Ministerial Statement – Free Home Care for Disabled People

This statement is a progress report on our commitment to provide free home care for disabled people. We have announced previously that we are intending to go out to public consultation on our proposals for a scheme to implement our commitment.  The paper sets out the basis on which, subject to some further work and data gathering, I currently plan to consult.  Decisions on the scheme which, as previously announced, we plan to introduce in the autumn, will be taken following the public consultation. The shape of the final scheme will be determined in 2006 following piloting in a number of areas from the autumn of this year. 

The National Assembly for Wales currently has neither the powers nor the resources to implement a policy of free personal care. The Welsh Assembly Government has, however, sought to moderate the impact of charging through improvements to the means testing arrangements for residential care and through statutory guidance which sets out general principles for the way that local authorities frame their charging arrangements for domiciliary care.  Some disabled people will already have benefited under these improvements.

The Assembly Government will continue to look for practical and affordable ways within existing powers to improve on the current arrangements.  The proposals to provide free home care for disabled people will be a substantial further step. It will help people who have to meet significantly higher living costs because of a substantial impairment in their daily living which requires hands on care. It will help to ensure that they are treated consistently and will reduce the burden of paying for care.          

Local authorities have discretion to charge for non-residential care services for adults under section 17 of the Health and Social Services and Social Security Adjudications Act 1983.  Under current legislation, the National Assembly does not have powers to remove that discretion except for the first six weeks. It is, however, lawful for the Assembly to institute a grant scheme under which local authorities would be funded for the costs associated with not charging specified groups of people for specified services and on the basis that grant can be withdrawn if a local authority should subsequently re-introduce a charge. I propose to implement the policy through a grant scheme. 

As general principles we want to introduce a scheme which:

• demonstrably delivers on our commitment
• is seen to be fair
• is clear to the service user
• is straightforward to deliver
• does not jeopardise entitlements to other forms of assistance and benefits:
• and is, and will remain,  affordable 

Last year, we set up an Expert Group to help to develop options for the implementation of our commitment.  We wanted to hear from those with knowledge of the subject area before framing our consultation proposals. The Group examined in some detail what definitions of disability and types of service should be eligible under the scheme and outlined how the grant funding arrangements might work. I am very grateful for the Group’s work which has helped to inform the proposals which I am outlining in this statement. While the Group’s work answered some of the questions surrounding the implementation of this policy, it did highlight issues where further research and consideration were required, and work is now underway in these areas.

Under the National Assistance Act 1948, to be eligible for a care service from a local authority a person must demonstrate a substantial and permanent impairment arising from physical or sensory disability, illness injury or other prescribed reason. Having considered the Group’s advice on various approaches to the definition of disability which might be used, I am minded to consult on the basis that the scheme should cover those who are determined as eligible for domiciliary care assistance by a local authority under the National Assistance Act 1948 and who are eligible for certain disability-related benefits, for example Attendance Allowance and Disability Living Allowance.
 
This is consistent with the framing of the manifesto commitment and uses tests which are already applied and which are widely understood.  There are however some risks associated with links to eligibility for benefits which the Assembly does not control - for example that eligibility for those benefits is changed.   I will be particularly interested in consultees views on this.  The further work currently in train includes mapping the take up of local authority services with take up of these benefits.     

In line with the principles set out above, I plan to consult on the basis of providing “personal care” in the service user’s own home which would require a domiciliary care agency to be registered under the Domiciliary Care Agencies (Wales) Regulations 2004.  The Care Standards Act 2000, under which the Regulations are made, does not supply a definition of personal care. However the introduction to the National Minimum Standards for Domiciliary Care Agencies in Wales sets out the Assembly’s view that personal care includes:

“  (a) assistance with bodily functions such as feeding, bathing, walking and toileting

(b) care which falls just short of assistance with bodily functions but still involving physical and intimate touching”

Local authorities are empowered to provide a wider range of support services (especially under the Chronically Sick and Disabled Person’s Act 1970) but I feel it is right that the priority for assistance under the policy must be personal care.  This is what happens in Scotland where personal care is provided free to all persons aged 65 and over.

The proposed grant scheme arrangements is another area where further work is in train and discussions are under way with representatives of local government.  The bulk of the costs of personal care services being provided to local authority clients is met from within the local government revenue settlement.   In total, local authorities collectively raise some 10 per cent of the cost of providing services from service users, although there is significant variations in charging from one local authority area to another.  The costs arising from the policy include the charging income foregone by local authorities, any additional demand (for example from those who currently make their own arrangements without involving the local authority) and any additional assessment costs.  Rising provision has been made for the scheme in the Assembly’s budgets from 2005-6 onwards (£7.5m in 2005-06, £15m in 2006-07 and £20m in 2007-08).  We are also currently commissioning an external and authoritative costing of the policy.

It will be very important for service users and those who implement the policy that we get this right.  I believe that a sensible and pragmatic approach will be to pilot these arrangements in a number of areas starting in the autumn and to draw on the experience from the pilots in the more general rolling out of the scheme.  I will invite expressions of interest from local authorities that wish to pilot these arrangements as part of the consultation process.