Christopher Pincher (Tamworth) (Con):
My right hon. Friend is absolutely right to say that Russia’s
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energy supplies give it tremendous muscle in eastern Europe and in other parts of Europe too. That has been reiterated many times this afternoon. Specifically, over the medium term will he encourage the development of the southern corridor gas and oil pipelines from the south Caucasus across Turkey and into southern Europe—pipelines promoted by BP, which will go a long way to helping to develop diversification of Europe’s energy landscape?
The Prime Minister: My hon. Friend makes a very important point. Diversifying Europe’s energy supplies requires looking at what action we can take to link Europe to some of the supplies in the Caucasus. I remember discussing this issue with President Aliyev when I met him recently, and I know the Foreign Secretary has had those discussions as well. This is part of a larger pattern of diversifying Europe’s energy supplies and making us more resilient in this sort of situation.
Andrew Gwynne (Denton and Reddish) (Lab): Further to the question asked by my hon. Friend the Member for Edmonton (Mr Love), Gazprom has already warned Ukraine that it may cut off gas exports unless it pays back the $1.89 billion debt it owes. Surely now is the time for the timely transfer of financial support to allow Ukraine to pay off that debt to prevent a repeat of 2009, but what contingency plans are in place should that not happen?
The Prime Minister: Clearly, Ukraine needs to pay its bills, as well as paying its pensioners and funding its Government to ensure—[Interruption.] I know that the hon. Member for Bolsover (Mr Skinner) misses the old days of the Soviet Union, but perhaps he will stop speaking from a sedentary position for five minutes. It is important that Ukraine pays its bills, and an IMF programme and IMF action can help that to happen.
Huw Irranca-Davies (Ogmore) (Lab): Sometimes it is the weight of small diplomatic acts, as well as the large, that make a breakthrough that can help. Back in 2008, the Prime Minister, then the Leader of the Opposition, made the bold pledge to withdraw his MPs, as well as, I hope, the people who sit in the other place, from the European Democrat Group in the Parliamentary Assembly of the Council of Europe, following the invasion of Georgia. Is it now right to think about membership of that group again, following the issues in Ukraine and Crimea?
The Prime Minister: It just shows that in politics, even if you give a straight answer to a straight question, you can still get the question again. I thought I said a minute ago that we have made sure that the Russians are out of the group that we sit in as part of the Council of Europe. We have taken that step, which is the right step. There may be steps for other political parties to think about taking now.
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Points of Order
4.41 pm
Pete Wishart (Perth and North Perthshire) (SNP): On a point of order, Mr Speaker—
Mr Speaker: I was about to thank the Prime Minister and the 47 Back Benchers who questioned him, in 47 minutes of exclusively Back-Bench time, which shows just what we can do when the questions and answers are pithy. But things would not be complete without points of order.
Pete Wishart: I am grateful, Mr Speaker. Last Thursday, the Secretary of State for Defence made a statement on the radiation leak at the Government’s Vulcan nuclear reactor test establishment at Dounreay. He said that
“there has been no measurable change in the radiation discharge.”—[Official Report, 6 March 2014; Vol. 576, c. 1085.]
We have since learned that all the environment agencies throughout the UK have found a tenfold increase in radioactive emissions. Clearly, both cannot be right. Have you had any indication, Mr Speaker, whether either the Secretary of State or the Prime Minister will come forward to put the record straight? If it is the Prime Minister, may we also have an explanation as to why Scottish Ministers were not told and perhaps even an apology for that omission?
Mr Speaker: The short answer is that I have had no indication from any Minister of an intention to make a statement on this matter. Whether intentions will change on the back of the hon. Gentleman’s observations, I leave time and speculation by colleagues to reveal. We will leave it there for today, but the hon. Gentleman has put his point on the record.
Sir Edward Leigh (Gainsborough) (Con): On a point of order, Mr Speaker, I hope you will not mind me sucking up to you for a bit. In my view, you are one of the best Speakers that we have had in recent years, because you have tried to make this place more topical. We have had an interesting statement and questions on Ukraine, but such issues are complex, and it is hard to express difficult economic and historical arguments in a 30-second question. As we have a House of Commons in which we are not overburdened with work at the moment, will you use your good offices with those who decide things—I do not know how much power you have—to get a full day’s debate on Ukraine, which after all is an extraordinarily important issue that we need to discuss urgently?
Mr Speaker:
I am grateful to the hon. Gentleman for his point of order and for his characteristic good humour in putting it. As he knows, that is not a matter for the
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Chair. The Government Chief Whip is present, but at least as importantly the Leader of the House is also present.
As colleagues know and as people who attend our proceedings appreciate, I am the servant of the House. I love listening to my colleagues on matters of local, national and global importance. My appetite for listening to them is pretty much unlimited. I would love there to be a full day’s debate and I would love to be in the Chair to hear the bulk of it, but I am dependent on a superior power in these matters, namely the Leader of the House. The hon. Gentleman, however, has made his point, and the Leader of the House cannot fail to have heard his point and my response. As for the response of the Leader of the House, it has to be said that it should probably be best described by Hansard as impassive.
The Leader of the House of Commons (Mr Andrew Lansley) indicated assent.
Care Bill [Lords] (Programme) (No. 2)
That the Order of 16 December 2013 (Care Bill [Lords] (Programme)) be varied as follows:
(1) Paragraphs (5) and (6) of the Order shall be omitted.
(2) Proceedings on Consideration shall be taken in the order shown in the first column of the following Table.
(3) The proceedings shall (so far as not previously concluded) be brought to a conclusion at the times specified in the second column of the Table.
(4) Proceedings on Third Reading shall (so far as not previously concluded) be brought to a conclusion at 7.00pm on the second day.—(Norman Lamb.)
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Care Bill [Lords]
[1st Allocated Day]
Consideration of Bill, as amended in the Public Bill Committee
Adult safeguarding access order
‘(1) An authorised officer may apply to a circuit judge authorised by the Court of Protection for an order (an adult safeguarding access order) in relation to a person living in any premises within a local authority’s area if the authorised officer has reasonable cause to suspect a third party is preventing access to allow enquiries to be made under section 42.
(2) The purposes of an adult safeguarding access order are—
(a) to enable the authorised officer and any other person accompanying the officer to speak in private with a person suspected of being an adult at risk of abuse or neglect;
(b) to enable the authorised officer to assess the mental capacity of a person suspected of being an adult at risk of abuse;
(c) to enable the authorised officer to ascertain whether that person is making decisions freely; and
(d) to enable the authorised officer properly to assess whether the person is an adult at risk of abuse or neglect and to make a decision as required by section 42(2) on what, if any, action should be taken.
(3) While an adult safeguarding access order is in force, the authorised officer, a constable and any other specified person accompanying the officer in accordance with the order, may enter the premises specified in the order for the purposes set out in subsection (2).
(4) The authorised circuit judge may make an adult safeguarding access order if satisfied that—
(a) the authorised officer has had regard for the general duty in section 1 (Promoting individual wellbeing) in making a decision under subsection (1);
(b) all reasonable and practicable steps have been taken to obtain access to a person suspected of being an adult at risk of abuse or neglect before seeking an order under this section;
(c) the authorised officer has reasonable cause to suspect that a person is an adult who is experiencing or at risk of abuse or neglect;
(d) the authorised officer has reasonable cause to suspect that a person is unable to make decisions freely;
(e) it is necessary for the authorised officer to gain access to the person in order to make the enquiries needed to inform the decision required by section 42(2) on what, if any, action should be taken;
(f) making an order is necessary in order to fulfil the purposes set out in subsection (2);
(g) exercising the power of access conferred by the order will not result in the person being at greater risk of abuse or neglect; and
(h) all reasonable and practicable steps have been taken to serve notice of the intention to apply for an order on—
(i) the person suspected of being an adult at risk of abuse or neglect; and
(ii) any relevant third party who the authorised officer has reasonable cause to suspect is preventing access to allow enquiries to be made under section 42 and for the purposes set out in subsection (2);
(5) An adult safeguarding access order must—
(b) specify the premises to which it relates;
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(c) provide that the authorised officer shall be accompanied by a constable; and
(d) specify the period for which the order is to be in force.
(6) An adult safeguarding order may attach other conditions, including—
(a) specifying restrictions on the time that the power of access conferred by the order may be exercised;
(b) providing for the authorised officer to be accompanied by another specified person;
(c) requiring notice of the order to be given to the occupier of the premises and to the person suspected of being an adult at risk of abuse; or
(d) such other conditions at the authorised circuit judge deems it necessary to attach.
(7) A constable accompanying the authorised officer may use reasonable force under section 117 of the Police and Criminal Evidence Act 1984 if necessary in the circumstance in order to fulfil the purposes of an adult safeguarding access order set out in subsection (2).
(8) On entering the premises in accordance with an adult safeguarding access order the authorised officer must—
(a) state the object of the visit;
(b) produce evidence of the authorisation to enter the premises; and
(c) provide an explanation to the occupier of the premises of how to complain about —
(i) the decision to apply for an order; and
(ii) how the order has been exercised.
(9) In this section “an authorised officer” means a person authorised by a local authority for the purposes of this section.
(10) Regulations may set restrictions on the persons or categories of persons who may be authorised.
(11) Subsections 2(c) and 4(d) refer to a person under constraint, or subject to coercion or undue diligence, or for some other reason deprived of the capacity to make the relevant decision or disabled from making a free choice, or incapacitated or disabled from giving or expressing a real and genuine consent.’. —(Paul Burstow.)
Brought up, and read the First time.
4.45 pm
Paul Burstow (Sutton and Cheam) (LD): I beg to move, That the clause be read a Second time.
Mr Speaker: With this it will be convenient to discuss the following:
New clause 2—Review of the case for establishing a commissioner for older people in England
‘(1) The Secretary of State shall establish an independent review of the case for establishing a statutory office of Commissioner for Older People in England.
(2) The review will consider the—
(a) increasing diversity of the older population in England;
(b) UN Principles for Older Persons in 1991 (UN 1991) and other relevant developments in international policy on ageing;
(c) lessons from the establishment of such offices in Wales and Northern Ireland;
(d) balance of advocacy, investigatory and enforcement duties and powers to be granted to the office in statute;
(e) jurisdiction of the office in relation to other public bodies;
(f) relationship of the office to Ministers;
(g) accountability of the office to Parliament;
(h) appointment of the office holder;
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(i) human and financial resources necessary to support the office; and
(j) any other matters the Secretary of State sets out in the terms of reference of the review.
(3) The review will report and make recommendations to the Prime Minister, Deputy Prime Minister, Chancellor of the Exchequer and the Secretary of State by December 2014.’.
New clause 3—Duty to identify carers
‘Each NHS body in a local authority’s area, as defined in section 6(8), shall co-operate with the local authority to ensure that effective procedures exist to identify patients who are or are about to become carers and make arrangements for carers to receive appropriate information and advice.’.
New clause 4—Local authority duty to make reasonable charges
‘Where a local authority that meets an individual’s needs under sections 18 to 20 of Part 1 of this Act is satisfied that the individual’s means are insufficient for it to be reasonably practicable for the individual to pay the amount which would otherwise be charged, the authority shall not require the individual to pay more for it than it appears to them that it is reasonably practicable to be paid.’.
New clause 5—Portability of care
‘(1) The Secretary of State must prepare a report containing an assessment of what primary or secondary legislation would be required to ensure people in receipt of care and support in the community in the UK receive continuity of such care and support if they change their place of residence, with particular reference to moves between countries of the United Kingdom.
