Care Bill [Lords]
The Committee consisted of the following Members:
Kate Emms, Committee Clerk
† attended the Committee
‘including the charges levied on the provider by other services regulated by the Commission and their impact on the financial sustainability of the provider’s business.’.
‘(8) Where this section applies to a registered care provider, the provider must disclose in full any relevant information that the Care Quality Commission considers it necessary to have in order to make an assessment under subsection (1), including information relating to any holding companies or other associated corporate entities.’.
Liz Kendall: At the end of the previous sitting, we were talking about the Care Quality Commission’s role in trying to prevent or deal with the consequences of provider failure, and I was saying that one thing that we had learned from the Southern Cross case was that there are often very complicated financial structures behind not just the care providers, but their owners or parent companies. There is increasing involvement of private equity and venture capital companies and others.
Amendments 129 and 130 would ensure that the CQC could gain access to all the financial data that it needed, including from parent or holding companies, to make a proper assessment of the financial sustainability of a care provider. The CQC may have been able to get hold of information from Southern Cross, for example, but what if it had wanted information from Blackstone, the private equity company behind it?
I point the Committee towards the comments that David Prior, chair of the CQC, made to the Select Committee on Health. Yesterday, that Committee published a very useful report on the CQC, including its new roles, and the Clerk helpfully forwarded it to us. In his evidence to the Committee, David Prior said that there were very complicated financial structures behind some care providers.
Amendment 130 is designed to toughen the Bill’s language, so that rather than saying that regulations “may” enable the CQC to obtain information that it considers relevant, it says that the regulations “must” do that.
I have tried to understand what powers the CQC currently has to require care providers to co-operate with it, and my understanding is that under the Health and Social Care Act 2008, the previous Government gave the CQC two powers to get care providers to co-operate—not specifically on finances, but generally. One is the power to issue a fine of up to £2,500, and the other is the power to suspend or cancel the licence. Let us be brutally honest. A fine of £2,500 will not put off any company the size of Southern Cross, let alone a private equity company such as Blackstone. The CQC needs to have the power to threaten to suspend or cancel a licence, but in this case, if it is worried that a provider might end up failing, cancelling or suspending its licence might precipitate its going into that situation. Therefore, I do not think that the CQC’s powers to get people to co-operate are sufficient, particularly on financial information. I have no doubt that many companies will not want to give over all their financial data; they will say that the information is commercially confidential.
Our amendments are clear. We are not saying that all the information should be published in the public realm. This is about giving the CQC all the information that it thinks is relevant in order for it to make its assessment of whether the care provider is financially sustainable. That is why we tabled those amendments.
I want to come back to a couple of points that I raised on Tuesday, if the Chair will allow me, on the CQC’s wider role. That is because we now have the Health Committee’s report on accountability and the CQC. That report came out only yesterday and it is relevant for the Committee to consider its recommendations before we leave this part of the Bill.
David Behan, the chief executive of the CQC, told the Health Committee—this was the point I was making on Tuesday—that for the CQC to fulfil its obligations under this part of the Bill, it will need to
Rather interestingly, David Prior, the chair of the CQC, said that it was highly unlikely that the commission would want to have the financial skills permanently in-house. In other words, he was saying, “We don’t want to bring in permanent staff to do this; we just want to keep buying it in.” My question for the Minister is this: how much will it cost for the CQC to buy in the skills? Is he convinced that it is value for taxpayers’ money to continue doing it on a consultancy basis, rather than taking on teams permanently? Why would the chair of the CQC not want those skills permanently in-house if this is to be a long-standing function? I do not understand that and I do not understand how that provides best value for money for the taxpayer.
The report states that because Monitor already has several in-depth skills in the financial oversight of foundation trusts. The Health Committee questions why that role should go to the CQC. If the CQC is just
Paul Burstow (Sutton and Cheam) (LD): I will speak about amendment 132, which does not deal with any of the issues that the shadow Minister raised. It is intended as an opportunity to probe the Government on a separate issue that came to my attention in the past couple of weeks. It relates to an important interaction between different regulated services and how the actions of one regulated set of services—in this case, primary care and GP practices—can have an impact on some of the costs of another regulated set of services, which in this case is care homes. I do not necessarily expect the Minister to be able to give me a full response today, but I ask him to reflect on what I say.
The amendment is based on a recommendation, again from the Health Committee, that dates back a long way, to an inquiry that it did in 2003-04 into a range of issues around elder abuse. One of the things it found when it took evidence was that a number of care home providers expressed a concern about the variability of supply and access to primary care services. An argument was made about the inappropriate use of retainer fees to retain the services of general practitioners, and the Health Committee made a clear recommendation that that practice should be abolished.
The Government of the day simply responded by saying that there were circumstances in which additional or enhanced services might be provided outside what a general practitioner would have a contractual obligation to provide to the public at large, and that there was therefore a reason for retaining such fees. However, the English Community Care Association undertook a survey in 2008 on the use of retainers. It found that the cost of retainers over the course of a year could amount to as much as £24,000 and that in a number of cases there was nothing to suggest that the retainer was being paid for more than the services that the GP had already been contracted to provide.
More recently, Care England, as it has become following the merger with the care home association, has surveyed a number of its members. One survey received 34 responses —not a big sample—of which 30 said they paid retainers and the other four did not. The survey showed that the amounts being paid ranged from £1,000 to £2,400 a month and several of the organisations responding said that if they did not pay the retainer, the in-house GP service would be withdrawn and all residents other than totally immobile residents or those in emergency situations would need to go to the surgery.
That cannot be right. It is unacceptable that GPs should use their relationship with care homes as an additional source of income to provide the service they are contracted to provide. That is why I am raising this issue now and why I raised it as a member of the Health Committee in 2004. I made the same recommendation then and I still feel strongly about it.
