4 General responsibilities of local
The well-being principle: Clause
its consultation paper the Law Commission proposed that there
should be tightly defined processes for determining the scope
of adult social care. Replies to the consultation persuaded them
instead to define the purpose of adult social care as promoting
or contributing to the well-being of the individual. That recommendation
was accepted by the Government and is central to the new policy
on adult social care; clause 1(1) of the draft Bill provides that
"the general duty of a local authority, in exercising a function
under [Part 1 of the draft Bill] in the case of an adult, is to
promote that adult's well-being."
whole of the policy structure, and hence of the draft Bill, is
shaped by this provision. All the evidence we have received which
refers to this has done so in terms of approval; the general sense
is that all those concerned regard this as a highly desirable
development and one which leads to improved legislation.
We agree. We also believe that when this legislation comes before
the courts for interpretation, as inevitably it will, it will
be easier for them to determine whether action taken, or not taken,
complies with this principle, rather than to attempt to decide
whether or not it falls within a definition of what constitutes
adult social care.
principle does not define the policy of a local authority, but
applies to individual decisions taken within the context of that
policy. "The well-being structure fits into the policy, rather
than determines the policy.
if one local authority only
met "critical" needs but another met "moderate"
needs then the well-being principle would not determine that you
could not have that policy, in terms of something equivalent to
the FACS banding
system. It would mean that within that FACS type structure, the
well-being principle would apply to each individual decision that
1(2) defines "well-being" as meaning, in relation to
an adult, that adult's well-being, so far as relating to any one
of a list of seven factors. It was put to us that other factors
should be included in the list. One of these, supported by Caroline
Abrahams, the Director of External Affairs of Age UK,
was "the dignity of the adult". The Law Commission considered
but rejected this: "We remain concerned that concepts such
as dignity and independent living are too imprecise
to be expressed as statutory principles. The notion of dignity
has been used by the courts in judgments which are addressing
texts which do not use the word dignity. This suggests
that while a legal structure can be constructed in a way that
is conducive to dignityor even in a way which undermines
itit is difficult to build a legal structure on the imprecise
notion of dignity. 
We respect that view, but believe that "dignity" is
no less precise than some of the other factors listed, and we
support its inclusion.
list does not currently include any reference to housing, and
a number of witnesses thought this was an omission that should
be remedied. In their written evidence Midland Heart, one of the
largest housing, care and regeneration groups in the country with
over 33,000 homes, said: "We believe that the definition
of well-being should include having access to safe and settled
accommodation so that individuals are able to live independently
in an accessible home which can be adapted to fit their needs."
We agree that the quality of housing is of such importance that
a local authority should always have it in mind when considering
the well-being of the individual, and that it merits a specific
reference in the list.
were other suggestions. One was a reference to parenting,
but we believe this is already adequately covered by paragraph
(f) which refers to "domestic, family and personal relationships".
Another was the insertion of a reference to the United Nations
Convention on the Rights of Persons with Disabilities (UNCRPD).
On behalf of Disability Rights UK Sue Bott, the Director of Development,
told us that the Convention "very much sees the disabled
person as the whole person, not just a person who might be in
need of particular support."
She was supported by Paul Farmer, the Chief Executive of Mind.
The Law Society made the same point in their written evidence.
The Law Commission, in considering a suggestion for the inclusion
of "independent living" as a factor, rejected it on
the ground that it was already adequately covered by Articles
8 and 19 of the Convention.
It does not however seem to have been suggested to them that the
Convention should itself be listed, and we do not think that it
should be. It imposes numerous obligations on the States party,
many of which have nothing to do with social care, and some of
which are cast in very general terms. We are not convinced that
it is realistic to suggest that local authorities, in exercising
their duties under the draft Bill, should be obliged to have regard
to such a document. The specific matters already listed in clause
1(2) will provide enough guidance.
of our witnesses also suggested that there should be an explicit
reference to human rights legislation. When the Law Commission
considered this question it concluded that statutory principles
were not necessary to promote non-discrimination and human rights.
In the Law Commission's view it would simply repeat unnecessarily
the provisions of the Equality Act 2010 and the European Convention
on Human Rights. We share this view.
recommend that the list in clause 1(2) of matters to which well-being
relates should be enlarged to include the dignity of the adult,
and the availability of safe and settled accommodation.
TO WHOM DOES THE PRINCIPLE APPLY?
we have said, the well-being principle applies "in relation
to an adult". Clause 1(5) defines an adult as "a person
aged 18 or over", without further restriction. On this basis,
the duty might be interpreted as including any adult in relation
to whom a local authority exercises a function under Part 1 of
the draft Bill. However there are provisions of the draft Bill
where "adult" plainly does have a more restricted meaning,
and in particular where it is contrasted with "carer".
Clauses 3(3), 3(5), 6(2) all contrast "an adult's need for
care and support" with "a carer's need for support".
Clause 9(5) refers to "the adult" and "any carer
that the adult has". It is clear that in these and other
provisions "adult", without more, means "a person
aged 18 or over who is or may be in need of care and support".
If "adult" was given this meaning in clause 1(1) to
(3), it would follow that the well-being principle did not in
terms apply to carers.
On the other hand, clause 10(3) defines "carer" as "an
adult who provides or intends to provide care for another adult
(an 'adult needing care')".
this is easily misunderstood is clear from the evidence of Emily
Holzhausen, the Director of Policy of Carers UK, who said: "[Clause
1] just refers to adults and does not refer to carers, whereas
in the rest of the Bill we refer to adults when they are adults
who need care and carers separately. Just for completeness' sake,
starting with clause 1, we need to include carers. I honestly
do not think for a minute that people would want to disentitle
carers, but for the removal of doubt we would need to do that."
intention of the Law Commission is not entirely clear to us. Paragraph
4.29 of their report begins: "As a general rule the well-being
principle relates to the subject of the decision. If there are
competing interests, such as those of the carer, these would only
be relevant insofar as they related to the well-being of the subject
of the decision." This suggests that the carer is not "the
subject of the decision" to whom they intend the well-being
principle to apply. But later they refer to "
two people are being assessed and their well-being is incompatible
(such as a carer and a service user)", and to "the carer's
their intention, the conclusion we draw is that it is at best
not clear on the current wording of the draft Bill whether the
principle will apply to carers. We believe that it should. We
asked the Department of Health what the Government's intention
was, and they informed us that it is their intention that the
principle should apply to carers as well as to adults needing
care. We believe
the draft Bill should be clarified to put beyond doubt that the
well-being principle applies as much to adult carers as to adults
who are or may be in need of care and supportadults needing
care, as they are described in clause 10(3). It would further
clarify matters if our recommendation to place the definition
of "carer" in clause 1 is adopted.
