. The Minister will know that one of those reviews was set to be completed last year. I am grateful for his categorical assurance that it will start this year, that it will be completed by the end of this year, and that the terms of reference will involve stakeholders. That is reassuring.

Most of all, I am absolutely delighted with the Minister’s assurance that he is determined to introduce the policy and that it refers to the issue of free social care at the end of life. Based on that reassurance, I look forward to seeing the progress of the policy, and I am happy not to press the new clause to a Division.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I beg to ask leave to withdraw the amendment.

Clause 22 - Exception for provision of health services

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I beg to move amendment 41, in clause 22, page 20, line 32, after ‘is’ insert ‘authorised or’.

Norman Lamb (Liberal Democrat, North Norfolk)

Clarity on the distinction between what local authorities are responsible for and what the NHS is responsible for is of great importance, as my right hon. Friend the Member for Sutton and Cheam says. Our intention is to retain the existing boundary. Clause 22 does that by setting out the limits of what a local authority may provide by way of health care. It does that by reference to what is required of the NHS and providing that such matters are off limits to the local authority. The clause therefore sets the boundary between the responsibilities of local authorities for the provision of care and support and those of the NHS for the provision of health care. Currently, in the case of the provision of accommodation under section 21 of the National Assistance Act 1948, local authorities are prohibited from providing anything that is

“authorised or required…to be provided under the National Health Service Act 2006”—

that is, things that the NHS has the power to provide and things it is under a duty to provide. That has sometimes led to confusion and uncertainty over what services might have been so authorised.

Section 29 of the 1948 Act, which deals with non-residential welfare services—and with which I am sure my right hon. Friend is familiar—sets the prohibition on what a local authority might provide by reference to matters required to be provided under the National Health Service Act 2006. There is therefore currently a difference in the “health service prohibition” depending on whether the support being provided is by way of accommodation or otherwise. The Bill does not distinguish between those two types of support—residential and non-residential. They are both examples of how need might be met under the Bill. Given the uncertainty in identifying what might have been authorised in some cases and given also that we no longer distinguish in any event between the different types of support—residential or non-residential—we have tried to make this boundary much clearer, while still retaining the ability to fix the boundary where it currently lies. We have framed the prohibition on the provision of health care services by local authorities by reference to services that the NHS is required to provide.

The Committee should note that we have also made provision for a regulation-making power, as my right hon. Friend said—clause 22(2)—so that where there is uncertainty on these matters, or where the need arises, we can clarify and detail the types of service that may or may not be provided by local authorities and in which circumstances. In that way, and if necessary, a local authority may be prohibited from providing a service if it is something that the NHS is providing. The regulation-making power gives us far greater flexibility than is currently available to control the boundary and prevent gaps or undesirable overlaps in provision. I hope the Committee is reassured that in the case of any regulations that might further restrict what a local authority might do, which might in theory lead to a gap in provision—it is not intended that such gaps be allowed to arise—such regulations would be made by the affirmative resolution procedure.

The provisions in clause 22 are not intended to change the current boundary—let me place that clearly on the record—and we do not believe that they will have that result. The limits on the responsibility by reference, as now, to what should be provided by the NHS remain the same. However, the prohibition, combined with the regulation-making power, is framed in a way that allows greater flexibility and greater clarity. I hope that I have reassured my right hon. Friend and that he will feel able to withdraw his amendment.

Meg Munn (Labour, Sheffield, Heeley)

As a former practitioner and a constituency MP, I want briefly to tell the Minister that this is an incredibly important area. The issue of continuing health care has been enormously complex over the years. Twenty years ago we used to have a debate about whether somebody needed a bath as a health bath or a social bath—I always thought a social bath was perhaps where more than one person was involved. However, at the end of the debate nobody disagreed that somebody needed a bath, but we would spend an enormous amount of time deciding whether it should be provided by somebody, say, from the district nursing service or from a care service. It was not a very helpful way to proceed.

Much more fundamentally, I have had cases in my constituency recently where somebody had payments and a very personalised service. Suddenly, following a period in hospital, they were deemed to be eligible for continuing health care support. Through that they lost control over the decisions about what kind of care and support they could have, so the issues that the right hon. Member for Sutton and Cheam has raised—about both the funding and the ability to make those kind of decisions—are fundamental.

Norman Lamb (Liberal Democrat, North Norfolk)

I assume that the hon. Lady will be pleased that we have legislated to provide a right to request a personal health budget if someone has NHS continuing care. It comes in from April, and from October this year there will be a right to have a personal budget. This is the first time that we have given a patient control over resources within health care. It is an enormously significant advance and it narrows the gap between social care and health care. It means that when someone’s condition deteriorates and they move from support within social care to become entitled to NHS continuing care, from October they will not lose that control. They will have a right to maintain control over it.

Meg Munn (Labour, Sheffield, Heeley)

I very much welcome that and agree that it will, I hope, give greater continuity of overall care and achieve the holistic approach for which I have been arguing throughout the Committee. I also welcome the fact that we will look at regulations on this matter. Over time, regulations create the opportunity for Government to respond to changes out there and identify where there are problems. Whatever the intentions are—I think they are proper in terms of establishing this difference—I am convinced that there will be difficulties, as there always are, in implementation, not least because we continue to be in a time of great austerity and cuts.

I do not particularly want to harp on about that. My fundamental point is that this issue causes a lot of problems for people and will continue to do so. Therefore I am pleased to note that there will be regulations on this. Obviously, the opportunity to see and comment on them would be greatly appreciated.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I echo the point about control when it comes to CHC. One of the frustrations was that a one-size-fits-all approach was taken—“You can have this or not.” As a Minister, I had to sign a number of authorisations to allow PCTs to start effectively to operate a direct payment system for that very reason. It is good that we are now going to have that policy translated into the system that the Minister has described. I listened incredibly carefully to what he said. Today’s amendment was intended to probe. This is not one of those occasions when I can offer the Minister any suggestion that I have been persuaded, because I have not—I really have not. There are unintended consequences, and if there is no change, they will be in an Act. A benign Government such as this one, with their clear commitment to keeping the boundary where it is, will be able to do that through regulation, but a less benign Government, under financial pressure or whatever it might be, will be able to use the regulation to move the boundary.

What we will do is allow secondary legislation to be the place in future where the boundary is tested, debated and changed. To me that seems the wrong place to do it. We have a clear establishment of case law in this area and that is not fully embodied in the drafting of the clause. I will look for ways to return to this issue. I hope I will continue to have conversations with the Minister about it. I am dissatisfied with his response, but I will not press the matter to a Division today. However, I may wish to divide the House on this issue if I get the opportunity at a later stage. I beg to ask leave to withdraw the amendment.

Clause 23 - Exception for provision of housing etc.

Grahame Morris (Labour, Easington)

I beg to move amendment 90, in clause 23, page 22, line 2, at end add—

‘(2A) Where a local authority is unable to meet the adult’s needs for care and support without the provision of housing of a specified nature or location, subsection (1) does not apply.’.

I declare an interest: I am vice-chairman of the all-party group on learning disability. I want to raise some issues relating to housing which have been highlighted by Mencap. I tabled the amendment to ensure that local authorities are provided with the flexibility they need to deliver housing solutions for vulnerable people with complex needs. Without that flexibility, people are at risk of remaining or ending up in institutional care. I remind the Committee that, as the Bill stands, clause 23 states that the local authority may not meet care and support needs by doing anything that they are already required to do under the Housing Act 1996.

The division of housing and care and support duties concerns a number of organisations, including Mencap and the Challenging Behaviour Foundation. We have already discussed how crucial it is that the Bill recognises that appropriate housing is an integral part of meeting care and support needs. I do not want to rehearse the arguments we had earlier in the week or about section 177 of the Health and Social Care Act 2012—just for the record, it was on 10 March 2011, at column 667. It is important that we meet care and support needs as well as being mindful of the importance of keeping costs down. It is fair to say that there was a general agreement by both sides of the Committee that that was a reasonable principle that we should apply.

The amendment is concerned with addressing the position of an individual with very complex needs, such as learning disabilities and behavioural issues, that can be triggered by environmental factors. In those circumstances the type of housing or the location of the housing would be critical in ensuring that a person’s care and support needs were met. The Minister has made several statements to the House on this issue following the events at Winterbourne View, but under the Government’s transforming care programme, the intention was that local areas had to ensure that the 3,500 people—if my numbers are correct—with a learning disability and challenging behaviour currently living in units such as Winterbourne View were moved back into their communities.

Norman Lamb (Liberal Democrat, North Norfolk)

The hon. Gentleman is raising important issues, but I want to correct his last point. If someone is in institutional care inappropriately and they are able to live independently with support, that is what should happen.

Grahame Morris (Labour, Easington)

That is a fair point; I should have used the word “appropriate”. The Minister is absolutely right: it is important that people receive the appropriate care and personalised support in an appropriate community setting where possible. Indeed, many individuals will require bespoke, tailor-made housing and support packages to be developed. As hon. Members will know from their own communities, a common solution is to come up with a standard self-contained flat or an adapted house shared with three or four others, but that simply would not work for people with complex special needs. Often, individuals will need to live on their own; and, with the relevant support staff, they might need additional space or they might need to live in a detached property, because their challenging behaviour produces excessive noise. Such housing options must be made available now and in the future to meet the housing and support needs of people with a learning disability and challenging behaviour.

The Minister has said several times that we must not agree amendments that have unintended consequences, but it is important that we do nothing to work against the Government’s commitment, restated by the current Care Minister, to ensure that people with learning disabilities are not put at risk of abuse in institutional settings such as Winterbourne View and are able to live fulfilling lives in the community, where appropriate, with the support that they need.

