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Lord Hunt of Kings Heath moved Amendment No. 19:
- Page 2, line 10, after first "to" insert "(a)"
On Question, amendment agreed to.
Lord Hunt of Kings Heath moved Amendment No. 21:
- Page 2, line 12, at end insert "or
On Question, amendment agreed to.
[Amendments Nos. 22 to 31 not moved.]
Clause 2, as amended, agreed to.
Clause 3 [Duties arising where a notice under section 2 is given]:
[Amendments Nos. 32 to 39 not moved.]
Baroness Barker moved Amendment No. 40:
The noble Baroness said: We now come to another series of amendments that may at first sight appear to be pure pedantry, but they are not. They are designed to raise an issue to which my noble friend Lord Bradshaw alluded. As many social services departments move along with the Government's current reforms, few of them are providers of services as they were and few operate their own in-house services, although some still do. As social services departments increasingly take on the role of being strategic planners and commissioners and are responsible for the scrutiny of services, they no longer have at their disposal vast armies of people to provide care services as they once did. Therefore, the flexibility with which they can respond to demand is different and perhaps more limited than it was in times gone by. They cannot simply absorb extra bits of work as they go along. I raise again the point made by my noble friend Lord Bradshaw. What do social services do in an area in which it is simply not possible to buy the services that they need?
The noble Earl, Lord Howe, alluded to another point that lies behind this set of amendments. Throughout our discussions we have referred to the fact that social services departments will have to respond to a need. When that need comes to them through the NHS, how can they determine in advance what the need will be? What will be the mechanism by which they manage the level of need? Lying behind the Bill is an as yet unquantified demand on social services. We have not yet reached that point in our discussions.
This group of amendments was designed for those reasons. We have gone past the days when social services departments had at their disposal armies of home helps willing to take on extra responsibilities and to be carers. Most of what they do is not made directly available by them but commissioned. What do they do when there are no services to be commissioned in their area? I beg to move.
Lord Hunt of Kings Heath: I am concerned about the amendment, although it is partly a probing amendment. The word "commission" would not make things clearer but add a loophole into the Bill. The normal use of the word "commission", particularly in service provision, is to refer to the long-term strategy of deciding on the different types of care and capacity needed locally, and contracting with local care providers to ensure that that can be provided.
If we used the word "commission" in that context, social services would say that they had commissioned the service needed, such as a care home bed—to take the example that Members of the Committee seem keen to discuss—but that the patient was on a waiting list.
The other problem with the word "commission" is that it could be taken to mean arranging the service to be provided by someone else, such as a private provider. I understand the noble Baroness's point. Social services are now a mixture of running their own services and commissioning from other providers. However, the terms that she uses in her amendment would probably preclude social services from providing care themselves. Therefore, there is a problem with the philosophy and wording of the amendment. The term "make available" is all embracing. It does not mean that the social services department has to provide all those services, but it makes it very clear that it has a duty to make those services available. Clearly, that is where we want to be.
At the end of her speech, the noble Baroness asked about the local authorities' responsibility to determine needs in advance. I think that there is something in that. There has to be an individual assessment of each patient following notification by the NHS. However, in order to sort out this problem and work together local authorities must make an overall assessment of the type of demands likely to be made over time, and then put in place arrangements that enable them to deal with that type of demand. Some of the good practice that I have quoted in local authorities suggests that they have been very successful in making those assessments and arrangements. I cite as an example a local authority that comes to a long-term arrangement with a nursing home to provide a certain number of beds over a lengthy period.
The other advantage of such an approach is that it will bring much greater stability to the residential care market, something for which owners of residential homes have long been asking. That immediately creates a win-win relationship between the local authority and the care homes and is entirely consistent with how we see health, the local authority and the independent sector working together in this legislation.
I turn to government Amendment No. 85, which corrects a drafting error to make Clause 4(5) consistent in using the term "make available" also for services for the carer which need to be in place to allow safe discharge. Use of the word "provide" is inconsistent both with the points I have just outlined and with the intention of the Bill—which is that if social services have the services ready to be provided, they have met their duty, even if they do not begin to provide them because the patient's discharge is delayed for some other reason. I again apologise to noble Lords opposite for not giving advance notice of this government amendment.
Baroness Barker: I think that we will forgive the Minister for not giving written notice of his intentions. I thank him very much for that explanation.
