Joint Committee on the Draft Mental Incapacity Bill Minutes of Evidence

Examination of Witnesses (Questions 460-479)


14 OCTOBER 2003

  Q460  Baroness Knight of Collingtree: So further consultations are actually scheduled?

  Mr Collingridge: I have spoken to the people and yes, they have given an undertaking to meet with us to work out in more detail the implications. That is particularly dependent on, I think, the report of this Committee and what exactly are the implications on and the expectations of local authorities.

  Q461  Huw Irranca-Davies: I have listened with interest to the immediately preceding comments in respect of the Bill as it stands now and the impact on resources. If, to go back to the previous discussion, we were to look at the much more strengthened, central role of the rights of citizenship and so on, you must have put some thought to this as to the impact on resources of much more central, much more focused rights of the individual?

  Mr Dixon: I think it would have some greater resource implications but I think it would be more that it would be underwriting the change in public policy that I think is happening already and which I think needs to be given an additional push. It would be very difficult to quantify.

  Q462  Huw Irranca-Davies: So you anticipate those demands will become apparent regardless of what we put on the face of the Bill?

  Mr Dixon: Yes. I think, to some extent, that affects the whole of this Bill. For example, in relation to Court of Protection work, Hampshire has started to do this work on Court of Protection, obviously, before this Bill has been enacted, and we have done too. It is because there are changes in expectations that we have got to respond to anyway, and the issue about adult protection has become a very major issue around the country. Again, without proper resourcing I think it is important that it is brought within the legal framework.

  Q463  Mr Burstow: It is that point I wanted to go back on, the whole question of adult protection. Two or three years ago now the guidance was issued by the Department of Health No Secrets. Can you tell us what assessment you have made of the implementation of that guidance by local authorities? Are we still at the stage of codes of practice and training or are we now at the stage of having procedures that are actually having a reaction on the actual delivery of service and in dealing with abuse in care settings?

  Mr Collingridge: My conversations with my colleagues around the country on this issue over the last week have revealed that there are quite different responses from authorities. My own and Herefordshire (who have just agreed to take the lead on this in our ADSS) have got some well-established guidance and local overview committees, practices and training in place. Other places have not really begun to implement it very substantially. It is not a matter that, at the moment, is regularly reported on to the Department of Health. As far as I am aware, there has been no particular inspections. So, frankly, we do not have, as yet, the overview. We would expect some time in the new year, with our new committee ourselves, to have a bit more of a feel, but it does feel a bit patchy at the moment.

  Mr Dixon: Could I just add that we do feel bothered that after No Secrets had been launched it has tended to slip a bit out of the public eye. I am Chair of the Adult Protection Committee in West Sussex and we have quite significantly taken action in this area, we have had a number of adult protection investigations; it was on the television about a care home in West Sussex, an independent care home, last week and automatically the National Care Standards Commission picked it up and referred it to an adult protection investigation. So there is a lot of activity going on around this.

  Q464  Mr Burstow: Are there any ways in which this Bill could help facilitate the roll out of No Secrets and the strengthened implementation around the country?

  Mr Collingridge: There are. We have heard some lobbying and I think you have probably heard it too—suggestions that local authorities should have statutory duties to intervene. I believe, for example, in the general authority, when that has not been working terribly well or there is conflict, perhaps there is a role for local authorities there. You can certainly think of issues around that area where we should have stronger powers to intervene, and perhaps a duty.

  Baroness Fookes: I do not have a clear picture of precisely what additional resources would be needed. Could you reduce it, as it were, to one local authority, one social services department? Would you need X number of additional social workers? What would be the cost per year and how is this going to be sold not to the Department for Constitutional Affairs but to the holder of the purse strings, the Treasury?

  Q465  Baroness Barker: I have an additional question that follows straight on from that. Does the way in which social services departments relate to different client groups in different ways have an impact on the quality of the service? Does that have a very significant impact for a detailed Bill that covers very different client groups?