(2) The report under subsection (1) must be laid before each House of Parliament six months after this Bill receives Royal Assent.’.
New clause 7—Independent review of future demand for social care and healthcare
‘(1) The Secretary of State shall make arrangements for an independent review of, and report on, the likely demand for adult social care, public health and healthcare services in England over the next twenty years.
(2) The objective of the review mentioned in subsection (1) shall be to identify the key factors determining the financial and other resources required to ensure that social care and health functions as a cost effective, high quality, equitable, integrated and sustainable single system which—
(a) promotes individual well-being (as defined in Part 1 of this Act),
(b) enables access to be determined on the basis of need, and
(3) The arrangements for the conduct of review shall include provision for a fully integrated modeling and analysis of health and social care including examination of—
(a) the technological, demographic and health status trends over the next two decades that may inform or affect demand for adult social care and health services;
(b) the inter-dependencies between adult social care, public health and healthcare and the appropriate balance between different types of intervention, in particular between:—
(ii) primary and secondary care,
(iii) physical and mental health, and
(iv) treatment and prevention; and
(c) any other matter that the Secretary of State sets out in the review‘s terms of reference.
(4) The Secretary of State shall lay before each House of Parliament a copy of an interim report on emerging themes and trends identified by the first such review by the end of November 2014 and make arrangements for a consultation process to be undertaken in relation to those interim findings.
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(5) The Secretary of State shall lay before each House of Parliament a copy of the final report by the end of July 2015.
(6) At no more than five year intervals, the Secretary of State shall make arrangements for the updating of the report of the review mentioned in subsection (1) with the same objective and approach as mentioned in subsections (2) and (3), and including such matters as are provided for in paragraph (3)(c), and shall prepare and lay before each House of Parliament a report on the outcomes.
(7) The Secretary of State shall prepare and lay before each House of Parliament, as appropriate, a statement on the extent to which the reports mentioned in subsections (1) and (6) inform the Government‘s wider fiscal and economic strategy and decisions in each public spending review.’.
New clause 9—Reporting on the funding for new costs arising from the Care Act
‘(1) The Joint Care and Support Reform Programme Board must inform the Secretary of State by an annual written report that it is satisfied whether sufficient funding is in place to ensure that social care is adequately funded and that the provisions in the Act can be implemented satisfactorily.
(2) In subsection (1), the “Joint Care and Support Reform Programme Board” means the board of that name consisting of representatives of (but not limited to): the Local Government Association, the Association of Directors of Adult Social Services and the Department of Health.
(3) The report mentioned in subsection (1) should include a statement of the satisfaction of the Joint Care and Support Reform Programme Board with (but not limited to)—
(a) adequacy of the funding of the provisions in this Act,
(b) on-going costs of implementation,
(c) an additional five yearly review of the short and medium term cost of setting the eligibility criteria at the level set out in regulations.’.
New clause 11—Provision of certain care and support services to be public function
‘(1) A person (“P”) who provides regulated social care for an individual under arrangements made with P by a public authority, or paid for by a public authority, is to be taken for the purposes of subsection (3)(b) of section 6 of the Human Rights Act 1998 (acts of public authorities) to be exercising a function of a public nature in doing so.
(2) This section applies to persons providing services regulated by the Care Quality Commission.
(3) In this section “social care” has the same meaning as in the Health and Social Care Act 2008.’.
New clause 13—Deferred payment data
‘The Health and Social Care Information Centre shall make arrangements to collect and publish data including, but not limited to—
(a) the number of individuals entering into a deferred payment arrangement,
(b) the proportion of those individuals who received—
(i) regulated financial advice,
(ii) other forms of advice, and
before entering into a deferred payment arrangement,
(c) the average length of time a deferred payment arrangement is held,
(d) the numbers of individuals holding such arrangements broken down by different periods of time held, and
(e) the amount of money deferred under such arrangement.’.
New clause 15—National framework for local authority fees for care providers
‘(1) The Secretary of State shall establish an indicative national formula with which local authorities shall determine the costs of care provision in their area.
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(2) In having regard to the matters mentioned in section 5(2)(b), a local authority must derive fee levels for independent providers of care and support services from the formula mentioned in subsection (1).
(3) The Secretary of State shall make arrangements for the audit of local authority fee levels to determine their compliance with the duty mentioned in subsection (2) and the extent to which this contributes to the effective delivery of the requirements of section 5(2), with particular reference to paragraphs (b), (d), (e) and (f).
(4) The formula in subsection (1) shall be made by regulations laid in pursuance of section 123(4) of this Act.’.
New clause 17—Duty to review economic, financial and other factors affecting provision of care services
‘(1) The Secretary of State shall make arrangements for—
(a) a review of the economic and financial factors affecting the employment (including recruitment, training and development, effective deployment and retention) of care workers and the extent to which current policies, mechanisms and relevant compliance by regulated providers of care services make it more or less likely that the objectives of this Act will be realised; and
(b) a public consultation on the conclusions and recommendations of the review.
(2) The Secretary of State shall lay a report of the review and public consultation before each House of Parliament by 1 September 2014.’.
New clause 18—Impact of working conditions on quality of care
‘(1) In exercising their functions under Part 1 local authorities must assess and consider how working conditions for people employed in care and support services impact on the fulfilment of local authority duties under Part 1 of this Act.
(2) “Care and support services” means—
(a) services provided by a local authority; and
(b) services commissioned by a local authority.
(3) Regulations may specify particular matters local authorities must have regard to in relation to subsection (1).’.
New clause 19—Promoting health of carers
‘(1) In exercising their functions health bodies shall—
(a) promote and safeguard the health and well-being of carers;
(b) ensure that effective procedures exist to identify patients who are or are about to become carers;
(c) ensure that appropriate systems exist to ensure that carers receive appropriate information and advice; and
(d) ensure that systems are in place to ensure that the relevant general medical services are rendered to their patients who are carers.’.
New clause 20—Local authorities: duties with respect to young carers
‘(1) A local authority must ensure that it takes all reasonable steps to ensure that in relation to—
(a) any school within its area and under its control; and
(b) any functions it discharges in pursuance of its responsibilities as a children’s services authority, there is in place a policy that both identifies young carers and makes arrangement for the provision of support for pupils who are young carers.
(2) In discharging its duty under subsection (1), a local authority must have regard to any guidance given from time to time by the Secretary of State.’.
New clause 21—Further and higher education: duties with respect of student carers
‘(1) The responsible body of an institution to which this section applies must identify or make arrangements to identify
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student carers and have a policy in place on providing support for student carers.
(b) any other institution within the higher education sector; and
(c) an institution within the further education sector.
(a) in the case of an institution in subsection (2)(a) or (b), the governing body;
(b) in the case of a college of further education under the management of a board of management, the board of management; and
(c) in the case of any other college of further education, any board of governors of the college or any person responsible for the management of the college, whether or not formally constituted as a governing body or board of governors.’.
New clause 22—Duty for Financial Services Consumer Panel
‘(1) The Financial Services Consumer Panel at the Financial Conduct Authority shall have a duty to review the availability, quality, adequacy and effectiveness of financial advice being provided to care users and their families on the implications of the relevant provisions of this Act, and make an annual report thereon to the Secretary of State containing recommendations for steps to take to remedy any deficiencies identified by the Panel.
(2) The Secretary of State shall lay a copy of the report mentioned in subsection (1) before each House of Parliament. The first such report must be so laid within 12 months of this Act receiving Royal Assent.’.
New clause 23—Financial advice for care users: qualification to provide
‘(1) The Financial Conduct Authority shall prepare and conduct a review of the implications of the relevant provisions of this Act for—
(a) training and development; and
(b) the level of the required qualifications
for advisers seeking licences to provide financial advice to care users and their families.
(2) The Authority shall submit a report of the findings of the review mentioned in subsection (1) to the Secretary of State, along with recommendations.
(3) The Secretary of State shall lay a copy of the report mentioned in subsection (2) before each House of Parliament. The first such report must be so laid within 12 months of this Act receiving Royal Assent.’.
New clause 24—Public awareness
‘(1) Local authorities shall have a duty to prepare, publish, consult on and implement a plan for raising and maintaining awareness amongst the residents of their areas of the arrangements for social care, and in particular of any changes to such arrangements brought about by Part 1 of this Act.
(2) The Secretary of State shall prepare and lay before each House of Parliament an annual report on the level of public awareness and understanding of the arrangements for social care, in particular—
(a) awareness and understanding of the changes brought about by the provisions of this Act; and
(b) the effectiveness of local authorities’ implementation of their plans for raising public awareness in their areas.’.
New clause 26—Declassification of a police station as a place of safety for the purposes of section 136 of the Mental Health Act 1983
‘(1) The definition of a place of safety in section 135(6) of the Mental Health Act 1983 shall no longer be read to include a police station for the purposes of section 136 of that Act.
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(2) With regard to persons removed to a place of safety under section 136(1) of the Mental Health Act 1983, subsection (1) above shall have effect from—
(a) 1 April 2015, where such a person is aged 18 years or under; and
(b) 1 April 2017, where such a person is aged over 18 years.
(3) By 31 March 2015 the Secretary of State shall prepare and lay before each House of Parliament a report setting out the progress made by that date towards fulfilling the objective set out in subsection (1) above.’.
New clause 31—Register of persons who provide regulated social care
‘(1) Health Education England must make arrangements for the compilation, publication and maintenance of a register of persons as set out in section [Provision of certain care and support services to be public functions] who provide regulated social care for an individual under arrangements paid for by a public authority that have undertaken education and training in accordance with the duty set out in section 95.
(2) This duty may be delegated by HEE to Local Education and Training Boards established under section 101.’.
New clause 32—Funding and remuneration of home care workers
‘(1) The Secretary of State shall establish an independent review of the funding and remuneration of home care workers with a view to a report making recommendations regarding—
(b) remuneration of travel time,
(c) remuneration of travel costs,
(d) minimum time required properly to fulfil each of the care tasks and duties to be performed,
(e) establishment of an efficient means of recording arrival and departure times at residential settings, and
(f) the charging basis of the agency employing the care worker with a view to ensuring that all the costs of providing for (a) to (e) above are adequately met.
(2) The Secretary of State shall lay a copy of the report of the review mentioned in subsection (1) before each House of Parliament.’.
Amendment 26, in clause 1, page 2, line 5, at end insert—
(j) the right to living independently and being included in the community.’.
Amendment 21, in clause 5, page 6, line 2, leave out from ‘must’ to end of line 4, and insert—
‘(a) have regard to the need to ensure that sufficient services are available for meeting the needs for care and support of adults in its area and the needs for support of carers in its area; and
(b) ensure that the fee levels provided to independent providers for the delivery of care and support services are derived from a national formula which determines the accurate cost of care in each local authority area, the result of which will mean that the provisions of paragraphs (2)(b), (d), (e) and (f) can be delivered effectively.’.
Amendment 20, in clause 12, page 11, line 31, at end insert—
‘(aa) require the local authority, when carrying out the assessment, to capture an individual’s main and other disabling conditions.’.
Government amendments 1 and 2.
Amendment 31, in clause 24, page 22, line 39, at end insert—
‘(3A) The Secretary of State shall, after suitable consultation, establish by regulation a specified timeframe for the conclusion of the steps required of local authorities by virtue of this section.’.
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Amendment 32, in clause 27, page 25, line 8, leave out ‘keep under review generally’ and insert ‘review regularly’.
Amendment 33, page 25, line 42, at end insert—
‘(5A) The Secretary of State shall, after suitable consultation, 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).’.
Government amendments 4 and 5.
