House of Commons Hansard Debates for 21 Apr 1995

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`(3) Sections (Assessment of ability of carers to provide care: England and Wales) and (Isles of Scilly) do not extend to Scotland.

(4) Section (Assessment of ability of carers to provide care: Scotland) does not extend to England and Wales.

(5) This Act does not extend to Northern Ireland.'.-- [Mr. Wicks.]

Clause 5, as amended, ordered to stand part of the Bill.

New clause 1

Assessment of ability of carers to provide care: England and Wales

`--(1) Subject to subsection (3) below, in any case where-- (a) a local authority carry out an assessment under section 47(1)(a) of the National Health Service and Community Care Act 1990 of the needs of a person ("the relevant person") for community care services; and

(b) an individual ("the carer") provides or intends to provide a substantial amount of care on a regular basis for the relevant person,

the carer may request the local authority, before they make their decision as to whether the needs of the relevant person call for the provision of any services, to carry out an assessment of his ability to provide and to continue to provide care for the relevant person; and if he makes such a request, the local authority shall carry out such an assessment and shall take into account the results of that assessment in making that decision.

(2) Subject to subsection (3) below, in any case where-- (a) a local authority assess the needs of a disabled child for the purposes of Part III of the Children Act 1989 or section 2 of the Chronically Sick and Disabled Persons Act 1970; and

(b) an individual ("the carer") provides or intends to provide a substantial amount of care on a regular basis for the disabled child,

the carer may request the local authority, before they make their decision as to whether the needs of the disabled child call for the provision of any services, to carry out an assessment of his ability to provide and to continue to provide care for the disabled child; and if he makes such a request, the local authority shall carry out such an assessment and shall take into account the results of that assessment in making that decision.

(3) No request may be made under subsection (1) or (2) above by an individual who provides or will provide the care in question-- (a) by virtue of a contract of employment or other contract with any person; or

(b) as a volunteer for a voluntary organisation.

(4) The Secretary of State may give directions as to the manner in which an assessment under subsection (1) or (2) above is to be carried out or the form it is to take but, subject to any such directions, it shall be carried out in such manner and take such form as the local authority consider appropriate.

(5) Section 8 of the Disabled Persons (Services, Consultation and Representation) Act 1986 (duty of local authority to take into account ability of carers) shall not apply in any case where-- (a) an assessment is made under subsection (1) above in respect of an individual who provides the care in question for a disabled person; or

(b) an assessment is made under subsection (2) above.

(6) In this section--

"community care services" has the meaning given by section 46(3) of the National Health Service and Community Care Act 1990; "child" means a person under the age of eighteen;

"disabled child" means a child who is disabled within the meaning of Part III of the Children Act 1989;

"disabled person" means a person to whom section 29 of the National Assistance Act 1948 applies;

"local authority" has the meaning given by section 46(3) of the National Health Service and Community Care Act 1990; and

"voluntary organisation" has the same meaning as in the National Assistance Act 1948.

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(7) In Schedule 1 to the Local Authority Social Services Act 1970 (enactments conferring functions assigned to social services committees) at the end there shall be inserted--

"Carers (Recognition and Services) Act 1995 (c.00)

Section (Assessment of ability of carers to provide care: England and Wales) Assessment of ability of carers to provide care.".'.-- [Mr. Wicks.]

Brought up, read the First and Second time, and added to the Bill.

Ms Rachel Squire rose --

The Second Deputy Chairman: We are having a slight private confab. I am not quite sure whether the hon. Lady is seeking to move her amendment.

Ms Squire: By leave of the House, I beg to ask leave to withdraw my amendment.

The Second Deputy Chairman: The hon. Lady does not need to withdraw the amendment if she has not moved it, but this is the point at which she would need to move it if that was going to be done. I just wanted to clarify the matter so that we did not move on swiftly and leave undone something that we ought to have done.