  Mr Collingridge: As I said before, we cannot give you detailed numbers. I can tell you, for example, in Hampshire how many social workers we have got.

  Q466  Baroness Fookes: That is what I want to know. For a particular authority.

  Mr Collingridge: I have my statistics here in front of me for Hampshire County Council social services. For example, we have got 200 managers of various sorts, 650 social workers and another perhaps just under 3,000 field workers of various sorts—support workers, home care workers. Plus, of course, you have got a whole tranche of people in the independent sector which I have not counted there. All of those people will need a basic level of training. Then, of those 650 social workers, if you are going to have to allocate particular adult protection cases—and we would expect demands to go up over the next few years—you might be able to factor in after a bit of research how much extra demand, but I cannot tell you. That is the baseline from which we are working at the moment in a total population in Hampshire of 1.2 million. Those kind of figures I have just given you, I can do more on that, but just to emphasise, Hampshire is one of the wealthiest county councils and, therefore, our numbers are relatively low in comparison to more metropolitan areas. That gives you a ballpark figure of where we are starting from.

  Q467  Baroness Fookes: How many additional social workers, for example, might you be thinking of?

  Mr Collingridge: We do not have a figure to put on it at the moment.

  Mr Dixon: For adult protection an authority of the size of about half-a-million to one million people might have appointed about three additional social workers. It is not a vast amount. It is certainly affordable. It is, I hope, not so much that it would scare the Treasury.

  Q468  Baroness Fookes: Are they there to be called upon? I thought there was a shortage of social workers.

  Mr Dixon: There is.

  Mr Collingridge: The recruitment and retention of social workers is a major issue. The Department of Health has been engaged in some work nationally to try and raise the profile.

  Q469  Baroness Fookes: Even if you have the money it may not necessarily be easy to get the bodies?

  Mr Collingridge: That is right. There needs to be a whole strategy around this. If I can just add as well to the issue about figures: I looked yesterday into how many adult protection referrals Hampshire had had. We had 80 in the first six months of this year. So that perhaps gives an indication of the size we are looking for.

  Q470  Mrs Humble: Of course, it is not just social workers, it is your trainers, it is the administrative staff, it is the back room people who make sure the social workers can do the job.

  Mr Dixon: Absolutely.

  Q471  Lord Rix: Could I add to that? You mentioned independent agencies; I presume you mean voluntary bodies, I presume you mean parents, you mean carers, etc. They have all got to be added to the bill, too, in some way or another.

  Mr Collingridge: Yes.

  Mr Dixon: An adult protection committee now comprises about 20 different organisations, including voluntary organisations, including a range of statutory organisations and others. Could I answer the other question about the impact on different, what we would call, client groups? I think that is a very important point because we do provide a differential level of service to different age groups and people with different ranges of need. I think part of, as it were, our bid today is to be saying that this is a group of people who have tended not to get their fair share of the resources that there are going because their profile is lower. I think it is important that we should address that because there is a groundswell of need and a groundswell of opinion that we should move to assist them.

  Q472  Baroness Barker: Following on that point, in the additional resources you are talking about, what would be the impact of Directors of Social Services to act as court appointed deputies, able to take welfare decisions for people who lack capacity? Could you answer that in light of the different and changing financial interests of charging policies which your departments are likely to be entering into?

  Mr Collingridge: First of all, I think possibly many more authorities are going to have to pick up on the financial issues and have receivership units like, for example, Hampshire has. That costs us about £120,000 a year, of which we get back some money in charges. Secondly, there will be additional social workers for cases. I think you will have to have an individual person allocated to keep a close eye on the people for whom we have powers. Thirdly, of course, there are the legal costs and administration. We may need some additional administrative committee-like committees to oversee implementation—I do not know. There is one other issue which you, perhaps, were not expecting me to say on this, but in our discussion with the Department for Constitutional Affairs they talked about not the Director but, perhaps, people lower down in the structure having the legal power. We have got some concern about that; we think perhaps it should be the statutory function of Director who then delegates down, but certainly some of the thinking was perhaps to give the legal powers to a manager or even a social worker, and we are not terribly happy about that. That is the first part of your question. I cannot remember what the rest was now.