Amendment 27, in clause 42, page 38, line 24, at end insert—
‘(2A) There are different types of abuse, as defined in guidance.’.
Amendment 28, page 38, line 29, at end add—
‘(4) A relevant partner, as defined in section 6(7) has a duty, where it has reasonable cause to suspect a person is an adult at risk of abuse or neglect, and the adult appears to be within the local authority’s area, to inform the local authority of that fact.’.
Government amendments 6 and 14.
Amendment 22, in clause 76, page 69, line 33, after ‘adults’, insert ‘and children’.
Amendment 23, page 69, line 37, after ‘adults’, insert ‘and children’.
Amendment 24, page 69, line 42, after ‘adults’, insert ‘and children’.
Amendment 25, page 69, line 44, after ‘adults’, insert ‘or child’.
Paul Burstow: I hope that the House will forgive my having a number of new clauses to explain in the time available to discuss part 1 of the Bill. I will try to crack on as quickly as possible to explain the thinking behind each of them. I will do so not in numerical order, but in order of importance, starting with the new clauses on which I particularly want to hear the Minister’s response.
First, I wish to discuss new clause 11, which deals with the Human Rights Act 1998 and its application to social care. The Act has enormous potential to improve the lives of those most vulnerable to human rights abuses in social care settings. People who are being provided care in their own homes or in care homes face risks in respect of their privacy, their family life, being safe and not suffering degrading treatment. Such matters are all very much at the heart of how we ensure that we provide dignified care.
I am sure that the Minister knows, as do other hon. Members, that a loophole has opened up in our law as a consequence of a judgment made by the courts some years ago. It arose in 2007 following the decision by the House of Lords in the YL v. Birmingham city council case. The Law Lords held that a private care home providing residential care services under contract to a local authority was not performing a “public function”, so its residents were excluded from the protections of the Human Rights Act. In practice, that means that domiciliary care users, or their families or carers, can complain to the care company, depending on the terms of their contract, but in many cases they will not be able to take their complaint any further. Contractual terms and conditions are important, but they can often fail to give the protection that we would want to see, and residents in care homes have no security of tenure and are often afraid to complain because of fear of eviction.
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Many people with care needs face additional challenges asserting their contractual rights, particularly if they lack the capacity to do so because of dementia or learning disabilities.
The decision that private and third sector care home providers were not directly bound by the Human Rights Act meant that thousands of service users had no direct legal remedy to hold their providers to account for abuse, neglect and undignified treatment, even though the public body commissioning those services remains bound in law by the Human Rights Act. There is need for change in this area. The loophole was partly closed by the previous Government, with cross-party support, through section 145 of the Health and Social Care Act 2008, which covers residential care services. However, under changes that this Bill will introduce, it will need to be reinstated by order, but there is a far better and more elegant way in which that could be done—by implementing new clause 11.
New clause 11 seeks to clarify the law so that all providers of publicly arranged or paid-for care are within the scope of the Human Rights Act. Service users who experience serious human rights abuses will then have direct means of legal redress. However, this is not just about going to law; it is about what goes on in the hearts and minds of those organisations and the attitude they take towards how they provide services, so the Human Rights Act has a part to play in culture change as well. For example, the Act has been successfully invoked in an argument about a local authority’s refusal to place a married couple in the same nursing home.
The Government have accepted that there is a loophole, and we very much welcome that. We raised the matter during consultation on and scrutiny of the draft Bill, and we offered up a suggestion, which their lordships adopted. In response to the Joint Committee, the Minister told us that organisations that were not covered by the Act should none the less consider themselves bound by it. Lord Hope, the recently retired Deputy President of the Supreme Court had this to say about that:
“Comments of the kind that were made, that people should consider themselves bound by a convention right, however well intentioned, do not have the force of the law”.—[Official Report, House of Lords, 16 October 2013; Vol. 748, c. 549.]
That is why we need to give it the force of law, which is what new clause 11 attempts to do. It puts back the law to where Members of all parties expect it to be, and ensures that a poor judgment by the court is corrected.
New clause 1 deals with the issue of power of access. Last week, I handed in a letter to the Prime Minister, setting out the case for the measure. It was signed by 602 organisations and individuals, including Age UK, Mencap, the National Autistic Society and many others with expertise in the area of adult safeguarding. They all share a common concern that there is a gap in the law when it comes to protecting vulnerable people who have the ability to make decisions for themselves but who are living in a home with someone else who is abusing them or neglecting them and who is denying them, because of their ability to exert their authority over that person, the ability to get the protection that they need. The Law Commission took that view in its review of mental capacity legislation, and the Equality and Human Rights Commission also took that view in its analysis of the legislation.
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In our debates in Committee, my hon. Friend the Minister of State said that when officials were asked to provide the evidence behind their advice that the new power was unnecessary, there was an opaqueness surrounding the issue. There was not the necessary level of clarity to understand what powers could be used and in what scenario. I must say to the Minister that the scenarios that have been offered up to justify the position that there is no need for legislation do not address the circumstance that I and my new clause 1 seek to address. I am talking about someone who legally has capacity but who is under duress and unable therefore to exercise their individual right to seek protection. As a consequence of that, we need this power.
Meg Munn (Sheffield, Heeley) (Lab/Co-op): I added my name to the right hon. Gentleman’s new clause. Does he agree that the Bill is putting in place a range of measures on new safeguarding boards, and that this power would complement the work that is now being done to raise the whole issue and to ensure that vulnerable people get the protection they need and their circumstances properly investigated?
Paul Burstow: The hon. Lady is right, and with her own experience in social work practice, she will know why this matters so much. She is right to say that in the Bill, for the first time, many aspects of adult safeguarding are put on a statutory basis, which is welcome. None the less, there is still a gap, which the Government with this Bill should seek to fill. We have had a lot of back and forth between the Minister of State and his officials, and I am grateful to him for the patience that he has shown. I just hope that the patience translates into something else. However, he has told Members that there is a balance of risks, and his judgment is that the powers are not needed. I say to him and to officials that if that is the case, why, in the scenario that I have described, can he not produce the evidence?
I welcome the fact that the Social Care Institute for Excellence has been commissioned to do work on this issue, but if there is a gap in the law, that will not fix it. It has been suggested that the problem is that practitioners are ignorant of the law. Again, I have to ask where the evidence is for that. Thanks to Action on Elder Abuse, which instituted a freedom of information request, we know that the evidence does not support that line either. So far, 84 out of 152 local authorities have responded. Twenty-nine councils have reported at least one instance in the past 12 months in which they have been unable to gain entry because a third party had denied them access. In 21 of those cases, they never gained access. Therefore, all the arts of negotiation and relationship building that are essential to good social work practice did not gain those people access, and who knows what happened to those individuals. Let us hope that they do not find their way on to the front page as a tragic story.
Not a single one of the 84 authorities that responded to that request have suggested that a failure to gain access was the result of a lack of knowledge. It is really about a lack not of knowledge but of that backstop power, which the new clause provides. In a survey of front-line practitioners, 365 of whom have responded, 82% believe that the power is necessary.
New clause 1 provides a proportionate power for a circuit judge, approved by the Court of Protection, to determine whether an entry warrant should be granted
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where a person is believed to be under duress and a victim of abuse. Let me be clear that the measure should be rarely used, but it is required for those circumstances in which a person is in the situation that I have described. I agree with the Minister about good social work, but just talking about good social work is not an adequate answer.
Mr John Redwood (Wokingham) (Con): Who drafted new clause 1 and which main outside organisations support it?
Paul Burstow: Organisations that have supported the new clause, which I have drafted, include people with a legal background, social workers, Age UK and Mencap—those who often provide a voice for the voiceless. One of my concerns is that the people whom the Bill seeks to benefit are very likely to be those who are under duress and therefore unlikely or unable to express an opinion. That is why the new clause has been crafted to try to ensure that the necessary safeguards are built in.
New clause 3 addresses the issue of carers, particularly the identification of carers. Carers are the backbone of our care and support systems. Without them, those systems could not function in delivering the quality of care that we would expect. Those carers make huge sacrifices to care for their loved ones. Their health, their wealth and their lives are often sacrificed as a result of what they do. We know from the census that a carer is twice as likely to be in bad health as a non-carer.
The Government should be applauded for the fact that in this Bill and in the Children and Families Bill they have taken great strides to improve the rights of adult carers, parent carers, and young carers. They have listened, engaged and responded to the concerns that Members in all parts of this House and in the other place, and many carers’ organisations, have raised with them. However, all this hinges on whether carers are aware of these new rights and whether their council is successful in its new duty of identifying them, as required under the Bill. The problem is that the NHS is still left untouched. Millions of people caring for someone with a health problem may never come into contact with their council or be aware that that would be the next step in coping with their situation.
Barbara Keeley (Worsley and Eccles South) (Lab): I welcome the right hon. Gentleman’s conversion to the identification of carers by NHS bodies, because when he was in the role of Minister he did not support that. I hope that he can convert the current Minister. Is it not the case that, as Macmillan Cancer Support has said, 95% of carers for people with cancer, who may care for only a short time but for people with terminal illness, do not have any contact with local government and do not have a carers’ assessment, and is not that the key? Are we just going to let those people struggling in those difficult circumstances carry on doing so?
Paul Burstow: The hon. Lady is not a convert. She has been consistent and clear in her pursuit of this provision, both with her own Government and with this Government, and I hope that eventually her persistence will pay off. It has persuaded me, along with many carers’ organisations, of the need for such a change.
Institutionally, the NHS is not good at grasping the different responsibilities it has towards carers compared with those who are its immediate concern—the patients.
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As a result, it lets carers down institutionally, and that is what the new clause says we need to address. We need to change the NHS’s mindset institutionally to make sure that it recognises its responsibility for millions of people with caring responsibilities and asks the necessary questions. Macmillan Cancer Support has found that 78% of health care professionals have come across a cancer patient who has been admitted because their carer could not cope at home. Here is why the NHS must fully engage with carers: only one in three professionals who sees an accompanied patient always goes on to check whether the person with them is their carer.
Sarah Newton (Truro and Falmouth) (Con): I, too, have supported my right hon. Friend’s new clause, because this is an essential point. This Government should be proud of the support that they have introduced for the legion of unpaid carers who do such a fantastic job, but if their doctors, district nurses and health care professionals do not let them know about these rights, they are not really worth having.
Paul Burstow: That is absolutely right. This is not, as it can sometimes be portrayed, a case of “Let’s just have a tick-box”; it is about signalling a set of changes that need to happen in the culture of the organisation, so that when a patient visiting their GP or a consultant is accompanied by a member of their family or someone else who is supporting them, that instinctively forms part of the conversation about signposting and information about carers.
At the moment, just 7% of practitioners always signpost for a carers assessment. That is why we need to make sure, through this new clause, that we place a simple duty on the NHS so that it plays its part in identifying carers. One of the most shocking statistics is that 64% of health professionals think that that is necessary. They think that it will help them in their day-to-day practice and in ensuring that the issue is put up the agenda.
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In Committee, the Minister talked about the work that NHS England is doing and its commitment to carers and the action plan that is being developed through consultation with carers and carers organisations. That is incredibly welcome and a good step in the right direction, but what are needed are effective procedures and systems to identify carers right across the NHS. The Government must make that a priority and the Bill provides an opportunity to do so; otherwise, only those places that get it will continue to do it, while those places that do not will not, and we will not see the progress we need.
The Minister also said in Committee that he would give consideration to statutory guidance. If there is to be such guidance, it has to have very clear requirements on the NHS. As I have said, it should be not a tick-box exercise, but a kick-start for the culture change to make sure that carers are properly valued and respected and given access to the support intended by the Bill.