1(5) should be amended to make clear that the well-being principle
applies as much to an adult carer as to the adult needing care.
clause would still not apply in terms to a local authority's functions
in relation to children, even though the transition provisions
in clauses 39-44 deal with assessment of a child's needs for care
and support, and a young carer's needs for support. Such assessment
are however made on the basis of the child's or young carer's
needs when they reach the age of 18, and we believe that it is
clear that the well-being principle must apply in such cases.
drafted the Bill applies the well-being duty to decision-makers
within the assessment and care planning framework set out in the
Bill. However, many of the details that will shape the way in
which local authorities discharge their functions under the Bill
are subject to regulations and guidance issued by the Secretary
of State. For example, clause 13 gives the Secretary of State
very broad powers to set out in regulations the rules governing
1B(1) of the National Health Service Act 2006
provides that "in exercising functions in relation to the
health service the Secretary of State must have regard to the
NHS Constitution." We suggested to the Secretary of State
that he should be obliged to have regard to the requirements of
clause 1 on well-being when exercising his functions under the
draft Bill. He replied: "We absolutely want the well-being
principle to apply comprehensively."
welcome the importance that Ministers attach to the well-being
principle. We recommend that the draft Bill should include a provision
requiring the Secretary of State, when making regulations or issuing
guidance, to have regard to the general duty of local authorities
under clause 1.
Information and advice: Clause
INFORMATION AND ADVICE
2 has often, in evidence to us, been described as the local authority's
duty to provide information and advice to adults and carers on
care and support. The obligation is in fact to "establish
and maintain a service for providing people with information and
". Sarah Pickup, the President of the Association
of Directors of Adult Social Services (ADASS), explained the difference:
"It does not have to be us that provides the advice. We need
to make sure advice is available. In my signposting system in
Hertfordshire, the HertsHelp system will get you to the place
that can give you the best advice. The CAB is part of that network,
for example, if you need advice in that territory. Our Money Advice
Unit is part of that advice. We do a lot of welfare benefits advice."
85. A number
of witnesses reminded us that information is not the same as advice,
and some thought local authorities were not always well placed
to offer impartial advice, a point made by Mears Group, one of
the largest UK providers of domiciliary care, support services
and social housing repair: "The key risks with the duty to
provide advice are around impartiality, balance and quality. Our
experience has shown that local authorities tend to be more reluctant
to promote and even engage with private companies than third sector
providers, even if it can be demonstrated that the private provider
is delivering a higher quality service at better value for money.
Mears would like to see the Bill ensure that advice is
given on the basis of the best quality of service and not whether
the provider is a third sector or private business."
Mears of course have a particular interest in this, but we agree
that this is another reason why advice services should be provided
at arm's length, and not by the local authority itself.
2(2) lists four particular matters on which the local authority's
service must provide information and advice: the system and how
it operates; the choice of types of care and support, and of providers;
how to access the care and support that is available; and how
to raise concerns about the safety of an adult. These are illustrative
only, but we received suggestions that other matters should specifically
be added to the list. The National Housing Federation told us
in their written evidence that a new paragraph should be added
to clause 2(2) to make clear that information and advice should
be provided on local housing options, including specialist housing,
accessible housing and adaptations. They pointed out that local
authorities already have a duty under the Housing Act 1996 to
offer advice on housing options to those in housing need.
Jake Eliot, the policy leader of the National Housing Federation,
made the same point in oral evidence, as did other witnesses.
For the same reasons that persuaded us to agree to the inclusion
of housing in clause 1(2), we agree that it should receive a specific
mention in clause 2(2). Another suggestion with which we sympathise
was that a new paragraph should be added to make clear that information
and advice should be provided on the ways in which people can
contribute to the design of new services, where none are available
to meet their needs.
of our witnesses were concerned that the Government had given
the impression that digital was their preferred channel for information
services. Given that there are over 5 million households without
we would be concerned if digital or on-line sources were to be
the sole means of obtaining information about the care and support
system, a point echoed in the responses we received in our web
forum. We were reassured to be told by the Secretary of State:
we will make sure there is provision for people who
are not IT literate, because they are some of the most vulnerable
people whom we need to help."
need for advice to be impartial is particularly acute in the case
of financial advice. This does not currently appear in the list
in clause 2(2), and several of our witnesses thought it should.
Independent Age said: "We suggest that clause 2(2)
should include: "(e) any relevant charging arrangements for
care and support in the local authority's area;" and "(f)
signposting to independent financial advice on the options for
paying for care and support".
care and support framework extends to those who self-fund their
care and support, giving rights to an assessment of care and support
needs and the information and advice services the local authorities
will be under a duty to provide. Clause 23(2)(c) gives those with
care and support needs, but who are not entitled to local authority
provided care and support, a right to information and advice.
Partnership, the largest provider of long term care insurance
in the United Kingdom, explained that advice would be particularly
important for self-funders, who constitute 41% of those in the
Patterson QC told us: "I suppose it might be arguedI
am not saying that I am going tothat under clause 2(2)(a),
which is so general about the system provided for by this Part
and how the system operates in the authority's area, it might
include financial advice. That would then be taken up in guidance.
For the avoidance of any doubt, if one wanted to go there, it
could be included. You put the question rather more precisely
by saying: does it have to be? I would say that it does not have
to be but it could be."
We believe that it could be and should be.
draft Bill should make clear that "information" and
"advice" include financial information and advice, and
that local authority services should recommend financial advisers
only if they are regulated by the Financial Services Authority.
following matters should be added to the list in clause 2(2) of
matters on which the local authority's service must provide information
- ways in which people can contribute to the
design of services, where none are available to meet their needs;
- local housing options, including specialist
housing, accessible housing and adaptations;
- any relevant charging arrangements for care
and support in the local authority's area;
- obtaining independent financial advice on
the options for paying for care and support; and
- where such advice can be found.
consider in Chapter 5 the particular need for financial advice
when a person in need of care and support enters into a deferred
payment agreement with a local authority, and in the case of third
is listed in clause 8(1) as an example of what a local authority
may provide to meet an adult's or carer's needs, but it is not
mentioned in clause 2 which, as we have said, deals only with
a service providing information and advice. A number of our witnesses
thought this a curious omission, and one which should be remedied.