I am concerned that the Bill as drafted will mean that social services, or the care and support arm of a local authority, might be prevented from taking innovative approaches to solving housing problems. Perhaps the Minister will comment on that. For example, they may wish to provide capital to ensure appropriate housing of the right type or in the right location can be bought or built to meet the needs of people with a learning disability. If the local authority is not able to do that, the only option where the housing authority is unable to meet high rental or capital costs will be for a local authority social services department to place a person in institutional care, as they would have no power to secure appropriate housing.

It is crucial that clause 23 allows for the local authority, in the discharge of its care and support function, to provide property or capital to make up any shortfall in rental payments. I hope the Minister will assure me that that will be possible. The local authority should not be prevented from doing that.

Mencap has given me examples that focus on the importance of enabling the resettlement of people stuck in institutions such as Winterbourne View. However, many other people with a learning disability are at risk of being sent to inappropriate institutional settings if there is no flexibility in the system to deliver appropriate housing solutions. It is sad but true that three quarters of the parents of people with a learning disability have not planned for the time when they are no longer able to care for their son or daughter in the family home.

Mencap commissioned a study in 2012 entitled “Housing for people with a learning disability”, which is recommended reading. For many families of people with a learning disability, planning for the future comes too late, when a family carer either becomes ill or dies. Indeed, the hon. Member for Totnes highlighted that in a debate on an earlier clause, when we were talking about end-of-life care. It is not always possible to plan for such situations, which creates a crisis situation for someone with a learning disability and a need for emergency housing and care provision.

People with learning disabilities and complex needs who live with elderly relatives are not homeless. Although they are vulnerable, they might be on a council waiting list for many years before suitable accommodation in the right location to meet their complex needs becomes available. Local authorities must have the flexibility to secure suitable housing for some of the most vulnerable people in our society. It would be a scandal if those with the most complex needs were destined to remain in, or continue to be sent to, institutions.

As the Minister has told us, the Bill aims to reform and transform care and support, with the well-being of individuals at its heart. We applaud that, but the amendment would help to ensure that there are no unintended consequences and that the Bill’s aims become a reality for people with learning disabilities and the most complex needs.

Norman Lamb (Liberal Democrat, North Norfolk)

I thank the hon. Gentleman for his contribution. He and I share a determination to ensure that people with learning disabilities get treated as equal citizens. The horrors uncovered both at Winterbourne View and by the subsequent review of treatment centres showed that so many still lived in institutional care—at the taxpayers’ expense, outrageously—in the wrong place. Sometimes, they were at risk of neglect and they were certainly not receiving appropriate care to meet their individual needs.

As a preface to my remarks, may I say that I will always listen to Mencap? It is a good organisation that has done important work in this regard to help the Government to respond properly and effectively to Winterbourne View. I have described the task of changing the behaviour of commissioners with regard to people with learning disabilities as like wading through treacle backwards. This is not about money, because we have spent enormous sums of public money on putting people in inappropriate care—I think the average cost at Winterbourne View was £3,500 per patient, per week.

This is therefore not about the Government being mean with public money. In my view, it is about commissioners at a local level sometimes being lazy and not taking proper account of the rights of people with learning disabilities to lead as good a life as they can. Instead, sometimes they are shoving them away hundreds of miles from home and forgetting about them. That scandal has to end. However much pressure we have to keep applying to commissioners to change their habits, we will apply it. If there are continuing concerns about what the hon. Gentleman has raised, I will continue to listen to Mencap about them—and, indeed, to the hon. Gentleman.

Let me reassure the hon. Gentleman that we agree that housing can play a vital role in meeting care and support needs. We have already discussed how we amended the Bill in the other place to make express references to housing to increase its prominence throughout the Bill. To be clear, specialised housing—for example, extra-care housing, supported living or minor adaptations—could already be provided to prevent or to meet the needs for care and support under the Bill. Where meeting an adult’s care and support needs require some form of accommodation, that may be provided under the Bill, as acknowledged by clause 8(1)(a), which, as an example of how to meet needs, states:

“accommodation in a care home or premises of some other type”.

The words “premises of some other type” are important, as that covers other options as well.

Further, the general duties to promote integration in clause 3 and the co-operation duty in clause 6, which apply to all the local authorities’ care and support functions, would require consideration of housing issues where relevant to care and support. Clause 3(5) expressly clarifies that housing is a health-related service, which local authorities must aim to integrate with the provision of care and support and health services when exercising its functions under the Bill.

The point of clause 23 is to clarify the difference in law between a local authority’s duties to provide adult care and support, which may include certain specialised housing services, and its duties to provide general housing under other legislation so as to avoid duplication. The clause does not place a bar on local authorities providing accommodation where that is necessary to meet care and support needs. What it does is prohibit local authorities from using care and support law to provide general or social housing that is not related to a person’s care and support needs. That is only right and proper to ensure clarity about roles and responsibilities.

I hope that that reassures the hon. Gentleman that the amendment is not necessary and that he is content to withdraw it. I repeat that I am happy to discuss his concerns with him and with Mencap so as to ensure that we get this right.

Grahame Morris (Labour, Easington)

I am grateful to the Minister for his sympathetic response and his offer of further consideration of the points raised by Mencap through me. In the light of his comments, I beg to ask leave to withdraw the amendment.

Clause 24 - The steps for the local authority to take

Emma Lewell-Buck (Labour, South Shields)

I beg to move amendment 113, in clause 24, page 22, line 26, at end add—

‘(3A) The Secretary of State after consultation must establish by regulation a specified timeframe for the conclusion of the steps required of local authorities by virtue of this section.’.

Hugh Bayley (Labour, York Central)

With this it will be convenient to discuss amendment 94.

Emma Lewell-Buck (Labour, South Shields)

It is a pleasure to serve under your chairmanship once again, Mr Bayley.

Amendment 113 is aimed at ensuring that service users are clearly informed of when they will receive an assessment and whether any support identifying that assessment will be in place. At the moment, no time scale is set down in law regarding that process. The matter is left for local authorities to decide and implement. I acknowledge that there are performance indicators that say that local authorities should begin all assessments within 48 hours; complete them within 28 days; and have services in place within another 28 days. However, the reality on the ground is that those performance indicators are not having their desired effect. Stronger incentives are needed.

As a former social worker, I understand how that can happen. In many ways, the profession is a reactive one. There will always be priority cases to deal with, and someone else’s case will always be pushed to the bottom of the pile until they become critical. Under a straining system, in areas with high need and savage cuts, those indicators are not incentivising some local authorities to complete assessments and provide services in a timely manner. I know that some authorities go the extra mile, but many others fall short of those recommended time scales. A benchmark needs to be set in regulations to ensure that local authorities see that to be a priority.

The lack of consistency also creates an issue regarding portability. Social care clients who move from one authority to another commonly find that the timetabling arrangements for assessment are different. That can lead to uncertainty for them, their carers and their family. People with care and support needs require clarity about when they can expect to be assessed and when they can begin to receive support. For those who are in need, whose health is failing them, who have care needs, or who are anxious about what their future holds, I want them at least to know when they can expect help. I am sure that the Minister would want that too.

Meg Munn (Labour, Sheffield, Heeley)

My point is related to clause stand part, but it probably makes sense for us to include it here, given your earlier guidance, Mr Bayley. It refers to the discussion that we had earlier and relates to subsection (3), paragraphs (a) and (b). It again concerns needs that might not be eligible needs and whether they would be met. [ Interruption. ] I see that the Minister is a little distracted at the moment.

I am asking whether the principle of a holistic approach applies to the application of subsection (3)(a) and (b). I am happy for the Minister to write to me on that point to provide clarity on how assessors will approach the situation when some needs might not fulfil the eligibility criteria.

Hugh Bayley (Labour, York Central)

For the sake of clarity I should say that I mistakenly said we were debating this amendment together with amendment 94. We have, of course, already concluded the debate on amendment 94. We are considering just amendment 113, which everyone who has spoken so far has addressed.

Norman Lamb (Liberal Democrat, North Norfolk)

I am grateful, Mr Bayley, for that clarification. It did distract me briefly from what the hon. Member for Sheffield, Heeley was saying. I would be grateful if she could clarify which subsection of clause 24 she referred to and repeat her point.

Meg Munn (Labour, Sheffield, Heeley)

I referred to subsection (3) and the criteria under paragraphs (a) and (b). I am suggesting that a certain interpretation of those could lead to lower-level needs, not normally eligible for support, none the less being important in an holistic view of the situation. In subsection (3)(a) does “needs” mean that the overall needs of the person meet the eligibility criteria, or does it refer to specific individual needs?

Norman Lamb (Liberal Democrat, North Norfolk)

I am grateful to the hon. Lady for raising that point. Rather than give an inadequate response now, the best thing would be to write to her to ensure that we are both on the same wavelength, if that is acceptable.

On amendment 113, I can assure the Committee that we have looked very closely at the issue of timeliness in the care-planning process. I totally agree with the points that she makes and this issue was discussed in the other place.

It is vitally important that local authorities retain the ability to be proportionate to the needs to be met. For some people the care planning process may be relatively simple, and therefore can occur relatively quickly. That may not be the case for people with multiple complex needs. That is not to say that it is right that there should be any delay. It may just take longer to do a proper and thorough assessment in some cases. There may also be a need for experts and independent advocates to be engaged in some cases, as we have previously debated. That should not be overlooked in order to meet a centralised target of time scale. Introducing a prescribed time scale for the completion of the care-planning process may also have the unintended consequence—to coin a phrase that has been used on other occasions—of some plans being rushed in order to meet the deadline. There is a fear that that could happen. I hope the hon. Lady would agree that that does not fit well with our vision of a personalised care and support system.