New clause 4 is about charging. The change proposed is small, but its potential impact is huge. The Bill provides for regulations to be used to govern the way in which charges are set for local authorities with regard to providing or arranging care and support. In Committee, I raised a concern that I first raised in the Joint Committee’s
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scrutiny of the draft Bill—that the removal of section 17(3) of the Health and Social Services and Social Security Adjudications Act 1983, which requires that charges should not be more than is “reasonably practicable”, is an important issue of principle and of protection and safeguarding in the system. The Minister undertook to give the issue careful consideration and in a letter to members of the Committee on 12 February he offered some reassurance. He wrote that, under the Bill, a local authority would have to consider what a person
“would be likely to be able to pay towards the cost”.
Regulations would then go on to prescribe the formula for calculating the minimum amount of income with which a person should be left.
My hon. Friend also pointed to the duty on both the local authority and the Secretary of State to have regard to the duty for well-being, which is the first guiding principle of the Bill. Will he confirm, therefore, that, in coming to a view about the reasonableness or otherwise of a charge, a court would examine it against whether someone was
“likely to be able to pay”
and the duty under clause 1? It would be very helpful for future interpretation if he clarified that.
New clause 13 deals with another issue that was raised in Committee, but it takes a slightly different tack. Many, particularly the Local Government Association, have suggested that we should have a national scheme to operate deferred payments. However, they have also said—many think this is necessary—that at this stage, given that deferred payments can be equated with other financial instruments that are regulated in a more strict way than that intended for deferred payments, the Government should at the very least provide assurances that they will carefully monitor what will happen with the increased numbers of direct payments, not least because of the concern that we may wind up with people being mis-sold the products with less redress than they might have with regard to other financial products.
New clause 15 relates to fair fees and to new clause 9, which I will come on to in a moment. It was striking that in Committee we returned on a number of occasions to issues relating to procurement decisions by local authorities. I proposed a mechanism for adjudicating disputes between councils and providers about the fees on offer to the providers. However, it is not adjudication that we really need, because that is the wrong end of the pipe—it is what happens when things have broken down, relationships have not worked and fees have been set at an unsustainable level. What is needed is transparency and certainty in the way the fees are set.
The Bill provides for people paying for their own care to ask the council to arrange their care in return for a fee. The concern is that, without transparency on the rate setting, councils will drive the price for care to unsustainable levels. Indeed, that is already happening in some care markets around the country. Only providers that sacrifice quality, reduce staffing and generally cut corners would still be able to stay in the market. For those who rely on such services, the consequences would be higher staff turnover, limited choice and poorer quality.
In that regard, both Care England, which represents residential care providers, and the United Kingdom Homecare Association have grave concerns about the
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unintended consequences of some of the measures. When I met UKHCA members in February, they were very clear that below-cost pricing by local authorities was a growing problem. According to Laing and Buisson, English councils are paying £480 on average for residential care, although the assessment of a fair market price was about £651. The issue concerns the use and abuse of monopsony power in a financially challenged market. It also relates to new clauses 7 and 9, which I will come on to in a moment.
Mike Thornton (Eastleigh) (LD): My right hon. Friend mentions Laing and Buisson. I believe that it has come up with a formula that should enable people to work out a fair funding system in advance. Is that something we could look at?
Paul Burstow: My hon. Friend is absolutely right. That is the basis of the average fair rate, which I mentioned. New clause 15 would provide a mechanism for establishing a formula by which fee rates are set transparently for both domiciliary and residential care. The organisations representing the sector believe that that would lead to much greater transparency, and I think that it would deal with some of the rather toxic relationships that sometimes appear to exist, both nationally and locally.
New clause 2 is about older people, particularly the proposition that we should take a leaf out of the book of our colleagues in Wales and Northern Ireland in relation to having a commissioner for older people. Ageism and ageist attitudes are endemic in our society and, indeed, in public services. Our society is ageing, with life spans increasing, and that profound change will affect us all. It has implications for how the NHS and care services behave, but it goes far wider.
My new clause simply calls on the Government to work on the mechanics of establishing such a post so that there is someone to listen to and give a voice to older people; to champion their vital contribution to our economy—in work, as care givers and as volunteers, mentors and community leaders—rather than their being seen as burdens, which is how older people are all too often portrayed; to challenge the complacent and lazy stereotypes; and to hold public services to account.
Such a role already exists in Northern Ireland, Wales and other parts of the world. It would involve asking such questions as: why do the 360,000 cases of abuse suffered by older people every year lead to so few prosecutions, why are older people excluded from clinical trials and other research, and why do we stop reporting people’s cancer survival rates once they pass the age of 75? I hope that the Minister is open to the idea, and I look forward to his response.
New clause 26 deals with the issue of mental health, which came up very briefly in Committee. I know that the Minister is a passionate champion of mental health concerns. The new clause simply says that if a person has an accident—for example, breaks their arm—suffers a stroke or has a heart attack, the last place they would expect it to be sorted out is a cell in a police station, but that that is exactly where people who have a mental health crisis find themselves. The statistics are stunning: 36% of all people who are taken to a place of safety find themselves in a police station and stay there for more than 10 hours. Not only have adults been subject to that
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process, but 263 children, on the most recent figures. My new clause simply seeks to place a sunset provision on the definition of a place of safety, including a police station, which should create a way of concentrating minds to ensure that services are provided in the right place at the right time for children and adults.
I come to new clauses 7 and 9 last because they are about addressing what we might regard as the elephant in the room in any conversation about care services and the Bill’s noble intentions of improving the quality of care and of driving well-being into the heart of how care and support are delivered. The new clauses raise interconnected questions about the future funding of care and support, and about the independent nature of our health and care systems. Social care has for far too long—for decades—been the poor relation to health in decisions about public expenditure. Today’s funding challenges are chronic and are not simply the result of deficit reduction.
New clause 9 reflects the concern of a remarkable coalition of interests outside this place, including the Local Government Association, the Care and Support Alliance, hundreds of non-governmental organisations, directors of social services and chief executives, and many more besides. They all want to serve notice on the Government that they are concerned about the serious impact that the continuing pressure on local government spending will have on the ability of councils to deliver the care and support that everybody in this House wants to be delivered under the Bill. The picture is complex. Different councils are coping differently—some are overspending their care budgets and some are underspending them—but the trend is clear, despite the extra £7.2 billion that was allocated in the 2010 spending review and the transfer of money as part of the better care fund in the most recent spending review.
New clause 9 simply provides for an assessment to be made and signed off by the programme board that oversees the implementation of the Bill. It is not an unreasonable request that we check that the sums add up and that the money is sufficient to deliver what the Bill is about. I hope that the Minister will reassure us about how transparent that process will be. Impact assessments are one thing; this process would be another. I think that it would provide considerable reassurance to those who will have the job of implementing the legislation.
Grahame M. Morris (Easington) (Lab): I apologise for breaking the right hon. Gentleman’s flow. I agree with virtually everything that he has said. On the need to ensure that the Bill does everything that it says on the tin, may I draw attention to the fact that when I met my constituent, Jason Roche, who is very active in the Royal National Institute of Blind People, he pointed out that 43% of blind and partially sighted people in England have lost access to adult social care services since 2005. Does the right hon. Gentleman agree that the Bill must address the needs of working-age adults who suffer from disabilities?
Paul Burstow:
I am grateful to the hon. Gentleman for that intervention. He makes an important point. If one looks at the trends, one sees that there is no doubt that there are questions to be asked about why some people are not receiving the service that one would
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expect. Some of that—although I do not pretend that this covers anywhere near all of it—can be explained by the changes to the way in which services are organised. Some of it can be explained by the need to do more to re-able people and to enable them to maintain their independence. I do not say that to evade the question. That is why I have put new clauses 7 and 9 before the House. I genuinely think that whoever is in government in future will have to have a much more systematic approach to making decisions about how we meet demand.
That brings me on to new clause 7, which simply says that the Government should take a longer-term view. It states that every five years, the Government should look 20 years forward and take an independent assessment of the future demand for care and health services. That could be done by the Office for Budget Responsibility. It could provide modelling for the whole health and social care system that looks at the impact on demand, technology, demography and health status, and at the balance between all those factors. It could also look at the interactions between health and care, primary and secondary care, physical and mental health, and treatment and prevention. That would finally implement a recommendation that was made by Derek Wanless in his review for the Government in 2000. That is supported by the King’s Fund, which has suggested much the same thing.
In Committee, neither the Government nor the Opposition were able to make any funding commitments about part 1 of the Bill. I entirely understand why that is the case. However, we know that as the eligibility criteria are drawn more tightly, more people are excluded from help. In the long run, that does not save money, but shunts the costs. It pushes people away from living an independent life and towards a life of dependency. I hope that all parties will, in the end, sign up to something like new clause 7 as a good part of the future sound governance of our health and social care system. I hope that the Minister will support that.
I apologise to the House for speaking at such length, but I have put forward a number of issues that I hope will provide a framework for debating this important set of reforms. I look forward to the Minister’s response.
Liz Kendall (Leicester West) (Lab): We are discussing a huge number of new clauses and amendments, and I will try to keep my comments brief to allow Back Benchers on both sides time to speak. I want to start with our new clauses 17 and 18, which deal with the critical issue of linking the quality of care with standards in the care work force. New clause 17 would require the Secretary of State to review the economic and financial factors affecting the employment of care sector workers, including their recruitment, training, employment and retention, and the extent to which the policies of care providers were making it more or less likely that the aims of the Bill were being achieved.
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New clause 18 would ensure that local authorities assessed and considered how the working conditions of people employed in care and support were affecting the ability of councils to fulfil their duties under part 1 of the Bill. This would apply to staff who were directly employed by the councils as well as those working for private and voluntary organisations that councils had
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contracted out to. The two new clauses state that if we want to improve the quality of care, we need to take a serious look at what is happening in the care work force, and to assess how people’s pay, terms and conditions and training are impacting on the better provision of care and support that we all want to see.
We know that an increasing number of frail, elderly people are getting home visits that last barely 15 minutes. That does not give the carer enough time to make a cup of tea, never mind get a frail, elderly person up, washed, dressed and fed, particularly if that person has dementia. Anyone who knows someone with dementia will know that mornings are a particularly difficult time for people with that condition. Care staff are being forced to rush from one person to another because of the way the care is commissioned and because of the squeeze on council budgets. According to the United Kingdom Homecare Association, one in 10 visits is now only 15 minutes long, and Leonard Cheshire has found that the proportion of visits lasting that long has risen by 17% over the past five years.
Care workers often do not get the proper training that they need. Camilla Cavendish’s review found that for many staff no minimum educational training requirements had to be met before they started working in social care. She heard from some home care workers whose induction had consisted simply of their being given a DVD to watch before they were sent out to work.
It is estimated that about 300,000 care workers are on zero-hours contracts. Some people might genuinely want to be employed on that basis, but thousands do not, because it makes it virtually impossible for them to budget for themselves and their families, to secure a home—some cannot even afford to rent a home, never mind get on the housing ladder—or to plan their lives. Those arrangements are also not good for the people using the care services: they need to know who is coming to look after them. Imagine having someone different coming in each morning to get you out of bed, take you to the toilet and wash you. You would want to know who was coming in; you would want continuity of care.