Paul Burstow: I agree with the hon. Lady. Obviously, the Government are concerned about this because they said that they were in the White Paper on care and support. They said that the evidence also showed that there is currently considerable variation between primary care trusts, as they were then, in the primary care services provided for care home residents. Of course, NHS England has a primary responsibility here, but the amendment seeks to suggest that, when one looks at viability, another regulated organisation levying additional charges that increase a home’s costs is not an irrelevant consideration. That is the basis on which I have tabled this amendment.
Will the Minister raise this matter with the chief inspectors of adult social care and general practice and ask them how they might satisfy themselves that, in health and care economies around the country, this practice is not being used as a way of topping up the incomes of general practices?
Dr Sarah Wollaston (Totnes) (Con): Perhaps I should state for the record that I never received any such fees in my time as a GP. There is a serious issue, but it is only fair to raise the problem of the real work force shortages in general practice. If GPs are to do the very valuable work that my right hon. Friend the Member for Sutton and Cheam mentions on prevention, we can use other vehicles—perhaps through the better care fund—to make sure that that happens, and that GPs have the time to prioritise it.
I ask the Minister to raise the issue with the two chief inspectors so that they can act in concert and satisfy themselves and the public that the use of retainer fees is appropriate, that there is clarity about when they can be used and that there is greater consistency about the level at which they are set, if they are to continue to be set in the first place.
That was the purpose of the amendment. I hope that the Minister, either in his response or correspondence, can offer some reassurance. I know that Care England and a number of its members are concerned about this issue, and the public would be concerned, too.
First, I will deal with the shadow Minister’s concern about the approach that the CQC will take and the comments of its chairman, David Prior. By way of giving some background, I will point out that he was the Member of Parliament whom I defeated to end up in this place. I feel that I was releasing him to do this very important job and he is an extremely good chair of the CQC.
David Prior has made some comments, I think to the Health Committee. The first point to make is that if one makes a body independent of Government, one has to respect that independence in the way that it goes about its business. However, I will meet him soon and independence does not mean that we cannot talk to each other. I will certainly raise this issue with him on behalf of the shadow Minister. It is a legitimate issue for discussion, and I am happy to raise it with him.
The shadow Minister also raised the issue of CQC versus Monitor. I think that I am right in remembering—forgive me if I am wrong—that the shadow Minister indicated at the last sitting that she thought that the judgment was probably right. Obviously, the Health Committee has since given its view, but that alignment of financial stability and quality of care is incredibly important. This is one of those issues where there is no right or wrong answer; a judgment call is needed. However, in having to reach a conclusion, I felt that having the organisation that is responsible for the quality of care looking at the sustainability of organisations is hugely important. It is important for us to recognise that a financially unstable organisation undermines the quality of care, and that people who play fast and loose with structures to make a fast buck undermine the quality of care. Having one organisation looking at those issues is the right way forward.
I make an observation that I hope is incontrovertible: it is unacceptable for care users to be left without the services they need, in particular where the interruption of those services, or the worry that they might be interrupted, could badly affect care users’ well-being, and place unacceptable stress on them, their families and their carers. The financial performance of a provider, whether exceptionally good or exceptionally poor, can be a leading indicator of serious quality failings.
During the past 20 years, the care market has obviously evolved massively. Today there are several medium and large providers of care operating across large parts of the UK, on a significant scale. The impact of such a provider failing would affect many parts of the country and it is not reasonable to expect individual local authorities to manage such a situation without central co-ordination.
We are therefore placing a duty on the CQC to assess the financial sustainability of the providers that would be most difficult to replace. It will support local authorities in ensuring continuity of care when providers fail, by informing them when it considers that such a failure is likely and providing information that they need, such as details of individuals receiving services from the provider in their area.
In amendments 129 and 130, the Opposition raised the important issue of ensuring that the CQC, in assessing the financial stability of registered providers, can obtain appropriate information from organisations in a registered care provider’s group. Some providers have ownership structures that complicate the assessment of their financial sustainability. For that reason—this is the critical point in answering the shadow Minister—clause 56(5) provides for regulations to require the CQC to require information from other organisations that would assist it in assessing a provider’s financial stability.
As the CQC develops its framework for implementing its regime and its approach to assessing financial stability, we will work with it and stakeholders to consider how the regulations should work in practice.
Norman Lamb: I do not have an estimate; it must be for the independent CQC to manage that process. The duty that the Bill places on the CQC is clear, and it must comply with it in such a way as to allow the arrangements to work effectively. I do not know whether we can find out about the likely cost; if I can provide that to hon. Members, I shall be happy to, but the matter is ultimately for the CQC.
Draft regulations will be developed through collaboration between the Department of Health, the CQC and stakeholders. The objective of the market oversight regime is to provide early warning to local authorities, to support them in ensuring that no one will suffer because the failure of a provider leaves a gap in the service on which they depend. That cannot be achieved if the CQC cannot make a fully informed assessment of a provider’s financial situation, so I reassure the Opposition that we fully intend to make the regulations. The shadow Minister wanted the word “must”, not “may”, in the provision, but we will make the regulations: we are absolutely committed to that. I hope that reassures her.
Liz Kendall: I would not want to tell the Minister what to do. Nevertheless I should not underestimate the difficulty of getting some of the detail about financial arrangements from companies based overseas. They are often offshore. HMRC cannot get information about what tax they pay, let alone the CQC.
I am serious; I have spoken to the CQC about the issue. I do not think that the provision is tough. The Minister is saying that a bod in the CQC will be able to
Norman Lamb: I understand and share the hon. Lady’s concern. It is incredibly important to get the information; that is why regulations will absolutely require it—not just from the specific company, but from other organisations.