New clause 2

Assessment of ability of carers to provide care: Scotland

` .--(1) Section 12A of the Social Work (Scotland) Act 1968 (duty of local authority to assess needs for certain services) shall be amended as follows.

(2) After subsection (3) there shall be inserted--

"(3A) Subject to subsection (3B) below, in any case where-- (a) a local authority make an assessment of the needs of any person (`the relevant person') under subsection (1)(a) above, and (b) a person (`the carer') provides or intends to provide a substantial amount of care on a regular basis for the relevant person,

the carer may request the local authority, before they make their decision under subsection (1)(b) above, to make an assessment of his ability to provide and to continue to provide care for the relevant person; and if he makes such a request, the local authority shall make such an assessment and shall have regard to the results of that assessment in making that decision.

(3B) No request may be made under subsection (3A) above by a person who provides or will provide the care in question--

(a) by virtue of a contract of employment or other contract; or (b) as a volunteer for a voluntary organisation.

(3C) Section 8 of the Disabled Persons (Services, Consultation and Representation) Act 1986 (duty of local authority to take into account ability of carers) shall not apply in any case where an assessment is made under subsection (3A) above in respect of a person who provides the care in question for a disabled person."

(3) In subsection (8), after the definition of "medical practitioner" there shall be inserted--

" `person' means a natural person.".'.-- [Mr. Wicks.]

Brought up, read the First and Second time, and added to the Bill.

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New clause 3

Isles of Scilly

`--(1) The Secretary of State may by order provide that section (Assessment of ability of carers to provide care: England and Wales) shall apply, with such modifications (if any) as may be specified in the order, as if the Council of the Isles of Scilly were a local authority within the meaning of that section.

(2) The power of the Secretary of State to make an order under this section shall be exercisable by statutory instrument; and a statutory instrument containing such an order shall be subject to annulment in pursuance of a resolution of either House of Parliament.'.-- [Mr. Wicks.]

Brought up, read the First and Second time, and added to the Bill.

Title

Amendment made: No. 8, leave out from `assessment' in line 1 to end of line 4 and insert

`of the ability of carers to provide care; and for connected purposes.'.-- [Mr. Wicks.]

Bill reported, with amendments; as amended, considered. Order for Third Reading read.

1.23 pm

Mr. Wicks: I beg to move, That the Bill be now read the Third time.

Much has already been said, and I should simply like to state that if the issues of community care and the needs of carers are important today, they will become far more important in years to come. That is partly because of simple demography and the aging of our population which, among many other things, will lead to more people suffering from dementia, Alzheimer's disease and other conditions for which carers will be required. It is also important to note that we live in a time when the population is aging but family sizes are becoming smaller--there is a declining fertility rate. It is a demographic trick in our society that the number needing care is increasing precisely when the number of younger citizens is declining. The care ratio is moving in the wrong direction.

Other issues challenge us. Many of the natural carers of the past were assumed to be women. Now, rightly, women as well as men are active in the labour market. Unless proper support is given, not least through employment policies, we cannot assume that there will be people able and willing to take on the care that we need in future.

The debates have shown that carers vary tremendously. Many are older people caring for very old people--people in their 60s caring for those in their 80s and 90s. There are also younger parents caring for children with disabilities. In Committee, much attention was focused on the many children who are themselves carers. I welcome the fact that the Committee agreed to provide for children in the Bill so that they are fully included alongside other carers.

I also welcome the fact that the Under-Secretary announced in Committee that next week the chief inspector of social work will issue a special letter to social services authorities about the needs of young carers. I regard that as an important social policy development.

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When I think of carers, I think of, among others, the Croydon wife looking after her husband who has multiple sclerosis, which he contracted just one year after their marriage 22 years ago. I think of the woman I met in Northern Ireland who looked after no fewer than three people in her family. I think of the 16-year-old girl whom I met at a sixth form conference who has been caring for her mother, who has serious liver failure.