In addition, the duty on local authorities to act reasonably applies to the care and support plan or support plan. That includes the time it takes to complete the process. We should also set out in guidance best practice regarding care and support planning, including indicative time scales for the completion of care and support plans. I hope that helps the hon. Lady. I absolutely agree with her that we do not want backlogs of cases where people may be in very real need waiting for something to happen, but a disorganised local authority does not get its act together and deliver the care plan on time. That has to be avoided, but I hope that she will understand that we also want to avoid over-prescription, which could have the unintended consequence of rushing a care plan, which genuinely might take a significant amount of work to get right. With that, I hope I have provided the reassurance to enable the hon. Lady to withdraw her amendment.

Emma Lewell-Buck (Labour, South Shields)

I thank the Minister for his response. I am comforted by what he said about indicative time scales, but the point I was trying to make is that the message is just not there in the legislation. It lacks weight because it is not in the legislation. Those time scales are not there, so people will not give it as much importance as it should have. I know that from speaking to social workers whom I know—just last night I was speaking to a former team manager—that they feel that the weight is not there and that it is not being given as much credence as it should be. However, bearing in mind what the Minister has said, I beg to ask leave to withdraw my amendment.

Clause 25 - Care and support plan, support plan

Norman Lamb (Liberal Democrat, North Norfolk)

I beg to move amendment 108, in clause 25, page 24, line 21, at end insert—

‘(14) The regulations may in particular specify that the paragraphs in question do not apply as regards specified needs or matters.’.

This minor and technical amendment clarifies that the regulation-making power in clause 25(13) allows the regulations to specify cases related to needs, or matters where aspects of the care plan, including the personal budget, are not required. This will allow regulations to exclude from the personal budget in the care plan the cost of meeting any specified prescribed care and support needs, which are otherwise incorporated in that plan.

It was always the policy intention that there may be cases where aspects of care planning are not appropriate. An example is the inclusion of costs related to the provision of re-ablement. This is where the provision of care and support needs to be short term, rapidly provided and may change often. Therefore it may not be appropriate for these types of care and support to follow the same processes as for long-term care and support. This also reflects current practice, and we intend to continue this arrangement through regulations under the Care Bill. The guidance and regulations that will accompany the Bill are being developed with stakeholders and will be open for consultation later this year.

Meg Munn (Labour, Sheffield, Heeley)

I would like the Minister to clarify subsection (1)(b), relating to the care and support plan. It states that the plan:

“specifies whether, and if so to what extent, the needs meet the eligibility criteria”.

I do not want the process to become a tick-box approach, which meets the eligibility criteria but it is being done by a carer. They could be told: “Shopping is low need, therefore we are not going to provide it,” when in fact shopping will support the carer who is supporting somebody with a high level of need.

Norman Lamb (Liberal Democrat, North Norfolk)

I absolutely agree that we must avoid that tick-box mentality and look at the holistic needs of the individual. However, this covers similar ground to the other points that the hon. Lady has raised. If I could deal with them together in correspondence, I hope that that will help her.

Clause 26 - Personal budget

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I beg to move amendment 88, in clause 26, page 24, line 40, at end insert—

‘(4) Where the needs are to be met through a direct payment, the costs to the local authority must mean the costs to the adult of meeting those needs.’.

Hugh Bayley (Labour, York Central)

With this it will be convenient to discuss the following:

Amendment 103, in clause 26, page 24, line 40, at end insert—

‘(4) A personal budget for an adult must be set at a level that would be sufficient to meet all of that adult’s eligible needs as assessed by regulations referred to in section 13(6).’.

Amendment 89, in clause 28, page 25, line 37, at end insert—

‘(1A) The specified costs to the local authority must mean the costs to the adult of the meeting their eligible needs.’.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

This amendment is to clause 26, which will importantly provide a statutory basis for personal budgets for the first time. In other words, the law is finally catching up with where public policy has been for a considerable time. In its report, the Law Commission described the current situation as having

“a confusing structure, whereby social care practice is not founded in the legal framework.”

With these amendments I want to explore whether the legal framework has fully caught up with public policy and practice, not least in terms of calculating the amount that is made available through a personal budget or direct payment. It is clear that unless personal budgets are transparent and it is possible to challenge them, some local authorities may potentially operate mechanisms for determining how much is available in a way that leaves people unable to access services that would meet their eligible needs. The personal budget is a critical part of the architecture of the Bill. It is a critical tool for delivering individualised, person-centred care, which Members on both sides of the Committee want to see, and which is at the heart of the well-being principle in clause 1.

This proposal is about where power sits in the system. We should be clear that we are trying to transfer power to the individual by giving people control over their budgets. To achieve that and to help them meet their eligible needs we need further clarity, and that is what the amendments seek to do. However, that will only happen if the budget is sufficient to enable the person to buy appropriate support. The Bill as drafted implies that the budget will always be set at a level equivalent to the cost to the local authority of meeting the need. That sounds like a perfectly reasonable way of constructing an obligation to the individual and making resources available to them. However, it does not make clear—and it will be useful if the Minister can indicate how this is to be done—the fact that, as I have said before, local authorities enjoy monopsony powers in the care market. They are purchasers, and can use their market power to get lower prices than an individual going into the market and buying services for themselves. The individual could, therefore, face higher costs.

Let me be clear about the intention behind the amendment. It is not to allow people to use public money to buy a level of service higher than what the local authority provides directly to meet their eligible needs. It is not to enable them to buy a more luxurious set of services. It is to ensure that direct payments do not inadvertently disadvantage their users, relative to others who have services provided directly.

One of the charities that is particularly concerned about this issue drew my attention to a hard case that illustrates that possibility. A carer for an disabled child said:

“We were told when direct payments started that it would help his choice and independence and be able to give him what he needed. But things have changed. We’re now told that travel to some place, paying for social activities and things he likes to do cannot be covered by direct payments. That’s the whole care plan gone. The cost of care services have also gone up and the direct payment no longer even covers enough in care for him. We have to pay to cover the gap to make sure he gets enough support.”

Norman Lamb (Liberal Democrat, North Norfolk)

Does not that case study address a different point? There is the question in that case study of the authority deciding to withdraw certain elements of the personal budget. None of us knows the circumstances of the individual case and whether that is in any way legitimate, but it is an argument about whether particular elements should be in the personal budget. It is not an argument about the value that the local authority attaches to meeting that need.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I entirely accept that I could well rely upon the same case study to make points about that. But I do not accept that it is not relevant to a debate about the adequacy of the resource available to purchase against an agreed care and support plan to meet eligible needs. I accept that after a reassessment it might be determined legitimately that the eligible needs have changed and therefore the package changes and certain things are no longer provided. I agree. That is a different matter. The matter I seek to draw attention to through this example is the one about the adequacy of the resource to provide appropriate care to meet the currently agreed eligible needs.

This is particularly acute when one looks at the care home sector, which we have already debated. One sees the differential in the price a local authority pays compared with the price that might be more publicly available. Given that we as a Government are exploring the possibility of direct payments in the residential care market as well, it becomes a more live issue. The clause is still not clear on how these matters are to be calculated. One of the things that we looked at in the Joint Scrutiny Committee was the evolution of resource allocation systems at a local level. We expressed concern in the report about how opaque these resource allocation systems are in practice.

This has evolved as a bit of public policy since 2008. It was in a circular and then subsequently reinforced in guidance. To be fair, the previous Government were clear that these things should be done in an open and transparent way. As we conducted our inquiry and looked at the evidence, it was clear that many local authorities treat these as something to be kept out of the public’s gaze and so they are not easily obtainable for people who want to understand how that figure in their personal budget has been calculated. That must be wrong, not least because it means that local authorities are flying in the face of existing statutory guidance.

The Bill quite rightly confirms the pre-eminence of the duty to meet eligible needs. It is how those costs are calculated that remains unclear. It is hard to obtain this information from a number of local authorities. Some guard it incredibly jealously. We recommended that the Government should review the efficacy of resource allocation systems to ensure that guidance is clear in the development of resource allocation systems or indeed other methodologies for determining how much the local authority will put into a personal budget or a direct payment. We suggested that this should be linked to clause 1 of the Bill.

My amendments seek to tease out the Government’s thinking on this. RAS is murky. It is an area that is not very well documented in public policy in terms of guidance and so on. The Bill gives the Government an opportunity to make these things much clearer and, from the point of view of the person who is receiving the personal budget, much more acceptable when it comes to understanding how the local authority arrived at its figure. I look forward to the Minister’s response.

Liz Kendall (Labour, Leicester West)

Our amendment 103 is along the same lines as the amendment tabled by the right hon. Member for Sutton and Cheam, which he spoke to extremely well. As hon. Members know, personal budgets and direct payments were brought in under the previous Government in 2007. They came out of people working on the ground to empower people with disabilities, including learning disabilities, who felt strongly that too often their choices, chances and needs were being ignored. They were told what institutional care they should have rather being given the power and control over their own lives. We may have introduced it as a national policy, but it came from people working on the ground, and I pay tribute to those early champions.

I am a long-standing and passionate supporter of personal budgets. If they are done properly and well, they can transform people’s lives by giving them more choice, say, power and control. I have always believed that the purpose of getting power is to give it away. The purpose is to give people more control and power over their own lives. That is what I have always believed, and personal budgets are at the heart of that.

However, I have had cases in my constituency, as I am sure many other hon. Members have, of people who are becoming critical of personal budgets because they are not being implemented properly. People feel that they could be becoming a cover for cuts. People say: “I’m not getting as much as I used to, even though my needs have not changed at all. They certainly haven’t gone down, in some cases, they’ve increased.” We must not allow personal budgets to get a bad name because they are vital and can and should be developed. They are not the sole way of delivering more personalised care and support, but they are an absolutely vital way of doing that.