In the aftermath of Southern Cross, while we have not had the legislation it has been for the Department to maintain an informal monitoring process. There has been quite good collaboration with the larger industry players where a collapse might have a significant impact in a particular area of the country. My clear understanding from officials is that that collaboration has worked well. Such collaboration is in the interests of both sides, because whatever people’s motivation in terms of making money, nobody actively wants the organisation to go bust.
The Care Quality Commission is responsible for registering those companies and must be satisfied on registration that a company meets the fundamental standards of care and can sustainably provide good quality care. There is an alignment of interest in getting financial information and continuing to monitor stability to facilitate the work of the CQC.
Grahame M. Morris (Easington) (Lab): I agree with the Minister’s analysis. Will he support my ten-minute rule Bill to extend FOIs to private health care companies? Does he agree that that would make life much easier for the CQC and others trying to achieve the same ends?
Norman Lamb: I offer the hon. Gentleman a discussion on the matter. If he sends me his ten-minute rule Bill, I will be happy to have a chat with him about it one afternoon in the Tea Room. I would really enjoy that. We will have to find somewhere mutually agreeable to sit together in the Tea Room, given the demarcation in that place.
Norman Lamb: I greatly appreciate the hon. Gentleman’s offer. He is clearly a peacemaker. We ought to get back on track. I apologise for the ill-discipline, Mr Bayley—not only mine, but that of others.
In amendment 132, my right hon. Friend the Member for Sutton and Cheam rightly emphasises the importance of ensuring the effectiveness of the new system of financial oversight of care providers that will be run by the CQC. Before I give the formal response in my
Nowhere will there be a greater concentration of people who may need hospital treatment than in a care home, and those people often have multiple morbidities and require proactive care. In the Secretary of State’s work, and in the work I am doing within my portfolio, the whole emphasis is on shifting towards proactive care and having an accountable clinician. We are reforming the GP contract, which was—this is just a tiny political point—deeply flawed in its make-up. [ Interruption. ] Mr Bayley, that is outrageous.
Norman Lamb: The reform of the GP contract frees up time from this box-ticking exercise to allow GPs to concentrate on proactive care. Alongside that, the emerging vulnerable older people’s plan will focus on maintaining the well-being of those individuals, preventing crisis admissions to hospital, which are so often completely disruptive to their well-being and care and enormously expensive to the system. Care homes and the role of the GP are critical to that. Those patients in that care home will have to be part of the vulnerable older people’s plan. There will have to be an accountable clinician who will be responsible for their care. This is a significant advance.
Jim Shannon: The Minister referred to appropriate care. One example that comes to my mind is people with brain injuries. Sometimes they are pushed to a care home which, let us be honest, is an inappropriate place for them. It does not give them the correct chance for rehabilitation, which is so important. There are specific ailments, injuries and diseases where people need to be in the appropriate place. Can the Minister confirm that after these proposed legislative changes, decisions will be taken to ensure that those with brain injuries are sent to the right place and not somewhere inappropriate for a short stay?
Norman Lamb: This all comes down to good care and addressing the issue of accountability. As for being sent off to an inappropriate care home, in future under the vulnerable older people’s plan, there has to be a named clinician—a GP—who is responsible for the care of that individual. That does not half focus the mind. So often at the moment, people fall through the gaps in a horribly fragmented system. The whole emphasis of the Government is to move towards a joined-up, integrated system that ensures good, proactive care to prevent those people from facing crises that are horribly disruptive to their lives.
Paul Burstow: An important step has been taken around much better co-ordination of care, particularly for those with complex multi-morbidities. It is key to getting the best results for them. Will the Minister
Norman Lamb: I am grateful to my right hon. Friend for raising the issue. It is important. On his specific point, I am happy to write to Steve Field, the chief inspector of primary care, and to copy in the chief inspector of social care, to raise the issue. There must not be barriers in the way of proactive care of people in care homes. My hon. Friend the Member for Totnes, with all her experience, raised exactly this concern and the importance of that very good proactive care.
Jim Shannon: The point I was trying to make and did not mention in my earlier comments was that if someone is in the right centre for rehabilitation—the right residential home, the right care home—there is a massive financial saving. Whether we like it or not, we have to focus on the financial savings, too. There are good savings to be made by putting the right person in the right home at the right time.
Norman Lamb: I agree. That is the whole purpose behind our integrated care pioneers. The hon. Gentleman should visit some of these brilliant parts of the country—Islington, Greenwich, Barnsley, Torbay or Cornwall. Those fantastic leaders are demonstrating a much more effective way to manage people’s care: shifting the emphasis to preventing ill health; preventing a deterioration of health; and critically, using the money more effectively.
Beyond the pioneers, we now have the incredibly important better care fund that has the potential to deliver that proactive preventive care across the country. I encourage the hon. Gentleman to visit some of those great places because there is a lot we can learn.
The Care Quality Commission will oversee the financial stability of these providers, assist them in mitigating any financial challenges to continuity of care and provide assistance to local authorities in managing continuity of care if a provider does fail. Where there is a significant risk to the financial stability of the provider, the CQC can arrange an independent business review.
It will be important that the way that the CQC assesses the financial viability of providers in the regime takes account of the wide range of different provider types and different business models. The information required to assess the viability of a corporate plc may be completely different from that required to assess a charitable trust.
Nick Smith (Blaenau Gwent) (Lab): I want to return to the CQC’s ability to monitor care providers. I accept the Minister’s good intentions to ensure that that happens, and I hope the regulations will be strong enough. However, I am still not persuaded that the CQC has the financial capacity, in particular the financial penalties, to hold these companies to account. Will the Minister look
In carrying out such assessments of financial sustainability, we would expect the CQC to take into consideration a range of factors, including not only any risks to the business, but the reasons behind those risks. Those might include, as the amendment suggests, debts or charges owed to other individuals or organisations. I can see the point that my right hon. Friend the Member for Sutton and Cheam is making through the amendment, although I do not think it necessary to specify such a requirement in the Bill. I suspect that his amendment is a probing one.