Action for Advocacy told us in their written evidence that it
was important to provide independent advocacy at the right time:
"This [clause 8] seems to be the wrong place to put advocacy.
If it remains in this place, advocacy may only be provided following
an assessment of needs for care and support. That would require
the assessor to identify a person's need for advocacy in order
to have their voice heard and ensure choice and control ... the
general duty to provide information and advice should be extended
to include independent advocacy." In his oral evidence Martin
Coyle, the CEO, reiterated this point: "
is implied through so much of the Bill so far that we may as well
at least spell it out."
for Advocacy is a charity whose purpose is to promote advocacy
services for vulnerable people and to support advocates, including
paid advocates. But others were of the same view. Sarah Pickup
thought it was "important that people have access to advocacy
if they need it."
Andrea Sutcliffe, the Chief Executive of the Social Care Institute
for Excellence, said: "
what we do not actually highlight
in the Bill or make happen is the provision of what you might
call either brokerage or advocacy to, as you suggest, fight the
corner for an individual who might not be able to do that for
themselves." Richard Humphries agreed.
Law Commission pointed out that "There is already a general
right to advocacy in adult social care legislation, in the unimplemented
provision of the Disabled Persons (Services, Consultation and
Representation) Act 1986." They recommended that this right
should be recreated in the new statute, but thought they would
be straying beyond their powers to recommend its immediate implementation.
We are under no such constraints; we believe that the general
right to advocacy should be included in clause 2.
"advice" and "advocacy" are nowhere defined
in the draft Bill. Action for Advocacy thought they should be
defined in regulations, but did not offer suggestions for a definition.
If "advocacy" is to be included in clause 2, we see
no reason to attempt to define the boundaries between information,
advice and advocacy.
the Ministers gave evidence to us, Sally Warren told us she thought
advocacy would be provided at two main stages: the point of assessment
and care and support planning, to help the person articulate the
outcomes they were trying to achieve, and the point of planning
for their care and support needs, to help them to be clear about
how they wanted to meet those needs. When asked whether the draft
Bill should make clear that advocacy could be provided at the
first stage, she replied that the Bill already did this through
the universal requirement for information and advice.
are glad that the Government intend that advocacy should be covered
by clause 2, but we do not believe this is clear on the face of
the draft Bill. Clause 2 should be amended to make clear that
independent advocacy is to be available before the assessment
process has begun, and not only as one of the ways of meeting
needs under clauses 17-19.
Promoting diversity and quality
in provision of services: Clause 3
3(1) imposes on local authorities the duty to promote the efficient
and effective operation in their area of a market in services
for meeting care and support needs. In our call for evidence we
asked how local authorities could satisfy that duty, and how they
could encourage a diverse range of high quality providers. The
Care and Support Alliance, while welcoming the duty placed on
local authorities to promote diversity and quality in the provision
of services, pointed out that local authorities have never had
this market function before, so that regulations and guidance
needed to be detailed and provide clarity as to how this function
should be performed.
of our witnesses stressed the variety of services available in
different local authority areas, and emphasised the importance
of a range of care services and accommodation being available.
Mears Group, while supporting the need to strengthen diversity,
were concerned that many local authorities interpreted this as
simply increasing the number of providers: more providers did
not in their view equate to more choice.
carry out this duty, a local authority needs detailed data on
the availability of different services, and on the pricing and
charging structures. There were suggestions that some local authorities
do not have adequate data to support their strategic plans. Mencap
told us that at a consultation event, service providers and Mencap
local groups shared experiences of poor planning by local authorities
which led to inadequate management of funding and a lack of choice
of services for individuals. There was particularly a poor knowledge
of people with a learning disability in local demographics. Mencap
suggested that the duty to produce strategic plans should be supported
by a duty on local authorities to keep accurate records of the
number of people with a learning disability in their area.
concern was summed up by Colin Angel of the National Home Care
Association who told us that "What many councils have is
a partial understanding of their local market based on the section
that they transact with. Traditionally, authorities have had lists
of approved providers; those are the organisations they will know.
They will largely be providers delivering services to a council's
specification. There is much less intelligence, however, about
what occurs outside of those arrangements. The risk is that people
will continue to be directed into the services that councils would
traditionally have purchased and to miss out on knowledge, understanding
and direction to more creative and flexible services that offer
different options to people."
number of our witnesses expressed concern about the way in which
local authorities exercised their existing commissioning responsibilities.
For example, while welcoming the market shaping duty Des Kelly
of the National Care Forum told us that "In a way, local
authorities already had this responsibility. The market we have
is a result of the way that local authorities have operated. We
talk about commissioning, but actually, mostly, we mean contracting
or procurement. It is not about commissioning. Too few of the
discussions between local authorities as commissioners and providers
are about commissioning rather than what price they are willing
to pay. It is not really about what services they want in the
future and how those services are best provided. That is part
of the difficulty."
led some of our witnesses to call for the market shaping duty
to be more explicit about the obligations on local authorities
to gather intelligence and "talk to all of the playersbe
they not-for-profit or for-profit."
Others wanted to make sure that there was a clear link with the
production of Joint Strategic Needs Assessments (JSNAs) to drive
a full understanding of current and future population level needs
for care and support. The Charity Sue Ryder in its written evidence
said "In order to develop a diverse marketplace local authorities
must complete an assessment of the local population's needs."
However, they expressed concern that the current generation of
JSNAs do not provide the data necessary to support the market
shaping duty. In its report The Forgotten Millions it reports
that only 5% of local authorities were able to provide detailed
data on the number of people with any neurological condition that
they provided care and support for.
Gallagher, the Department of Health's Director for Social Care,
Local Government and Care Partnerships, was clear that the market
shaping duty is a broad one. He told us "First, you are missing
a trick if you see this only as something that the social care
bit of the authority is going to worry about. A really good market-shaping
responsibility works with the local NHS and with housing authorities
and other functions, because one of the best bits of innovation
is where you can define new types of service that span those different
areas. You actually achieve more by bringing those things together.