  Q473  Baroness Barker: I wanted to focus particularly on charging policies and potential conflicts of interest. If I might add to that, what are the implications for this work when you are increasingly involved in joint planning of services with PCTs, for example?

  Mr Dixon: Clearly, we need to think through what the implications would be for charging, but local authorities are very used to charging where we can because, otherwise, we are not going to be able to provide services for others who are in need of them. So where that is feasible and appropriate we want to explore that possibility as part of the development of the codes of practice.

  Q474  Baroness Barker: How would you deal with conflicts of interest?

  Mr Dixon: I think, to come back to the point we made at the very beginning, we have a clear responsibility to receive tax, to raise taxes locally and to try and square the equation in terms of the way we spend the money in relation to meeting our legal obligations and, indeed, our moral obligations. We need to establish advocacy and support for families and for service users to balance out what is that evident conflict of interest between us. The executive, whether it be a local government executive or national executive, always has that conflict of interest between resources and what we spend. It is the job of advocates, as it is the job of families, to be unconcerned about the resources but to be concerned only on the need. We need to have somebody who will come forward who will tell us also what that need is, so that we can hopefully do better at balancing that equation, but is a perennial problem that we live with.

  Q475  Lord Pearson of Rannoch: Forgive me, but should that be up to a director of social services?

  Mr Dixon: I think there is an issue there. I think there is a potential problem. On the other hand, we do, not infrequently, intervene in people's lives whether it be children or whether it be adults where other people who would be expected to undertake those responsibilities fall down. So if somebody has a general authority and is abusing that in some way, or there is an adult protection issue around an LPA then we would expect to intervene because somebody needs to do so. There is a principle here, in the Bill, of the least intervention in people's lives, and that is very important.

  Mr Collingridge: Your question prompts me to think about some of the new arrangements that have come in recently about scrutiny and overview committees. Our one in Hampshire has just reminded me recently that they could scrutinise what I do, and there is a whole new set of relationships and functions in local government whereby the executive is called into account by other groups of elected members. So that offers a possible check or balance.

  Q476  Baroness Knight of Collingtree: Coming back to a point you made just a few moments ago, in your submission to us you say at one point "We would like to know what proposals are being developed to enhance access to these services through the voluntary and independent sector, including the resources made available." Was that just a cry in the wilderness or were you actually hoping to get an answer there? If so, from whom?

  Mr Dixon: That is back to the advocacy question. I think it is not a cry in the wilderness—

  Q477  Baroness Knight of Collingtree: You anticipate getting an answer at some point?

  Mr Dixon: Yes, indeed.

  Q478  Baroness Knight of Collingtree: From whom?

  Mr Dixon: Anybody who is prepared to give it!

  Q479  Mr Burstow: I wanted to come back to this issue of conflict of interest. It is really central to the part that local authorities and social services departments will play in giving effect to this legislation. Are you saying to us today that you have a clear idea of how you would separate out your responsibilities as a substitute decision-maker for an individual who lacked capacity from your responsibilities both as executive and scrutineers of your activities in carrying out your fiduciary duties to your ratepayers, or your council taxpayers? They are two completely separate things. If one over-weighs the other, and you act in the interests of the ratepayer, you may well means-test someone and charge them, dispose of their assets in circumstances where, in fact, if they had capacity, they may well have wished to contest the argument and, indeed, argue that they had, for example, continuing care rights that were not being properly discharged. How do you square that circle? Can you square that circle?

  Mr Dixon: No, you cannot square the circle. It is a continuing tension and it is one that we live with on a daily basis. Social workers take decisions, managers take decisions, and I, along with our elected members, oversee those decisions on a constant basis. I think it is impossible to take that tension and that task away from any executive. You always have to balance out the question of meeting need with rationing the resources that are required to meet that need.

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