I echo the comments of the right hon. Member for Sutton and Cheam. The Care and Support Alliance raised the point that people are very worried that, while councils can make block purchases and contracts, when the money is given to individuals they cannot buy as much for their care as they might want. The Bill must be clear that local authorities have a duty to meet people’s eligible needs and that a personal budget must be sufficient for an individual to get the level of care and support they are assessed as needing.

Care provision is changing in response to personal budgets. This is an important policy area that could be developed in future. For example, when people say, “I’ve got my personal budget but still the kind of care and support I want isn’t out there,” some councils, such as Lambeth, bring groups of those people together and ask, “Okay, what is the support you would like to buy?” If they say, “We want x, y and z and it’s not out there” the council can act as a kind of negotiator, go back to the providers and tell them they need to change, or bring new entrants in, if the existing providers refuse to change. Some things will be done individually, while others will involve personal budgets, still with individual choice, but on a more collective, market-shaping basis. However, we will do that only if personal budgets really work for people.

Even if the Minister does not—as I predict he will not—accept the amendments, having greater clarity about how the level of the budget is set and making sure it covers eligibility is vital. As the right hon. Member for Sutton and Cheam said, this is an area where legislation has not kept up with policy. Some of the practice in local councils and in Government policy has not kept pace with how we intend personal budgets to work on the ground. We need more clarity on this somehow, even if it is not on the face of the Bill, because we cannot let personal budgets have a bad name.

Norman Lamb (Liberal Democrat, North Norfolk)

I thank my right hon. Friend the Member for Sutton and Cheam and the shadow Minister for their points. I agree with both of them. I am a very strong advocate of personal budgets and direct payment. The new area of development is the concept of the personal health budget in the NHS. As I mentioned earlier, we introduced the right to have personal health budgets for NHS continuing care. I want to extend that. I am impatient to extend it to mental health. If any group of patients ought to be given power over the resources that are available to them, surely it is people with mental health problems.

I agree with the shadow Minister that, if applied wrongly, personal health budgets can be given a bad name. We must guard against that. There is frustration that practice among local authorities is quite variable. Many local authorities have embraced the concept and absolutely get the need genuinely to empower the people they are there to serve, but others either have not extended personal budgets nearly far enough, or —[Interruption]—as the shadow Minister is indicating from a sedentary position, simply go through a tick-box exercise. We must avoid that. The measures in the Bill are incredibly helpful in developing the concept of personal budgets, entrenching it in law and giving people clear legal rights, but we must also ensure that things work properly in practice.

My right hon. Friend the Member for Sutton and Cheam made a point about the importance of transparency so that the individual can understand how their personal budget has been calculated. We completely agree. It is critical that people understand how it has been calculated, both to help them understand their needs and the options available to them and for the credibility of the system as a whole. We intend to use statutory guidance to set out the expectations on local authorities regarding transparency in calculating personal budgets. Such guidance will allow for more detail on different circumstances and the means of publishing information to reflect people’s needs.

Grahame Morris (Labour, Easington)

Can the Minister clarify how personal care budgets will be applied and what they could be used for? During the Joint Committee inquiry, a Conservative authority highlighted the fact that one reason why local authority day care facilities were being run down was that people with personalised budgets could not purchase day care from the local authority. Was that anomaly ever addressed?

Norman Lamb (Liberal Democrat, North Norfolk)

I would need to get back to the hon. Gentleman on that point. As much as possible, I want the personal budget genuinely to empower the person to use the money as they wish. Of course, it may well be the case that the individual does not want to use an old-style day centre. They might choose to, but they might not, and we must always respect their particular wishes.

I have spoken before about our commitment to rebuilding the law around the person, and in few places is that more evident than the provisions that deal with the new entitlements to a care and support plan and a personal budget. They have been warmly welcomed through consultation. Set against that, the amendments are not necessary because either they serve only to restate matters that are already clear, or they run the risk of undermining the gains made in the Bill.

Let me explain. Amendments 88 and 89 propose similar changes to the personal budget and the independent personal budget, to state that they should reflect the actual cost of care to the individual. The personal budget must be the amount that it costs the local authority to meet the adult’s needs—needs that it is required or decides to meet. If the local authority meets the adult’s needs by making a direct payment, that payment must always be of an amount that is sufficient to enable the adult to meet their needs in a reasonable way.

The personal budget will be derived during the development of the care and support plan. That will take into account the needs of the particular individual and how they wish to meet their needs. The new focus on meeting needs provides for a more personalised approach and should lead to personal budgets and direct payments reflecting individual circumstances and preferences, rather than being a more simplistic service-based calculation.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

That is a helpful description of how the Government intend things to work. Several organisations representing people who use services have made representations that led me to table the amendment—indeed, they also made representations to the Joint Committee. I think that they would find it incredibly helpful if, rather in the spirit of the round table discussions that were offered on end-of-life care, there could be, once the Bill is enacted, a conversation about how the regulations are drafted. Getting user input could ensure that the regulations deliver what the Minister says they will.

Norman Lamb (Liberal Democrat, North Norfolk)

I am completely open to such an approach. I have tried to stress throughout that the collaborative co-production approach does not end with the passage of this primary legislation, but must continue. We must continue to involve those user groups to ensure that their voice is heard and that we get the best possible result.

Everyone’s personal budget must be based on the same principle: that it relates to the cost to the local authority. That ensures fairness and consistency. If a direct payment were the cost to the person, it might have the unintended consequence of incentivising people to source more expensive care and support to meet needs, and thus progress quicker to the cap on care costs. If a person is unable to use their direct payment to purchase care to meet their eligible needs, they can ask the local authority to review their care plan, and consider whether there are other ways to meet their needs, such as through the provision of care and support arranged by the local authority or a combination of such provision and direct payments.

Similar to amendment 88, amendment 89 seeks to change the way the independent personal budget is calculated. To provide consistency with the personal budget, the Bill defines the independent personal budget as what the cost would be to the local authority of meeting a person’s eligible needs for care and support. It is important that people progress towards the cap at the same rate, whether the person’s needs are met by the local authority or the individual. The amendment would mean that people funding their own care would progress towards the cap at the actual cost they pay for their care.

Although in some cases there will be little difference between what the individual pays and what the authority would pay, in other cases self-funders may choose care more expensive than that that the local authority would usually provide. That would therefore increase the rate at which those individuals progress towards the cap. Although it is right that individuals are free to choose to purchase care of their choice, including at a price of their choice, the amendment would unfairly advantage well-off people who spend much more on their care. It would be inequitable, because wealthier people who are able to purchase more expensive care would reach the cap more quickly.

The reforms offer the first ever opportunity to protect all people from catastrophic costs and provide more transparency about the costs of care and support. The amendment would undermine those gains—I suspect that my right hon. Friend the Member for Sutton and Cheam sees the point I am making—and make the system less fair, directing public money to those who need it least, but I absolutely understand that that is not the intention.

Amendment 103 intends to link the personal budget to the needs to be met as identified in the eligibility criteria, which will be set out in regulations underpinning the Bill. The amendment is not required because clause 26 already ensures that the personal budget specifies the cost to the local authority of meeting the person’s eligible needs. That is because the personal budget must include a statement of the cost to the local authority of meeting those of the adult’s needs that it is required to meet or decides to meet as mentioned in clause 24(1). Clause 24(1) refers to the duties and powers in the Bill to meet eligible needs, so the link back to the needs identified in the eligibility criteria already exists. Those provisions ensure that the amount at which the personal budget is set is sufficient to meet the eligible needs of the person. There is no ability for the local authority to reduce the personal budget to an amount less than it would cost to meet the person’s needs. I therefore urge my right hon. Friend and the hon. Member for Leicester West not to press their amendments.

Hugh Bayley (Labour, York Central)

It might help members of the Committee if, before calling Mr Burstow, I make a brief procedural announcement: if the Minister or any other Member plans to table an amendment for debate on Tuesday—the next sitting—they need to do so before the rise of the House today. The procedural point I want to put to the Committee is that I have had a message that the debate in the main Chamber is likely to end before 5 o’clock. If someone is working on amendments, they should come and talk to the Clerk quickly to ensure they do not miss the deadline.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

That is very helpful information, and I will rush to the Clerk after I sit down.

I welcome the spirit in which this debate on personal budgets has been held. There is unanimity on the importance of personalisation. The distinction I would draw is that the personal budget is merely the means, and sometimes in some quarters the personal budget gets elevated to being more important than the goal, which is individualised, personalised care. I welcome what the Minister said about extending the personal budget to mental health, which is a great step that is long overdue.

The shadow Minister is right that personal budgets came about because grass-roots activists pushed the case for them. Some of those grass-roots activists have subsequently begun to question some of the ways in which local authorities have gone about translating personal budgets into practice, hence my raising the question of resource allocation systems. I welcome what the Minister said about the intention to use statutory guidance to set out in more detail how those calculations will be made in future. I merely point out that there is already extant guidance on them and the evidence is that many local authorities ignore the guidance and treat such things in a “Hitchhiker’s Guide to the Galaxy”-type way: the guidance is locked in a filing cabinet in a basement of the town hall so that it is not accessible to anyone who might choose to seek it out. That cannot be right and it has to change. I hope the Minister will address that.

The Minister talks about notional costs and their relevance to the cap, which is important. It is one of the reasons why, in his continuing reflections on the arguments about appeals mechanisms, I hope he will bear it in mind that many more people will be contesting the calculation of that notional amount to reach their cap. Those people will have the financial means to contest, so avoiding costly legal cases is why we need some mechanism of the sort for which I argued earlier in our consideration of the Bill.

The Minister has been very persuasive, and as ever he has been helpful. With his commitment to meeting charities, and hopefully me, to discuss guidance after the Committee has concluded and the Bill is enacted, I will not press the amendments.