I assure my right hon. Friend that the CQC intends to develop its methods through consultation to take account of the wide diversity of providers, and I hope I have given enough reassurance for him not to press his amendment. I hope, in a similar spirit, that the shadow Minister will not press her amendment.
Liz Kendall: I remain concerned about this matter. I understand that regulations are to come forward. I will not press the amendments at this stage; we have put our concerns on the record. However, I think the issue needs to be looked into in far more detail. If the Minister will write to hon. Members about the issue, we can keep it under scrutiny, which is our job. I beg to ask leave to withdraw the amendment.
Liz Kendall: I want to make a small point about the clause on the important issue of transition from childhood to adult life. We could have a big debate about how difficult the issue is and how many families feel let down. I know that the Bill seeks to improve that transition so that people get continuity of support. Also, there have been changes in the Children and Families Bill, which also looks at the issue.
I want to raise just one issue. Under the Care Bill, a child’s care needs will be assessed up to the age of 18. Under the Children and Families Bill, I understand that there will be new education, health and care plans,
We want families to get just one assessment. They do not want to go through the process twice. I am concerned about that disparity, and I would like to know what the Government are going to do about it.
I am completely with the shadow Minister; it would be crazy if different assessments overlapped with each other. There needs to be one joined-up process. The two Departments have tried as much as possible, and I think largely successfully, to collaborate closely with each other to ensure that the measures in the Children and Families Bill match those in the Care Bill. I will look at the hon. Lady’s specific point and write to her about it, and copy in other hon. Members.
‘(1) Where a local authority is satisfied on the basis of a child’s carer’s assessment that a carer of a child has needs for care and support, it must determine whether any of the needs meet the eligibility criteria (see subsection (6)).
(2) Having made a determination under subsection (1), the local authority must give the carer concerned a written record of the determination and the reasons for it.
(3) Where at least some of a child’s carer’s needs for care and support meet the eligibility criteria, the local authority must—
(a) consider what could be done to meet those needs that are eligible;
(b) ascertain whether the carer wants to have those needs met by the local authority in accordance with this Part; and
(c) establish whether the child needing care is ordinarily resident in the local authority’s area.
(4) Where none of the needs of the carer concerned meet the eligibility criteria, the local authority must give him or her written advice and information about—
(a) what can be done to meet or reduce the needs; and
(b) what can be done to prevent or delay the development of needs for care and support, or the development of needs for support, in the future.
(5) Regulations may make provision about the making of the determination under subsection (1).
(6) Needs meet the eligibility criteria if—
(a) they are of a description specified in regulations; or
(b) they form part of a combination of needs of a description so specified.
(7) The regulations may, in particular, describe needs by reference to—
(a) the effect that the needs have on the carer concerned; or
(b) the carer’s circumstances.’.
‘(1) A local authority, having made a determination under section 62( ), must meet a carer’s needs for support which meet the eligibility criteria if—
(a) the child needing care is ordinarily resident in the local authority’s area; and
(b) the local authority is satisfied that support would be better provided to the carer under this section than to the carer and/or the child under section 17 of the Children Act 1989.
(2) A local authority may meet a carer’s needs for support if it satisfied that it is not required to meet the carer’s needs under this section.
(3) Where a local authority has carried out an assessment under section 61(1)(b) it must give the carer—
(a) an indication as to whether any of the needs for support which it thinks the carer is likely to have after the child becomes 18 are likely to meet the eligibility criteria (and, if so, which ones are likely to do so), and
(b) advice and information about—
(i) what can be done to meet or reduce the needs which it thinks the carer is likely to have after the child becomes 18; and
(ii) what can be done to prevent or delay the development by the carer of needs for support in the future.’.
Paul Burstow: The amendments are changes that would need to be made to the Bill to pave the way for new clauses 5 and 6. The new clauses are on how we continue to improve the rights of carers and ensure that there is an alignment of responsibility on local authorities in how they deal with carers, regardless of their age or of the circumstance that leads them to be a carer. That is what the group of amendments seeks to do.
The Government have deservedly been commended by organisations such as Carers UK, the Carers Trust and others for breaking new ground for carers. They introduced new rights for adult carers and lowered the threshold for determining the recognition of carers and their entitlement to assessments. We should celebrate those things because they are new. When we deal with legislation of this kind, it is easy to forget about the new things, bank that and move on to the next thing. Having said that, I want to move on to the next thing because there are some important issues outstanding. [ Interruption. ] Well, we are always asking questions. I did not hear what the Minister said, so I will move swiftly on.
We are discussing the needs of adults, because only adults will be addressed by the Bill. The draft Bill left other carers’ rights to be governed by the carers legislation that has been passed as private Members’ Bills over the years. It is interesting that carers legislation in this country has been prosecuted through Back-Bench initiatives, with Government support. I am proud to have been associated with some of those Bills—my name was attached to at least one.
I put my hands up; I regret that when we looked at these issues in the adult statute I did not look at them as thoroughly as I should have done—this is a confession—but sometimes one gets a second chance in life. I am grateful to the Government for giving me a second chance and asking me to chair the Joint Committee, which allowed me to consider and reflect on the representations we received. The Government have been open to those concerns ever since.
The Joint Committee spotted two issues: first, the issue of young carers, which was addressed by the Children and Families Bill and is currently before the other House, and secondly, the issue of parent carers. That is what this set of amendments is about. The Government have been listening. The Children and Families Bill was amended to give young carers stronger rights to assessment and support. That is a good thing.
