I do not think I can vote for the amendment as it stands. What is driving this difficulty is not the profligacy of this Government, previous Governments or local authorities—we can all tighten our belts and are doing so—but the reality of changing demography. My favourite statistic is that since the start of this Committee stage our statistical life expectancy has increased by 27 minutes. We cannot cash that in individually, but that is the reality. That is the driver of the difficult position we are in.
Ministers are often between a rock and hard place, and none more so than now. However, in the light of these facts, the Government have not reviewed the priorities of public expenditure across the board—I hope the Minister will persuade them to do that—and how many things can we afford to do with the population that we have. That means looking at priorities across departments. I do not just mean health and social care. It is inevitable that we will have to do this. The sooner the Government—the previous Government were not good at this—are prepared to say that we must undertake a review of priorities in view of the changing nature of our society, the sooner we will begin to move forward. In the mean time, I am in favour of keeping pressure on the Government by introducing a Bill of this kind because there is no doubt that that will sharpen the appetite of the voters for how change should be devised in the future.
Lord Beecham: My Lords, I declare an interest as a vice-president of the Local Government Association and as a member of Newcastle City Council.
Forty years ago, as the newly-appointed chairman of the social services committee in Newcastle, I had to come to terms with the impact of Sir Keith Joseph’s reorganisation of the health service which came into force that year. Among much else, that involved the transfer of responsibility for public health from local government, where it had largely resided for over a century, to the NHS, taking with it paramedical services such as chiropody and bath attendants. The area health authority, as it turned out, was so limited in its resources that, for a period, we as a council felt it necessary to fund the continued provision of those services by the health authority. At the same time, we hugely increased social care provision, doubled the home help service and trebled the number of meals on wheels. I am sad to say that now those services are roughly back to where they were in 1973 as a result of the pressure on the authority’s budget. Now, in a step on which the Government are to be congratulated in principle, public health largely returns to its local government home and the concept of a holistic approach to social care, involving both local government and the NHS, is enshrined in the Bill.
It is unfortunate that the previous Secretary of State, in his shadow capacity, walked out of cross-party talks which the Labour Government had initiated to
address the issue of care and its cost, and that it has taken three years to produce the proposals that we are debating. However, it is even more unfortunate that during that time not only has demand risen inexorably, but local authority funding has been severely and deliberately reduced by a greater extent than any other area of government expenditure. It is sad, but not untypical, that the Secretary of State for Communities and Local Government should not only have acquiesced in, but actively promoted, this perverse order of priorities with all it has implied for key services, including those that we are debating in this Committee.
As we have heard, the Local Government Association avers that adult social care budgets have been reduced by £2.6 billion, or 20%, over the past three years, with additional dire impacts on other services, such as leisure and housing, which should contribute to health and well-being and which are threatened with virtual extinction as local authority services by the end of the decade. The noble Lord, Lord Best, reminded us of the London Councils report and its estimate that the cost of the reforms—which, I repeat, we welcome in principle—will amount nationally to an average of £1.5 billion a year over the next four years. Apparently, the greater amounts will be spent in the first and last years of those four. London itself will be facing a bill of at least £877 million as a result of implementing the proposals.
Of course, this, in part, reflects the increasing demand from different client groups. We largely talk of the elderly, but there are other significant groups. The noble Lord, Lord Rix, has reminded us about people with learning disabilities, and there are also people with physical disabilities. These two groups are growing as medical advances have enabled them to live longer. The quality of their life, of course, is the subject of much concern and that imposes additional strains on the budget. It is another example of incremental demand that needs to be met. In addition to that, there are people suffering from mental health problems. The increasing demand so far has manifested itself as between something like 10% and 14% in these different categories. It is clear that inflation and demographic trends alone will push up the cost, as the noble Lord, Lord Best, has indicated, by some £421 million by the beginning of the next spending review period.
There is also a serious question about the amount and timing of the funding designed to assist transition to the new regime, given that this welcome increment was announced in the spending review for 2015-16, but work will have to begin before then if we are to make progress at that time. It would be helpful to know, given that part of the rationale for the changes is that a whole-systems approach is likely to be more cost effective, just what savings the Government anticipate will be made and over what timescale by each of the two principal partners—local government and the health service—and in the case of the latter, by which of its several components.
Given the huge problems currently experienced in A&E—in contrast with the position under the previous Government when 98% of patients were seen within four hours—and the emerging problems that we have
read about in the past few days in general practice, how confident can we be that the basic funding projected for both partners is adequate, even before taking into account the scale of change envisaged? How do the Government respond to the comment on the spending review of the Foundation Trust Network, which warns of,
“a further major squeeze on NHS front line services as £4 billion is diverted from the NHS budget to social care”
in 2015-16? It points to fact that trusts,
“are, in many cases, struggling to meet the rapidly rising demand created by an ageing population”.
The concept of pooled budgets is welcome, but given the number of parties to the commissioning process, with local authorities joined by clinical commissioning groups commissioning hospital services and NHS England, currently the national Commissioning Board, commissioning general practice and mental health services, how will this pooling work in practice?
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Moreover, the Minister’s letter of 27 June makes it clear that,
“to stimulate real change, £1 billion of the £3.8 billion”,
which is the sum that the Government are investing in the change and allocating to pooled budgets,
“will be linked to the delivery of outcomes. So local authorities and the NHS will only benefit from this investment if they show commitment to integration and take action which makes a difference on the ground”.
Perhaps the Minister will explain what is meant by this. What outcomes are we talking about? How will they be measured, by whom and when? Will money paid up front, as presumably it would have to be, be clawed back if the outcomes are deemed insufficient? If so, given that we are talking about pooled budgets, by whom, when and from whom?
We are anxious that progress should be made in addressing the urgent need to transform the provision of social care and promote the essential joint working of health and social services in the interests of those who need such care and indeed of their carers. The whole House is united about the desirability of these objectives. I hope that the Minister will be able to respond positively to the concerns expressed by the noble Lord, Lord Best, and other noble Lords in this debate, and I offer a suggestion which could help to allay at least some of those concerns while facilitating an early start on fulfilling the aspirations set out in the Bill.
I join my right honourable friend Andy Burnham in calling on the Government to demonstrate their commitment by utilising part of the £2 billion NHS underspend that the Chancellor siphoned off in his March Budget. Some £1.2 billion could be used in the next two years to help tackle the current crisis in social care and smooth the way to the new system, which we all welcome, by relieving the pressures it will face.
Baroness Wall of New Barnet: I know very little about local government other than that I work with it in the health sector, but I wonder whether, with the pressure that is on all of us with the cuts and the
absolute need to reduce things, local authorities have looked at every opportunity. All I know is that since our income in an NHS trust has been looked at more carefully, we have had to have a look at the cost improvement programmes that we can deliver. We had never done that before, but we have delivered so many of those, improving costs by £17 million in the last year.
I am not making a criticism as I have no idea at all, and I know that we can all bemoan the fact that we have less money and all the rest of it, but until we know that we have done everything that we can, and got right down to questioning if we could do things differently, then we perhaps need to look at ourselves as well. Forgive me if you have already done that.
Perhaps I might respond to the question that the noble Lord is asking about what it means to integrate social care and local authority stuff. This is why I worry to death about this amendment. If this part of the legislation does not happen, the whole system will be in much worse straits than it is now. We have an issue about our local authority cutting back on some of the places in nursing homes, which means that we do not have the opportunity to put patients who no longer need to be in a hospital in the place where they ought to be to receive care.
At some stage or other, all of us have got to work together and say, “How do we do this?”. For lots of different reasons, not just the bed space, it is much cheaper for an individual to be in a care home bed than in a hospital bed. If we cannot resolve it between ourselves, and we cannot do it on our own as providers, local authorities cannot do it on their own, and neither can the care sector generally, then I wonder if we are ever going to get there. People perhaps need to start to look at how we might achieve this by being a bit tighter in other things.
Lord Beecham: My noble friend is right to draw attention, as many of your Lordships already have, to the need to integrate the provision and to avoid the sort of cost-shunting that can arise if organisations are kept separate. That is the point of the pooled budget: you look not just at the straightforward provision of care by one or other partner, or both partners, but at what will perhaps reduce the need for care in other ways. As I say, other local services such as leisure and adequate housing, in conjunction with the public health agenda, may very well reduce the demand for particularly expensive forms of care, as I am sure we all agree.
Of course, local government’s track record is not uniform, but it is right to say that local government has proved over the years to be the most efficient part of the public sector. There has been a huge improvement programme in local government, recognised by the shortly to be lamented Audit Commission, and others, over the years. The LGA in particular has sought, through a whole series of policies, including the very extensive and successful use of peer review, to engender new approaches and more cost-effective ways of dealing with a range of problems, including those in the social care arena.
I was about to conclude by drawing attention to another figure, which has just emerged today. It is a rather startling figure: £9.8 billion of uncollected VAT—10% of the total take—according to today’s Guardian. That dwarfs the amount that the Government are putting into the new arrangements. Just as local government needs, together with its partners, to engender the utmost efficiency in the mechanisms that it develops to provide services and make them cost-effective, as my noble friend suggests, so on the revenue-raising side central government has a massive obligation to ensure that it collects the taxes—instead of cutting the resources going into HMRC, which is responsible for collecting VAT, by a further 5% in the spending review.
We do not consider the cost of £3.8 billion and the welcome money that the Government are going to provide to be the last word in these matters. There will have to be a continuing process of establishing programmes that are effective and cost-effective. Looking at the totality, there is scope within the system to prioritise this area, providing that the Government take the right decisions—across the piece, not merely on the narrow front of health and social care but considering the implications for other services and functions of government—and collect the money that they are due anyway and which would relieve the huge pressure on these services and others.
I have a good deal of sympathy with the concerns expressed by the noble Lord, Lord Best, but I share the view of the noble Lord, Lord Sutherland, that it would not be right to hold things up. We must get on, but in doing so we must be realistic about the challenges that will be posed to those responsible for delivering these services. I look forward to hearing the Minister’s response to the various questions that have been raised in the debate.