I was not seeking to put forward our philosophy in these amendments at all; I was trying to indicate some of the realities that lie behind them. Commissioning managers in PCTs and in social services departments have essentially two jobs: to make an estimate of need, and to make contracts for provision. In these amendments I seek to highlight the fact that the Bill will present them with difficulties in both those jobs.
I accept that, in individual cases, the NHS notice may give managers a far greater understanding of individuals' needs and demand levels. However, I return to the point about their being able to commission services. It is interesting that Members of the Committee mentioned two outer London boroughs where, to the best of my knowledge, there already exists a certain level of care home availability. What happens in areas where there is no such availability? My honourable friend in another place, Mr Andrew Stunell, represents the constituency of Hazel Grove, where there is very substantial care home availability. Indeed, his local hospital was informed by the SSI that it had overshot its discharge targets. He is not alone. Other MPs have been in a similar position. That is going to happen where there are large properties available that are comparatively cheap.
I shall not press the amendments; I never had any intention of doing so. However, I flag up the issue. I say to the Minister that I believe that some social services departments which are not in the slightest recalcitrant simply may not be able to buy the services they are being asked to buy. I am not convinced that the sum of £100 million will enable them to buy those services. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Baroness Barker moved Amendment No. 41:
The noble Baroness said: I return to an area that is comparable to one which we discussed earlier and which to a certain extent has been obviated in part by the noble Baroness's proposal to undertake consultation. One of the key deficiencies of the Bill was that there was no requirement for older people and their carers to be informed of their right to an assessment. They could have asked for an assessment, but few carers wind up in acute hospitals holding a copy of the Carers (Recognition and Services) Act 1995. We seek to adopt measures in the Community Care and Health (Scotland) Act 2002 and the Carers and Direct Payments Act (Northern Ireland) 2002 which place a duty on local authorities to offer an assessment and to make that good practice UK-wide.
The noble Baroness, Lady Pitkeathley, will be the first to tell me whether I am right, but I believe that Carers UK has done a great deal of research into discharge policies. As regards discharge, carers tend to go to the
Baroness Noakes: I wish to speak to Amendments Nos. 51 and 59 which are grouped with the amendment we are discussing. The noble Baroness, Lady Barker, mentioned Amendment No. 51. It seeks to ensure that carers are aware of their right to have their needs assessed. It is worth remembering why we are handling these amendments here. It is one of the curiosities of the way in which Bills are handled in another place that, despite many amendments being tabled for the Committee stage, they somehow never get debated. That is, indeed, what happened. The Government, having been pressed on the issue of carers, introduced amendments into the Bill in another place to deal with carers, but the amendments that the Opposition wished to discuss were never discussed properly. We are now trying to complete that process of looking at how the needs of carers need to be reflected in the Bill.
Amendment No. 51 asks that carers be informed of their rights. I expect that we shall be told again that that is unnecessary and that it is implicit or required elsewhere. When dealing with a Bill of this nature we should try to make matters explicit in the Bill so that anyone reading it will know what their rights and obligations are without having to consult half a dozen other statutes enacted in the past few years.
Amendment No. 59 continues the theme of involvement of the carer by seeking to insert a new subsection after subsection (8) of Clause 3. Amendment No. 59 states:
The Minister is well aware of the role and importance of carers, and I hope that he can agree to the amendments.
"(b) if it appears to them that the patient has no settled residence, to the social services authority in whose area the hospital is situated"
Page 2, line 42, leave out "make available" and insert "commission"
Page 2, line 42, at end insert "; and
(c) inform any person where it appears to them that they may be entitled under section (1) of the Carers (Recognition and Services) Act 1995 (c. 12) (assessment of ability of carers to provide care: England and Wales) and section 1 of the Carers and Disabled Children Act 2000 (c. 16) (right of carers to assessment) to request an assessment of their ability to provide and continue to provide care."
9.45 p.m.
"The responsible NHS body must take into account the views of the patient's carer . . . before deciding what services",
should be provided to the patient following discharge. I am sure that the Minister will be aware that there is a close relationship between what the NHS, or, indeed, local authorities, have to provide and what carers can be relied upon for. Carers have a much better understanding of what patients can do for themselves. It would be folly to assess services without involving the carers. Amendment No. 59 does not require the NHS to comply with the views of the carers; that would be going too far. However, it requires the NHS to take their views into account.
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