Jonathan Edwards (Carmarthen East and Dinefwr) (PC): The Social Services and Well-being (Wales) Bill is going through the Welsh Parliament. My party tabled an amendment to the Bill that would have prohibited the use of zero-hours contracts in the care sector in Wales, but the Labour Government there voted against it. How disappointed is the hon. Lady with her colleagues in Wales?
Liz Kendall: I am sure that my colleagues in the Welsh Assembly want to do everything they can to improve care and support. Today we are discussing the care sector in England, and I hope that the hon. Gentleman will give his support to what we are proposing.
David T. C. Davies (Monmouth) (Con): Will the hon. Lady give way?
Liz Kendall: I am really sorry, but I want to make a bit more progress. I have a lot of new clauses to get through, and Back Benchers have also tabled new clauses and amendments.
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We also know that many care workers do not even get the minimum wage at the end of the week, because they are not paid for their travel time, among other things. Her Majesty’s Revenue and Customs recently undertook an evaluation of minimum wage enforcement in the social care sector. It found that a staggering half of all care providers had failed to pay the minimum wage to at least one of their employees, yet despite Ministers’ insistence that such people will be named and shamed, not a single provider in the care sector has so far been identified.
We need to look at all those employment issues, which I think have a fundamental impact on the quality of care. If the Bill is to promote well-being, shift services towards prevention and improve standards, we must get to grips with those issues; otherwise, it will not work. New clause 17 would require the Secretary of State to conduct an overall review of the economic and financial factors affecting employment, publish the results and consult on the findings.
Mr Redwood: I quite agree that we need a high quality work force who are well trained and supported, but if the review concludes that they are not, is the hon. Lady saying that controls should be imposed on local authorities from the national level?
Liz Kendall: If the right hon. Gentleman reads our new clause 18, he will see what our approach is. Local councils commissioning social care and having to fulfil their obligations under the Bill will need to look at employment terms and conditions. We have tabled the new clause because unfortunately the Government are removing the Care Quality Commission’s role in assessing how well councils are commissioning services, which I think is a mistake.
Alison McGovern (Wirral South) (Lab): Given the point my hon. Friend has just made, does she agree that it is all the more important that councils up and down the country follow the lead that Labour Wirral has shown in sticking to the principles of Unison’s ethical care charter, which tries to rid us of 15-minute appointments and limit zero-hours contracts?
Liz Kendall: I know about the approach that has been taken in Wirral and think that it is an excellent example. If we kept the CQC’s role in assessing how well councils are commissioning services, that is just the sort of thing that it would be able to spread. It is a real problem that that role is being removed. We will come later to our amendments that seek to return it to the CQC.
I will now turn to a group of new clauses on how better to identify and support carers. They stand in the name of Opposition Front Benchers, but really they are the work of my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), who has made sterling efforts in this regard. We have tabled them to give carers the focus and attention they deserve. They pick up on some of the points that the right hon. Member for Sutton and Cheam (Paul Burstow) made. New clause 19 would ensure that all health bodies have effective procedures in place to identify people who are or are about to become carers and ensure that they get the help and advice they need. New clause 20 would require local authorities to take all reasonable steps to
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ensure that schools in their area identify young carers and put support in place. New clause 21 would require universities and colleges to do the same.
As the right hon. Member for Sutton and Cheam said, family carers—unpaid family members looking after the people they love—are the absolute backbone of our care system. They need and deserve more support. They are looking after their relatives because they want to, but they really need help. One in five family carers provide more than 50 hours of care every single week, and their own health suffers as a result. One in three have to give up work or reduce their hours, which means their income suffers and the cost to the taxpayer goes up.
The Bill puts in place welcome new rights for carers, building on the approach taken by the previous Labour Government, but they will be meaningless if carers are not identified in the first place. Many carers do not actually come into contact with local authorities. Macmillan Cancer Support has made a powerful case, showing that 95% of the over 900,000 carers of people with cancer in England have not received a carer’s assessment—only one in three of them have even heard of it. That is because they are mostly in touch with the health system. Unfortunately, hospitals and GPs still do far too little to identify carers of people who have cancer and other conditions, such as stroke and heart disease. I understand that GPs identify only around 7% of carers, and other health professionals, particularly in hospitals, identify only one in 10. We need clear duties on those bodies and proper processes in place, because too often at the moment there is just a tick-box approach. I recently had to move GP practice, and the form I filled out contained two pages on how much alcohol I drank, which was welcome, and a little box that asked, “Are you a carer?” I knew what that meant—but did it mean a paid care worker, or a health care worker? That is not good enough and needs to be thought through.
I also stress the need to do far more to identify young carers, who we know can see their lives and life chances suffer because of what they do to help look after sick or disabled parents. Many schools might not understand if kids are not doing their homework or not turning up on time because of their responsibilities. If young carers are lucky enough to get to university or college, they may find their studies hard because they are travelling to and from home to try to help support their loved ones. We believe there should be clear duties on those bodies to identify young carers.
New clauses 22, 23 and 24 are about getting people the right financial advice—an issue we discussed a lot in Committee. The Bill introduces a new and complicated system of social care funding with the so-called cap on care costs and new deferred payment schemes. It is complicated and I have lost track of the number of times people have said to me, “Well, it’s okay because at least my care costs will be capped at £72,000 now”, and I have to go through the process of explaining to them that that is not actually the case. People are unaware of the new system, and if they are looking at financial products to help them cope with later costs, they need decent financial advice.
Currently, financial advisers must have studied a range of different financial and regulatory subjects, and they must sign up to a statement of professional standing and a code of ethics and conduct. Has the Minister
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talked to the Financial Conduct Authority about whether the training of financial advisers should change as a result of the Bill? Is he confident that all financial advisers can give people advice about the products they might want to take out to protect themselves against future costs, on the basis of the Bill?
I am concerned that unless people get high quality, proper financial advice, we could be in for another mis-selling scandal because the issue is complicated. People will have to figure out how much their average local authority rate will be for their area in five, six or seven years’ time, and how different that will be from what private providers charge. Will people’s care needs enable them to start counting towards the cap on care costs if they are not defined as “substantial”, as under current eligibility criteria? I would struggle to figure out all those finances, and we must ensure that financial advisers are properly trained.
“The Financial Services Consumer Panel at the Financial Conduct Authority”
should publish an annual report on the
“availability, quality…and effectiveness of financial advice”
available to care users and their families. New clause 23 states that the FCA should consider raising the level of qualifications that financial advisers must have. We must ensure that people get high quality financial advice so that they are not mis-sold any products.
We also want much greater efforts to raise public awareness of the new capped cost model introduced by the Bill. Under the Bill, local authorities have a duty to raise awareness, but new clause 24 would make that much stronger and require them
“to prepare, publish, consult on and implement”
a proper plan for raising awareness among their local residents. That is important so that people know about the new system and what it means for them.
I support new clause 11, which would ensure that all users of publicly funded or arranged care have direct protection under the Human Rights Act 1998. Under the law as it stands, the fundamental protection and access to individual redress offered by the Act are not applied equally in all care settings. In the other place, Lord Low tabled the former clause 48, which sought to close that loophole. There was a long discussion on it in Committee—the clause was passed in the House of Lords but the Government voted to remove it in Committee. The Minister’s argument was that it went too far, because it would mean that the Human Rights Act applied to entirely privately funded and arranged care. He also claimed that the clause was not needed because the CQC could deal with the problems.
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Since that Committee, the Joint Committee on Human Rights has published its analysis of the measure. It states:
“The Bill provides an opportunity to fill the gaps in human rights protection for all those receiving publicly arranged care…and we recommend that the opportunity to legislate to this effect not be missed”.
The Joint Committee proposed new clause 11, to which the right hon. Member for Sutton and Cheam and I have put our names. It differs from the former clause 48
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by making it clear that its scope is confined to regulated care services that are either publicly arranged or publicly funded.
The Joint Committee on Human Rights says that the law must be clarified. Organisations including Age UK, Mind, the Alzheimer’s Society, Mencap, the Law Society and the Equality and Human Rights Commission agree. New clause 11 deals with the concerns that Ministers and others have raised. It is an important point. Why should people who have their care arranged by the local authority but pay for it themselves not have the same rights? Someone who has entirely publicly funded and arranged care can get redress under the Human Rights Act. We need to fill that gap.
I support new clause 9, which is an important one. It would require the Department of Health’s joint care and support reform programme board to produce an assessment of the adequacy of funding for the provisions of the Bill and the ongoing costs of implementation. It would also require the programme board to conduct a five-yearly review of the short and medium-term costs of setting the eligibility criteria at the level set out in the regulations, which, according to the Government, will be substantial.
Local councils will be required to take on substantial new work as a result of the Bill. That includes assessing thousands of additional users and carers, who currently do not get an assessment because they fund their own care; setting up new care accounts to keep track of how much money people have spent, in order to figure out when they reach the so-called cap on care costs; establishing and running the deferred payment schemes; running information campaigns about the new system; and training staff in the new capped-cost model of funding.
The Local Government Association and the Association of Directors of Adult Social Services have strongly argued that there needs to be a thorough assessment—it is only an assessment—of the costs of delivering the new roles, so that the Bill can be properly implemented. Why is that so important? Many councils thought they would get additional resources to support the Bill’s provisions. In the spending review, the Government said that the money would be new funds for the Bill. However, when the details of the local government funding formula were revealed in July, it transpired that the money was not new money for the Bill—the Government were simply top-slicing existing council budgets. That means that councils will have to take money from existing care users, many of whom are desperately struggling with low levels of, and poor quality, care and support, to set up the extremely complicated new system of care accounts, the capped-cost model and deferred payments. We need openness and transparency about what the measure will cost and where the money will come from if we are to assess whether the priorities are correct.
The five-yearly review of the short and medium-term costs of the eligibility criteria for social care is extremely important. Hon. Members will know that many organisations that work with older and disabled people and their family carers welcome the framework set out in the Bill to promote well-being, to prevent the need for care and support, and to integrate local care and health services, but those organisations are very concerned that these objectives will not be achieved if the eligibility criteria are set too high, which will mean that people lose out on care and support. This is not good for them
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and does not make sense for taxpayers. If older people do not get the grab rail that helps to prevent them from falling, or decent care and support at home that helps them get up, washed, dressed and fed, and they end up having to go into hospital or more expensive residential care, it is not good for them and it costs us all more.
For working-age disabled people—
Mr David Ward (Bradford East) (LD): Will the hon. Lady give way?
Liz Kendall: Perhaps the hon. Gentleman will let me finish this point.
For working-age disabled people, the level at which the eligibility criteria are set is crucial and could mean the difference between being able not just to get access to training and a job but to spend time with their family or go out into their community—things that we take for granted. As hon. Members know, Scope and other organisations have warned that the Bill could risk shutting more than 100,000 disabled people out of the system, with all the human and economic costs that that entails.
The Minister will know that in Committee many hon. Members cited the economic modelling that has been done by organisations such as Deloitte, which shows that shifting the focus of investment and resources up front can save more money further down the line. The Deloitte modelling predicts that for every £1 invested in care for disabled people with moderate needs, savings of £1.30 per person are created. It predicts £700 million of savings for central Government from helping disabled people and their family carers to get work, and £570 million of savings to local NHS and local council services by avoiding the use of more expensive residential and crisis care and by reducing the need for more expensive medical care.
Such a long-term approach, whereby we assess the true costs and benefits over a longer term, is a good framework for making decisions about where priorities lie—
Mr Ward: Will the hon. Lady give way?
Madam Deputy Speaker (Mrs Eleanor Laing): Order. Before the shadow Minister considers taking further interventions, she may not have realised that although the House appreciates that she is making some important points on a complex matter, she has spoken for some 24 minutes. She will not be aware, but I am, that a very large number of colleagues wish to speak in this debate and there is a limited time, so she might consider bringing her remarks to a close.