That brings me to the issue of parent carers, which I raised on the Floor of the House. We have had exchanges with Ministers in the Department for Education, and I have met the Minister with representatives of Carers UK to talk about this issue. I welcome that engagement with the Minister. It was important that we had it, because when this issue was first discussed in the House of Lords through amendments some unfortunate things were said and links were made between the rights of parent carers and concerns about child protection. That misadvised conflation was caused by a misunderstanding of the situation, and it caused deep offence to parent carers and the organisations that represent them. I have put that in gentle terms, but others could put it more stridently.
The Government are in discussions. They have had round tables with parent carers and their organisations, and they are clearly listening to their concerns. However, it is important that we discuss these matters in this Committee to determine whether they should be dealt with in this Bill or the other Bill. If they are dealt with in the Children and Families Bill there needs to be something in this Bill to link across, not least because of the issue of transitions, which we have just been discussing. We are talking about a category of carer who, along with the person they care for, go through a transition,
If we do not make that change, however, the law would become much more complicated for people to navigate, with the need to refer to the Children and Families Bill for young carers, the rump legislation for parent carers and what will become the Care Act to find the obligations for adult carers. Young carers of a disabled sibling will have greater rights than their parents as a consequence of the changes made so far. I am sure that that is not an intention that the Government signed up to, but an unintended consequence of where we are in the passage of these two pieces of legislation. That can be fixed, however, because neither has completed all of its stages. Similarly, not until a transition, or someone becoming 18, will a parent be deemed to be an adult for the purposes of the Bill we are discussing.
For all of those reasons, I hope that the Minister will give us some words of comfort and indicate the route by which those matters will be resolved so that we can have as clear cut a set of arrangements for parent carers as we now have for adults who care for adults and for children who care for other people. I look forward to the debate.
Norman Lamb: Clauses 61 and 62 intend to provide for timely assessment of those caring for young disabled people approaching adulthood to support the shift from children’s services to adult care. I reflect on the danger that my right hon. Friend pointed out that when one pursues the next thing down the track, one can forget to celebrate the considerable advances we have achieved with this legislation and the Children and Families Bill. He was right to say that the measures already taken have been widely welcomed. He is also right never to be satisfied, because we should always keep on pursuing improvements to the system. When one meets with parent carers and other groups of carers and hears their testimonies, one realises that we have a continuing burden of responsibility to try to improve their lives.
Amendments 43, 44, 46 and 47 would extend the period for assessment of those caring for children to cover children of all ages and skew the focus of the clauses away from planning for adulthood. The Bill is ultimately about the care of adults. While we should try to align the two pieces of legislation, it is important to avoid confusion and to be clear about the responsibilities of each Bill.
New clauses 5 and 6 would extend the Bill’s provisions and introduce a totally new concept of eligibility into children’s services. In the Government’s view, that would be inappropriate. Policy on assessing and supporting children and their families, which includes support for families where that is in the child’s best interests, lies
In the light of debates on the Care Bill and on the Children and Families Bill in the other place, the Government have agreed to work closely with carers’ organisations, parent carers and other stakeholders to review existing legislation, guidance and practice for assessing the support needs of those caring for children. A very constructive round-table discussion took place on Friday 10 January—I have mentioned that previously in Committee—and last night I attended a meeting with the Schools Minister, Lord Nash; Baroness Pitkeathley, who has been widely praised for her work in this area by members of the Committee; Baroness Tyler; representatives from parent carer networks; Carers UK; and parent carers themselves, who spoke directly of their aspirations and the challenges that they face. It was a helpful meeting and we explored legislative and non-legislative options to improve support for parent carers of disabled children.
The Government’s review is the right place to explore the issues. I can assure the Committee that rapid progress is now being made. I am sure that my right hon. Friend will understand that I cannot go into more detail because I have to respect proper process, but I was encouraged by the discussion last night and I repeat that I think we have a responsibility to do what we can to improve the lives of people caring for children.
The intervention was just in time, because I was coming to the end of my speech. I hope that I have reassured my right hon. Friend about the direction that the Government are taking and I hope he will agree to withdraw his amendment.
Paul Burstow: I am grateful to the Minister for being open to consideration of the issue. He expressed concern when he was before the Joint Committee and he has been pursuing the matter with Ministers in the Department for Education. I am pleased about the meeting he had yesterday and that the review will be rapid. I am also pleased he was able to confirm that rapid means before the legislation is concluded.
Will he at least undertake today to write at the earliest opportunity to members of the Committee once any write-round process and any other decisions that need to be made within Government have been concluded, so that the Committee might benefit from the news and then be able to act accordingly? It would be useful if the Minister could give us some reassurance that he could do that for us and write round to the Committee once he knows.
Norman Lamb: I am being very generous in agreeing to write on all sorts of things. Hundreds of letters are at this very moment being written by the Department to my right hon. Friend and other members of the Committee, but I will be happy to write on this subject as soon as we have an answer to the question that he poses.
Paul Burstow: The Minister is being very generous, and generous with the time of others. Having sat in his place and steered a Bill through Committee, I know that that can sometimes be an easy thing to do and that it does create work. I do appreciate the work that the Bill team do and I know how important they are to the effective discharge of our work in this place. None the less, I look forward to the letter and I am grateful to the Minister for conceding it. It helps us to do our job.
I understand the concerns expressed by the Minister. We took a conscious decision to establish an adult statute when we framed the draft Bill, so there was a clear decision. The question is about how we make sure there is symmetry in the arrangements, which is where the Children and Families Bill comes in, or other methods. I await the rapid review and its conclusions. With that, I beg to ask leave to withdraw the amendment. I will review the situation when we get the letter.
‘(5A) Where, in the case of a carer to whom a child’s carer’s assessment relates, the child becomes 18, the local authority must decide whether to treat the assessment as a carer’s assessment; and if the authority decides to do so, this Part applies to the child’s carer’s assessment as if it were a carer’s assessment that had been carried out after the child had become 18.