Secondly, you need to work with the existing providers to say,
'Okay, we think that our community needs a different type of service
over the next five or 10 years. What are you going to do to try
to develop that and where we might need to see some new developments,
whether that is social enterprises or other sorts of innovative
of these concerns are not directed at the market shaping duty
itself. They reflect existing procurement practices, behaviours
and relationships. The Department advised us that it is running
a national support programme offering tailored assistance to local
authorities to develop their capability to discharge this new
duty. The Government should ensure that the Department of Health's
national support programme and guidance to local authorities address
these concerns; in particular they should make certain that Joint
Strategic Needs Assessments provide a sufficiently detailed picture
of the scale and character of current and future individual needs
to support market shaping.
also believe clause 3 should be amended to put beyond doubt that
local authorities must involve service providers, service users
and carers in market shaping activity.
3(2) sets out four matters to which local authorities must have
regard in promoting efficient and effective operation of the market
in services. The Standing Commission on Carers suggested adding
to this list a duty to monitor the match between local supply
and demand, and thereby to seek continuous improvement in quality
They drew to our attention the relevant provisions of the
Childcare Act 2006; they said these provisions appeared to have
worked well and could be a model for provisions in the draft Bill.
3(2) should be amended by the addition of a paragraph to provide
for a duty analogous to that set out in section 6 of the Childcare
Act 2006, which would require local authorities not only to develop
a local market but also to monitor the match between supply and
demand in their areas to and report publicly on the sufficiency
of care and support services.
draft Bill does not directly refer to how the commissioning function
of local authorities is to be discharged, except to state in clause
3(3) that in meeting an adult's needs for care and support or
a carer's needs for support, a local authority must have regard
to its duty to promote diversity and quality in the provision
of services. However, in promoting a diverse market of services
both to meet the needs of those local authorities support and
those who make their own arrangements there is no obligation on
local authorities to have regard for the actual costs of providing
a service when setting the price they will pay. As we acknowledged
in Chapter 1 this is ultimately a question of funding; nonetheless,
the market shaping duty could be rendered worthless if local authorities
undermine the diversity of the market through their pricing decisions.
As John Adams from the Voluntary Organisations Disability Group
told us, "We have seen a series of judicial reviews recently
which have pretty much said that you have to take into account
the provider's real costs of providing that care."
evidence on 7 February Sally Warren, in response to a question
concerning the need for the actual cost / usual cost requirement
to be transposed into the new legislation, pointed out that there
might be a number of reasons why the local authorities might pay
a different price from what self-funders might pay, including
the bulk buying power of local authorities and the fact that self-funders
often choose a higher quality home or a better room. She said:
"Our current intention is that we would not be replicating
[provisions about the price of care] in guidance, but I am very
happy to look at the evidence that has been provided to the Committee
over the course of your hearings and reconsider that."
draft Bill should include a requirement that local authorities
properly take into account the actual cost of care when setting
the rates they are prepared to pay providers.
note that the Government have recently legislated to provide a
mechanism for resolving disputes in the groceries market, establishing
a Groceries Code Adjudicator. We have not had the opportunity
to take detailed evidence on how such a model could be applied
to the care and support sector. However, from the evidence we
have received it is clear to us that a mechanism that enabled
disputes over costs of care to be resolved would support the objectives
of the draft Bill. The Government should examine the scope
for introducing an independent adjudicator to settle disputes
between local authorities and providers over the cost of care.
announcement by the Government that they will be introducing a
capped cost system raises further questions about disputes, redress
and complaints which we discuss in Chapter 7.
3 provides that in exercising the market shaping duty local authorities
must have regard to the "importance of fostering continuous
improvement in the quality" of services. This reflects similar
duties on the NHS. However, in the Health and Social Care Act
there are clear references to quality standards. Gary Fitzgerald,
the Chief Executive of Action on Elder Abuse told us: "I
was quite surprised that the Bill does not link in with the essential
standards that CQC measures against or the proposed NICE standards.
There does need to be a link in commissioning between understanding
what is taking place."
If local authorities are to be accountable for discharging their
market shaping duty there need to be standards against which the
public can judge them, a point Lord Adebowale made to us in his
evidence. We agree.
The Government should amend the market shaping duty in clause
3 by making an explicit link to both the essential standards of
quality and safety and to NICE quality standards. This could be
achieved by adding to clause 3(2) a requirement to have regard
to regulations made under section 20 of the Health and Social
Care Act 2008, and to the quality standards prepared by NICE under
section 234 of the Health and Social Care Act 2012.
the White Paper the Government refer to "particular tasks
that are unrealistic to be carried out in a 10- to 15-minute home
care appointment" and say that they "risk stripping
people of their dignity and jeopardising their human rights."
This concern was highlighted by the Equality and Human Rights
Commission's inquiry into home care.
These concerns were repeated in evidence to our inquiry; in particular,
Leonard Cheshire was concerned by what it said was an increasing
tendency to commission ever-shorter home care visits. "This
can mean care workers are asked to provide person-centred personal
care to an individual in a timeframe that does not allow for them
to be supported with dignity or for any meaningful personal contact.
We do not believe that such short visits are suitable for personal
care, except in very limited circumstances." The Government
should ensure that they have the necessary statutory authority
to make regulations or issue guidance concerning what they call
"unacceptable" commissioning practices, and amend the
draft Bill if necessary.
Cooperation: Clauses 4-5
4 and 5 deal with cooperation between local authorities and their
partners generally and in specific cases. Clause 4(5) contains
a list of relevant partners: other local authorities, NHS bodies
in the authority's area, the local police, prison and probation
services, and other persons prescribed by regulations. Nothing
is said there about housing providers, and we think they should
be specifically mentioned, as one of our witnesses suggested.
list of relevant partners in clause 4(5) should be extended to
cover registered housing providers, including housing associations
and registered social landlords.
Promoting integration of care
and support with health services: Clause 6
adults in need of care and support, and probably all carers, will
need health services. Clause 6 requires local authorities in exercising
their social care functions to ensure the integration of care
and support provision with health and health-related provision.
This is the mirror-image of the duty under the Health and Social
Care Act 2012 which confers similar duties on the NHS Commissioning
Board and clinical commissioning groups. The benefits that such
integration can bring are demonstrated in Torbay, which has taken
the lead in integrating services. Members of the Committee visited
Torquay on 24 January to see this in action, and to talk to those
providing the services and to those receiving them. Although participants
from both the NHS and local authorities stressed the importance
of culture and relationships in creating the right conditions
for successful coordinated care, they did point out the value
of the use of section 256 of the National Health Service Act 2006
to transfer resources and as a catalyst for integration. A note
of that visit is at Appendix 4.
can mean many things, as Sarah Pickup told us: "You could
integrate commissioning and you could do that for one service,
all, or many. When people talk about integration they often mean
integrated delivery, so there is one person going in to see people
and you have generic teams.