Liz Kendall: Thank you, Madam Deputy Speaker. I have two more paragraphs. I agreed that I would speak for 25 minutes, so at 24 minutes I am almost in.
New clause 9 would help secure that shift in approach. I ask hon. Members to consider the new clause seriously because we need to introduce the up-front prevention, help and support, which requires a change in the way we look at the costs and benefits in the system.
Madam Deputy Speaker:
Order. Before I call anyone from the Back Benches, let me say that the shadow Minister has been most courteous in bringing her remarks
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to a conclusion when I indicated that that might be a good idea. It would also be a good idea, if Members wish to be courteous to their colleagues, if they would limit their remarks to some five minutes. That way everyone will get to speak. If anybody speaks for more than 10 minutes, I will remind them of the fact.
Sir Tony Baldry (Banbury) (Con): I am not quite sure who to be bad-tempered with. As the House knows, I am not characteristically bad-tempered, but I think my bad temper should probably be directed at the usual channels, given that the timetable motion went through on the nod. We have to deal with 21 new clauses and 20 amendments on an important Bill in two hours, which by my calculation allows three minutes per clause or amendment. The hon. Member for Leicester West (Liz Kendall) spoke perfectly reasonably, given the number of amendments that have been tabled, but it is impossible to do justice to all this in two hours. The usual channels should bear in mind that some of us feel rather bad-tempered about the time provision. These things, as we all know, are agreed between the usual channels; it is not one side or the other that is responsible.
I wish to speak briefly about new clause 3. The Bill does fantastic things for carers, and I think it would be a real tragedy if, once the Bill completes its passage, carers or their advocates felt that it was a missed opportunity. I shall not repeat what my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) said. The Minister will doubtless say that clause 6 and the duty to co-operate deal with this point. Clearly, the duty to co-operate is very important for local authorities and the NHS. In the past, GPs may not have sought to identify carers as well as they could because they did not think there was much they could do for them. Now they will be able to ensure that there is a carer’s assessment. If the Minister intends to resist new clause 3, could he seek to ensure that we have statutory guidance for the NHS on the services that it should provide for carers?
I fully understand that for those aged over 75 the aim will be to have named clinicians, and those clinicians should, as part of their duty, ensure that carers are identified, but of course many carers, including young carers, are under the age of 75. It would be a real pity if the Bill missed this opportunity on carers. If we could have some statutory guidance on what the Minister, the Department and all of us expect the NHS to do to identify carers, we can then have a quick rendition of the “Hallelujah Chorus” and I will not be so grumpy.
Hazel Blears (Salford and Eccles) (Lab): I shall do my best not to be grumpy and to be as quick as the right hon. Member for Banbury (Sir Tony Baldry). I wish to speak in support of new clauses 9 and 19. New clause 9 has support across the breadth of organisations from the Association of Directors of Adult Social Services to the Care and Support Alliance. It makes fundamental good sense, when setting up a new system, to have the ability to have an annual report about whether there is sufficient money in the system. Whichever Government are in charge, we need to know that. We are in danger of willing the ends but not the means for social care, and we have to make sure that this issue is kept under close review.
We all support the two fundamental principles of the Bill, which are about promoting individual well-being and moving towards a more preventive system. Those
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are commendable and high ideals, but if we do not have the funding in the system to be able to deliver them, the Bill will not achieve the potential that we all know is there.
I spoke on Second Reading about transformation, and I look forward to welcoming the Minister to Salford on Wednesday to show him how we are transforming the system for dementia care in the city by bringing together £97 million of our total health and social care budgets to try to squeeze every bit of impact out of every last penny to give better care for people with dementia. I hope he will be impressed, but more than that I hope he will help us to do this with his better care fund. That fund should be used for the transformation of our services at a time of austerity when we need more money in the system.
The second part of the new clause is about having a five-yearly review of eligibility criteria, which is essential—to be frank, I would like to see that happen more often than every five years. Eligibility criteria are now set at “substantial” instead of “moderate”, which means that in Salford 1,000 fewer families are being helped, and the heartache and misery that that causes are enormous. It also goes against the second fundamental principle of the Bill. If we do not have eligibility criteria at the right level, how can we transform the system to be preventive? If we only pick up people when they are in crisis, they are escalated into the acute sector, which costs a fortune. If we invest in lower level community-based interventions by social enterprises and voluntary groups, we can save money in the acute sector.
Meg Munn: Does my right hon. Friend agree that even when people’s needs are substantial, they are often not getting the support they need because the local authorities are not recognising that low level services, such as shopping and cleaning, help to support the care that is being provided by families? The Government need to have clear guidance on this.
Hazel Blears: My hon. Friend, as ever, makes an extremely worthwhile and practical point. Simply having the words in statute does not always portray the real position on the ground. A small intervention can often help to stop things becoming a crisis.
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In Salford we are having to make cuts of £600,000 from transport for disabled people. For many, this could lead to family breakdown. We are in consultation to see whether we can alleviate the worst of the impact, but some of the most disabled people one can imagine, who have complex needs, face the possibility of not having transport.
I support new clause 19(1)(d), which would
“ensure that systems are in place to ensure that the relevant general medical services are rendered to their patients who are carers.’.”
I commend my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) for her commitment on this issue, and I want to give one brief, personal example. Last year, my father, who is 84 years old and a full-time carer for my mother who has dementia, had a medical problem. It took us some time to get him the simplest of medical attention, and in that time my mother had to be admitted to respite care. She was there for four weeks, during which time her condition declined
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dramatically. It would have made much more sense, as well as being in the economic interests of the health service, for my father to have received fast-track medical treatment.
Will the Minister consider having a system that flags up people who are 24/7 carers, so that when they need fast-track treatment they can receive it? That would save not just money, but misery and distress to the whole family. I therefore commend new clause 19(1)(d): its two lines could transform people’s lives. I ask the Minister to take this simple and practical step, which would make such a difference.
Mr Robert Buckland (South Swindon) (Con): My amendments 27 and 28 are on safeguarding. Clause 42 contains a raft of measures that will go some way to enhancing the powers and role of the authorities in dealing with disturbing and worrying cases of abuse or neglect, which we hear about all too often when it comes to the care of vulnerable adults.
Amendment 27 relates to the definition of abuse in clause 42(3), which rightly makes reference to financial abuse. We are all aware of the rising phenomenon of financial abuse, where older people and those with learning difficulties have been preyed on, sometimes by their own family, for financial gain. My worry is that, while a distinct reference to financial abuse is welcome, there is a danger of creating an imbalance that will make other forms of abuse less relevant or important.
Statistics from the Health and Social Care Information Centre on the number of safeguarding referrals in the last year for which records are available show that the most common causes or types of abuse are physical abuse and neglect. My concern is that they do not appear in the Bill. It would perhaps be better to have an amendment, along the lines of the one I have tabled, that acknowledges different types of abuse and refers the matter to guidance that could be carefully and comprehensively drafted, so that practitioners can be safe in the knowledge that one type of abuse does not take precedence over another. This is an issue that has been raised in the other place and in Committee here. The Government have said they are concerned that defining abuse further might restrict the scope of a local authority’s duty to inquire, but my concern, and the concern of organisations such as Mencap, is that not having a reference to other forms of abuse might lead to an undue focus on financial abuse only, to the detriment of others.
Amendment 28 would place a duty on relevant partners, such as those providing care and support, to notify the local authority if they believe an adult is at risk of abuse. It is clear that local authorities cannot be expected to identify all types of abuse themselves, or to rely on the good will of other people or agencies. If relevant partners, including providers of care, had a duty to report that adults were at risk of abuse, that would make their responsibilities clear, and would help to secure greater transparency. I, and others, fear that leaving the matter to guidance would pose a risk that the duty would not be taken seriously enough. A legal duty for relevant partners has already been introduced in Wales, and the amendment seeks to mirror that.
We are familiar with the existing framework relating to adult safeguarding boards and the joint agency working that takes place, but concerns that arise day in, day out
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are not always reported, and, sadly, there is also under-reporting of concerns from hospitals. While there are many examples of local excellence in the development of safeguarding procedures, I fear, as do others, that there will be too much of a patchwork and not enough of a national framework. It is essential for us to know, wherever we live, that the standards of reporting and obligations placed on agencies and other partners to make that all-important report about abuse are consistent. Because adults are often much more isolated than children and young people who are surrounded by a framework, a duty to report when an adult is at risk could be considered to be more crucial.
Mrs Emma Lewell-Buck (South Shields) (Lab): I shall speak briefly about new clauses 17 and 18 and amendments 31 to 33, which stand in my name.
New clauses 17 and 18 go to the heart of the social care profession. They say a great deal about how much we value the care of vulnerable and older people. New clause 17 would reveal the full extent of poor employment practices in the care sector, including zero-hours contracts and failure to pay the national minimum wage. Good social care thrives on the provision of well-trained, motivated staff who can develop proper relationships with the people whom they visit, but we know that that does not happen. According to the Social Care Workforce Research Unit, more than 150,000 people in the care work force earn less than the national minimum wage. Poor pay not only affects employee morale, but makes it difficult to attract skilled staff and encourages high staff turnover. None of that is good for service users, who need to have confidence and trust in the people who visit them.
The Government promised to get tough on employers who do not pay the national minimum wage, but so far only five employers have been “named and shamed”. Not one of them was in the care sector, which is worrying given how widespread we know the problem to be. New clause 17 would give a clear picture of the state of the sector, and would create a foundation for possible action.
New clause 18 would create a requirement for local authorities to consider how the employment practices of providers they commission might affect the quality of care. The aim is to build checks into the system so that standards are not allowed to slip. Training is a particular concern: more than 40% of respondents to a Unison survey reported that they had not been given specialised training to deal with the specific needs of clients with conditions such as dementia. Nearly a quarter reported that they were required to carry out medical procedures or give medicine to clients when they had not been trained to do so. More worryingly, a care worker who spoke to me recently told me that it was standard practice in the agency to leave tablets for clients by their bedsides to save the cost of another visit later in the evening to ensure that the client had taken his or her medication. That means, essentially, that hundreds of vulnerable, confused people who are not in control of their own care are left to control their own medicine.
The issue of 15-minute care visits has rightly attracted considerable attention, not just because they often make the practicalities of care impossible, but because they eliminate almost any chance for a relationship to develop between carer and client. An under-reported crisis among
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older people is growing isolation, and the carer may be the only person to whom many of them speak on most days. That has real, measurable impacts on people’s well-being, and is made worse by those flying visits. New clause 18 would force authorities to take such factors into account when commissioning services.
A care worker on a zero-hours contract told me that it was common for 15 or 30- minute visits to be scheduled back to back, which gave him time to do only the bare minimum. He had no time to speak to his clients, or to go the extra mile to keep them comfortable. He often drops in on them in his spare time just to ensure that they are okay. On one occasion, he arrived at a client’s home to find that the man had fallen and needed to go to hospital. The man asked whether the care worker—a constituent of mine—could go with him, and my constituent rang his employers to see whether that was possible. He was told that it was not. It is extremely worrying to see cases in which social care has lost that basic element of compassion. Employers must be required to build some kind of flexibility into their practices.
My own experience in adult social care has convinced me that a general duty of well-being is simply not enough.
Mrs Madeleine Moon (Bridgend) (Lab): Because of the local government cuts, people are no longer thinking about that general duty of well-being. What is almost a “something is better than nothing” attitude has crept in and replaced concern for the well-being and care of the individual, who should be receiving quality care.