Norman Lamb (Liberal Democrat, North Norfolk)

I absolutely agree with my right hon. Friend on the importance of a clear mechanism to enable challenge, which reinforces his point on people with money being willing to challenge. We need to end up with a mechanism that is straightforwardly clear and has an independent element but is not overly costly, burdensome and bureaucratic, which would cause delays and take enormous costs out of the system to everyone’s disadvantage.

I want to address further the points raised by the hon. Member for Easington on the use of direct payments. Direct payments cannot be used to purchase care directly from the home local authority, but there is no such restriction on local authority care provided via a personal budget, which continues to be the case under the Bill. If people choose to have a personal budget and not to take on direct payment cash, they may continue to opt to use local authority day facilities and so forth.

Grahame Morris (Labour, Easington)

Does the Minister not think that that is an anomaly that should be corrected if he believes in choice? Part of the consequences that all Members are foreseeing is a run-down in day care facilities. The amendment would be an easy way to address that.

Norman Lamb (Liberal Democrat, North Norfolk)

I will reflect on what the hon. Gentleman says.

Liz Kendall (Labour, Leicester West)

I know this might sound like a dry and technical issue, but it is important that people get the right personal budget to pay for care that meets their eligible needs and that that is done in an open and honest way. That is the bedrock of what will make the personal budgets work. I do not think that Government policy and regulations are up to scratch, so I look forward to hearing what the Minister says. The detail may not go into the Bill, but this is a serious issue and we need to figure out how councils can provide these budgets in the best possible transparent way; otherwise, the budgets will get a bad name and we do not want that. I will look to the details in the regulations and make my judgment according to those.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I beg to ask leave to withdraw the amendment.

Clause 27 - Review of care and support plan or of support plan

Emma Lewell-Buck (Labour, South Shields)

I beg to move amendment 114, in clause 27, page 24, line 4, leave out ‘keep under review generally’ and insert ‘review regularly’.

Hugh Bayley (Labour, York Central)

With this it will be convenient to discuss amendment 115, in clause 27, page 25, line 33, at end add—

‘(5A) The Secretary of State after consultation must establish by regulation appropriate arrangements and timetable for the regular review of care and support plans and of support plans by local authorities provided for in subsection (a).’.

Emma Lewell-Buck (Labour, South Shields)

These amendments would perform a similar function to amendment 113, but would apply to the review of care plans rather than assessment. In my experience, it is the review stage at which delays are most common and local authorities fall the most short of their duties. The amendments would require local authorities to conduct regular reviews of service users’ care and support plans and establish a timetable for that through regulations.

In my constituency, care plans are supposed to be reviewed every 12 months, but that does not always happen. Just a few days ago, I spoke to a constituent, Mr Bennetts. He is registered blind and his sight loss is increasing, but his most recent review was more than three years ago. As with assessments, I understand that time pressures on care workers mean that routine assessments are often put on the back burner in the face of more urgent cases. However, that does not change the fact that, without regular assessment, checks show that many people’s conditions are allowed to deteriorate. Stronger terms need to be put on local authorities to ensure that such checks are carried out.

Care plan reviews are particularly important for people with progressive or fluctuating conditions. For them, even a few weeks can make a huge difference. A person with a progressive condition whose needs are not assessed for many years may find themselves with support that is completely inadequate for their developing condition.

Regular reviews also provide a built-in check on the care system, which can improve safeguarding. Regular contact with service users enables inadequate care to be identified quickly. I was involved with a care home in my constituency where, due to a lack of scrutiny by a number of agencies, criminal negligence went on unchecked. That had heartbreaking consequences. I do not ever want to experience that again and nor do I want anyone else to have to.

Like amendment 113, the amendments deliberately do not specify a time scale, as that is best left open to consultation. However, even the current target used in most areas of an annual review is too long, given the speed with which conditions can change and the vulnerability of some clients. Adult social care workers are fed up that their profession never receives the same rigour and attention as children’s care, in which review meetings can take place as regularly as monthly if a local authority has concerns about a case. Local authorities strictly keep to children’s social care time scales because of the emphasis placed on child protection and the public scrutiny. There is no such urgency for adults.

I am sure that the Minister agrees that an 85-year-old with dementia deserves the same protection as a vulnerable child and that, therefore, the priorities need to be rebalanced. I fancy, however, that the Minister’s response will be the same as for my previous amendment. When responding, I would like him to think seriously and carefully about the message his Government is sending to service users and local authorities by not prescribing any time scales in legislation.

Meg Munn (Labour, Sheffield, Heeley)

I want to make a brief point in addition to those made by my hon. Friend. It is important to review the care that service users receive, not just because their needs change in a negative way, but because they could improve. Some of the most successful cases that I dealt with in practice were where, by providing a significant amount of care at the point when a person was discharged from hospital—thus enabling them to be discharged—a review quickly after that enabled care to be reduced, often much more quickly than either the service user or the social worker expected, thus releasing the budget to be used for other people.

Often, particularly with elderly people, the issue is a lack of confidence after a period in hospital. Returning home is a bit of a lottery; no one knows or can judge properly how that person is going to cope. My experience was that, by putting someone in who slept there, perhaps for a week or two, that elderly person could be enabled to return home to regain their confidence. There could be a proper assessment of just how able they were to cope at home. Subsequently, their care needs were often reduced to the level of home care that they had before their admission to hospital.

Not to proceed in that way could lead to a person entering residential care, with their lack of confidence compounded, the costs escalating, and the person never going home. Looking at early reviews and ensuring that the needs of people, both when they deteriorate and when they improve, are properly addressed and supported by changing services are fundamental to a much more efficient service.

Norman Lamb (Liberal Democrat, North Norfolk)

On the hon. Lady’s final point, I agree that the whole objective should be to help a person improve their mobility and well-being; that is at the heart of the Bill. We all need to be focused on improving well-being.

One of the things that I feel strongly about is the need to improve how commissioning works by providing incentives to providers to improve well-being. We have amended the Bill through clause 5(4) to require local authorities to focus on well-being when they are commissioning services.

We know that if the right things are done, we can often reduce someone’s dependency. There is a role for the voluntary sector, friends and neighbours to help as well, tackling the awful consequences of loneliness. That can have a massive impact on reducing loneliness. Therefore I am very much with the hon. Lady, and I share the view that a follow-up assessment makes absolute sense if we can identify reduced need.

The points of the hon. Member for South Shields were, on the whole, well made. Right at the end, she introduced a sour note, which I thought was misplaced. The whole tone of our discussions has been about valuable reforms, which I think most people are behind. We are trying to achieve something that has been widely supported. The sense that the Bill sends a message about what this Government think of people introduces an unfortunate tone, which has been missing from the discussion until now. I gently chide her in that regard.

The local case described by the hon. Lady, about someone who has been waiting three years for a review, is absolutely shocking. I hope that she is taking her own local authority to task for that complete failure of care and support for that individual, who is clearly a vulnerable person. Failures can occur all over the system, and we should be indiscriminate in being unwilling to accept them where they occur.

Amendment 114 would require care plans to be reviewed regularly. Taken in conjunction with the related amendment 115, which would provide for regulations to specify a time frame for the regular review of care plans, the effect would be to establish a review period that local authorities must adhere to. Clause 27, which deals with the review of care plans, creates a general duty to keep plans under review and a specific duty to review a care plan whenever the adult concerned requests it. The clause introduces a right to a review if a reasonable request for one has been made, which should help in cases such as that of the hon. Lady’s constituent who has been requesting a review and not making any progress.

The clause also requires the local authority to revise the care plan and carry out fresh assessments whenever it believes that an individual’s needs or circumstances have changed. We believe that to be a more pragmatic way of fitting reviews around people’s lives. It supports our policy of personalised care, because it bases the decision to review on an individual’s needs, not on an arbitrary time scale. A regular review would imply only that the frequency of a review was consistent over time; it would not necessarily mean that the frequency was right or that the review took place at the most appropriate time for an individual. Our proposal to keep the plan “under review generally” would ensure that it was monitored constantly, and steps could be taken to change it as required.

Local authorities must act reasonably in the discharge of their duties, including those in relation to care and support planning and reviews. It would not be reasonable to delay or extend that process, as in the case of the hon. Lady’s constituent, beyond what is appropriate in an individual case. We will set out in guidance best practice for conducting care and support plans and reviews, and we will work with social care partners to include indicative time scales for care plans. I hope that that might help the hon. Lady. For the reasons that I have given, we intend to refrain from specifying and prescribing time scales. I hope that on that basis, she will agree to withdraw the amendment.

Emma Lewell-Buck (Labour, South Shields)

I believe that the word “generally” is too vague, but I will not divide the Committee on the issue. I am comforted by the Minister’s response, but not entirely convinced. I would like to think about the matter outside the Committee and I may return to it at a later date. I beg to ask leave to withdraw the amendment.

Clause 33 - Direct payments: further provision

Norman Lamb (Liberal Democrat, North Norfolk)

I beg to move amendment 109, in clause 33, page 29, line 22, at end insert—

‘(da) cases or circumstances in which an adult who lacks capacity to request the making of direct payments must or may nonetheless be regarded for the purposes of this Part or the regulations as having capacity to do so;’.

Hugh Bayley (Labour, York Central)

With this it will be convenient to discuss Government amendments 110 and 111.

Norman Lamb (Liberal Democrat, North Norfolk)

These minor technical amendments should not detain us long. They allow the direct payment regulations to provide flexibility in cases of fluctuating capacity. Amendment 109 makes a mirror provision to the one in clause 33(2)(e) to allow regulations to be made so that adults for whom a direct payment is made under clause 31 can be treated as continuing to have capacity notwithstanding some periods of incapacity. That regulation-making power allows regulations to reflect the provisions in the current direct payment regulations. Clause 33, together with the proposed amendments, allows regulations to make provision for cases where a person with a direct payment has a fluctuating capacity, so that the local authority can continue with the original direct payment arrangements. This is intended to provide continuity and to prevent direct payments from having to be terminated unnecessarily.