Then in between that you have
things like integrated access, where you want to have one front
door where people can access therapeutic services, nursing or
social care. Or you can have integrated assessment, where you
look once at what people's needs are and then you holistically
get a care plan to meet them. The problem with having a firmer
legislative requirement to integrate is that, in fact, you cannot
really do that until you get to the regulation and the guidance."
importance of integrated care, and in particular the financial
context in which it operates, was emphasised to us by the Department
of Health: "
if we want to see the overall shift in
the pattern of services that we all talk about all the time, which
is that we need to move health and care services to a more community
focus, to support earlier intervention and preventive services,
which will in its totality involve a better use of resources across
the entire system, if we are to achieve that big picture, which
unquestionably will be a better use of resources and more efficient,
the integrated working between health and social care and indeed
other partners is an absolutely essential component."
have been a number of proposals for adding to the face of the
Bill a general requirement for local authorities to ensure the
integration with particular services which have an impact on care
and support. Many witnesses sought to include a requirement to
integrate housing services with care and support. The BMA wrote:
"Clause 6 on integration deals with integration between care
and support provision and health provision but does not refer
specifically to housing arrangement. Without explicit reference
to integration of these elements of wellbeing, it is not specifically
promoted within the draft Bill."
Mark Goldring, the Chief Executive of Mencap, made the same point.
Leonard Cheshire Disability asked that the integration duty should
apply equally to employment and housing.
clause 6(1) a reference to "housing provision" should
be added to the reference to "health provision and health-related
wording of clause 6(1) requires a local authority to exercise
its duty to ensure integration "where it considers that this
would" promote well-being, contribute to prevention or delay
of the need for care and support, or improve the quality of care.
We agree with Leonard Cheshire Disability that this subjective
requirement leaves too much latitude to local authorities, and
could be strengthened. We recommend that the words "it
considers that" should be deleted from clause 6(1).
asked why there could not be a provision in the Bill giving a
power to direct the proportion of budgets being used for joint
commissioning of health and social care. The reply we received
from the Department was that "
all the evidence of
where integrated care makes a difference tells you that it is
locally led and locally owned and that there is a real resistance
to something that is prescribed from the centre."
We are not persuaded by this answer.
is moreover a good argument that joint commissioning and joint
budgets will minimise funding disputes which are damaging to those
who receive care and support, and which have been seen as part
of the problems that led to the scandal at Winterbourne View.
The Government have accepted this for children with special educational
needs in the Children and Families Bill. That Bill states that
local authorities and partner clinical commissioning groups must
make joint commissioning arrangements in respect of children with
special educational needs.
Currently, the powers to pool budgets and undertake joint or lead
commissioning are set out in section 75 of the National Health
Service Act 2006. This should provide NHS and local authority
commissioners with a toolkit to support the discharge of the integration
duties that the Health and Social Care Act 2012 and the draft
Care and Support Bill impose. However, section 75 is not designed
to enable such arrangements; it stipulates a complex set of requirements
that amount to a "pre-nuptial agreement" that is cumbersome
to put in place.
6 should be amended to reflect the approach taken in the Children
and Families Bill by giving the Secretary of State a power to
prescribe groups of people or services that should be subject
to joint commissioning and joint budgets.
Government should take the opportunity to review section 75 of
the National Health Service Act 2006 to make the requirements
add a word of caution. It is clear from the Torbay experience
that there is much that can be done without legislation, and the
converse is also true: there is a limit to what can be done by
legislation. Sally Warren told us: "
. what is going
to drive integration is leadership, culture and a shifting at
a local level."
And Richard Humphries took the same view: "
back on my career and the various initiatives I have been involved
with in trying to draw these different services together, I cannot
think of a single one where it was made possible by new legislation.
The best that legislation can do is create the right framework
that makes it easier for people to do it locally."
number of our witnesses expressed concern that the draft Bill
did nothing to support information sharing between agencies. The
Department acknowledged the problem in the information strategy
it published in May 2012 when it said: "Concerns over security
and privacy issuesand a lack of clarity for professionals
in understanding what level of information sharing is permittedcan
lead to a culture that is overly risk adverse and reluctant to
share information at all, even where it would improve care."
The strategy goes on to set out a number of actions including
the aspiration that the NHS number be used to provide a common
identifier across health and social care.
We suggested that the NHS number could form the basis of a shared
record across different healthrelated services, and the
Minister of State replied: "The idea of the NHS number applying
across the system is enormously attractive. Having two different
identities is crazy
The Government should review before the introduction of the
Bill whether they have the necessary powers to support the implementation
of information sharing using a common identifier such as the NHS
number across different services.
Discharge from hospital
Abrahams told us that 6% of hospital beds are occupied by people
readmitted within a week of discharge, often because their care
arrangements have not worked out properly.
This must be hugely distressing for those involved, and also a
considerable waste of resources. Proper management of hospital
discharge was seen as one of the most important areas for enhanced
integration between services, and we received evidence, some of
it anecdotal, on the problems that can be caused by inadequate
preparation for and coordination of discharge.
Hospitals owe it to their patients to consider their needs on
discharge, and how they will be met, as part of the admission
process. This point was further reinforced in the recommendations
of the Francis Inquiry Report which said that "it should
never be acceptable for patients to be discharged in the middle
of the night, still less so at any time without absolute assurance
that a patient in need of care will receive it on arrival at the
Eliot said that the Bill needed tightening by requiring, where
patients had needs for care and support, that an assessment of
the need for home adaptations and housing related support should
be undertaken before discharge.
The same point was made by Domini Gunn for
the Chartered Institute of Housing,
and by Midland Heart in their written evidence.
This concern was not restricted to patients with acute physical
care needs. A number of respondents
in their evidence expressed concern that patients
from psychiatric hospitals are frequently being discharged without
adequate support in place or facing delayed discharges in high-cost
secure units because of inadequate arrangements for step-down
and community support.
6(1) should be amended to require local authorities to ensure
the integration of care and support provision with health provision
on discharge from hospital, with particular emphasis on the adequacy
of housing provision on discharge.
number of respondents
made the point that
Schedule 2 applies only to those in acute
care. This excludes people receiving psychiatric treatment or
re-ablement services, an omission which in their view undermines
the Government's efforts to create parity of esteem between physical
and mental health. They are concerned that patients from psychiatric
hospitals are frequently discharged without adequate support in
place or facing delayed discharges in high-cost secure units because
of inadequate arrangements for step-down and community support.