Mrs Lewell-Buck: I entirely agree. The budgets of council adult social care departments are now so stretched that they fill a gap wherever they can, as cheaply as they can.
Andrew George (St Ives) (LD): The hon. Lady is making an excellent point. In new clause 32, I propose that the Secretary of State should undertake a review of care standards, including hourly pay and other kinds of remuneration for home care workers. Does she agree that unless we have decent national standards for visiting times and remuneration, we shall be faced continually with a race to the bottom?
Mrs Lewell-Buck: I apologise for not having read the hon. Gentleman’s new clause. I have been focusing on my own new clauses and amendments, but I will look at his new clause at a later stage.
Amendments 31 to 33 would establish firm time scales for assessments and reviews of service users’ care needs. During the Bill’s passage so far, the Opposition have repeatedly tried to raise the issue of the funding gap in adult social care, which threatens some of the positive changes that the Bill would bring about. In my constituency, our local authority has been forced to make £24.3 million-worth of savings, with predictable consequences. One of the consequences for local authorities has been a decline in the regularity of assessments and reviews. I have spoken to people whose assessments have been grossly delayed; I have also visited care homes in which some residents have not been reviewed for up to three years, during which time their needs may have changed dramatically and their support may have become inadequate.
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It is easy to understand how that happens. Under-resourced departments must set priorities, and routine steps such as the reviewing of someone’s care plan are often at the bottom of the list because there is no pressure for them to be taken in a timely way. However, those steps are very important, because they identify changes in a person’s condition which, if ignored, might lead them to a crisis point. The amendments would reverse a worrying trend which has seen delayed assessments rise significantly since 2010, when 18.7% of new clients waited four weeks or more for an assessment. By 2011-12, the latest year for which figures are available, the figure had risen to 22.7%. In some individual local authorities, the change is even more worrying. In one authority, the number of new clients waiting to be assessed jumped from 12.6% to 70.7% between 2010 and 2012. It is important to remember that those are not just percentages, but represent vulnerable people whose needs are not being met.
In Committee, the Minister said that he was concerned about assessments being rushed to meet the timetable, and that a simplistic time scale would not be tailored to meet individual needs. I agree that that is of concern, but it should not be necessary for the time scale drawn up by the Secretary of State to be a “one size fits all”. The timetable for more complex cases could take into account the more complex nature of the assessment and allow more time for completion. It would be much more dangerous to have no benchmark at all and for those people to have their assessments delayed and their needs not met. The amendments would improve the situation for people with more complex needs, for whom putting support in place quickly is most important.
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The Minister made two points on reviews: that a “regular” review would be too rigid and would impose an arbitrary time scale on clients whose needs might be very different from each other; and that clause 27’s introduction of a right to review on “reasonable request” would guard against the problem of clients going unreviewed for long periods. I do not believe that a timetable would need to be so rigid. As with assessments, the timetable would not need to be identical for all patients regardless of need. During the consultation, the severity of individual conditions could easily be addressed, as could other factors such as age, to ensure that local authorities use their time most effectively. A properly formulated time scale would not have the disadvantage of inflexibility that the Minister suggests. I hope he will agree that only through legislation can we really motivate local authorities to conduct a review in a timely manner.
On the Minister’s second point, I agree that a right of request is a step forward, but I worry that it does not address all, or even the majority of cases. Many of the people we are talking about live alone, or have issues with mobility or communication. They do not have a family member or other permanent carer to be an advocate on their behalf. Establishing a firm timetable would ensure that those people are not overlooked.
The Minister said in Committee that the Government would produce indicative time scales for support plans and reviews. Although that is helpful and shows that the Government recognise the problem, I do not think that indicators will provide enough motivation for local
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authorities to get on top of the issue. As I have explained, a measure already exists to show how quickly initial assessments are conducted. A measure also exists for reviews to be proportionate, but neither has stopped the gradual slide in performance of recent years. Informal measures simply do not carry much weight.
Mr Ward: I will try to hit my five-minute target by excluding a lot of other comments, including on the eligibility criteria, which I have spoken about at length on other occasions.
The shadow Minister, the hon. Member for Leicester West (Liz Kendall) effectively made the case about the false economy, whereby the criteria are at the wrong level and people’s conditions deteriorate, so they and the state face a greater cost. My right hon. Friend the Member for Sutton and Cheam (Paul Burstow) referred to the provision to identify patients who are or may become carers. I am concerned about carers who end up becoming patients or needing care because of a lack of support. We need to consider that, too.
I will confine my comments to new clauses 7 and 9. Without those, the rest is almost irrelevant. My right hon. Friend referred to the elephant in the room. An elephant in the room is something we are vaguely aware of; we know it is there but we are not prepared to talk about it. Out there, people are talking about the crucial issue of whether these services can be afforded. So much in the Bill is so good, but we are in danger of casting doubt on the deliverability of what we know is good and on whether it can be implemented.
As is often the case, it is no use relying on the good old principle of localism and local authorities making the decision to pick up these things. There is a difference between localism that is freedom and localism that is an abrogation of responsibility by Government to fund services during a national crisis. If we get that wrong, we will simply give local authorities the freedom to fail. We need to ensure that that does not happen.
The sad thing is that, although there is so much good will out there for the Bill— we are in grave danger of not responding to the comments of the voluntary and community sector and the public sector generally on the principles of the Bill and many of its provisions—there is a suspicion that, at the end of the day, we cannot deliver on it. The question is why would we not support new clauses 7 and 9. We are asking for assurances, not for additional money, because the truth is we do not really know. We are asking for assurances through a review. We are asking not for additional funding but for a commitment to a review.
I was going to give a grand finale about the voyage into the unknown, but it is not unknown, is it? We know that huge demands will be placed on the system and that that will have grave implications for many people who are receiving and providing care. We know that that is on the way. We think we have a system in place through the Bill that will enable us to deliver on that. The big question is not an elephant in the room. The groups that I am working with on the Bradford Cares projects, Age Concern, Mencap, Scope and the Bradford and District Disabled People’s Forum say that this is good and they like so much of the Bill, but they raise their eyebrows and say, “Will the funding be there?” That is the big question that is asked over and again. Through new clauses 7 and 9, we can at least give them
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some faith that we recognise that it is a big issue and that we are seeking to identify and meet our responsibilities to fund what we all want to do and see.
Barbara Keeley: In introducing new clause 3, the right hon. Member for Sutton and Cheam (Paul Burstow) said how he felt that the NHS institutionally must change to identify and support carers. Of course I agree with that. My hon. Friend the Member for Leicester West (Liz Kendall) introduced new clauses 19, 20 and 21. She mentioned my private Member’s Bill, which I feel is having its last outing today in these new clauses; it proposed measures on the identification of carers. I want to touch on how long these issues have been around.
Eleven years ago, I completed a project on identifying and providing support for carers and co-wrote a report on that. The report made recommendations to Government, NHS bodies, GPs and their teams on how important it was to identify and support carers. That project mapped 36 primary care support initiatives for carers run by the Princess Royal Trust for Carers. We are talking about a long time ago. We felt that the role of carers, including their contribution to the work of the NHS, had generally been under-recognised and under-valued.
Through the 1990s, to the point where I wrote that report, we had carers assessments following the excellent Carers (Recognition and Services) Act 1995, introduced by Malcolm Wicks. That was strengthened by the Carers and Disabled Children Act 2000, which enhanced the carer’s right to an assessment. We even had in 1999 standard 6 of the national service framework for mental health, which said:
“all individuals who provide regular and substantive care for a person on the Care Programme Approach should have an assessment of their caring, physical and mental health needs, repeated on at least an annual basis”.
Even at that point, the Department of Health said that the implementation of the carers’ right to an assessment four years in was
“patchy. Assessments are not always carried out. Some carers are offered very sensitive practical and emotional support. But others receive very little, or no help”.
Fast-forward 15 years to the Care Bill, and carers are still in a similar situation. The identification of carers and referring them to sources of advice and support is still not happening on an adequate scale, and we have had all that legislation and good practice. Carers UK has told us that two thirds of carers that it surveyed said that, although their GP knew they had caring responsibilities, their GP did not give them any extra help. We have heard examples of what that can mean.
Carers week is in June, and we look forward to that. We know that in that week we meet carers at events. There is a common theme: they tell us repeatedly they are not getting advice and information to help them care. They can be carers of people with cancer, carers for people with terminal illness, carers of people with Parkinson’s or of people with dementia. Does the Minister want to start changing that for carers week this year? Does he want to go along to carers week events and have carers start to say to him, “I have been identified by my GP and my GP does recognise my caring role”? I hope he does, because I have heard so many people say how much it would have meant to them and what a difference it would have made to their caring if their GP had recognised it.
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Even for conditions such as Parkinson’s, only one in 10 carers has been offered an assessment. These are people who are caring very often more than 50 hours a week, and, as a disease such as Parkinson’s progresses, up to 24 hours a day. They and the people caring for somebody who has had a stroke or who has dementia are the people who really need advice, support and breaks. These are the reasons we must support new clauses 3, 19, 20 and 21.
The Care Bill puts great emphasis on carers assessments rather than on the identification of carers, and I introduced a private Member’s Bill on that in September 2012. The clauses in that Bill, which we see again today, would have ensured that NHS bodies had procedures in place to identify carers and to promote their health and well-being and ensure they receive information and advice. I believe the key reason in identifying carers should be because we have a concern for their health, particularly those with the heaviest caring commitments. That is one in five of all carers, and that is more than 1 million people, which is just too many.
Those caring for more than 50 hours a week are twice as likely to suffer ill health, particularly those caring for a person with dementia or stroke. My right hon. Friend the Member for Salford and Eccles (Hazel Blears) has just talked to us meaningfully and movingly about the impact of that caring role on her family. We want early identification and support for those carers so they can maintain their health and manage and sustain their caring role. I agree with my right hon. Friend that they should be fast-tracked for appointments. As hopefully we move towards integration and, beyond that, whole-person care, local authorities cannot be expected to act alone to identify and support carers.
As has been touched on in this debate, we also have to face the fact that the number of people receiving social care services is shrinking. In Salford this year, because of budget cuts, 1,000 people are going to lose their eligibility for social care services and 400 people who would have become eligible for care will not become eligible. The unpaid carers in those families will be taking on that substantial burden, yet, sadly, the GPs and doctors around them will not identify them, will not help them, will not make sure they get advice and support.
This Care Bill is the place to make the change, and I say to the Minister let us not wait another 15 years to make the change and place such a requirement on health bodies—and schools, universities, colleges and further education colleges in the case of young and student carers. Let them just have policies in place to identify carers and to provide support for them.
Dr Sarah Wollaston (Totnes) (Con):
I would like to speak briefly to new clauses 1, 26 and 9. I hope new clause 1 on the adult safeguarding access orders would rarely ever be necessary because, as the Minister knows, the vast majority of carers are out there day in, day out, night after night providing dedicated care, often at the expense of their own health. There is a tiny minority of people, however—and I am afraid I have met some of them—who are coercive, controlling and manipulative, particularly if there is money at stake. At the moment there is no right of entry even if other relatives or neighbours and friends have raised concerns, and even if clinicians have concerns. Of course in most cases a
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negotiation can take place and access can be gained, but very often that access is only with a rather controlling person in the room as well, and it can be very difficult to make a full assessment of capacity under those circumstances, as I am sure the Minister is aware. There are people who are at risk. We know that 29 local authorities have identified that there have been vulnerable adults for whom they have been unable to gain access.