Earl Howe: My Lords, I do agree with the spirit of this amendment. It is critical that care and support generally, and these reforms in particular, are fully funded. Without adequate funding, they will not deliver the benefits we all want to see. However, let me reassure noble Lords that we already have full procedures in place to ensure that there is proper funding for social care.
The first and very basic point is that the Government set spending plans for all areas of public expenditure at once during a spending review. This ensures that decisions can be taken about the future funding requirements of government as a whole, rather than assessing each part piecemeal. The noble Lord, Lord Sutherland, spoke about the review of priorities being a task of government. I agree, and that is exactly what spending rounds are designed to do.
Secondly, we have the new burdens doctrine in place, which requires that,
“all new burdens on local authorities must be properly assessed and fully funded”.
That ensures that all new funding pressures, including those that result from this Bill, are fully funded. I can tell the noble Lord, Lord Best, that our commitments are in line with the new burdens doctrine, the costs have been identified in the impact assessment, and the
funding in the spending round will support local authorities to deliver on current and future commitments through to 2015-16. To answer the noble Lord, Lord Campbell-Savours, yes, the work has been done.
It is only right that the Government take spending decisions for all areas of public expenditure at once. This ensures that future spending plans are drawn up which are coherent and consistent across all public services. This is exactly the purpose of a spending round, the latest of which concluded last week, as noble Lords know, and set spending plans for 2015-16. Fundamentally, this settlement delivers the funding required to ensure that service levels in the care and support system can be protected and are able to deliver on all the commitments in this Bill.
However, with additional pressure on the system, we must ensure that the Government, the NHS, local government and care and support services are all working together to offer the best possible services for patients while also addressing the growing demand on the system that the noble Lord, Lord Best, rightly referred to. That is why we have announced in this year’s settlement a £3.8 billion pooled health and care budget to ensure that everyone gets a properly joined-up service, so that they get the care and support they need from whoever is best placed to deliver it, whether that is the NHS or the local authority.
In 2014-15, the NHS will transfer £1.1 billion to support social care with a health benefit. The pooled fund will include £2 billion more through the NHS in 2015-16. But this money will be given only on the basis that services are commissioned jointly and seamlessly between the local NHS and local councils. I hope that that helps to answer the question posed by the noble Lord, Lord Beecham.
Lord Campbell-Savours: Before the noble Earl moves on, perhaps he can answer this question. Is he saying that the statistics that were used in the report by the Committee on Public Service and Demographic Change were known to the department and were all taken into account, and that the calculations the department made were based on those statistics, which were well sourced, when the budget for these areas was decided upon by the Government?
Earl Howe: The statistics that the Government relied upon were official statistics and, I think, were exactly the same as the statistics used by the report to which the noble Lord referred. Of course, that report takes us forward 10 and 20 years. I am not pretending that the spending round has done that—it never does and I think it is safe to say that it never will. But we did look forward in a rigorous way to the pressures on the system in 2015-16 and based our assessment on the statistics that are officially issued.
As all plans will be jointly agreed by the NHS and local authorities in the pooling arrangements that I referred to, that in itself will provide a strong guarantee that the money is spent in a way that delivers on the priorities of health as well as of care and support. Not only will this fund help to deliver joined-up services, it provides the necessary funding for all the commitments and duties set out in this Bill, and the growth in
demand from an ageing population and growing number of disabled people—I say in particular to the noble Lord, Lord Rix, and the noble Baroness, Lady Campbell. In particular, funding worth £335 million has been set aside for the introduction of the cap on care costs and the extension of deferred payment agreements.
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With some of the biggest users of the NHS being those who also use care and support services, the drive towards better integration in the system is absolutely essential. This is not just to create a more efficient service, but because the individuals and families who will benefit the most are often those who fall between the cracks of the two systems, being pushed from pillar to post and not getting the care and support that they should.
The investment in integrated services will back the wider moves towards supporting people at home, reducing unnecessary admissions to hospital and focusing more on prevention and support in the community. All of this will improve care and help to reduce burdens on the system. Local areas will work together to draw up plans for the use of this money, ensuring that it is spent on health and care services. All plans will include a commitment to protect care and support, which will guarantee that care and support services receive the investment that they need.
Pooling budgets and producing joint plans have all kinds of advantages. Importantly, they will help to drive down costs in the acute sector by tackling expensive pressure points in the system, like A&E; by improving prevention services; by reducing unplanned hospital admissions; and by allowing people to stay in their homes and live independently.
The noble Lord, Lord Best, raised the point about regional variation and questioned whether the funding allocations would adequately address that. Funding for social care is distributed to local authorities according to relative needs formulae, which ensure that local variation is taken into account. I am satisfied that that was done during the spending review.
The noble Baroness, Lady Howarth, pointed to the risk that, if we are not careful, funding pressures could mean commissioning cheaper and poorer quality services. We are all alive to that risk and we want to avert it. We recognise that the last spending review provided local authorities with an extremely challenging settlement. That is why we took the decision then to prioritise social care and we have done it again in the spending round. I hope that the announcement last week, together with this Bill, demonstrates our commitment to funding social care and promoting quality in care and support services. We took the decision to provide extra funding to help local authorities maintain access to services. As I said, that includes £1.1 billion in 2014-15. Local authorities, however, should be looking at how they can transform care by innovating and exploring new ways of working. Many local authorities are already doing this; I will mention a few examples in a moment.
The noble Lord, Lord Beecham, asked me how the pooled budget arrangements would produce the kind of outcomes that we all want to see. I think the key point here is that this pooled health and social care budget will benefit by its very nature both care and
support and the NHS. It will safeguard those funds in the process and it will, as I have outlined, help to save money by keeping people well for longer. It will be given only on the condition that services are commissioned jointly and seamlessly between the local NHS and local councils. I have already explained about having all the plans agreed together, so that we can ensure that the NHS’s priorities are also met and that this money, as it delivers on the priorities that are important to the NHS—I have mentioned a few—will be used effectively.
Lord Beecham: My question was not about the purpose of the pooling, which I think we all share. My question was rather more detailed. If part of the funding is to be based on outcomes, how and when is that to be judged? If the outcomes are not achieved, how will the money be reclaimed? All this is something of a mystery as matters stand.
Earl Howe: The details of the payment-by-results system will be worked through. We are working with our partners in the sector including the LGA and NHS England to ensure that the system is designed with a view to incentivising integration. Further details of those arrangements are in course and we will announce them as soon as we can.
The kind of things that we will be looking for are, for example, the results that we have seen in places such as Cheshire West and Chester. The pilots, the whole place community budgets, showed that savings from integration could be substantial if implemented effectively. A business case needs to be presented. In that context, the pilot suggested that, once proposals are fully implemented, the net savings that could be achieved over five years are considerable.
Cheshire West and Chester has made savings of £26 million, with £3.8 million for Greater Manchester, £190 million for the Triborough authorities and £90 million for Essex. These savings are being identified. It gives us confidence to say that there is real potential to save money across the country, as shown by the pilots and other reviews, such as the Audit Commission review. Oxfordshire recently announced that it was nearly doubling the amount of money in its pooled budget for older people. That is a significant move.
I agreed with much of what the noble Baroness, Lady Wall, said. Savings are eminently possible without detracting from quality, by slowing and preventing the development of care needs or the onset of health conditions, or the loss of independence. We hope and believe that preventive care can increase the quality of life for individuals. A proactive stance by local authorities will deliver that. At the same time, preventive care will provide longer-term financial savings to the public purse. For the first time, Clause 2 creates a clear legal duty on local authorities to ensure the provision of preventive services.
I come to the point raised by the noble Lord, Lord Campbell-Savours, about the Dilnot package. I do not view the Dilnot package in the same way that he does. I do not see funding reform as being about protecting people’s inheritances. It is about providing hard-working people with peace of mind about how much they will pay for their care. Deferred payments will ensure that
people will not have to sell their homes in their lifetime to pay for care. That will prevent distressing sales of houses and provide everyone with breathing space to make decisions and choices about what happens to their home. In the long term, the scheme is broadly cost-neutral to government, because the deferred payments will be repaid. Everyone will benefit from these reforms, but they will particularly help people with modest wealth who are most at risk in the current system of losing their entire home and savings.
Delivering on these transformational changes to health and care is the only way to secure the long-term sustainability of services, both for the NHS and local authorities. I would be firmly against delaying this —I think we would be heavily criticised if we did. The noble Lord, Lord Bichard, referred to the burgeoning weight of regulation during the past 60 years and one cannot argue with the statistics that he produced. This Bill serves to consolidate more than 60 years of legislation; it will repeal provisions from more than a dozen Acts of Parliament. Reducing the complexity of the statute and rationalising burdens on local authorities are our key aims in this context. I hope that, for the reasons that I have outlined, the noble Lord, Lord Best, will feel sufficiently reassured to be able to withdraw his amendment.
Lord Best: My Lords, I am deeply grateful to all noble Lords who have spoken: to the noble Lord, Lord Bichard, for pointing out that we cannot keep loading responsibilities on local authorities and others without willing the means to pay for those things; to the noble Baroness, Lady Howarth, who said that we cannot go on like this; and to the noble Lord, Lord Rix, who explained the position from the Mencap perspective—it could have been that of many other charities which are facing very tough times because local authorities cannot keep up the level of support that they used to have. The noble Lord, Lord Campbell-Savours, produced more impressive statistics, not least in relation to the people with long-term conditions and dementia who are living in the community and need to fund their care needs. The noble Baroness, Lady Campbell, brought us the users’ voice, pointing out that funding cuts have already meant people losing some of the control and choice which had been increasingly expected with use of direct payments and so on.
The noble Lord, Lord Sutherland, pointed out that the culprit is not local government or central government but demography, and that we need to make some choices as a result of those demographic pressures. However, in his view, one of those priorities is clear: it is that we should go ahead with this Bill. The noble Lord, Lord Beecham, also felt that it would be unwise for us to delay things, even though he accepted that cuts mean that social services in Newcastle have returned to the position that they faced in 1973 in terms of the resources available. He pointed that it is local government that has shown itself best able to be more efficient in these difficult times. We need to remember that. The noble Baroness, Lady Wall, pointed out that local authorities should try to make savings wherever they can, and the noble Lord, Lord Beecham, was right that statistics show that local government is doing just that.