The guidance and regulations that will accompany the Bill are being developed with stakeholders and will be open for consultation later this year.

Clause 34 - Deferred payment agreements and loans

Liz Kendall (Labour, Leicester West)

I beg to move amendment 104, in clause 34, page 30, line 46, at end insert—

‘(9) The Secretary of State shall make available to all local authorities a model deferred payment scheme and all local authorities must follow this model unless they can show due cause not to.’.

Hugh Bayley (Labour, York Central)

With this it will be convenient to discuss the following:

Amendment 105, in clause 35, page 31, line 15, at end insert—

‘(3A) The regulations must require any interest incurred on an adult’s deferred amount or interest on an amount charged under subsection (1)(b) to count towards the set level above which an adult starts receiving financial assistance with the costs of their care.’.

Amendment 106, in clause 35, page 31, line 20, at end insert—

‘(4A) The regulations may not specify any threshold of other assets above which a person is not eligible to receive a deferred payment loan.’.

Amendment 107, in clause 35, page 31, line 27, at end insert—

‘(5A) Regulations under this section must provide that—

(a) a local authority shall direct anyone considering a deferred payment arrangement to an appropriately qualified financial adviser or to appropriately qualified financial advisers; and

(b) any loan under this scheme shall be sufficient to pay for advice under paragraph (a) above.’.

Amendment 96, in clause 35, page 32, line 12, at end add—

‘(11) The regulations in subsection (1) are subject to the affirmative resolution procedure.’.

Liz Kendall (Labour, Leicester West)

We now come to another important clause in the Bill, which is about the deferred payment schemes: council loans to people who require care to help them pay for their residential care. Such loans are absolutely at the heart of what the Government claim the Bill will achieve. Hon. Members will have heard the Prime Minister and the Health Secretary say many times that the Bill will ensure that nobody has to sell their home to pay for their care. However, that is not true; they will have to sell their home to pay for their care, but after they have died. The Minister had the foresight to include the second part of that sentence, but when the Prime Minister and the Health Secretary regularly say that no one will have to sell their home to pay for care, that is not the case. They will—after they die—to pay off the loans.

Daniel Poulter (Conservative, Central Suffolk and North Ipswich)

The hon. Lady will be aware that someone cannot sell their own home after their death, so the statement by the Prime Minister is absolutely accurate. The point is that when someone does die, there is generally a division of the assets among the beneficiaries, which are normally many in the case of any estate.

Liz Kendall (Labour, Leicester West)

I am saying that the Prime Minister especially should be careful about what he says, because many people have heard his statement and think that they will not have to sell their homes. I want to be careful and accurate in my comments on this.

Amendment 104 states that the Secretary of State has to make a model deferred payment scheme, or one of the loan schemes, available to all local authorities, although they can opt out if they so choose. Amendment 105 specifies that the interest that people would incur on the loans will not count towards the cap on care costs. We discussed that issue on Tuesday. Amendment 106 would remove the means test for the loans, which was not recommended by Dilnot, who wanted a universally available system, and the matter was sprung on people when the Government issued their consultation document on the deferred payment schemes just before the summer.

I pay tribute to Lord Lipsey for raising the issue and moving the amendment in the other place. He was the first person to highlight the fact that the new loan schemes will not be available to everybody as was intended, but are being means-tested.

Amendment 107 states that local authorities must direct anybody considering taking out such a loan to a financial adviser so that they can be well advised about the best financial options for their situation.

Amendment 96 calls for regulations on deferred payment loan schemes to be subject to the affirmative resolution procedure of both Houses of Parliament.

To provide some background, the loans are widely available but not widely taken up. I did a freedom of information survey on local councils and 95%—we had a high response rate—said that they offered the loans but do not often promote them—

Norman Lamb rose—

Liz Kendall (Labour, Leicester West)

Perhaps what I say will prevent the Minister from intervening, although if it does not it does not matter. That is why the duty in the Bill requiring councils to offer the deferred payment schemes and the Minister’s commitment on a public awareness programme is important. The loans are available but councils often do not tell people about them. Does the Minister still want to intervene?

Norman Lamb (Liberal Democrat, North Norfolk)

As the hon. Lady says, there is no duty at the moment. If they are theoretically available that is one thing, but if the local authority does nothing to publicise that fact and if they attach all sorts of conditions, limitations and restrictions, the reality is that they are not available.

Liz Kendall (Labour, Leicester West)

I agree. I was just explaining, because some people will think that this is a brand new thing, although it is not. It does exist, but needs to be more widely available.

It is important to ensure that everybody sets up a deferred payment scheme that is simple, easy to understand and easy to use. Our amendment 104 would require the Secretary of State to have a model deferred payment scheme that local authorities should follow, unless they show good reason not to. Each local authority, as the Minister just said, has designed and implemented different schemes and they will have to set up different care accounts to keep an eye on how much money people are spending and how much they have taken out in a loan. This is a big undertaking. Allowing councils to do this in different ways is potentially wasteful and could lead, as the Minister said, to variations in the schemes; some could be good and others could be poor quality. A simple single model that could be opted out of would aid councils. That could be a good way to have simple, clear, universal access, cutting back on bureaucracy and waste and saving the taxpayer money. This is a value for money and efficiency proposal, which I hope that the Minister will accept.

Amendment 105 relates to the interest on the loans. Let me clarify. I am sure that the Minister will correct me if I am wrong. Currently, councils are not allowed to charge interest on the loans while the person is alive. Interest can be charged once they have passed away. Our freedom of information survey shows that the rate councils charge varies between nothing and 8%. Once people die, their home has to be sold to pay back the loan. Some may sell a home quickly, but others may not. The interest really matters.

We do not disagree with the Government’s saying that interest should be charged on the loans. Councils are not going to be able to balance their books if lots of people take out the loans and they do not have that money in the bank. We are not disagreeing about interest. However, we have never heard that said by anyone, even the Care Minister, until we raised this issue in the media. It was in the fine print of the consultation document, but there has never been a big public statement saying, “You’re going to get these loans and interest will be charged.”

As I told the Committee, if interest is charged at 4%, as the Government’s consultation document suggests, for an average stay in a care home of two and a half years that would cost some £3,500. For the one in eight elderly people who stay in residential care for five years that could rack up almost £14,000 in interest charges. As I said, the interest will continue to grow until the family home has been sold, even after the person has died. It would be even bigger for elderly people who live in areas where residential care is more expensive. We have calculated this according to the average price of a care home and some people face paying much higher bills. Our amendment would ensure that the interest on the bills counts towards the cap. That is what many elderly people and families would expect. They would expect that that was part of their care costs.

I turn now to amendment 106 and the new means tests on the loans. When Dilnot recommended that the scheme be made universal he said he wanted it to be available, obviously, for everybody who might want to use it. However, in the consultation document the Government issued this summer they unexpectedly proposed a £23,250 limit on people’s savings. In other words, those who have more than that in savings would not qualify for the deferred payments scheme. The concern about this relates back to these claims that no one will have to pay for their care. As Lord Lipsey pointed out in the other place, someone who spends all of their savings down to £23,250, which would be a lot of money for many people, would get £700 a year at current interest rates, or just £14 a week.

For many elderly people in residential care, that means they would not be able to afford the little things that make life in a care home tolerable and give them pleasure in later life: buying a newspaper; getting presents for the grandchildren; buying them sweets. It is this human aspect, this personal cost to people’s quality of life that the Minister seems to have forgotten in suddenly saying that people will not be able to get a loan unless they have less than £23,250 in the bank. Our amendment does away with the means test for eligibility for these loans and restores the Dilnot principle of universality.

Amendment 107 relates to the point we have frequently raised about financial advice. Opposition Members and Government Members, particularly the hon. Member for South Derbyshire, have been engaging in the discussion about financial advice. There is concern about the deferred payment scheme and the loans and providing proper financial to people is really important. For some people it might make more financial sense to rent out their homes rather than to take out these loans because of the cost implications later on. People must get that good quality advice because they may not understand how the loan will affect them.

We have had this debate before but we still have not nailed this down. I would certainly want my constituents or my parents to get proper financial advice on whether the loan would benefit them because of the cost implications. I hope that the Minister takes this issue away. It has come up many times before. This is yet another reason why people need proper financial advice from properly trained and qualified advisers to ensure that all these issues are covered when they are thinking about the cap on care costs and this deferred payment loan.

Finally, hon. Members will be pleased to hear, amendment 96 calls for the regulations about the deferred payment loans to be subject to the affirmative resolution of both Houses of Parliament. This is yet another complex area. There is complex interplay with the cap and complex interplay with the means test. We need to see more details of all of this: the interest rates on these loans and whether they will be means-tested and at what level. It is essential to understand the combined package of who will benefit, and how, across the different income levels. The Minister is moving in an unsure way—[Laughter.]—with his eyebrows.

Norman Lamb (Liberal Democrat, North Norfolk)

That is an over-interpretation.

Liz Kendall (Labour, Leicester West)

We have to take decisions in this House based on who benefits from a proposal, according to their level of income and which part of the country they are from. Who does this benefit: the poorest, those in the middle or the better off? It is very confusing for us to decide as MPs who really benefits. My concern is that unless we see all the details, including of the loan scheme, we are not clear about who benefits. That is an important issue for Opposition Members and, I hope, for Government Members.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I wish to pick up on a couple of points made by the hon. Lady and to ask a question of the Minister. Deferred payment is fundamentally about having a mechanism that avoids the family facing the trauma of a fire sale of the property at the moment of crisis. Having a deferred payment gives that peace of mind of knowing that is not something they have to address at that point.