We agree with these witnesses that the Bill should not only introduce
a clear duty on local authorities to carry out assessments for
everyone leaving hospital with care and support needs, but should
be extended to cover people using mental health services. We recognise
however that the delayed discharge provisions in Schedule 2 simply
replicate earlier provisions that put in place a system of reimbursement
or fines and seek to apportion responsibility for delays in discharge.
would be concerned that any extension of Schedule 2, as presently
drafted, to other groups or settings could have unintended consequences.
The Government should consider redrafting Schedule 2 to reflect
its ambitions for integration and parity of esteem between physical
and mental health. Any redrafting should seek to codify
best practice in the coordination of the care of a person before,
during and after their discharge.
are aware of past controversy over the scope of section 117 of
the Mental Health Act 1983. The Law Commission made a number of
proposals concerning this provision. Paul Farmer told us: "We
see concern around the way that this Bill is drafted and we certainly
would encourage you to remove sub-section (5)(a) of clause 48
in that regard, because we think that would have a very detrimental
effect on the application of [section] 117 care."
Paul Farmer expanded on his concern in written evidence: "Under
the draft Bill as it stands, the definition is extended to state
that these services must also meet a need 'arising from the mental
disorder of the person concerned'. In practice, it can be very
difficult to establish which needs arise directly from an individual's
mental health problem and which don't. We are concerned that narrowing
the criteria for aftercare in this way will lead to disputes over
what constitutes section 117 care, causing delays in the provision
of services, distress for the people concerned and leaving them
eligible to be charged for care that is essential to prevent their
readmission to hospital. For example, under this new definition
it seems likely that many local authorities will begin to charge
for accommodation or residential care needed to prevent readmission
to hospital, as it could be argued that the need for accommodation
does not arise directly from a person's mental health problem.
People would have to go through difficult financial assessments
while being discharged from hospital, with some likely to refuse
crucial elements of their care that they worry they will be charged
Law Commission came to its recommendation in part to reflect the
judgment in R (Mwanza) v London Borough of Greenwich.
The court held that a local authority's responsibility to provide
after-care services under section 117 is restricted to those services
necessary to meet a need arising from the former patient's mental
disorder and aimed at reducing that person's chance of being readmitted
to hospital for treatment for that disorder. The Law Commission
concluded, "Consequently, the section 117 duty does not extend
to providing normal accommodation simply on the
basis that there is an increased risk to the person if accommodation
is not provided, rather than because of their mental disorder.
If the person is in need of care and attention then section 21
of the National Assistance Act 1948 is the more appropriate provision
for seeking assistance."
Government have sought to translate the Law Commission's recommendation
on section 117 of the Mental Health Act 1983 into the draft Bill.
Insofar as this simply reflects the court's interpretation of
the current legal framework for after care, we do not recommend
any change. However, ministers should ensure that in the guidance
to local authorities the risks are recognised and the well-being
Preventing needs for care and
support: Clause 7
that can prevent or delay the development of needs for care and
support is obviously good for the adult concerned, good for any
potential carer, and incidentally also good for the finances of
local authorities and others who would have to pay for that care
and support. The duty imposed on local authorities by clause 7
to take steps to prevent, delay or reduce needs for care and support
is very welcome, and was welcomed by a number of our witnesses.
term "prevention" is not well understood. Alex Fox,
the Chief Executive of Shared Lives Plus, told us that "things
labelled preventative often had no clear idea of what they were
preventing, for whom and how they knew whether they prevented
it ... Actually, all social-care interventions should be future-focussed
as well as reactive. Things that are genuinely preventative leave
people better informed, better connected and more able to live
with dignity themselves. .. The more that we can help people connect
and embed into a community, the more empowered and resilient,
and the less dependent, they are. That to me is a much more helpful
idea of what prevention is that applies at an early stage and
is relevant at end-of-life care. There is no stage of life at
which we want to be dependent and isolated."
We share Mr Fox's desire for clarity.
should ensure that the explanatory notes to the Bill and the guidance
both provide clarity about the prevention duty and how it should
be seen as an integral part of the care and support system at
financial benefits of prevention can appear relatively quickly.
Sally Warren explained: "People always assume that prevention
takes a long time to get returns. Actually, some prevention and
early intervention can [produce] returns very quickly. What we
need to get better and smarter at is sharing the evidence of where
that works. Re-ablement, which is more on the early intervention
than on the prevention side, has been proven to pay back very
quickly within the financial year for local authorities, so that
is definitely worth investing in."
7(2)(b) requires local authorities to have regard to "the
importance of identifying adults
with needs for care and
support which are not being met". This reference to those
who already have unmet needs does not include those who do not
yet have needs, but may be at risk of developing such needs; nor
does it include those who already have needs, but for whom prevention
of deterioration might delay an increase in their needs. This
is particularly true of people with a learning disability. Mark
Goldring explained that "for people with a learning disability
prevention has a rather different meaning
a modest level
of support to people to live an everyday life can prevent not
learning disability but a massive deterioration in their well-being".
7(2) should be amended to state that, additionally, local authorities
must have regard to the importance of identifying adults at risk
of developing care and support needs, or increasing such needs,
who may benefit from support to prevent deterioration in their
7(1) requires local authorities to provide or arrange for the
provision of services, facilities or resources to prevent or delay
the development of needs. When asked if the market shaping duty
in clause 3 included preventative services officials from the
Department told us it did not.
A similar point was made about the contribution that information
and advice can make to preventing and postponing the onset of
need by Laura Robinson, the Policy and Communications Adviser
of National Voices, 
and also by Sarah Pickup who told us "Our line in ADASS,
and indeed in my own authority, is that our priority must be to
prevent, inform and advise."
The draft Bill should be amended to make clear that both clause
2 and clause 3 are linked to the duty of prevention.
our oral evidence session with Ministers, Norman Lamb MP told
us that the Government were looking at how implementing a capped
cost system would impact on existing clauses in the draft Bill.
He expressed the hope that a cap, "encourages people to come
forward early to have the assessment as to whether their care
needs meet the threshold for the clock to start. The more the
local authority can do to have the early conversation with people
to help them build their own resilience and to give advice and
support about what the family can doand the more the community
can do to maintain independence and slow down any deterioration
of conditionthe better. I think that proactive conversation
as early as possible is really important. Dilnot would help facilitate
that earlier conversation, so we are looking both at the new clauses
and any impact that they would have on existing clauses."