I think that it is fair to say that the noble Lord, Lord Bentham, felt that it was necessary to find additional resources, but he thought that those could be found from the underspend in the NHS or the uncollected VAT or some other source. However, he did not want the amendment to delay the good things that the measures bring with them. The noble Earl, Lord Howe, agreed that we need fully to fund the measures—did I say Bentham?
Lord Best: Oh, not again! I do apologise. How many times has this happened to the noble Lord?
Lord Beecham: My Lords, I hope to be of some utility, but I would not claim to be utilitarian.
Lord Best: I deeply apologise, and not for the first time, to the noble Lord, Lord Beecham, one of the most distinguished of the vice-chairs and past chair of the LGA.
The noble Earl, Lord Howe, agreed with everybody that we need fully to fund the new measures and to ensure that the funding for existing care services is there. He expressed to us the belief that the new measures will do just that and they herald a sustainable funding arrangement for the future. He noted that the settlement for local authorities is extremely challenging this time round, but that, in terms of social care, the settlement that we are now pointing towards, with jointly commissioned services, the pooling of the £3.8 billion and NHS and local authorities working together, will in his view prove enough to fund a sustainable care service. Only time will tell whether those calculations prove to be accurate rather than too optimistic. In the hope that the noble Earl’s predictions are correct, and recognising that government really are attempting to make serious change in this Bill to the funding system as well as in so many important ways to the care services, I beg leave to withdraw the amendment.
Clause 1 : Promoting individual well-being
78: Clause 1, page 1, line 4, at end insert—
“( ) The Secretary of State, in making regulations or issuing guidelines under this Part, must have regard to the general duty of local authorities in exercising a function under this Part in the case of an individual to promote that individual’s well-being.”
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Lord Hunt of Kings Heath: My Lords, I shall speak also to my Amendments 78D and 88L. I am also supportive of Amendment 79, which very much follows the thinking behind my own Amendment 78. I also support Amendment 78ZA, in the names of the noble Lord, Lord Bichard, and the noble Baroness, Lady Tyler. I am sympathetic, too, to the amendments tabled by the noble Lord, Lord Black. I have also added my
name to Amendments 78A and 78B in the name of the noble Baroness, Lady Barker. She will speak substantively to those amendments, which we have proposed in a number of Bills going back many years. They try to make sure that, when a regulator is dealing with a religious care home, regulations do not get in the way of the spiritual beliefs of the residents in that home.
Amendment 78 takes us to the very important well-being principle. In its consultation paper which led to the consolidation of the social care legislation that we see in this Bill, the Law Commission proposed that there should be tightly defined processes for determining the scope of adult social care. That follows on from the debate that we have just had. Replies to that consultation persuaded the Law Commission 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 their new approach to adult social care.
Clause 1 provides for a set of legal principles which govern how local authorities are to carry out their care and support functions for adults under the Bill. Subsection (1) establishes the overarching principle that local authorities must promote the well-being of the adult when carrying out functions under the Bill in relation to that adult. This duty applies both in relation to adults who use services and to carers. The well-being principle applies to local authorities when they exercise a function in the case of an adult. My understanding is that it is not intended to be directly enforceable as an individual right, but to carry legal weight where a local authority’s failure to follow the principle may be challenged through judicial review.
This issue was considered very carefully by the Joint Select Committee, which commented specifically on the role of the Secretary of State in relation to the well-being principle. It took the view that 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. We will, of course, come on to one example—that is, the regulations in relation to eligibility, which we will debate not, I suspect, tonight but on another day.
The Joint Select Committee referred to Section 1B(1) of the National Health Service Act 2006, which provides:
“In exercising functions in relation to the health service, the Secretary of State must have regard to the NHS Constitution”.
The Select Committee suggested that the Secretary of State should be obliged to have regard to the requirements of Clause 1 on well-being when exercising the functions under the draft Bill. In giving evidence to the Joint Select Committee, the Minister replied:
“We absolutely want the wellbeing principle to apply comprehensively”.
The Joint Select Committee comments:
“We 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”.
We debated this at Second Reading. The noble Earl, Lord Howe, said that,
“Clause 1 is intended to apply at an individual level, when a local authority makes a decision. This individual focus on the specific
well-being and outcomes for that person is at the heart of the way that the Bill has been drafted. It is not intended to apply in a more general way”.—[
Official Report
, 21/5/13; col. 829.]
He went on to say that it would therefore not be appropriate for the Secretary of State to be subject to the same duty, as the Secretary of State does not make decisions at the individual level.
I think there is an element of Ministers almost washing their hands of what actually goes on at ground level in health and social care. We have already seen that in the Health and Social Care Act 2012, and we are seeing some elements of that here. Of course, the Bill places a responsibility on local authorities to promote well-being in the way they implement the provisions of the Bill locally. However, if the Secretary of State were to issue regulations without having regard to the promotion of well-being, there is a risk that those regulations or guidance will conflict with the well-being principle. That would place local authorities in an impossible situation. For instance, if the eligibility criteria issued in regulations by the Secretary of State do not take full account of all aspects of well-being in Clause 1, local authorities may find that people who need support to promote well-being as defined in Clause 1 fall outside the eligibility criteria. I will come on to debating the eligibility criteria, but there are some aspects of the eligibility criteria which would suggest that they do not meet the well-being principles in Clause 1. I hope the noble Earl will think very carefully about this. There is a broad consensus in your Lordships’ House and within the Select Committee dealing with the draft Bill that the Secretary of State, when issuing regulations and giving guidance to local authorities, ought to be operating under the same principle of well-being as those local authorities are. It seems to go straight back to the debate instituted by the noble Lord, Lord Best, in relation to the Government legislating but not giving the wherewithal to local authorities to actually carry out that legislation effectively.
I turn to Amendments 78D and 88L, which are concerned with ensuring that health needs are taken fully into account in decisions taken by the local authority. I fully acknowledge that I have been inspired to do this by the noble Baroness, Lady Campbell. The starting point here is that it is essential to look at this through the prism of person-centred integration. As a starting point, we need to look at ways to put the individual’s and carer’s need for integrated working in the Bill and outline a statutory framework for person-centred integration that will support and incentivise local moves towards more integrated working. There are clearly points of contact here with the scheme which the Minister’s honourable friend Mr Norman Lamb announced recently for local pilots on health and social care integration.
Promoting the individual’s well-being, assessing their needs and those of their carers, deciding on eligibility and the priority for needs to be met, developing them with an appropriate care and support plan, enabling the best use of a personal budget and/or direct payment, and ensuring continuity of capacity during and after a move such as a house move are all processes or stages in which active engagement of NHS professionals or services could have a positive effect on the outcomes for individuals and carers. Integrated approaches by
social care and the NHS can inform decisions, expand options, widen choice, retain or restore capability, prevent or reverse deterioration, avoid admission to and accelerate discharge from more intensive support and enable more efficient, equitable and economic use of scarce resources.
These amendments, which aim to ensure that happens in relation to the whole well-being agenda, are entirely relevant to the eligibility criteria. I remind the noble Earl that Mr Lamb, in his foreword to the document that we have received, makes the observation that,
“there needs to be better integration between local authorities and the NHS to remove gaps and build services around the needs of people”.
The discussion document’s only reference is in one paragraph which says:
“The assessment process in the Bill … provides for joint assessments between local authorities and other bodies such as the NHS. Improved integration will ensure that the person does not have to undergo separate assessments and will support better care planning to meet the individual’s overall health and care needs, or to join up whole-family assessments which look at an adult needing care alongside those who care for them”.
Of course, that is welcome as far as it goes, but there is a risk that it depends on an ill-defined concept of better integration and may well fall short of a holistic approach to well-being, assessment, care and support planning, carer support and review. We will come to the draft regulations later. This has a significant bearing on assessments for health and social care integration. The intention is to scrap the present assessment system, based on judgments about degrees of risk to areas of individual capability and exclusion from participation in various aspects of ordinary living. The new model proposes to examine people’s ability to carry out various personal care tasks and undertake a selections of household tasks. The rationale offered is that the new system will be more objective and fairer in its application, but there are some concerns here. First, this is explicitly a deficit-model of assessment, requiring individuals, their carers, relatives and social workers to almost play up or exaggerate the things that they are unable to do in order to qualify for support. In many ways, that replicates the very bad approaches that we have seen in some welfare assessments. It is certainly bad for morale and distorts the overall framework for making decisions. In one sense, one can argue that it reverses efforts over the past 20 years to maximise independence, choice and control and build on the strengths, contributions and aspirations that people can have. I must say to the noble Earl that is has some very uncomfortable reminiscence of the new approach to disability benefits, whereby people are required to prove limitations under the inexpert and unsympathetic eye of ATOL assessors. I hope that is not the approach that is going to be taken in relation to the eligibility criteria. There will be very great concern if that is to be the case.
The noble Baroness, Lady Campbell, has many examples, which I hope she might be able to intervene and provide, of disabled people with high health and social care support needs, who are ready for discharge but languishing in costly high-dependency hospital units because clinical commissioning groups have almost
ground to a halt due to decision-making, with arguments about who pays being one of the many reasons for this. It is absolutely essential to ensure that when we debate and take forward the well-being concept, which of course we welcome, not only do we have a situation where the Secretary of State is subject to those principles as well, but the health service plays its part in ensuring a wholly integrated approach. As we come to debate the eligibility criteria, that is going to be a very important factor for our consideration. I beg to move.
Lord Bichard: My Lords, I support the amendment and in particular speak to my own Amendment 78ZA, which seeks to place the concepts of dignity and respect on the face of the Bill at the outset. I should declare an interest as chairman of the Social Care Institute for Excellence.
A week or so ago I visited a residential home in Edgbaston, Birmingham, and I came away convinced that I could happily live there. I am not sure that they would want me but I was convinced that I could live there if they would have me. As I reflected on that visit I asked myself why I felt so positively, because I do not always feel that way about a visit. The accommodation was comfortable, clean and not overly institutionalised. The staff were skilled and well qualified. There was a rich programme of voluntary recreational activities and a great deal of interaction between the local community and the home. A special school was visiting on a regular basis and there was clearly a bond between the residents and the students at the special school.