I think of the elderly woman in New Addington, Croydon, who became a carer in 1945, at the birth of our modern welfare state. She is, herself, a courageous, energetic, gutsy, one-woman welfare state, who has been modestly and humbly caring for different members of her family for 50 years. I think of the carer I met in Edinburgh who said that, because of her mother's condition, she had had to sleep on the floor of her mother's bedroom for two and a half years. The week before I met her, she had provided care for 165 hours in one week alone.

I think, too, of the modesty of carers. They are people with enormous burdens of care who ask for so little and should be asking for rather more. I hope that if the Bill becomes an Act of Parliament, it will at least be a modest but significant step away from what is often community neglect and towards true community care.

It has been said that, if we had to value carers, they would be worth £30 billion a year. I regret that the calculation has to be made, but when parts of our society know the price of everything and the value of nothing, perhaps we, too, need to give a price to care. It has already been said that, if only one in 10 carers gave up the task, the cost to the state would be £2 billion a year. Such people form Britain's major army of carers--a larger army than the entire national health service and all the social services departments. It makes sense for social and moral reasons to provide services and support, and to find what resources are necessary to support the carers, but it also makes economic sense.

Some 11 years ago, when I was the director of the Family Policy Studies Centre, we quickly learned that, as well as considering the needs of children in families, we had to recognise the extended family and the role of the carer within it. In 1984, my colleague at the Family Policy Studies Centre, Melanie Henwood, and I wrote a report called, "The Forgotten Army", which was how we referred to such carers then.

I believe that in the years since--not least thanks to the Carers National Association, whose work I applaud again--carers have come in from the cold in many respects. They are now an applauded army. Politicians, pundits and priests have applauded the carer, patted him or her on the back and said, "You are doing a wonderful job." But that is no longer good enough. As hon. Members on both sides of the House have said in a great show of unanimity on the issue, we must recognise carers and provide them with services and support, including respite care.

We must strike the correct balance between rights and responsibilities. We can never talk about rights or duties alone; it is the balance that counts. Politicians sometimes attack irresponsibility within society and in the family. In so doing, if we are not to be guilty of hypocrisy, we must recognise and support responsibility. I have said it before and I will say it again: the carers whom I have met in England, Wales, Scotland and Northern Ireland are among the most responsible citizens in this country.

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Sensible social policy sometimes plays to strengths and those people provide the strength. They are the people who put the "care" into community care in Great Britain. They are truly heroes and heroines; they are responsible people who have conducted, through the Carers National Association, a responsible campaign. I feel confident that an equally responsible Parliament, speaking with one voice, will soon turn the Carers (Recognition and Services) Bill into an Act. 1.30 pm

Mr. Harry Greenway (Ealing, North): I beg the indulgence of the House so that I may speak briefly on the Bill. I congratulate the hon. Member for Croydon, North-West (Mr. Wicks) and all those associated with him on his undoubted achievement in introducing the Bill.

If the national value of the work by carers is £30 billion per year, the value in Ealing is certainly several million pounds a year. I have been associated with carers in Ealing for a long time. I greatly value the work of the local committee and its chairman, Richard Smith, as well as that of the trusted and hardy carers who meet regularly and who perform notable duties for those whom they cherish. I particularly emphasise respite care. The hon. Gentleman mentioned that issue, but I still do not believe that it has been developed enough. Elderly carers in particular are often taken to the limits of their strength and beyond in performing caring duties. I hope that the Bill will lead to the provision of respite care of a more immediate nature. That would be a superb achievement and one that is much desired.

As the hon. Gentleman said, the aging of the population will necessitate an increase in the number of carers. I do not wish to hoist difficult or trying work on to anyone's shoulders, but it is important that people who are unwell or who suffer from an illness, such as senile dementia, should remain in their own homes if that is humanly possible. Carers make it possible for them to do that and, as a result, I am sure that the number of carers will increase in the future.