We agree with the Minister. Realising the "public health"
benefit from introducing a capped cost system could result in
significant quality of life gains by helping to engage more people
in maintaining their health and well-being, with a positive impact
on demand for long term care.
Safeguarding: Clauses 34-38
fact that the draft Bill places adult safeguarding on a statutory
footing for the first time was widely welcomed by our witnesses.
However, we were told by a number of witnesses that "We are
concerned that the first reference to safeguarding in the draft
Bill is in relation to an enquiry
this does not recognise
the need for local authorities to take steps to prevent abuse
occurring in the first place."
The need clearly to link the safeguarding duties in the Bill to
the other general responsibilities of local authorities set out
in clauses 1 to 7 was suggested as an improvement to the drafting
of the Bill. We agree that prevention should be an explicit part
of the safeguarding responsibilities of local authorities.
safeguarding provisions of the draft Bill should be moved to the
General Responsibilities section.
authorities should be placed under a statutory duty to take steps
to empower individuals to understand what abuse is, and how to
protect themselves from it, whether by seeking help or otherwise.
the draft Bill describes as "safeguarding" is in fact
two different matters. Clause 34(1)(b) gives the local authority
the duty to make enquiries where it has reasonable cause to suspect
that the adult needing care "is at risk of abuse or neglect"what
the Law Commission describes in Part 9 of its report
as safeguarding. But that paragraph also deals with the similar
duty of local authorities where it suspects that the adult needing
care "is experiencing" abuse or neglectwhat the
Law Commission describes as adult protection, which is in fact
the heading of that part of its report. The first is a duty of
prevention, the second a duty of investigation. In neither case
is there currently a statutory framework giving local authorities
the powers they require. It seems to us that by putting the two
together the draft Bill may have caused some confusion about the
put this to the Law Commission who told us: "We are concerned
that this duty may not extend to adult protection cases where
abuse or neglect has or may have occurred in the past. This is
because the duty appears to require that the abuse is occurring
at the present time or is likely to occur in the future. However,
there may be cases where the local authority is aware that abuse
or neglect has occurred in the past but still needs to investigate.
For example, enquiries may be necessary in a situation similar
to that which occurred at Winterbourne View where procedures had
been put in place to address the past episode of abuse but the
local authority still needed to investigate to ensure that the
residents were not at risk." .. The Law Commission concluded:
"we remain concerned that the duty will not cover a small
but significant number of cases where the local authority has
no reason to suspect that abuse is ongoing but still needs to
investigate to ensure that the arrangements put in place are sufficient.
We therefore think that the Bill should be amended to ensure that
the duty to investigate covers such cases."
34(1) should be amended to put beyond doubt that the duty of local
authorities to make enquiries extends to cases where abuse or
neglect has occurred in the past but still needs to be investigated.
A similar amendment should be made to clause 4(4)(c).
its written evidence ADASS expressed concern that the clause as
drafted does not make clear what "cause to be made"
means in practice, a point also made by the Practitioners Alliance
for Safeguarding Adults. They suggest that the guidance on this
point needs to be robust to ensure that action occurs and accountability
is clear. We agree. The Government should ensure that both
the explanatory notes to the Bill and the guidance make clear
what obligations the words "cause to be made" place
on local authorities and other agencies.
34(2) does not define "abuse", but states that it includes
having money or property stolen or misused, being defrauded, and
being put under pressure in relation to money or property - what
might be termed financial abuse. The lack of a definition was
criticised by some witnesses.
The Independent Living Association wrote: "
appreciate that clause 34(2) is not an exhaustive list, it erroneously
suggests that financial abuse is the only type of abuse individuals
are subjected to."
We do not agree with this criticism. Abuse is an ordinary English
word, capable of being understood without being defined. It might
not however normally be thought of as including financial abuse,
and it is right that clause 34(2) should put this beyond doubt.
But to attempt an exhaustive definition always has the danger
of omitting something which, as subsequent events make clear,
should have been included.
A POWER OF ENTRY
Equality and Human Rights Commission (EHRC) suggested that "there
should be an additional power of entry for local authority representatives,
where a third party is refusing access to a person who may be
at risk of abuse and neglect."
Several other witnesses took the same view.
In subsequent evidence the EHRC suggested that the local authority
representatives should be experienced in adult safeguarding and
should where appropriate use independent advocates to establish
effective contact with the person about whom they have concerns,
to advise whether that person is in fact being subjected to abuse
or neglect. They added that the relevant regulatory and inspection
organisations should undertake a regular assessment to ensure
the powers were used proportionately.
provision on powers of entry already exists in the Adult Support
and Protection (Scotland) Act 2007 and is proposed in the Social
Services and Well-being (Wales) Bill. Sections 37 to 41 of the
Scottish Act set out the necessary procedures for applying to
a sheriff or, in urgent cases, to a justice of the peace, for
a warrant for entry. It seems to us that these or similar provisions
which require court authorisation and application of the Human
Rights Act to a power of entry would provide an adequate protection
against the powers being abused.
Minister of State told us that the Department of Health had carried
out a consultation. The results of the consultation had not yet
been published but, not surprisingly, those who wanted to use
the power were in favour, while those who believed that they might
be subject to it were opposed to it.
are obvious dangers in according such powers to new categories
of persons, but on balance we believe that the safeguarding
provisions should include a power of entry for local authority
representatives where a third party is refusing access to a person
who may be at risk of abuse or neglect.
SAFEGUARDING ADULTS BOARDS
35 requires each local authority to establish a Safeguarding Adults
Board (SAB), and Schedule 1 sets out detailed provisions about
the membership and strategy of SABs. The membership list does
not include the relevant Health and Well-being Board; although
it could be added by regulation, we think that, in order to identify
relevant areas of concern and to ensure that strategies and planning
arrangements fully reflect local needs, the local Health and Well-being
Board should specifically feature in the list of members of the
Care and Support Alliance suggested that the CQC should be required
to identify a person within the regulator who should act as a
link with each of the SABs. That person would be responsible for
sharing information, advice and guidance with the board. We can
see that this might have advantages, but we believe it would be
unduly onerous to ask the CQC to name people to act as a link
with 152 local authorities (fewer if two or more authorities established
a joint SAB). We do however believe that the CQC should be added
to the list in paragraph 3(2) of Schedule 1 of those who receive
copies of the annual report of all SABs.
local Health and Well-being Board should be added to the list
of members in paragraph 1(1) of Schedule 1 to the draft Bill.