All very impressive, but above all, I experienced a place where residents were treated with dignity and with respect by staff who seemed to understand that people’s greatest need at a time when they have to receive some support is not to lose their dignity. Those residents wanted, above all else, to retain their dignity, and so would I.
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Recently, we have all seen distressing coverage of care—residential or domiciliary—which falls below anyone’s acceptable standards. Although I am sure that we have all been shocked by the nature and level of abuse and neglect which have been exposed, I, for one, found the most heart-rending thing was the way in which all that had stripped people of their dignity. The fact that someone in a caring profession could treat another person with such a lack of respect and basic humanity—whatever the pressures, and we know that those pressures are considerable—is what I found truly shocking. To see vulnerable people stripped of their dignity is, frankly, devastating.
Dignity and respect are the basic rights which those in care have the right to expect, but they also provide the benchmark by which professionals should be judged as they go about their work. Whatever else carers do, it is simply not acceptable to treat people with a lack of dignity and respect. That brings me specifically to the Bill and my amendment.
Many of us have said on Second Reading and already today that in many respects this is a mould-breaking Bill, much of which is to be welcomed, but because it is so significant it will long be a reference
point for those in the caring professions and a place where people look for definitions of good care. They will look for a clear statement of what users and professionals should expect and should be expected to provide. That is why I think that it is so important that we ensure that the Bill captures and articulates boldly what we expect. As it stands, Clause 1 says much that is important, as it is intended to exemplify what is meant by providing well-being. In Clause 1(2), there is even a cross-reference to personal dignity. I suspect that the Minister may well suggest that that deals with the thrust of my amendment, but for me, it is lost in a series of other references. It just does not stand out boldly enough and its impact is diminished.
Well-being is a phrase well used now in the world of health and certainly within the Department of Health. There is nothing wrong with it, but for me, it just does not quite capture the essence of good care. It is also not a phrase in common usage. It does not encapsulate the fundamentals of good care in the way that “dignity and respect” do. My amendment would state boldly at the outset of the Bill that dignity and respect is what we are all about. They encapsulate the cornerstones of good care. They are the foundations on which everything else should be built. Even in an age of austerity and cost-reduction, they cannot ever be compromised, because they are, in many ways, our most basic human rights.
The amendment is really meant to help the Government and the Minister, to enable them to make at the outset that bold statement of intent and expectation. It does not need additional expenditure—that must be a good thing—it just involves us being prepared to state simply and unambiguously what the Bill is about and what good care is about.
Baroness Barker: My Lords, I shall speak to Amendments 78A and 78B, which stand in my name and that of the noble Lord, Lord Hunt of Kings Heath. These and other amendments which will crop up throughout our discussions have been inspired by the Christian Science movement. I wish to say that I am not a Christian Scientist, but Christian Scientists hold to some very firm beliefs which are of great importance to them. Part of their belief system is that they do not wish to receive medical treatment in circumstances where other people would make a different decision. Therefore, in health Bills such as this, where we are setting out the principles that underlie what we define to be good care, it is not uncommon for me and the noble Lord, Lord Hunt, to put on record again that there is a spiritual dimension to health and well-being and that the way in which that spiritual belief is manifested can be different for minority groups.
One great strength of the Bill is that it takes a principled approach to what we define as well-being rather than attempting to define well-being in a descriptive sense. One reason why I think that that is increasingly important is that we have an increasingly diverse population. Therefore, the meaning of well-being for individuals is becoming distinct and diverse throughout society. The amendments place a duty on local authorities and relevant health bodies to respect the increasing diversity of our population.
There are two other reasons why I am very pleased to support the amendments. Like everyone else in the
House, I am greatly in favour of the integration of health and social care. I see the undoubted benefits of that, but as someone who has worked in the field of social care, as opposed to health, all my life, I still carry with me the fear of the medicalisation of disability or of old age. When push comes to shove, when budgets are tight, some of the certainties which surround physical health, in particular, can overtake social goods which are less easy to define. Therefore, it is important that we ensure that we do not allow that to happen. One way to prevent that is by taking the approach of the amendments.
The final reason why I raise the amendments now is that I think that setting that out as they do right at the top of the Bill is a strong reminder to everyone who will refer to the Bill in years to come that the autonomy of individuals is an important part of health and well-being. You cannot have good health and be a fully functioning member of society if you do not have that autonomy, an autonomy which means that, in some cases, you have the right to make decisions which other people would regard to be unwise. It is a point of principle, but one which I think has a great deal of practical application not just for those who are receiving care but for those who are in charge of making decisions about it.
Baroness Jolly: My Lords, I am very sorry that the noble Lord, Lord Warner, is not in his seat. He tabled Amendment 79 to express the strength of feeling of Members of this House who were sitting on the scrutiny committee about the Secretary of State’s the duty to have regard to well-being. Were there room for more than four names to the amendment, there would have been more Members of your Lordships’ House on that list.
To put this in context—and the noble Lord, Lord Hunt, has taken us through quite a lot of this—this Bill was widely consulted. It was probably the coalition’s most widely consulted Bill; somebody might be able to tell me to the contrary. At each stage, people welcomed the well-being principle. Perhaps I may remind the House that in the majority report on the Bill, one of the recommendations was that the Secretary of State should have due regard. When the final Bill was produced, many in the sector approached me, and I suspect many others, to express their disappointment that that was not included in it. When the Secretary of State came to give evidence with the Minister for Care and Support, the right honourable Norman Lamb, he was very positive about it. According to the transcript of the session, Norman Lamb said:
“We absolutely want the wellbeing principle to apply comprehensively”.
The well-being principle is around the change of culture and it puts the person at the centre. It is absolutely critical that that happens, and next week we will debate the whole business of assessment and how we are undertaking it. However, unless the Secretary of State has to have regard to the same principle as local authorities, there is an opportunity for future Secretaries of State when making regulation to disregard well-being and just make regulation in the old way. One thing that sets this Bill aside from many others is that it is written in plain English and throughout its intention is pretty clear.
I ask the Minister if he is able to offer any assurance to the House, to the sector and to those for whom the Bill is written—the service users and the carers—that the Government will think again about the decision not to include in the Bill a duty on the Secretary of State to take well-being into consideration.
Baroness Pitkeathley: My Lords—
Baroness Campbell of Surbiton: My Lords, I apologise for not being able to bound in as soon as the noble Lord, Lord Hunt, sat down. At that moment my papers cascaded to the floor. I rise to support Amendment 78D. For logistical and physical reasons, as my noble Lords can probably hear, I was unable to put this amendment down myself and the noble Lord, Lord Hunt, has done miracles to articulate our conversations in such a lucid manner.
I feel, however, that I must give your Lordships a very clear example of why I believe this amendment is so necessary. Why do health and social care practitioners need this further direction in this amendment?
It is true that health and social care consumers enjoy greater personal control now, which affords a small percentage support to live independently in the community. I am an example of the few who live with complex health and social care requirements and live a life just like any other: pursuing a career, tending the family, or in my case revising legislation.
We remain, however, an exception, rather than the rule. Let me give your Lordships a couple of examples. Just over a year ago, I led a JCHR inquiry into Article 13 of the UNCRDP, a right to independent living. When we launched the findings, I dedicated the report to a disabled young man who had secured optimum control over his own life using social care direct payments. He lost everything within a couple of months, after his support needs changed, due to requiring a tracheostomy. He had graduated from university and was about to start his first job .
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The tracheostomy is a significant procedure requiring recovery and adaptation, but he was considered well enough to return home after two months to pick up his life. Despite what he had been through, he was bright and optimistic about his future, and I had no doubts that he would adjust and go back to work.
Five months later, he was still on the same high dependency ward. Had his health declined? No. He remained in hospital because his tracheostomy meant he was no longer allowed to manage his social care direct payments. Without his knowledge, he was passed from social services to his local PCT, which suggested he move to a nursing home for older people. When he and his consultant said no, this file was put in the pending tray. There this young 23 year-old watched patients die, and the noise of machinery made sleep possible only for the very tired or the very ill. It was a life barely lived for days, weeks and months on end.
That situation occurred only due to the inability of local health and social care services to work in an integrated, efficient and effective way. It could not have been a question of funding, as the cost of his care
was three times more expensive in the hospital unit. This was not an isolated case. Since then, the unit has experienced an increasing number of cases.
Britain no longer routinely places disabled people in institutions, but that does not mean that it does not institutionalise disabled people through bureaucratic failure, red-tape and a lack of support, precisely because the duty struggles to provide a holistic publicly funded health and social care support service.
I am not a fan of a health model of disability, but so many disabled people are living with considerable health issues. That is why we have to have a clear structure and direction in both health and social care so that they work together equally to produce outcomes for disabled people that enable them to go on living the life that they so long for: a life lived independently in the community.
Baroness Pitkeathley: My Lords, I apologise to the noble Baroness, Lady Campbell. I was so eager to follow the noble Baroness, Lady Jolly, on Amendment 79, and I did not know that she was wishing to speak.
I particularly wanted to follow the noble Baroness, Lady Jolly, in speaking in support of Amendment 79, on which my name appears as well as hers and the noble Lord, Lord Warner, who was unavoidably absent today, and indeed the noble and learned Lord, Lord Mackay.
It will not have escaped the notice of the Committee that we are all members of the Joint Select Committee which scrutinised this Bill. We were very keen to have in Clause 1 the recommendation that when making regulations or issuing guidance, the Secretary of State must have regard to these principles, as must as local authorities.
We put this issue to the Secretary of State and the Minister as the noble Baroness, Lady Jolly, has mentioned, when they appeared before the Joint Committee. They appeared to be very favourably inclined towards it. We were very hopeful that this would be in the Bill. The civil servants were clearly less eager about this, so perhaps it was no surprise that it did not appear. However, we took away from the evidence session the understanding that Ministers were sympathetic to the idea. That is one of the reasons this amendment has been tabled.