New clause 1 is about stating that there needs to be a final backstop in circumstances where it is clear that the safeguarding of a vulnerable adult at risk is paramount. I know there are those who say we already have right of access under the Police and Criminal Evidence Act 1984, but unfortunately the bar is set too high and there is uncertainty about the ability to gain access. New clause 1 sets out very clearly the thresholds, and also the safeguards, because this is not about riding roughshod over individuals who do not wish to have a social worker entering their home. Instead it is about setting out the rights of an individual who may be under the control of a coercive third party. We need to have greater clarity and I hope the Minister will consider this new clause. Having a final backstop works well in Scotland; it is very rarely used but we need to have it in place as a final resort.
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On new clause 26, I asked the Minister to imagine a circumstance when he might have crushing central chest pain and the ambulance takes him not to a casualty department but to a police cell because a cardiologist is not available to make the assessment or a bed is not available on a coronary care unit. That is completely unthinkable yet that is the reality in the UK for people experiencing a mental health crisis. It has gone on for far too long. I am perhaps one of the few Members of this House who has been in a police cell in the middle of the night because I was a forensic medical examiner for several years. These are extraordinarily scary places for anyone, let alone an individual experiencing an acute mental health crisis.
Mr David Burrowes (Enfield, Southgate) (Con): I, too, have had experience of being in a police station, as a duty solicitor in my case, and therefore have seen for myself that the very last place these most vulnerable of people should be is a police station. Given that the Government have made commitments—indeed, financial commitments—on a diversion service, to ensure that the principle of diverting these vulnerable people is recognised, surely the next step is to support the principle of my hon. Friend’s new clause?
Dr Wollaston:
I thank my hon. Friend for those comments and I welcome the mental health crisis care concordat, and what is being done to emphasise that prevention is by far the best way forward, but even with those prevention measures in place I think we would all accept there will still be circumstances where people will reach crisis, and unfortunately a police station is absolutely the last place anyone, let alone a child, would wish to be in crisis. In Devon and Cornwall alone, 27 children last year were taken to police cells for long periods of time. On three occasions those children were as young as 12 and 13. That is simply unacceptable. One of the reasons it is likely to continue is that there is no penalty currently for the NHS in continuing to use such facilities. It does
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not have to pick up any of the financial tab. That is putting enormous pressure on our police forces. They do not wish this to happen, of course. If we cannot at least have this sunset clause, which I think is eminently sensible, I hope the Minister will consider making sure that the NHS has to pay to use the police cells, and that there is a significant financial penalty, because that would be a driver. That would make it financially much more sensible for the NHS to put in place measures for these vulnerable people—who often have been found by the police at the point where they are about to take their own lives. It cannot be acceptable for this situation to continue.
Moreover, the variation in such use of police cells is extraordinary. There are some areas where that is not used at all and others where it is very heavily relied on. I hope the Minister will say in his response that he is prepared to consider a sunset clause, or at least a financial penalty, so we see drivers in place and we continue to move away from such a practice. However, I absolutely recognise the point made by my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) that prevention is far better, and I know all areas are working towards that and that the Minister fully supports it.
New clause 9 is an extraordinary measure that is widely welcomed because of the principles to which the right hon. Member for Salford and Eccles (Hazel Blears) referred about well-being and prevention. These are at the heart of the Bill and everybody welcomes them. However, I think the Minister recognises that there could be unintended consequences if we were to introduce many new statutory obligations without their being funded fully. As he will know, we have two tests—a needs test and a means test—for people to pass in accessing social care, and 88% of needs tests are now set at a substantial level, which has been quite a considerable change. There is also the means test, which stands at £23,250. On many occasions as a GP, I remember coming across the absolute shock encountered by people when they realised that they would get no help whatever.
The change under the Bill will be extraordinarily welcome, although we should be under no doubt about the burdens that it will place on local authorities, in particular in my area. Devon has the third oldest demographic in the country, but funding of local authorities for health care does not have sufficient emphasis on the age structure of the population. There will be great impact on Torbay and on other areas in Devon, such as my constituency.
New clause 9 is a sensible measure about how we plan for the future and make an appraisal of whether we are fulfilling the important provisions in the Bill, ensuring that we have sufficient resources directed towards prevention and well-being. I hope that the Minister will see the new clause as helpful and as one that will assist us in planning for the future.
John McDonnell (Hayes and Harlington) (Lab):
I will speak to the amendments in my name. I share the view of the right hon. Member for Banbury (Sir Tony Baldry) that we should not have nodded the programme motion through blithely. Many of my constituents have contacted me about the Bill, because care in my area is on the edge of crisis, with the new threshold rolling it back for many
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people. That is why I support new clause 11; people need their human rights to be ensured in the Bill. New clause 2 is important, because we have a Children’s Commissioner and we need a commissioner for the elderly and other care services, so that there is someone to speak out for people. I support new clauses 7 and 9, because I agree that introducing legislation without funding is meaningless. We place local authorities in an impossible position, as they struggle to provide the services.
With regard to the work force, we need to ensure pay and adequate training, so that we fully professionalise the work force. In my area, we have a high turnover of care workers, which leads to distressing results. In one case, an elderly lady was burgled and on the next day a new carer came in, but she thought that she was being burgled all over again, because she did not recognise the person. That is the instability in the industry at the moment. That is why I support new clauses 17 and 18.
On the amendments in my name, new clause 31 is generated by one of my constituents called Jonathan Kay, who asked me to get the matter dealt with in the Bill. For many years, Jonathan has been funded by the local authority to employ a personal assistant to enable him to carry out his day-to-day tasks—he is a disabled person—but he has experienced serious problems with personal assistants in the past, even suffering abuse on more than one occasion. When employing personal assistants, Jonathan has found assessing the suitability of candidates extremely difficult, and he has not been able to obtain reliable recommendations from any public body, despite using public funds to employ them.
Part 3 of the Bill provides that the training and education —but no qualifications—of carers will be undertaken by Health Education England. The purpose of my new clause is for Health Education England to allow scope for the local education and training boards to do such work and to compile, publish and maintain a register of all persons who provide regulated social care for individuals under arrangements made by or paid for by a public authority. That would allow people such as Jonathan to access a list of trained professionals whom they can employ with confidence, we hope, in future.
With amendment 26, I am simply seeking to install into the Bill a provision on the right to live independently, as recommended by the Joint Committee on Human Rights, but dismissed by the Government. The Government might well have been concerned about the legal actions that were taking place with regard to the independent living fund, but the Committee’s report made its disappointment very clear that the Government had not taken the opportunity of the Bill to be explicit about their support for the convention on the rights of people with disabilities and article 19—“Living independently and being included in the community”—being a human right. It should therefore be included in the Bill. The Government have given assurances that the general direction of the Bill might achieve the same ends, but that is not good enough in that it does not enforce the rights in law.
My amendment 21 covers the same ground as new clause 15, so I will not dwell on it in any depth, but I will give an example. Whether with our parents or in our community, we all know about the uncertainty of charges for residential care. They cause real concern and anxiety among families. Yes, the ability of local authorities to
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negotiate rates influences the overall market, but that is why there is a need for some form of indicative price. A care funding calculator is used to set the care of people with learning difficulties, and that model has worked and saved public funds. We should at least be considering in the Bill that sort of process for care overall.
My proposals in amendment 20 would
“require the local authority, when carrying out the assessment, to capture an individual’s main and other disabling conditions”.
A whole group of organisations, including the Parkinson’s Disease Society, Sue Ryder, the Motor Neurone Disease Association, the Multiple Sclerosis Society, the Epilepsy Society, the Neurological Alliance and the Alzheimer’s Society, have all campaigned for this simple change in the assessment process, which merely requires local authorities to collect and record information about an individual’s main and other disabling conditions when they are conducting their social care assessments and arranging care packages. Why is that important? It is important for local authorities to be aware of the different conditions in their community, so that they can plan long-term services, but it is also important for us to be aware of the information nationally, so that care services and our investment can be planned in the long term. Taking that into account seems to be a minor amendment.
Amendment 22, which I also tabled, was proposed by the Royal National Institute of Blind People and lobbied for by a number of my constituents. In clause 76, the duty is placed on the local authority to establish
“a register of sight-impaired and severely sight-impaired adults who are ordinarily resident in its area.”
The existing provision relates only to adults and does not include children. My amendment simply ensures that the local authority is required to collect information on both adults and children. The reason for this is that, under the Children Act 1989, there is a requirement on local authorities to collect information with regard to blind and partially sighted children, but 20% of local authorities admitted failing to meet that legal requirement. Furthermore, 20% of local authorities have no register; three councils include just 1% of disabled children known to the authority on the registers; one in four authorities have whole registers with fewer than 2% of disabled children known to the council; and almost six in 10 councils include 10% or fewer of the disabled children. The RNIB therefore emphasises that in clause 76 we should place on local authorities a duty, when collecting information, to include children ordinarily resident in their area. Again it is the same mechanism; it is about the planning of services to ensure that they are properly invested in over the long term.
Overall, I welcome the Bill, but I fear that it will disappoint many as a result of the failure to address some of the considerable issues with regard to funding, rewards to the work force and professional training, and the appropriateness of the cap on costs.
Sheila Gilmore (Edinburgh East) (Lab): I am pleased to have the opportunity to speak to new clause 5, which is in my name. I thank the many Members who have supported the clause.
I have been pursuing the issue since 2011, initially on behalf of a constituent, a Mr Kenny, who suffered an injury when he was serving in the Army and is paralysed from the waist down. He originally lived in the London
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area, but his family is from Edinburgh and he wanted to move back to his family. For four years, he got absolutely nowhere, because neither authority would take responsibility for him being able to move. They argued backwards and forwards. Eventually, his family helped him to move physically, but for a period none of his care costs was being met, until Edinburgh relented and began to meet those costs. By that time, he had incurred quite a lot of debt.
I first raised the issue in 2011. The right hon. Member for Sutton and Cheam (Paul Burstow), who was then the Minister, said that it should be covered in the White Paper, but when that came out it only related to portability of care within England and not to the devolved authorities. I kept raising the matter and I was assured that something would be in the Bill, but when it was published the measures related to the portability of residential care packages but not home care packages.
6.30 pm
I did not serve on the Public Bill Committee, but I know that this matter was examined there. Warm words have been spoken, but I tabled the new clause because I hope to tie the Government down to a timetable. I want them to make some progress and report back in six months on what further legislative or regulatory changes are needed to make this portability of care a reality; I do not want this to keep being argued backwards and forwards, as has happened for such a long time. As my new clause is modest, I hope the Government may be prepared to accept it at this stage, so that six months after Royal Assent we will be coming back with practical steps that can be taken to move this on. In that way, I hope that people such as Mr Kenny will not in the future be faced with having this argued over their head, with their not being able in the meantime to have the care they need—care near to their family, which of course will probably, in the end, result in a saving to everyone.
Grahame M. Morris: I echo the sentiments of other hon. Members about the lack of time we have been allocated. I appreciate that it is not your fault, Madam Deputy Speaker, but we have so much to get through and the shortage of time means that although I would like to speak in support of a raft of amendments and new clauses, I will limit my remarks to a discussion of new clause 9.
I am supportive of the Care Bill—changes that make care simpler and fairer are to be welcomed—but there are real concerns about the sustainability of the changes this Bill seeks to make. I do not doubt the integrity and good will of the Minister of State, Department of Health, the hon. Member for North Norfolk (Norman Lamb), but with all the good will in the world the proposals in the Bill can be implemented successfully only if they are properly funded.