I welcome the fact that children are included in the terms of the Bill. In 25 years in teaching, I often came across children who, at a very young age, had responsibility for caring for very sick or dying relatives. I remember particularly the case of a small girl, Anne, who lived not far from here. At the age of 11, she nursed her mother for three years and, when her mother died of cancer, she assumed responsibility for caring for her father and about eight children. She somehow managed to perform that task as well as attending school regularly and

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working hard. That is a severe burden to place on any child, and I know of children as young as five, six or seven who are performing a caring role. I hope that their extreme youth will not exclude them from the terms of the Bill. I hope and believe that it will apply to children of all ages, including the very young.

I was once a carer myself. Many years ago, when I was a teenager, my mother was taken ill. My father was already dead, and I became her carer, right through to the time when she became terminally ill. So I know what being a carer means, and I know what the Bill will mean, which is why I especially commend it to the House.

1.34 pm

Mr. Hinchliffe: I do not want to detain the House or to go over what I said earlier. I commend my hon. Friend the Member for Croydon, North-West (Mr. Wicks) for the--unusual--way in which he has steered this measure through, procedurally speaking. He has shown such great talent that it may be recognised when the current vacancy in the Labour Whips Office comes to be filled.

On behalf of carers and of the Opposition, we warmly commend this measure. I congratulate my hon. Friend and all concerned on bringing it thus far.

1.35 pm

Mr. Bowis: I echo that tribute, and I wish the Bill well. The hon. Member for Dunfermline, West (Ms Squire) summed up the debate well when she said that no man is an island:

"No man stands alone. Each man's joy is joy to me, each man's grief is my own".

Read "carer" for "man"; read "all of us" for "me". We all need to understand the realities of caring: its joys, the fact that it is willingly given, certainly, but also the griefs, pain and struggle--not to mention the occasional frustration and anger that can be felt by carers. If, as a result of the Bill, loving care will be given and supported, not demanded and taken for granted, the House will have done well by carers and by those for whom they care. We shall all owe a debt of gratitude, too, to the hon. Member for Croydon, North-West who has brought the Bill before us today. We wish it well.

1.36 pm

Mr. Wicks: I thank hon. Friends on both sides of the House for voicing their support for the Bill, and I urge colleagues to give it a Third Reading.

Question put and agreed to.

Bill accordingly read the Third time, and passed.

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National Health Service (Amendment) Bill

Considered in Committee.

[Dame Janet Fookes

in the Chair ]

Clause 1

Disqualified practitioners: engagement in provision of services by others

Question proposed, That the clause stand part of the Bill. 1.37 pm

Mr. John Austin-Walker (Woolwich): Clause 1 makes an addition to section 46(2) of the National Health Service Act 1977, so that if a tribunal decides that a practitioner should be disqualified from appearing on a family health services authority list or lists of people providing FHS services, it may also make a declaration that the practitioner is unfit to be engaged in any capacity in connection with the provision of those services. The current provisions allow a tribunal to disqualify a person from appearing on a medical, dental, ophthalmic or pharmaceutical list, but do not prevent him from practising as a locum, assistant or deputy for some other person or body providing such services.

In essence, current legislation provides only for principals. Under this clause, the tribunal would not be obliged to make such a declaration when disqualifying a practitioner, for two reasons. Obviously, if a tribunal disqualified someone from one list but not from all lists, it would be nonsensical if he were then suspended from practising as a locum elsewhere when he may be able to practise as a principal.

Similarly, the tribunal might conclude that the offence is such that the practitioner should be prevented from being a principal, in one family health services authority or a group of FHSAs, but might not want to prevent him from working as a locum, assistant or deputy. Indeed, if the tribunal felt that the practitioner was capable of redemption, it could choose not to prevent such work and so provide an opportunity for the practitioner's rehabilitation within the NHS. It is a discretion that the tribunal could exercise.

Question put and agreed to.

Clause 1 ordered to stand part of the Bill .