Sadly, the official line now seems to be that used by the Minister at Second Reading on 21 May, when he said that,
“the well-being principle in Clause 1 is intended to apply at an individual level, when a local authority makes a decision. This individual focus on the specific well-being and outcomes for that person is at the heart of the way that the Bill has been drafted. It is not intended to apply in a more general way. Given that we do not think it would be appropriate for the Secretary of State to be subject to the same duty, the Secretary of State does not make decisions at the individual level”.—[
Official Report
, 21/5/13; col. 829.]
Nobody could disagree with the first part of that statement but the second part simply does not follow on, because the Secretary of State’s actions in regulations and guidance determine to a great extent whether local authorities can discharge their duties under Clause 1.
If the Secretary of State asks so much of local authorities without adequate funding being available, they will simply be unable to discharge their duty.
Only if the Secretary of State is bound by the same duty as the local authorities can there be any realistic chance that, over time, he will avoid making unreasonable demands of local authorities in the instructions that he gives them. The way that the Bill is drafted, the Secretary of State can simply pass the buck back to the local authorities, which differs from his position in relation to the NHS, where he is required to act in accordance with the NHS Constitution. If it was the Secretary of State’s intention, as he seemed to be saying in his oral evidence to the Joint Committee, to support the well-being principle in practical terms, this amendment should be acceptable, and I hope it will be.
Lord Black of Brentwood: My Lords, I shall speak to Amendments 78E, 87K and 88J, which are in my name. They raise the issue of companion animals—mostly cats, but dogs as well—and the positive role that they can play in the care of elderly, vulnerable and sick people, whose welfare is at the heart of the Bill. I should declare an interest as president of the Printing Charity, as it runs two homes providing sheltered accommodation and financial support and care for people from the printing industry.
Amendment 78E includes the positive contribution of a companion animal to an individual’s well-being in the list of factors to which a local authority must have particular regard in exercising its functions under Part 1. Amendment 87K includes identifying the role of companion animals in the care and support of an individual when a local authority is assessing their needs and those outcomes that an individual wishes to achieve in day-to-day life. Finally, Amendment 88J deals with the issue of companion animals in regulations under Clauses 9 and 10. Taken together, their purpose is to ensure that the benefit which companion animals can provide to well-being, a subject not currently covered in the Bill, is not overlooked by those implementing and interpreting it.
It is estimated that 25% of people over retirement age own one or more pets. For the elderly and vulnerable, the companionship that cats and dogs can bring cannot be overstated. Academic research over many years has documented this. One study by Brooks, Rogers and others, published just last year, highlighted the emotional and practical impact that companion animals offer. Noting that they provide unconditional support and love, as we all know, the study concluded that,
“the policy implications of this study suggest that pets might usefully feature alongside consideration of the usual support systems associated with the management of long-term conditions and in planning how needs might be ... creatively met”.
That, of course, is precisely what this Bill is designed for and what these amendments are crafted to deliver.
Cats in particular can help those who are vulnerable, through age or health, in three ways. First, there is a powerful body of evidence about the contribution of cats to physical health. According to one study published recently in the Journal of Vascular & Interventional Neurology—not a magazine I look at frequently, but it is there—they contribute to a reduction of fatal cardiovascular disease by around 30%.
Secondly, the ownership of a cat brings positive benefits to an individual’s mental health. Research conducted in 2011 for Cats Protection and the Mental
Health Foundation among people with a mental health problem found that 76% of people who owned a cat felt they could cope with everyday life much better as a result, and that 87% said it had a positive impact on their well-being. Cats can be especially helpful for depression during the winter period—a particularly important point since, as we now know, this goes on for about nine months of the year. As the Cinnamon Trust, which works tirelessly to support the elderly and their pets, summarises it:
“Pets have the ability to bring happiness and laughter and lift depression. Communication with other people is often easier when a pet is present for reassurance”.
Thirdly, cats make particularly suitable companion animals for those with chronic health problems, including those who are immobile or disabled. I know that this is a charge always made against cat lovers, so I am not forgetting our canine friends. I highlight, for instance, the excellent work of the innovative Dementia Dog Project, which helps to keep people in the early stages of dementia active and engaged with their local community, as well as providing a constant companion to reassure those suffering from dementia in new or unusual situations. This project in particular shows that a dog may aid a sufferer to stay on longer in his or her home—an important ambition that many noble Lords have highlighted in this debate—and may even slow the onset of this terrible disease.
Real-life examples of how cats promote well-being and play a vital role in an individual’s care appear regularly in the excellent magazine, The Cat, which is a publication I do look at regularly and is published by Cats Protection. In recent months, there have been stories about how their cats helped an owner to cope with epileptic seizures, helped a seven year-old boy to deal with the debilitating problem of selective mutism, and comforted a 17 year-old girl confined to bed with the life-long incurable condition of Behçet’s syndrome. One particularly moving story related to how a visit from a cat to an elderly lady who was in a hospital ward and suffering from severe dementia got her to speak for the first time in three months.
There are many other examples. Indeed, I think of the experience of my own mother. In the last year of her life, she was widowed, immobile and more or less housebound. Her faithful cat, Toby, was her constant companion. She talked to him, laughed with him and moaned and shouted at him; he cared for her in return. Indeed, he lay on her bed as she died. That companionship is a priceless gift, which this legislation should protect. Let me explain briefly how these amendments might help, as I ask my noble friend the Minister to consider these three issues.
First, one of the many problems that those who are elderly with a pet can face is how to care for it when they go into a care home. There are some amazing care and retirement homes which welcome pets but others do not have a policy on them, which can cause anxiety and distress to those who need to enter one. For a person to have to give up what might be their sole companion is a tragedy for an owner and for the pet. It also adds to the growing burden on many animal charities, which are having to take increasing numbers of abandoned pets as economic problems have bitten hard in so many families.
Secondly, it would encourage those at the front line of care—GPs, in other words—to become aware of the role of a pet in an individual’s life. Many GP surgeries include in their information about the over-75s whether a companion animal forms part of the client’s household. The signal sent from amending the Bill would encourage many more GPs and clinical commissioning groups to ensure that this important information is routinely collected for all age groups, including the elderly.
Finally, the Bill needs to be drafted widely enough in its definitions of well-being and needs assessments to allow for money, whether budgets or direct payments, to be used where necessary to support an individual who perhaps wishes to retain a pet but is having problems due to health. Professional pet-sitting or feeding may be needed when an individual is hospitalised and where there are no friends or family to help. Knowing that a pet is being cared for can help encourage otherwise reluctant individuals to go into hospital for treatment and relieve anxiety. Equally, in cases where a care assessment shows that a companion animal would bring individual health benefits, money may be needed to help an individual obtain a companion animal. There are many examples of such budget programmes in other countries—most notably, I think, in Australia—where health and local authority budgets are pooled to provide companion animal support programmes. This principle should be embedded in regulation and statutory guidance for all relevant implementing bodies.
Most importantly of all, these amendments would ensure that the role of companion animals is given proper recognition and protection through an individual’s care journey. Some may be too vulnerable or frail to request that their beloved pet is taken into account when their care is planned. Others may need help or assistance in retaining their companion. Others still may not be aware of how a cat or a dog could improve their quality of life, ease their loneliness or help tackle a chronic disease. The amendments I have tabled would ensure that this happens as a matter of routine and is not left to chance in the way that, tragically, too often happens now.
Baroness Masham of Ilton: My Lords, today is bowel awareness day. I have been chairing a reception for bowel care this afternoon. Two of the speakers had disabilities: one with multiple sclerosis and one a tetraplegic, paralysed from the neck down. Both needed bowel care and they both said that dignity and respect were so important. Amendment 78ZA should therefore be a must for the Bill. There are many important amendments in this group, including those on well-being and companion animals, which I support. Happiness is something we should all aim for.
Baroness Tyler of Enfield: My Lords, I add my support to Amendment 78ZA, to which my name is also attached. The noble Lord, Lord Bichard, has already spoken very eloquently of the reasons behind the amendment. Dignity and respect are absolutely fundamental pillars of well-being, which is why I would like to see these words spelt out in the Bill. Well-being is unattainable without dignity and respect as central components. In saying this, I am conscious
that the public’s opinion on this matter is one of pessimism and distrust of the current social care system. In a recent survey, only 26% of the public felt confident that older people receiving social care are being treated with dignity. If the public do not trust their loved ones in the hands of the social care sector, what hope is there that well-being is being promoted?
We have recently seen and heard of shocking failures in the care of older people in both the health and social care sectors. These very harrowing examples serve to illustrate the importance of enshrining dignity and respect as a critical part of well-being in order to try to change the culture among care workers in the health and care sectors, to ensure the transformation of services that this Bill is intended to bring about and to have the sort of compassionate care that we all like to see. Dignity will also be very important when it comes to secondary legislation and specifically to the eligibility criteria. It is vital that these criteria have regard to the well-being principle. I am happy to be corrected about this if I am mistaken, but the draft feels very health-and-safety-oriented and does not mention dignity at all.
I would have liked to add my name to Amendment 79 about including well-being as part of the Secretary of State’s duty, the reasons for which have already been set out very clearly. The very wide-ranging definition of well-being, set out in The Care Bill Explained, makes it absolutely clear that for the well-being principle to be made a reality it would need to be the joint responsibility of a wide range of partner agencies, nationally and locally. Government action on key issues such as welfare, transport and housing are likely to have a very distinct impact on well-being at an individual level.
We rightly hear a lot about the importance of joining up health, social care and wider services: horizontal integration, if you like. For any system to work as it is intended and to be fully aligned it must be, as I said at Second Reading, vertically integrated as well to make sure that everyone, from the Secretary of State downwards, has the same objectives and is pulling in the same direction.
Baroness Greengross: My Lords, I support Amendment 78ZA. Six years of serving on the Equality and Human Rights Commission taught me that if we embedded dignity and respect into the training of staff we would avoid many of the tragedies we have read about. This applies, right across the board, to staff in health, social care and housing. It is essential that we take dignity and respect as very serious elements of the training of all staff who come into contact with frail and vulnerable people.