It also ensures that the property is not sold at a point when everything else is going on, potentially at a lower price than it would achieve if properly marketed over time. It is an important protection of the asset, but a much more important protection of the emotional crisis that a family is in at the point at which this takes place. That is the best way to understand what deferred payment should be about.

It was great that the previous Government, with one of the few things it did following the recommendations of the Royal Commission on long-term care, sought to introduce deferred payments. What is great about this Government and their determination to see it through is that they have legislated and made it a mandatory requirement that they are delivered. They were never mandatory. As the hon. Lady said, because of that many local authorities had them, paid lip service to them, but did not deliver them, and they were highly variable. This is a good step by the Government.

The other reason that deferred payment is important goes to a point made by the hon. Member for Sheffield, Heeley about reassessments being done in a timely fashion. Someone who has a crisis, who is a self-funder and admitted from a hospital into a nursing home, may recover social function and function, but because they are a self-funder that all too often becomes invisible, and they live for years in that home spending a large amount of money on their nursing home fees, and as a consequence they fall back on the state because they have spent everything they have.

Deferred payment also provides the breathing space to allow those things to be sorted through and provide assurance. There is an issue there about how this can be exploited in a proactive way to achieve another public policy goal, which is to spend money where it most has effect. That is about helping people recover, not helping people increase their dependency.

We have already debated clause 4 but it is relevant to this clause. Clause 4(3)(a) states that local authorities must identify the people

“who would be likely to benefit from financial advice”.

I want to press the Minister on the point about regulated financial advice and seek further clarification on how he envisages the guidance being crafted so as to ensure that local authorities do bear that in mind. There is a huge reputational risk for local authorities and a huge risk to the individual. I was in this House when misinformation around the state earnings-related pension came to light. As a consequence, the then Government had to sort out and compensate many people who had been told effectively to opt out of the state earnings-related pension and were in a less advantageous state as a result.

My fear is that, unless an individual has had the benefit of regulated financial advice, what will come back to haunt either the Government of the day or certainly the local authority in question is that they did not act diligently, and did not fulfil their duty of care and ensure that the individual received the right advice. In some ways, this product mimics equity release, which is why it should be treated as a financial product for the purposes of regulated financial advice.

Norman Lamb (Liberal Democrat, North Norfolk)

It is legitimate to debate this concern, but does my right hon. Friend agree that this is ultimately a low-cost loan? As he and the shadow Minister have already said, deferred payments have been around for quite some time, albeit not widely available in reality. Is my right hon. Friend aware of any circumstance in which someone who has taken out a deferred payment arrangement—in the whole time since their introduction—has later claimed that it was mis-sold to them? We might expect that assertion to have been made by now were it a genuine and legitimate fear.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I accept the Minister’s challenge, but I do not have the answer off the cuff. My only other point in response is that that, in and of itself, is not a sufficient reason not to ensure, when designing a national obligation on local authorities, that we look around the corner and guarantee that the Government design a system that makes it certain that such a scenario does not play out.

Grahame Morris (Labour, Easington)

On that point about the national obligation to establish deferred payment schemes in 150 authorities, which is a low-cost but not a no-cost option, would it not be advantageous and more efficient to have a model scheme that all 150 authorities could adopt?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I am about to come on to that point, about which I had the benefit of a conversation yesterday with representatives from the Local Government Association, who are canvassing such an idea. Under the powers to delegate functions, it would of course be possible for local authorities to act in combination to operate a national scheme, but I dare say that that may be one argument that the Government could use to counter the case for it. There is, however, a case for the Government giving more thought to having a clear national offer around deferred payment, because this whole area of financial advice is so important. The personal social services research unit says that 40% of self-funders could benefit from existing financial products, so it would be good for people get such advice so that they can consider the alternatives to a deferred payment scheme, which is part of the point here.

The £23,250 means test is being unfairly characterised, partly because it happens to be the same figure as the threshold for access to financial support for care itself, which allows for some inadvertent conflation. That was certainly not intended by Lord Lipsey, who raised some important points. It is the case that this specific proposal, which was also present in consultation papers issued by the previous Government, excludes the property that the person is living in. The proposal aims to address those who have considerable wealth beyond the property in which they live.

Earlier, the shadow Minister rightly told Government Members that we need to focus on those in the middle. The way in which the Government are trying to craft the rules for access to deferred payment is doing exactly that. It is about addressing those in the middle, not those with super-wealth, who will be able, through good financial advice, to access other products more suited to their circumstances, or to self-insure using their resources. That issue has not been fairly discussed. The Government have none the less consulted on it, but I have not yet heard the outcome of the Government’s deliberations. It would be useful to know when the Minister expects to share with us whether the Government intend to stick to the £23,250 figure, because they need to move past this argument.

My final point is a question. In a scenario where a person takes out a deferred payment in one area to move into a care home there, then perhaps for reasons of family or something else, they choose to move to another care home which is not in that local authority’s area, who will have responsibility for the deferred payment? Does it stay on the loan book of the local authority which issued it in the first place, or will it transfer to the other local authority? I am not sure that the Bill makes this clear. It would be another reason why perhaps a national framework would be useful for this purpose. It would be helpful to the Committee, and I suspect others outside, if the Minister answered that.

Finally, I hope that those who follow our business in this Committee—and they follow it closely on these matters of financial advice—will take up the Minister’s challenge. I will be only too pleased then to come back to him with some further answers.

Norman Lamb (Liberal Democrat, North Norfolk)

I would be happy to hear back from my right hon. Friend when the cases come in. May I respond to one specific point, about how guidance will ensure that local authorities have in mind the need for financial advice around deferred payments? We are developing statutory guidance in partnership with local authorities and the financial services industry, including representatives from the financial advice sector. We are committed to providing local authorities with the implementation support that they will need to implement the scheme well.

With regard to my right hon. Friend’s other point about what happens when someone moves to another area, we will write to him and other hon. Members to confirm the point. He has managed to flummox both me and, I suspect, officials with that question, but I have no doubt that we will have an answer and we will enlighten him.

To make a very gentle, political point, some of the debate around this has been unfortunate. Whatever the intention, it has ended up being somewhat misleading in its intent. It is slightly irritating—if I can go that far—because I remember that in 1998 the then Prime Minister, Tony Blair, that great man, said words to the effect: “I do not want to live in a country where people have to sell their homes to pay for care”. Thirteen years later, tens of thousands of people have had to sell their homes to pay for care because nothing was ever done. I know that predecessors of mine shared that frustration, and I know that many of those who have held this job were completely frustrated that the previous Government failed to act—[Interruption.] My right hon. Friend says: “And me”.

The great thing is that this Government are acting. They commissioned Andrew Dilnot to do the work and we are now getting on with righting a wrong that has been in existence for far too long. The shadow Minister made the assertion that deferred payments are not a new thing and have been around for a long time. What is new, and so important, is the duty.

Liz Kendall (Labour, Leicester West)

I said that!

Norman Lamb (Liberal Democrat, North Norfolk)

I know and I do not seek to claim that the hon. Lady did not say that, but it is important to assert the fact that in the past deferred payments have been theoretically available in many areas, but without a duty to provide them, they have not been available for many people. My right hon. Friend made the correct point that the protection of individuals and families from having to sell at a moment of distress is what makes this so valuable. Having to sell at the moment when someone goes into care, or soon after, when it has to be done to pay for those care costs, is a deeply unfortunate situation. My right hon. Friend also made the valid point that the availability of a deferred payment may also enable someone to recover and return home, if that is possible.

The shadow Minister had a go at the Prime Minister and others for the words that they used, but the deferred payment can of course be paid off using other assets; it does not have to be paid off from housing assets following the death of the individual. That is a matter for the beneficiaries to decide, subject—of course—to the amount of money that is available.

The introduction of the universal deferred payment scheme will provide protection and peace of mind for those people who face having to sell their home in their lifetime to meet the cost of their care. Our open approach to this legislation will not cease with the primary legislation completing its passage through Parliament but will continue as we develop regulations and statutory guidance. It will remain as we develop the necessary support to ensure that all local authorities are in the right position to offer deferred payment agreements from April 2015. We will provide this support in a consistent way and we have already committed to making a model scheme available, which directly addresses the shadow Minister’s concern. The guidance will say that local authorities should use the model scheme, unless there is good cause not to use it. In effect, that will mean local authorities have to use it, so we will achieve what she seeks to achieve. I do not believe that any of the amendments are necessary to clarify our commitment to collaborative working or to ensure successful implementation of the reforms in the Bill.

The purpose of amendment 105 is to provide that any interest or charges on deferred payment agreements would count towards the cap on care costs. Deferred payment agreements do not have any relation to how much a person is expected to contribute towards the cost of their care and nor will they necessarily have any relation to the rate at which a person meters towards the cap. Instead deferred payment agreements are a mechanism that people can choose to use—if they wish to do so—to pay for their care costs. The method by which a person chooses to pay should not affect how much they are expected to pay before they reach the cap. I do not believe that people should meter towards the cap faster if they choose to pay through a deferred payment agreement than people who choose to pay, for example, through an immediate needs annuity, an insurance policy or, indeed, by selling their home. Why should we benefit one group of people over other groups in reaching the cap faster as a result of counting interest? This is a low-cost loan, giving people a very valuable facility, but they should not be advantaged over and above others in that regard. To do so would simply be unfair and that would be an undesirable result of the amendment.

Liz Kendall (Labour, Leicester West)

When elderly people or their families receive advice about this scheme, will they be clearly told about the interest, how much interest they will clock up and that the interest will not count towards the cap?

Norman Lamb rose—

Liz Kendall (Labour, Leicester West)

How will the Minister guarantee that they are told those things?

Norman Lamb (Liberal Democrat, North Norfolk)

I am moving in an unsure way again.