The Care Quality Commission should be added to the list of recipients
of reports in paragraph 3(2).
contribution of housing providers to safeguarding has been raised
by a number of witnesses. In written evidence Imogen Parry told
us "that the role of housing in preventing and addressing
adult abuse is neglected in legislation, policy, practice and
research." Graham Carey pointed out that the current guidance
on adult safeguarding, No Secrets, sought to include housing in
safeguarding boards but this had not happened in practice. We
agree that housing has a place in adult safeguarding arrangements.
The Government should consider amending paragraph 1(1) of Schedule
1 to include appropriate housing representation in the membership
of Safeguarding Adults Boards.
local authority is, rightly, a member of the SAB which it establishes.
However there will be occasions when an SAB will be carrying out
case reviews under clause 36 which might well be investigating
alleged failures by the local authority in adequately carrying
out the enquiries required by clause 34. Participation by a local
authority in an investigation of its own shortcomings would be
undesirable. Paragraph 1 of Schedule 1 should be amended to
specify the circumstances in which a local authority should not
take part in the proceedings of the Safeguarding Adults Board.
serious case reviews, which become safeguarding adults reviews
under the draft Bill, would not have the same statutory authority
to obtain information as serious case reviews involving children.
The current powers are set out in section 8 of the Children, Schools
and Families Act 2010,
which amended the Children Act 2004 to give Children's Safeguarding
Boards an express power to require a person or body to comply
with a request for information from the Board where the information
relates to the Board's duties. The absence of any express power
in safeguarding adults reviews leaves a gap which could undermine
the ability of such reviews to learn the lessons from serious
cases of abuse and neglect. The draft Bill should include an
explicit power to obtain information relevant to the conduct of
safeguarding adults reviews.
47 By way only of example, Sue Bott (Disability Rights
UK): "That principle of well-being is absolutely essential.";
Paul Farmer, Chief Executive of Mind: "We too would very
much welcome this well-being principle."; Sue Brown, Head
of Public Policy, Sense: "We very much welcome the well-being
principle and the checklist of what is included
Fair Access to Care Services, now located in Department of Health
Guidance (2010) Prioritising need in the context of Putting People
First: A whole system approach to eligibility for social care.
Guidance on Eligibility Criteria for Adult Social Care. Back
Richard Percival, Q 92. Back
Q 168. Back
Report, paragraph 4.35. Back
Paragraph 3.2. Back
The Children's Society, written evidence, paragraph 3.4. Back
Q 194. Back
Paragraph 6. Back
Report, paragraph 4.36. Back
Report, paragraph 326. Back
A point raised by Emily Holzhausen, the Director of Policy at
Carers UK (Q 152). Back
Q 152. Back
Supplementary written evidence, 30 January 2013. Back
Inserted by section 3 of the Health and Social Services Act 2012. Back
Q 317. Back
Q 106. Back
Written evidence, paragraph 3.1 Back
Paragraphs 6.2-6.3. Back
Jane Ashcroft, Chief Executive, Anchor Trust, and Domini Gunn,
Director of Health and Well Being, Chartered Institute of Housing,
Q 246. Back
Shared Lives Plus, written evidence, paragraph 2.8. Back
There were 5.2 million households in Great Britain without internet
access in 2012: Office for National Statistics (ONS) Statistical
Bulletin, 24 August 2012. The ONS quarterly update issued on 20
February 2013 showed that of the 7.42 million adults (15% of the
adult population) who had never used the internet, 44% (3.23 million)
were aged 75 and over. Back
Q 318. Back
Written evidence, paragraph 32. Back
Written evidence, paragraph 1.2.2. Back
Q 96. Back
Q 256 Back
Q 122. Back
Q 46. Back
Report, paragraph 12.9. Back
Written evidence. In their Code of Practice they offer the following
definition: "Advocacy is taking action to help people say
what they want, secure their rights, represent their interests
and obtain services they need." Back
QQ 318-319. Back
Written evidence paragraphs 25-26. Back
E.g. Dr José Luis Fernández, Deputy Director, Personal
Social Services Research Unit, LSE, Richard Humphries, The King's
Fund, and Andrea Sutcliffe, Chief Executive, Social Care Institute
for Excellence, QQ 56-58; Leonard Cheshire Disability, paragraphs
7-18; Standing Commission on Carers, response to Question 11. Back
Written evidence, paragraph 4.1. Back
Written evidence, paragraph 21. Back
Q 138. Back
Q 11. Back
Written evidence, response to Question 11. Back
Q 140. Back
QQ 320-321. Back
Q 200. Back
Q 140. Back
Equality and Human Rights Commission, Close to home: an inquiry
into older people and human rights in home care, 2011. Back
Imogen Parry, independent safeguarding adults trainer for the
housing sector, written evidence. Back
Q 102. Back
Sally Warren, Q 15. Back
British Medical Association (BMA), written evidence, paragraph
Q 181. Back
Written evidence, paragraph 19. Back
Shaun Gallagher, Q 16. Back
Clause 6 of the Children and Families Bill. Back
Q 14. Back
Q 39. Back
The power of information: Putting all of us in control of the
health and care information we need. Back
Q 322. Back
Q 190. Back
E.g. written evidence from the National Housing Federation (Appendix),
Age UK, and Arthritis Care. Back
Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry,
HC947, February 2013, Recommendation 239. Back
Q 241. Back
Mind, Rethink Mental Illness, the Mental Health Foundation, the
Centre for Mental Health and the Royal College of Psychiatrists. Back
Q 201. Back
 EWHC 1462 (Admin), (2010) 13 CCLR 454 Back
E.g. Laura Robinson, Policy and Communications Adviser, National
Voices, Q 178. Back
Q 17. Back
Q 178. Back
Q 46. Back
Mencap, Care and Support Alliance, The British Red Cross, Action
on Elder Abuse. Back
Paragraph 9.2. Back
Letter from Frances Patterson QC to the Chairman of 5 February
E.g. Action on Elder Abuse. Back
Written evidence, paragraph 30. Back
Written evidence, paragraph 19. Back
E.g. Action on Elder Abuse paragraph 2.34, College of Social Workers
paragraph 22. Back
Q 331. Back
Section 8 of the Children, Schools and Families Act 2010. Back