Earl Howe: My Lords, the well-being principle in Clause 1 was devised on the basis of the Law Commission’s report on adult social care which this part implements. The report recommended that the new statute should set out a single, overarching principle that adult care and support must promote or contribute to the well-being of the individual. Not least in the light of our debate at Second Reading, I can therefore understand the noble Lords’ intention in tabling Amendments 78 and 79. It is to ensure that any
functions that the Secretary of State exercises under this part take into consideration how such provisions will impact upon people’s well-being. I can give the Committee what I hope will be a welcome reassurance on that issue and, in the process, a rather better and fuller answer than I gave at Second Reading.
It is already the case that the Secretary of State must have regard to the general duty of local authorities to promote an individual’s well-being when making guidance or issuing regulations. This is because, when making regulations or issuing guidance, the Secretary of State must consider how local authorities can fulfil their statutory obligations. He cannot ignore those obligations and I believe this addresses the central concern of the noble Lord, Lord Hunt, and others who have spoken to the amendment. The question is whether the Bill should go further. The Government do not believe that it is appropriate to apply the well-being principle directly to the Secretary of State. The well-being principle is intended to apply at a very real, individual level. It has been designed to frame the relationship that exists between the local authority and the individual adult, in effect setting out how it is expected the local authority will behave when making a decision, or doing anything else, in relation to a person needing care and support or to a carer. The Secretary of State does not act at this individual level, and I am still reluctant to make any amendment which might be seen to detract from this important legal reform.
Having said that, I have listened with care to the strength of feeling in this debate, not least to the point made by the noble Baroness, Lady Pitkeathley, about the Secretary of State’s duty to have regard to the NHS constitution and whether there was something comparable that we could devise in this context. That is an interesting comparison and, while I am not yet convinced that it is fully comparable, I am happy to take the points that have been made away with me and give this matter further thought before the next stage of the Bill.
Amendment 78A seeks to bring in to the well-being principle the idea of spiritual well-being and I listened with care to my noble friend Lady Barker who spoke to this amendment. The Government believe that the clause, as it is already drafted, takes such a factor into consideration. Clause 1(2) sets out that well-being means an individual’s well-being in relation to emotional well-being. The Government believe that emotional well-being incorporates the concept of spiritual well-being.
I turn to Amendment 78B, which proposes that local authorities must take into consideration an individual’s beliefs, values and past practices. While we share my noble friend’s intention in this regard, we believe that the clause as it stands already incorporates the idea that people’s beliefs and values should be taken into account when a local authority has regard to an individual’s views, wishes and feelings.
The second part of the amendment would be to ensure that “past practices” were also taken in account. I reassure my noble friend that we will be setting out in guidance the importance of taking into consideration, when planning a person’s care, their views and feelings as well as considering any practices in the past that have been important to that individual.
The noble Lord, Lord Bichard, highlights the importance of dignity in care in his Amendment 78ZA, and he spoke about that concept very powerfully. I am pleased to say that the Government agree that this is important, which is why we amended the Bill to make an explicit reference to dignity into the well-being principle, following pre-legislative scrutiny. With respect to the noble Lord, I cannot agree with him that the word has somehow been lost; it is right there on the page.
I turn to Amendments 78E, 87K and 88J, tabled by my noble friend Lord Black of Brentwood. These amendments focus on the very important topic of pets. The Government have considered this issue carefully since the amendment was tabled, and we believe that the Care Bill already allows for the consideration of pets. First, Clause 1, the well-being clause, provides that local authorities, when exercising any function under Part 1 of the Bill, have a duty to promote the well-being of an individual. Well-being is composed of many aspects, including emotional well-being. A pet might be so important to an individual that their emotional well-being would depend in some way on their pet. If that is the case, a local authority will have to take it into consideration.
Furthermore, Clause 1(3)(b) sets out that in exercising any function under Part 1 of the Care Bill a local authority must have regard to an individual’s “views, wishes, and feelings”. This could include how an individual feels about a pet, and their wishes for the pet. Clause 9, which covers the assessment of needs for care and support, also allows scope for pets to be taken into consideration in the assessment process. As Clause 9(4)(a) sets out, a needs assessment must take into consideration a person’s well-being. This could certainly include an individual’s pet, from which they derive a lot of emotional well-being.
I turn to Amendments 78D and 88L. The Government believe that it is more important than ever that care and support services operate in tandem with health services. The Government have committed to breaking down barriers between health, care and support, as well as encouraging co-operation, integration and joined-up working between local partners. The Government believe that the Care Bill already allows for such co-operation to occur, and I shall explain how. First, Clause 1(2)(a) makes it clear that the well-being principle incorporates physical and mental health. Local authorities must therefore already consider a person’s health when exercising any functions under Part 1. Secondly, Clause 3 details how local authorities must exercise their functions under Part 1 with a view to ensuring the integration of care and support with health provision, where they consider that this would promote the well-being of an individual.
Regulations on assessments for care and support are also relevant. As Clause 12(1)(f) sets out, regulations may set out when a local authority must consult someone with expertise before undertaking an assessment. Regulations may also set out conditions around co-operation with the NHS, by specifying the circumstances in which the local authority must refer the adult concerned for an assessment of eligibility for NHS continuing healthcare.
The noble Lord, Lord Hunt, expressed the view that the eligibility regulations do not sufficiently promote integration. I note the point that he made and look forward to debating this in perhaps fuller measure when we come to discuss eligibility. However, I ought to point out that the draft regulations published last week are subject to consultation, and I am sure that the discussion will explore the points that he made.
My noble friend Lady Tyler said that the regulations do not mention dignity specifically. I think that they have to be read in context. The well-being principle, including the reference to dignity, applies to the assessment of the adult’s needs and to the local authority’s determination of whether those needs are eligible.
To return to my noble friend Lord Black’s amendment on companion animals, we are clear that there should not be any limitations on the uses of direct payments, which was an issue that he raised, as long as they are used to meet needs for which they are paid and not in a way that is unlawful. The key is that direct payments are used to improve people’s outcomes.
I understand the intentions of noble Lords in tabling these amendments but I hope that they feel reassured that they are not necessary, although I will take back the specific issue that I referred to earlier. In the light of that, I hope that the noble Lord, Lord Hunt of Kings Heath, will feel able to withdraw the amendment.
7.45 pm
Baroness Masham of Ilton: Before the Minister sits down, I would just like to ask him: does he not really want to get things right? When there were problems at Mid Staffordshire, people were desperately thirsty, drinking out of flower vases, and were lying in their own refuse in their beds. Surely dignity must be written in all over the Bill.
Earl Howe: I agree that dignity is a very important concept, which is why we expressly amended the Bill to include that word right at the beginning. Clause 1, which defines the well-being principle, is the foundation for everything that follows. While one could pepper the Bill with references to the word “dignity”, I am not sure that that would add very much in practice.
Lord Hunt of Kings Heath: My Lords, I am grateful to the Minister for that response. I hope that he will reflect a little on the amendment from the noble Lord, Lord Bichard, and the noble Baroness, Lady Tyler. I understand what he is saying about the words in the Bill; I think that noble Lords just wanted to find a way of giving that greater focus. That will be well worth giving further consideration to. With regard to the amendment from the noble Baroness, Lady Barker, I am grateful for the reassurance that the Minister has given.
On Amendments 78 and 79, the Minister has essentially said that he still sticks to the general principle that the well-being clause applies to local authorities and individuals. The point here, though, and the reason why I am glad he is taking it away, is a point raised by a number of noble Lords: this legislation, which is a wholesale recasting in the light of the Law Commission’s
work, is likely to endure for many years to come. That is why it is so important that the link between the Secretary of State’s duties, and those of local authorities, and the Secretary of State’s powers regarding guidance and regulations are brought together. I hope that the Minister will find a way of getting this into the Bill.
The noble Baroness, Lady Campbell, was very eloquent when she talked about what happens if health and social care do not provide an integrated service. She gave an example of a very distressing case of someone who could be out of hospital and back into work. This was down to a failure of two public bodies to sort things out. I know that the Minister says that in fact the legislation is okay; the problem is that these public bodies will continue to fail people who fall between two stools. These bodies do not seem to have an understanding that it is imperative for them to look after the interests of those individuals. I hope that the noble Baroness might return to this at a later stage.
The noble Lord, Lord Black, made some wholly persuasive arguments. My noble friend Lady Wheeler reminded me that Canine Partnerships is another organisation that is very much involved in pet companions for people with stroke, epilepsy and other illnesses. I myself have come across organisations in Birmingham in connection with the health service that do a fantastic job. All I would say is that if the noble Lord put this to a vote, the Opposition would be right behind him, so let us see. I beg leave to withdraw the amendment.
Amendments 78A and 78B not moved.
House resumed. Committee to begin again not before 8.50 pm.
London Finance Commission: Raising the Capital
Question for Short Debate
7.50 pm
Asked by Lord Harris of Haringey
To ask Her Majesty’s Government what assessment they have made of the findings and recommendations of the report of the London Finance Commission Raising the Capital.
Lord Harris of Haringey: My Lords, I am grateful to all noble Lords who have put down their names to speak in this short debate. As somebody who has lived in London all my life, I should explain that my starting point is that London is the greatest city in the world. I would find it difficult for anyone to argue against that. I spent 26 years as an elected politician in London: as a councillor, council leader, chair of the Association of London Government, and member of the London Assembly. I believe that the London Finance Commission should be congratulated on the report that it has produced.
I should explain that the London Finance Commission was established by the Mayor of London and London Councils, which in my time was called the Association of London Government. It was an independent group, chaired by Professor Tony Travers, who is probably the country’s pre-eminent expert on local government finance, and it contained cross-party representation and senior representatives from elsewhere in the United Kingdom, including Stephen Hughes, the chief executive of Birmingham City Council. It published its final report in May, and its recommendations have been accepted by the Mayor of London and by Mayor Jules Pipe, on behalf of London Councils, with both Conservatives and Labour accepting. It has been supported by all four parties on the London Assembly.