(5B) In considering what to decide under subsection (5A), a local authority must have regard to—
(a) when the child’s carer’s assessment was carried out, and
(b) whether it appears to the authority that the circumstances of the carer to whom the child’s carer’s assessment relates have changed in a way that might affect the assessment.’.
Norman Lamb: I promise not to detain the Committee for long on this group of minor and technical amendments, which reflect a policy intention about which we have always been clear—that a transition assessment can be treated as a full assessment under the Bill where that is appropriate and proportionate. That power already existed
‘(4) “Carer” has the same meaning as in section 61.’.—(Norman Lamb.)
“(1) Subsections (2) to (4) apply where a local authority in England providing services for a child in need in the exercise of functions conferred by section 17—
(a) are required by section 59(1) or 64(1) of the Care Act 2014 to carry out a child’s needs assessment or young carer’s assessment in relation to the child, or
(b) are required by section 61(1) of that Act to carry out a child’s carer’s assessment in relation to a carer of the child.’.
Norman Lamb: I come now to another group of minor and technical amendments. In the other place the Government tabled amendments to remove the requirement that transition assessments must be requested and to change the power to carry out a transition assessment
The amendments do not change the substance of the Bill. We were always clear about our policy intentions when we tabled the amendments in the other place. They simply embody technical changes to ensure that the Bill fully reflects the intentions already agreed. I hope again that they are approved by hon. Members without the need to detain the Committee any longer.
‘decide to comply with the request but’.
“(4A) Subsection (5) applies where a local authority in England providing services for a child in need in the exercise of functions conferred by section 17—
(a) receive a request for a child’s needs assessment or young carer’s assessment to be carried out in relation to the child or for a child’s carer’s assessment to be carried out in relation to a carer of the child, but
(b) have yet to be required by section 59(1), 61(1) or 64(1) of the Care Act 2014 to carry out the assessment.’.
“(1) Subsections (2) to (4) apply where a local authority in England making arrangements for a disabled child under section 2 are required by section 59(1) of the Care Act 2014 to carry out a child’s needs assessment in relation to the child.’.
‘decide to comply with the request but’
“(4A) Subsection (5) applies where a local authority in England making arrangements for a disabled child under section 2—
(a) receive a request for a child’s needs assessment to be carried out in relation to the child, but
(b) have yet to be required by section 59(1) of the Care Act 2014 to carry out the assessment.’.—(Norman Lamb.)
This is another minor and technical amendment, which I hope that we can deal with quickly. The amendment will make a small change on a point of legal technicality in the way that the Bill refers to children’s legislation. We are simply updating the Care Bill to reflect amendments made to the Children and Families Bill. I am sure that hon. Members will join me in welcoming the changes to the Children and Families Bill, which we have already discussed: making it easier for young carers to get an assessment; in support of whole family approaches, in line with the provisions in the Care Bill; and to protect young people from inappropriate or excessive caring roles. Amendment 21, however, is simply a technical update to reflect the legal apparatus behind those changes. I therefore hope that it will receive the approval of the Committee.
‘(1) The Secretary of State must provide local authorities with sufficient funding to enable them to meet new costs arising directly or indirectly to them by virtue of this Part.
(2) The costs mentioned in subsection (1) include (but are not limited to)—
(a) costs of introducing the new measures set out in this Part;
(b) on-going costs of implementing those measures (to be allocated through the annual spending review);
(c) costs identified by the Department of Health to be funded through the Better Care Fund.’.
‘The Secretary of State must prepare a report on the costs and benefits of requiring, and providing funding for, local authorities to offer all social care free at the point of use. This report must be laid before each House of Parliament within 12 months of section 3 coming into force.’.
‘(1) Before any provision of Part 1 is brought into force, the Joint Care and Support Reform Programme Board must have informed the Secretary of State whether sufficient funding is in place or will be put in place to ensure that the provision in question 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 including the Local Government Association, the Association of Directors of Adult Social Services and the Department of Health.’.
‘An independent ministerial advisory committee shall be set up to keep under review the workings of the set level as set out in section 15, and the means-testing arrangements set out in section 17.’.
‘The Secretary of State must ask the Office for Budget Responsibility to complete by the end of 2014 a review of the funding of adult social care that assesses—
(a) the adequacy of current public funding of these services;
(b) the proposals for funding the provisions in this Act;
(c) the implications of the Act and its funding for the NHS over the next five years; and
(d) in particular the short and long term costs of setting the eligibility criteria at the level set out in regulations.’.
‘(1) Before bringing into force sections 13, 17 and 35, the Secretary of State must lay before Parliament an impact assessment of the regulations set out in those sections.
(2) In relation to the regulations set out in subsection 13(6), the assessment must show how the provisions will affect the likely impact of the set level above which an adult starts receiving financial assistance with the costs of their care.’.
Meg Munn (Sheffield, Heeley) (Lab/Co-op): I apologise for not being present for the start of the Committee. I had a meeting with a Transport Minister on a constituency matter which was arranged before I was put on this Bill Committee.
I am pleased to speak to new clause 13, which is in essence probing and important to the cost of implementation. I have identified—for the Ministers, who are paying great attention to what I am saying—that the new clause relates to the new costs identified in the Bill. I will give one or two examples of where such new costs occur for local authorities in measures under part 1.
For example, for clause 9, “Assessment of an adult’s needs for care and support”, it is estimated that the changes will require councils to carry out 500,000 additional assessments of people with eligible needs in 2016-17. My own local authority anticipates a significant increase in demand for assessments, with implications for costs and work force capacity. It fears that a two-tier system of assessment may be required to deal with high-end, complex cases and simpler cases, in which the assessment is conducted simply to start the care account running.
My hon. Friend the Member for Leicester West has already talked about the cap on care costs and I will not refer to that again. I want to spend a moment on clause 34, which covers the universal deferred payment scheme, because it is likely to lead to increased debt and costs.