Clause 2

Interim suspension of practitioners

Question proposed , That the clause stand part of the Bill.

The Second Deputy Chairman of Ways and Means (Dame Janet Fookes): If the Committee is agreeable, we can take clauses 2 to 6 together.

Mr. Austin-Walker: Clause 2 did not have an airing on Second Reading. It is important that it has one now, because the clause is the essence of the Bill. The clause enables an authority to apply to the tribunal for a practitioner to be suspended prior to a substantive hearing of the tribunal. It enables the tribunal to make a direction

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that a person shall be suspended if it is satisfied that it should do so to protect patients. The essence of the Bill is the need for the NHS to protect patients.

Under the National Health Service Act 1977, any person or body may make representations to a tribunal that a practitioner shall be disqualified. The tribunal itself decides whether such

representations need to be heard. That is to avoid the tribunal having to hear frivolous or vexatious representations. However, the tribunal is obliged to hear representations if they are made by a health authority.

For the same reason, under the clause the power to make application for suspension will be restricted to health authorities. If other bodies or individuals have information which suggests that a practitioner should be suspended, they have a duty to lay that information before the health authority, as it is the family health service authority which is the regulator of local family health services.

If the tribunal considers that a practitioner should be suspended to protect patients, it may make an order that the practitioner is to be regarded temporarily as being removed from any relevant list. For this purpose, the practitioner will be deemed to be unfit to provide relevant services in any capacity. That will be mandatory on the tribunal under the clause. The question at issue will be patient safety.

The initial period of suspension would lapse when the tribunal, following a hearing, disposes of the case by issuing a decision whether or not the practitioner should be disqualified, unless that decision includes a further direction that the suspension should continue. That further period of suspension would prevent a practitioner returning to practice until his appeal rights had been exhausted or, in the case of no appeal being made, until the disqualification direction is enforced by the health authority at the end of the period for appealing.

To preserve due process the practitioner is given the right to be heard by the tribunal, to call witnesses and to produce evidence in his defence before the tribunal decides whether or not to make a ruling. So that a suspension application should be heard as quickly as possible, the chairman or deputy chairman will be able to consider a suspension application sitting as a judge in chambers. Regulations will provide the procedures for that.

Clause 2 also includes an enabling power to make regulations that will provide payments to be made to practitioners who are suspended. In my view it is necessary to make such provision for suspended practitioners to continue to receive income from the NHS. If a practitioner is self- employed, the effect of suspension is to remove that practitioner's livelihood. Suspension must, therefore, be paid. At that point nothing will have been established against the practitioner.

Clause 3 would remove the current unrestricted right of appeal to the Secretary of State for Health. It provides that, where the tribunal has determined that a practitioner is disqualified, the health authority or authorities concerned shall remove his or her name from the list at the end of the period for bringing in an appeal, or at the end of the appeal process if an appeal is made.

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The Franks committee recommended that appeals from decisions at all tribunals should be made to a court. There is an anomaly in current legislation, and the clause would bring the NHS tribunal into line with good tribunal practice.

Clause 4, which deals with the removal of disqualification, follows on from that. The provisions of the National Health Service Act 1977 give a practitioner two routes by which he or she may apply for reinstatement following disqualification. At present, a practitioner may apply either to the NHS tribunal or the Secretary of State for Health.

The effect of the clause is that applications for reinstatement shall be made only to the tribunal. The provision under which the Secretary of State could reinstate the practitioner is linked to the appeal provisions within the 1977 Act. Since the provisions for making appeals to the Secretary of State are being removed, it follows that the tribunal alone should decide applications for reinstatement. As is the case for other tribunal decisions, decisions on reinstatement may be appealed on points of law to the High Court. Question put and agreed to .

Clause 2 ordered to stand part of the Bill.

Clauses 3 to 14 ordered to stand part of the Bill .

Schedule agreed to .

Bill reported, without amendment; considered .

Order for Third Reading read.

1.46 pm

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