The context for this report is that London is the engine that drives growth in the rest of the UK economy. I will give just one example. Forty-one thousand jobs were supported outside London last year simply by Transport for London’s supply chain—24,000 of them in the North and Midlands. That is more than the number directly employed by Transport for London—London Underground, buses and so on—in London itself. In addition, 62% of Transport for London’s procurement spend went to suppliers outside London, with the bulk outside the south-east. That is one example of the extent to which London drives the rest of the UK economy. London also makes a net contribution of over £5 billion in tax to the rest of the country each year.
Even without my bias, London is universally acknowledged as one of the leading international cities in the world. To quote the report:
“It is difficult to envisage a scenario in which London’s economic decline would be favourable for the rest of the UK and we reject the notion which is occasionally articulated that London should be constrained in order to ‘balance’ UK economic growth. In most markets, London is competing as much, if not more so, internationally than against other UK cities. Many foreign direct investment projects that London wins in competition with other international cities provide benefits for other regions, and many tourists who visit London go on to other parts of the UK. Other international cities vie for investment, visitors, students and talent, and in the global competition, London risks falling behind and, in respect of infrastructure, further behind”.
That is the context in which this report was prepared.
London's population is equivalent to those of Scotland and Wales combined—and probably to that of Northern Ireland as well if those here in this capital city illegally are included in the count. Its economy is almost double the size of Scotland and Wales combined, but as the report says,
“while the dynamic of devolution continues to offer new powers and financial freedoms to the governments in Edinburgh and Cardiff (and, indeed Belfast) there have been no proposals to increase the autonomy of London government”.
The commission received no evidence as to why London and other English city regions should not be afforded the kind of decentralised power offered to Scotland, Wales and Northern Ireland.
Yet London’s international status and its continued ability to help drive the rest of the UK economy cannot be taken for granted. Historic population growth in London has already placed considerable pressure on the full range of public services and local infrastructure and this is set to increase from a growing population
with increasingly complex demography. London's population is growing at a faster rate than any other region in the country. By 2020, its population will exceed 9 million. London’s school-age population grew by 107,000, at a rate of 8.2%, in the past decade—the fastest regional rate.
London has an inherently mobile and changing population. In 2011, it had approximately 70,000 short-term residents, over a third of all short-term residents in England and Wales. It is estimated that 240,000 households live in overcrowded conditions, with 90% of London’s housing stock built before 1991, and new housing supply meeting housing need in only six of the past 20 years. This means that London has the most overcrowded households in the UK, living in the oldest homes, where the market is not delivering sufficient new homes to match current and future demand.
However, if London’s infrastructure crumbles and the quality of life deteriorates, its ability to attract and retain international business will decline, and that cannot be good for the rest of the United Kingdom. It is economic growth that the commission sees as the potential prize of a further shift of financial and fiscal control to London. As the city population grows to 9 million, then perhaps 10 million by 2030, there will need to be massive investment in enabling infrastructure simply to accommodate these new residents and, indeed, commuters. Beyond this investment to keep pace with the population, the commission is convinced that London would be better able to prioritise decisions about that investment. After all, Londoners know they need new railways, schools, homes, waste facilities and streets. Because of their day-to-day dependence on physical infrastructure, London voters are much more likely than voters elsewhere in Britain to prioritise spending on longer-term investments.
If London had enhanced fiscal capacity to back such investment, there could be an enhanced level of capital spending which would, in turn, produce additional growth and tax yield. London government could then reinvest higher tax revenues in more infrastructure and a virtuous circle would be created. As the report acknowledges:
“London is not a city state. But it could have a greater degree of self-government and thus, in our view, be better governed. The same is true for other city regions. No one can seriously any longer believe that Whitehall always knows best”.
In terms of fiscal autonomy, London is an outlier compared to the other cities that the commission studied. By comparison, it relies heavily on transfers from central government, with 74% per cent of its income received through grant, compared to 37% in Madrid, 31% in New York, 25% per cent in Berlin, 17% in Paris and only 7% in Tokyo. Moreover, London does not have comparable access to the diverse tax bases enjoyed in other cities.
I understand that, in correspondence with the chair of the commission, no less a person—if such a thing were possible—than the Chancellor of the Exchequer, the right honourable George Osborne, expressed support for the commission and stated that,
“under the right conditions, fiscal devolution has the potential to increase the financial accountability of local government and promote additional growth”.
The commission accepted his suggestion that the proposals should be judged against three tests. First, they should be based on evidence; secondly, they should have cross-party support; and thirdly, they should be without detriment to the rest of the UK. The achievement of the commission is to meet those three tests. The report is evidence-based. It has the support of all four parties on the London Assembly, all three parties in London Councils, the Corporation of London and significant, leading sections of the London business community, including the London Chamber of Commerce and London First. What is more, what is proposed would not be to the detriment of the rest of the UK. Indeed, it is likely to be of benefit in sustaining the UK’s future growth.
The commission proposed that any devolution of tax-raising powers would be offset by a reduction in government grant. Moreover, many of the commission’s recommendations could be replicated in other cities. Some cities, such as Manchester, have already evolved governance models from which London could learn.
The report, No Stone Unturned, of the noble Lord, Lord Heseltine, who is not in his place, made a parallel case for devolution to city regions. I hope that the Minister will agree that technical working parties should be established by her department and by the Treasury, with the Greater London Authority and London Councils, to examine the detail of these recommendations.
The London Finance Commission report meets the Chancellor’s conditions. It provides a blueprint for taking forward the localism agenda that the Government espouse. It protects and enhances the position of the rest of the United Kingdom. Above all, it would ensure that London continues to be the greatest city in the world.
8.01 pm
Lord Patten: The first-order question to ask is whether there is a problem in London, and, if so, whether this report answers it. I do not think that London itself is a problem. In the 1940s, the French scholar over the Channel, Jean-François Gravier, wrote a great book, Paris and the French Desert, in which he reflected on the absolute dominance of the capital in French national life, sucking energy from the rest of the country. It is an odd reflection, which he would certainly not have predicted, that London is the city with the fifth or sixth largest French population, because of the large number of extremely welcome financial and professional people who have come here en masse to escape the Hollande terror.
London has dominated English life for a very long time—certainly since Cobbett’s day. Now it is the most dominant city in Europe, and one of only two or three true global megalopolises. I agree entirely with the noble Lord, Lord Harris of Haringey, who in his tip-top speech said that London was probably the greatest city in the world, among the two or three other megalopolises—the term was coined by another great French geographer, Jean Gottmann.
This has not happened because it was planned or because of governance. It happened of its own volition and vigour, always—at least until recently—more or
less free from, and often despite, the actions and policies of national and local government of all colours. Truly, Mr Livingstone and his successor, Mr Johnson, inherited a going concern. This has not happened overnight. I do not think that this is clearly recognised in the report, which in many ways seems to think that London will run into problems caused by its own success, and that those perceived problems will be sorted out only by more government and more power going to London government. So much for lack of concentration.
All this is not surprising, because the commission, with its solemn, grand-sounding title, is a creature of the present London government, and so generally starts from the point, “Please give us more government and more powers as quickly as possible”. Yet already the United Kingdom is one of the most overgoverned countries on earth. This may well be reaching a satiation point rather than a tipping point.
There is a constitutional change industry that promotes constitutional change as the only way to deal with any issue facing any part of the United Kingdom. Hosts of experts, otherwise indigent scholars and think tanks without number and no visible means of support are always proposing more constitutional change as a solution. To suggest that constitutional change, more power and more government is a cure-all for London is a delusive and tinsel thing.
In my experience, most Londoners are much more concerned with the present system of governance and whether it is delivering the goods. I will give one very rapid example: namely, the growing number of rough sleepers in London. The number is indisputably rising, not going down, at the moment. This is a tragedy. I walk along Victoria Street to our flat down the road by the cathedral every night. Since late May, just opposite New Scotland Yard, where Strutton Ground meets Victoria Street, there has been a growing number of rough sleepers, tragically, right under the window of the commissioner for the metropolis. I walked past them tonight at about 6.30 pm and counted seven. They were all clearly British. Two, possibly three, were extremely jolly Scotsmen. That is not a xenophobic remark. They deserve help and not criticism for being there. It is extraordinary, in the middle of what the noble Lord, Lord Harris of Haringey, called one of the greatest cities, if not the greatest city, in the world, that for the past six or seven weeks we have had a growing city of people sleeping rough on the streets. Where is the help coming from? Is the Minister in contact with the mayor, or with other authorities that could help with this issue?
That said, this thought-provoking report—it certainly provoked me—seems to set London, despite the somewhat disingenuous claims that of course it is not a city state, on a course of morphing little by little into becoming such a state. That is not in the national interest, unless it is set in the context of whether we need more or less government in the United Kingdom as a whole.
The report proposes the transfer of the full suite of property taxes to London government, and the assignment of income tax in the same way. There is also a wonderful aside:
“London government should be able to introduce smaller new taxes”.
I look forward to that innovation. How dear Mr Livingstone would have relished having that power in his hands in the old days.
London can properly be viewed only as part of the kingdom as a whole. It will continue to develop apace without many of these proposed changes. It needs to govern better in the first instance. I wonder whether the powers of scrutiny that the London Assembly has are adequate.
In the mean time, the foreword to this report states:
If all the report’s proposals were implemented overnight én bloc, London would be more than half way to becoming a city state, and that would not be in the national interest.
8.07 pm
Baroness Hamwee: My Lords, I welcome and support this report, and did not want to miss the opportunity of saying so from the Liberal Democrat Benches just because I had not had the opportunity I would have liked to produce a perfectly honed and intellectually challenging speech. Sometimes it is more important to say these things than to be proud and retiring.
It is always nice to find one’s prejudices confirmed. I was not surprised at the commission’s finding, or belief, that there would be more jobs and growth if London had more financial autonomy. It goes without saying that it would need to be used well. What is proposed does not seem to be so very extreme. Central government would retain about 88% of taxes paid in London, as against around 93% now.
Devolution in 2000 was very welcome—to me at any rate. The noble Lord, Lord Harris of Haringey, remembers it as well as I do. I declare an interest as a former member of the London Assembly and, some years ago now, a councillor in a London borough. It was welcome to the extent that there was devolution, as distinct from the hoovering up of powers from the boroughs. The noble Lord, Lord Patten, talked about more government, but normally one is talking about a rearrangement.