An LGA analysis of the ongoing costs of deferred payment shows that the total value of loans would increase from £122 million in 2015-16 to £1.1 billion by 2024-25—I am worried that I might need care by that time, but hopefully not—which compares with £139 million to £230 million in the Government’s impact assessment. There is a huge difference between what the LGA, which represents many councils of all political colours, says and what the Government’s impact assessment says. The main factors affecting the cost to councils will be demographic pressures, inflation and the cost of borrowing. Clause 34 also constitutes a significant financial and reputational risk for councils, threatening the long- term sustainability of local government funding. The Government have not to date provided reassurance that
I want to talk a little about funding adult care and rising demand. As we have heard many times in the Committee, adult social care budgets are under pressure. They have been reduced by £2.68 billion over the past three years—20% of the budget. That is compounded by the cost of demography—more people are getting older, with more needs—which is approximately 3%. Just meeting ongoing demographic pressures costs £400 million a year—that is just to stand still. The overall context in which we are considering the Bill—the need to identify further savings across the public sector, even for the needs we are meeting now—does not fit well with the aspirations of the Bill, which we have said many times we are all behind.
LGA estimates are that spending on care will pass 45% of council budgets by 2019-20, which is a huge amount. Part of that is of course due to the savage cuts this dreadful Government have made to local government. [Interruption.] It is not a laughing matter, Minister. The leader of my local authority says that the cuts are more savage than any of those experienced during the dreadful years of Margaret Thatcher, and that view is backed by my right hon. Friend the Member for Sheffield, Brightside and Hillsborough (Mr Blunkett) and my hon. Friend the Member for Sheffield South East (Mr Betts), who have led local government in the past.
We must ensure adequate funding for the reforms. [Interruption.] This is not a laughing matter. It is crucial to ensure that we meet the aims and objectives of the Bill, which we are all behind. We must strive for individual well-being. A survey of County Councils Network members, many of which are Conservative-controlled councils, showed that 70% are in favour of the reforms in the Bill, but due to financial concerns, only 30% are confident of delivery. The network says:
“Integration needs to be properly funded and is not fully achievable by moving existing NHS financial resources to social care, or vice versa. Access to integrated care services needs to be based on NHS principles—funded through taxation and free at the point of delivery, based on need and not the ability to pay.”
Andrew Griffiths (Burton) (Con): I share the concerns the hon. Lady raises, but she made a point about council cuts. Does she not think that her council would be better off using the £160 million it has in its reserves to fund such services?
Meg Munn: The hon. Gentleman displays his ignorance. Councils do not sit on reserves that they can use to fund services willy-nilly; they have commitments that they have to meet. When I was a councillor many years ago, I recall my city treasurer saying that reserves can be used only once. It is not sensible to use reserves for revenue. They are needed for a wide range of issues.
Meg Munn: I will not give way, because I want to stay with this issue. There is no way that the Government, by saying such things, can hide from the real impact that their cuts are having on local government.
Let us get back to the funding for new things in the Bill, some of which the Opposition support and some of which I support. What funding has the Secretary of State already outlined? The 2013 Budget set out reforms that would mean additional spending of £1 billion in 2016-17 and 2017-18, but there was no detail of how the care cap would impact on costs beyond 2017-18. We know of £335 million for implementation in 2015-16, which breaks down as follows: £145 million for early assessments and reviews; £110 million for deferred payment, including the cost of administering the loans and the loans themselves; £20 million for capacity building, including recruitment and training of staff, which we all know is vitally important for cultural change; £10 million for an information campaign; and £50 million for capital investment, including IT systems, that sits within the better care fund. For the better care fund, there will be a £3.8 billion pooled budget between health and social care. It is, however, not new money, but rather a pooling of existing resources. Allocations to clinical commissioning groups will provide £1.9 billion, and the rest will be made up from a variety of existing funding schemes—[ Interruption. ] The Minister is gesticulating to say that he has not hidden that fact. He has not, but the impact is that things that are being done now will have to stop. While it may be possible to stop some such things, I do not accept that there will be no impact on services—[ Interruption. ] I am going to keep going, Mr Bayley, because the nature of the Minister’s role means that he gets to reply at the end, so it makes sense if I keep going.
When speaking to the Health Committee, Sir Bruce Keogh, NHS England’s medical director, said that there was “great scepticism” that the £3.8 billion better care fund would achieve one of its stated aims of reducing demand on A and E services. Pooled funding carries inherent risks by withdrawing significant funds from the NHS front line at a time of unprecedented pressure on the service. The NHS Confederation has said that it wants to see care moving into the community and that local health services need a period of time, during which current services continue to be funded in parallel with investment in new models of care. That was precisely how changes were made when the National Health Service and Community Care Act 1990 was implemented in the early 1990s, which led to greater success.
There are questions about the level of additional funding required beyond the first two years, because most people are unlikely to have reached the cap by the time that local authorities will have to fund the cost. There is no account for the socio-economic differences between local authorities. There may also be a case for a consistent national approach to the whole area of systems development, including data sharing between local authorities and within the NHS, rather than having 150 locally developed systems.
The amendment is probing. Significant costs are involved for new services, and new money is required up front to help local authorities and the NHS to put in place the
The Chair: It will probably be helpful if I remind the Committee that, formally, this is a debate on whether clause 72 stand part of the Bill, but grouped with that question is this batch of new clauses on funding for care and related issues. The debate may range over any of the matters in the various new clauses, but not points about the performance of an individual council or such matters.