Hugh Bayley (Labour, York Central)

It is my job to tell people to sit still.

Norman Lamb (Liberal Democrat, North Norfolk)

Yes, of course people will be told about the interest that is payable, and I am sure that it will be part of the provisions in the guidance on the model deferred schemes that the hon. Lady’s amendment sought to achieve, but that amendment is not necessary, as I have tried to explain.

Amendment 106 would prohibit the use of any asset-based criteria for access to deferred payments. First, I will take a moment to refresh our memories about the Dilnot commission’s report. It recognised that people who can afford to contribute towards the cost of their care should do so. The commission’s recommendations sought to define a new partnership between the individual and the state and to focus the money available on those who need it most: those with the fewest assets or who face catastrophic care costs.

Amendment 106 would go against that principle. It would not target those people who most need support but instead ensure that anyone, even those with assets of great monetary value in addition to their main home, can have a deferred payment agreement. I simply disagree with that principle. I do not think that the public purse should be helping people who do not need financial support to pay their care fees. A person with a substantial sum in their bank account would not be

“unable to afford care charges without selling their home”.

Such a person would therefore not be the principal purpose of a deferred payment agreement, as set out by the commission. In effect, if the shadow Minister presses the amendment, Labour would be advocating cheap, Government-subsidised loans for millionaires.

Liz Kendall indicated dissent.

Norman Lamb (Liberal Democrat, North Norfolk)

She shakes her head, but that is what it would be. A low-cost loan is a very attractive proposition. Anyone with a lot of financial savvy and a lot of money in the bank would go for it. Why on earth should hard-working people on relatively low incomes help to subsidise the cost of giving low-cost loans to millionaires? I simply do not understand where Labour is on that, and I find its whole argument deeply frustrating.

Liz Kendall (Labour, Leicester West)

I do not want the Minister to misrepresent what Andrew Dilnot said. He said that the loan should be universal. Is that the case?

Norman Lamb (Liberal Democrat, North Norfolk)

The loan is universal for anyone who may be forced to sell their home to pay for care. I also find the principle of having a threshold over which the loan would not be available to be remarkable, because, clearly, if someone has £100,000 in the bank, they are not in a position in which they would be forced to sell their home. Does the hon. Lady believe that someone with £100,000, or indeed £1 million, in the bank should be entitled to a loan? That is what her amendment would provide for.

Liz Kendall (Labour, Leicester West)

What we are saying is that someone with, say, £20,000 in the bank—they may want to pass on those savings to their children—might be living off the interest on those savings, which does not actually provide that much per week. That is the point raised by David Lipsey in the House of Lords. It goes back to what Andrew Dilnot said. The Government have constantly said that they are putting in place what Andrew Dilnot and the Law Commission recommended, but Andrew Dilnot said that the loan should be universal. If the care Minister wants to disagree with what Dilnot recommended, he should say so. We are questioning why he has changed the fundamental principle of a universal, all-in system.

Norman Lamb (Liberal Democrat, North Norfolk)

I absolutely believe that it is a universal system. We will make the loan available to anyone in this country who would be forced to sell their home to pay for care. It is universal.

Let me tempt the hon. Lady once more. Her amendment would mean that someone with £100,000 in the bank is entitled to a cheap, Government-subsidised loan. Does she support that?

Hugh Bayley (Labour, York Central)

The hon. Lady does not have to ask Minister to give way. She might refer to the question when she replies.

Norman Lamb (Liberal Democrat, North Norfolk)

I think the silence is very telling. In the dying days of the last Labour Government, Labour finally, after 13 years of waiting, came up with a scheme. It was a crazy scheme, and I suspect that in her private moments the hon. Lady agrees, but none the less the scheme included a universal right to a deferred payments scheme. Do you know what? The assessment provided for a threshold of £23,000, or whatever the amount was subject to price rises. It appeared to be right for Labour’s deferred payments scheme; why is it wrong for this Government’s deferred payments scheme? I am happy to give way on that.

Liz Kendall (Labour, Leicester West)

I will save my comments until the end.

Norman Lamb (Liberal Democrat, North Norfolk)

I just make the point that the threshold is exactly the way that Labour proposed to do it. I hope that we can agree that the principle of having an upper threshold for non-housing assets is a sound one that is in line with the conclusion of the debate on this issue in the other place. I am sure that there are different views within this room on what that amount should be.

Although the matter is for regulations, I hope to build some consensus on the principles that should determine that amount. First, I expect it to be an amount that prevents people from being forced to sell their home in a moment of crisis to pay for their care. Secondly, the amount should, as far as possible, complement and align with the new charging system to facilitate smooth transitions. Thirdly, the amount should be targeted not at those who are looking for a cheap loan and have enormous assets, but at those who are most in need of the flexibility and peace of mind that deferred payment agreements can offer. I think that those are reasonable principles, and I hope that the Opposition agree with them. These principles will guide the development of regulations on the deferred payment access criteria, alongside the responses we received to our consultation and the views of our partners in local government and the care and support sector who will develop the regulations with us.

Amendment 96 is not necessary for regulations specifying the interest rate for deferred payments to be subject to the affirmative resolution procedure. We have already consulted on the issue and asked for evidence in our consultation on funding reform. We have committed to consulting on draft regulations this spring, before regulations are laid in Parliament. Such consultation on the first use of these powers is sufficient scrutiny, especially when we have been clear that the interest rate is about making the scheme cost-neutral and not about raising revenue for local authorities.

Finally, amendment 107 is on financial advice for people considering a deferred payment agreement. I agree that it is important that people make well-informed and considered choices on the care they receive as well as on how to fund their contribution towards its cost. That includes people considering a deferred payment agreement. The local authority has a central role to play in ensuring that its local population is aware of the range of information and advice, both regulated and non-regulated, that is available and how to access it. We have set out the active and facilitative role that we expect local authorities to take in meeting the duty in clause 4 on information and advice, which includes financial information and advice.

I have already spoken of how deferred payments provide protection to people in a moment of crisis, typically by providing much needed breathing space, as my right hon. Friend the Member for Sutton and Cheam made clear, to decide how to meet the costs of care in the longer term. A balance needs to be struck to ensure that people have the information and advice they need to make a well-informed choice while maintaining access to deferred payment agreements in a moment of crisis. It is my view that mandating a local authority direction to advice from an appropriately qualified financial adviser would be too onerous, especially as not everyone will require independent advice to make a well-informed decision. Compelling them to seek it would simply be a waste of their time and money. Equally, having to go through a Government-mandated tick-box exercise could cause enormous frustration for people.

In light of what I have said, I hope that the hon. Member for Leicester West feels able to withdraw the amendment.

Liz Kendall (Labour, Leicester West)

I know the Minister clearly feels passionately about this matter. He is many things, but a mind reader he is not, so for the record I want to say that his assertions about what I think are wide of the mark—he has no idea about that.

Let me go through things in turn. First, on amendment 104 and a model scheme being available, that is important and I welcome hearing about it. On the point about interest counting towards the cap, it is important for that to be spelt out clearly, not only in the fine print of a consultation document, but in the advice given: councils must be required to tell people that they will be charged interest and how much it could be, so that they can make a decision about the loan.

Norman Lamb (Liberal Democrat, North Norfolk)

Does the hon. Lady still feel that it is right for interest to count towards the cap, advantaging those people, as against other people who choose equally reasonable and appropriate schemes to meet their needs?

Liz Kendall (Labour, Leicester West)

The Minister made a good argument, and people need to be treated fairly. My point has always been that people need to know about the interest on the loans. That had not been made public except in the fine print—[ Interruption. ] I am sorry, I thought that the hon. Member for Burton was making an intervention.

Andrew Griffiths (Conservative, Burton)

Will the hon. Lady give way?

Liz Kendall (Labour, Leicester West)

I will give way once I have finished my point. It is important to be clear about the interest, because it could be fundamental to someone’s decision about whether to take out the loan—and how much for—or, in future, an insurance product to guard against such a level of interest rate.

Andrew Griffiths (Conservative, Burton)

I was talking to a colleague, but as the hon. Lady overheard me I will repeat what I was saying for the record. Is what she is offering actually a tax break for millionaires?

Liz Kendall (Labour, Leicester West)

That is rich—excuse the pun, if it is one—coming from a party that cut the top rate of tax to benefit millionaires at a time when many others were suffering. I will come on to that point in a minute, though.

On qualified financial advice, we will keep returning to the subject, because it is important. I take the Minister’s point: has anyone seen an example of a person who was told about the deferred payment scheme and has anyone ever complained about it later? It is more complicated now, however, because the loan, the cap and the means test together are all complicated. The three are interrelated and that proper financial advice is required. I have no intention of setting up a system that predominantly benefits millionaires. As I think I said, Lord Lipsey said in the other place that if someone had £20,000 of savings in the bank and is living off the interest of those savings, it is not very much a month or a week. He was deeply concerned about that, and we are reflecting that issue today.

There is much more to be debated, and the Opposition will be thinking about this and many other issues and the implications for Report stage. I am aware of the time and of Members’ commitments. Although I am prepared to withdraw the amendment, more thinking must be done—

Norman Lamb (Liberal Democrat, North Norfolk)

By the Opposition.

Liz Kendall (Labour, Leicester West)

No, by the Government. I stress seriously that how the loans, the means test and the cap work together will affect who the Bill benefits—those at the top, at the bottom and in the middle. I do not think that anyone present is fully clear—I am happy to admit that I am not—about exactly who will benefit when all the different elements come into play. It is right that we scrutinise the Government’s legislation; the purpose of the Committee stage is go through things in detail. I hope that we have done at least some of that today.

We will think about what amendments we might table on Report, but for now I will sit down. I beg to ask leave to withdraw the amendment.