Liz Kendall: New clause 15 states that before any of part 1 of the Bill comes into force, the Department of Health’s joint care and support reform programme board must inform the Secretary of State whether there is sufficient funding to implement the Bill satisfactorily. New clause 16 would establish an independent committee to advise Ministers on the workings of the so-called cap on care costs, the level at which it is set and the working of the means test. New clause 17 would require the Secretary of State to ask the Office for Budget Responsibility to conduct an assessment of social care funding, including the adequacy of current public funding, the proposals for funding the provisions in the Bill, the implications of the Bill and funding for the NHS over the next five years, which is crucial, and eligibility criteria. New clause 18 would ensure that before the Bill’s provisions on eligibility criteria, the means test and deferred payments come into force, the Secretary of State must publish an impact assessment of them.
New clause 15 takes forward the points that my hon. Friend the Member for Sheffield, Heeley made very powerfully. The Government have given repeated assurances that they have provided enough resources to implement the Bill. Many councils thought that those resources would be additional, but we have discovered that they are not. As my hon. Friend has just said, in the June 2013 spending review, the Chancellor announced £335 million in 2015-16 so that
That covers early assessment, the cost of setting up deferred payments, training, and a whole load of IT systems that will have to be set up to develop people’s care accounts so that they can see how much they are clocking up towards the cap.
When the Government spelled out further details of the local government funding settlement in July 2013, we and the LGA discovered that that money was not new, but was top-sliced from existing council budgets. Following that, the Department of Health announced that it had figured out that it needed another £130 million to pay for implementing the adult safeguarding boards, putting carers on a par with users in terms of assessment, and for setting the national eligibility criteria. Again, that money is not new. It has been taken from the better care fund. The £3.8 billion integrated budget for the NHS and social care, as we have heard, is not new money, but a pooled budget. They are taking money out of that to set up care accounts, assessment and other things. Almost £500,000 of implementation costs will come from existing budgets. That will mean taking
With the best interpretation, that is not what the Government claimed when they made their announcement. They said that there would be additional funding, fully resourced. There is a concern that setting up a care account and doing all the necessary assessments under the Bill will take money from existing users who are already struggling desperately to get the care they need. They are getting 15-minute home visits, we have staff on zero-hours contracts and people are not getting their home adaptations. That is the reality of this Bill: £500 million from existing users to pay for setting up the new system.
Our new clause says that we have to be clear where the money is coming from, whether it is enough to implement what is going on in the Bill and what the consequences are. ADASS and the LGA rightly say that the joint care and support reform programme board within the Department of Health must make a thorough assessment of that. If we are being asked to vote on a Bill, we need to know where the money is coming from and who it is coming from.
New clause 16 proposes setting up an independent committee to keep under review the workings of the cap and the means test and to advise Ministers. We have said throughout the passage of this Bill that we are really concerned about who the cap, means test and eligibility criteria will benefit: which people, in which parts of the country and which levels of income? We want a fair and just system that helps those on low and middle incomes, the people who have worked hard and saved all their lives, not just those at the top. However, we cannot see how this will work.
We want some independent advisers on this, drawn from academia, councils, the voluntary sector and others, so that we get a proper assessment of who this benefits, because we still do not know the answer to that question. New clause 17 is a fundamental requirement and is part of what I would argue is a long-term piece of public policy reform. It asks the Office of Budget Responsibility to report by the end of this year on its assessment of the funding for adult social care. I remind members of the Committee that Andrew Dilnot said that we need enough money in the current system in the baseline as well as reforms for the future. There have been huge rows, essentially, about this. The Government say: “We have put enough money into local councils,” ignoring many of their own party’s council leaders who say the precise opposite.
ADASS and the LGA say that £2.7 billion has been cut from adult social care so far in this Parliament. The Government say no—it is all efficiencies. I have no doubt that some are efficiencies. Our councils are working really hard to do that, but it is simply not credible to claim, when local councils’ budgets have been cut by a staggering third, that it is not having an impact on front-line services. We want the OBR to look at and assess the current level of funding in social care and, critically, to look at the impact on the NHS of what is happening to the local council care budget.
We have to stop looking at these two budgets separately. They are intimately linked. We have called for one budget across both the NHS and social care, so that we can really plan for the future. The OBR can look at this
In the other place, Earl Howe said that the Government did not want a proposal like this, because the OBR was independent and should have nothing to do with politicians. However, it is precisely its independence that would give people using care, politicians and those working in care a proper sense of whether we are providing a sufficiently funded service. On new clause 18, as we have said many times before, we need to have an assessment of all these regulations on the means test, the cap and the deferred payments scheme if we are to properly judge the Bill.
As we are coming up to time, I want to ask a couple of final questions to the Minister about clause 72, on a stand part basis. This is about the Secretary of State needing to review the provisions in this Bill every five years: the means test, the cap, eligibility criteria and how it is working. I am surprised that the five-yearly review does not also look at one of the fundamental claims that the Government have made regarding the Bill, which is that it will create a market in long-term care insurance products.
“By creating a cap on what people will be charged, we can create an insurance market so that everyone can try to protect themselves against the long-term costs of social care.”—[Official Report, 13 February 2013; Vol. 558, c. 856.]
However, yesterday, there was a story in the Financial Times entitled, “Long-term care policy suffers setback”. There is a pretty glum picture of the Minister; I do not
“Insurers have dashed government hopes of early products covering the cost of long-term care for the elderly, undermining one of the coalition government’s most trumpeted policy successes…Creating a framework within which people can insure themselves against care costs is seen in government as a key part of demonstrating that the Dilnot reforms will not simply help the better off…but will also enhance security for the less well-off. However, since the Dilnot recommendations were accepted, it has emerged that in many cases people will have to spend far more than £72,000 before attracting government help”;
Finally, I am not clear whether the five-yearly review will look at the deferred payments scheme. All the reforms are intimately linked, and if there is to be a review, they need to be looked at together.
There are big questions with the clause about the long term. We want the clause to be a long-term and sustainable solution for the funding of social care. We are not fully convinced of that at the moment.