It would be disappointing if London government were not ambitious to do more—as are the Scots, leaving aside independence, and the Welsh. I am well aware of views from other parts of the UK about the London-centric nature of so much of our government. Non-Londoners might say, of the contents of this report, “Well, they would say that, wouldn't they?”. However, the noble Lord, Lord Harris, mentioned the membership of the commission—and they look to be a pretty independent-minded bunch of individuals.
What is good for London tends to be good for the UK as a whole because of London’s role in the wider economy. Knowing of the debate that is going on about HS2, I rather tremble about venturing that way, but, as regards infrastructure, one has only to ask not just any Londoner and not just any visitor but any company considering locating here.
Of course, housing is a hugely important part of the infrastructure and one about which, like other noble Lords, I feel very strongly, meaning that I support borrowing, including borrowing by the boroughs, to
build housing within the prudential rules. That is not least because London’s government, representing Londoners and understanding what is going on in London, knows what is needed. Too often, the social housing element of bigger schemes seems a grudging add-on. It is easy for the developer and it is often identifiable just by looking at the development. Among other things, I think it is offensive.
In the foreword to the report, Tony Travers says that the message from the evidence was,
“clear and unanimous: London’s government needs to be given greater freedom to determine and use the resources raised from taxpayers”.
I read the subtext as including “clarity” and “transparency”. I suspect, too, that introducing new, smaller taxes may not have an entirely smooth path but, as someone who thinks that there is advantage in taxation, I do not dismiss that proposal.
Of course, the mayor should use his existing powers. It is not so very long since prudential borrowing was introduced in the form that it is now, and it does not advance the argument for new powers if the current ones are unused or underused. The mayor could fund a significant increase in affordable housebuilding.
The noble Lord, Lord Patten, referred to rough sleepers. I, for one, am not convinced that centralisation or the reduction of taxes would assist that.
If central government resists these proposals, it will not be the first time that any central government has grasped for arguments as to the importance of central control. I, too, lighted on the quotation from the Chancellor of the Exchequer. It begs the question of what the right conditions are, as the noble Lord, Lord Harris, said.
A Government who believe in entrepreneurship should apply the same thought—that freedom facilitates creativity and success—and apply that to finances, with the raising and spending of taxes. The dynamic in a wider context is towards more financial autonomy. I welcome the Raising the Capital report and I thank the noble Lord, Lord Harris, for the opportunity to say so.
8.12 pm
Baroness Valentine: First, I declare that I am chief executive of London First, a not-for-profit membership organisation for businesses based here in the capital. I am also a board member of Peabody housing association.
I congratulate the noble Lord, Lord Harris, on securing this debate today. The London Finance Commission and its report on local government finance might sound arcane but its analysis is in fact at the heart of how we can stimulate growth, not just in London but across our country as a whole.
The commission’s starting point is that the Mayor of London should have a long-term, high-level capital investment plan for the city—a position that manages to be banal and radical at the same time. It is banal because surely every great city ought to have such a plan, and it is radical because local government in the UK just does not do that sort of thing, not least because it does not have the powers or the cash to finance and fund it.
So let us pause for a moment to consider London’s starting point. As the report politely puts it, London, in fiscal autonomy terms, is an,
“outlier compared with other cities”.
Nearly three-quarters of the GLA’s income is through grant, compared with roughly a third in New York and less than 10% in Tokyo. The core competence for a London mayor, therefore, must be good lobbying skills with central government, and particularly the Treasury, to try to get some of our money back at every spending review. This is no way to run a world city and it needs to change. That need is becoming ever more urgent as London accelerates towards a population of 10 million, and maybe more, by 2030.
The commission recommends, in essence, that London government takes ownership of a suite of property taxes raised in London—council tax, business rates and stamp duty land tax—and uses them to create a stable funding stream to support a long-term infrastructure investment programme. This does indeed have the potential to create a virtuous spiral for both the city and the Treasury. New infrastructure will support private sector investment, which creates jobs, adds to private consumption and leads to greater tax revenues for City Hall and Whitehall. This, in turn, supports further, future investment. It is, in my view, a powerful analysis, persuasively made, and a conclusion that could equally be applied to other great cities.
It is also important to emphasise that this is not a bid for more cash for London. The commission’s modest proposal is that the property taxes I referred to earlier simply substitute, pound for pound, existing government grant. However, this simple change has two merits. The first is that it gives much greater certainty to London government that it will have the revenue, over time, to fund investment. This means that it can plan into the long term and, potentially, borrow against that funding. This is substantially more efficient than annual, or even five-yearly, spending settlements. The second is that London government then has a share in growth. If its investments generate prosperity, it has an automatic share in that prosperity. It does not have to go back to the Treasury to haggle.
Those changes would be good, too, for central government in at least three ways. First, it could focus on driving the big policies such as—dare I say?—high-speed rail, which only national government can do, rather than fiddling around with local matters that can best be done elsewhere. Secondly, local government would have a real incentive to support growth. This goes with the grain of the Government’s localism agenda—and puts it on steroids. While London would keep the growth in London’s property taxes, the Exchequer would get the growth on the really big-ticket items such as income tax, national insurance and VAT. Thirdly, local politicians would no longer be able to blame all their ills on the Treasury. If they want more cash, they can make the case for taxing their voters more, or not.
As ever, some details require further analysis—for example, the mechanism to align business rates with council tax and the need to review the levels and banding of the latter. We cannot rationally or credibly
base our property taxes on 1990 house prices. There also needs to be a more effective and formal mechanism through which London government consults and listens to business over its budget plans. This is particularly relevant to London, where many of those responsible for generating the city’s wealth do not have a vote on its governance.
However, those important points do not detract from the fundamental strengths of the commission’s conclusions. London, like our other great cities, needs greater freedom from central government if it is to generate the growth, jobs and prosperity that we all wish to see. The Government have recognised this in their localism agenda; the noble Lord, Lord Heseltine, confirmed it in his growth analysis; and the London Finance Commission brings yet greater depth to the arguments. It is time to stop talking about devolution and wrest the cold, although all too alive, hand of the Treasury from the management of our great cities.
8.18 pm
Baroness King of Bow: This report sets out the role that financial autonomy can play in driving economic growth. A greater tax base for London means a greater incentive to promote growth and, as the report’s conclusion states, this would be good news not just for London but for the whole country. It is amazing to consider that New York keeps over 50% of taxes levied there, yet London keeps only 7%. London needs to be freed up to compete with the other leading global cities.
On the whole, it is fair to say that I am not a huge fan of this Government’s economic policy—it seems to have almost pushed us into a triple-dip recession—and therefore I am not known for quoting its key architect, George Osborne, but perhaps I may change the habit of a lifetime and quote him very approvingly. The Chancellor of the Exchequer stated that,
“under the right conditions, fiscal devolution has the potential to increase the financial accountability of local government and promote additional growth”.
I was also very impressed by the three tests the Chancellor of the Exchequer set the commission, which my noble friend Lord Harris has already quoted. His proposal was that whatever the commission came up with, its recommendations should be judged against three tests; namely, whether they were evidence-based, whether the proposals had cross-party support and whether they were without detriment to the rest of the UK. Those are excellent tests and I am sure that we would all like a lot of legislation to be benchmarked against them, especially in the current climate.
However, the real issue is how we are going to deal with a huge and growing city, and support growth in London. It is estimated that the infrastructure spend required to support London and allow it to thrive will need to be about £75 billion by 2020. Like the noble Baroness, Lady Hamwee, I feel strongly that housing is one of the most important aspects of infrastructure, although it is not always technically considered to be infrastructure, along with transport and so forth.
As regards housing, the London Finance Commission states:
“Measures to shift public funding from personal subsidy to investment in built assets should be further explored”.
I have argued for that since I became an MP many years ago. The London Finance Commission has put that in very polite terms but the lack of affordable housing in London presents a massive, ongoing crisis. London workers need somewhere to live. Not everyone can commute into London, especially those on modest incomes which do not allow for the cost of the commute. If we do not have that investment in bricks and mortar, only the very rich, or the very poor in whatever social housing is left available, will be able to live in the capital city. That will inhibit growth for our capital, and that is putting aside for one moment the moral obligation that I think is there as well. Therefore, as has been stated, one way in which to resolve the issue is to move from individual subsidy to bricks and mortar. I trust that the Minister will press the Government to look at this issue with urgency.
While I am on housing, I cannot help but comment on what the noble Lord, Lord Patten, said. He decries the concept of more government but is concerned about rough sleepers. The biggest drop in the number of rough sleepers was under the leadership of Louise Casey who was tasked with reducing rough sleeping. Although she is one of the most innovative civil servants you will ever come across, even she would admit that a lot of her success was down to the fact that investment was quadrupled. A laissez-faire approach is the last thing that will reduce the number of rough sleepers on our streets. This cross-party report clearly argues that such an approach is also the last thing that will deliver a high-level investment plan for London.
The report essentially argues for a more grown-up relationship between London and central government. It argues that London needs greater freedom to borrow. Most critically, that would be subject to London’s own self-discipline. It is only where that self-discipline is proven that such freedom should be granted.
In summary, we do not want a city state. We want a world city which will support the growth of the whole of the UK. I believe that that is what this report sets out. It provides the framework for that and I sincerely hope, notwithstanding the politics between the Mayor of London and the Prime Minister, that this report will be acted upon.
8.24 pm
Lord Bilimoria: My Lords, I thank the noble Lord, Lord Harris, for initiating this debate. He said right up front that London is the greatest city in the world and I could not agree more. It is the greatest of the world’s great cities. He congratulated the London Finance Commission on its report, Raising the Capital. I had the privilege of serving on mayor Boris Johnson’s Promote London Council, which was a great experience. It came up with what ended up being London & Partners and had huge success. It really understands London and looks at its competitiveness.
It struck me that few cities in the world—the report did not really touch on this—are a political capital, a government capital and a financial business capital. London is one of them: think about Washington, New York, Delhi and Mumbai. We have a huge advantage. But for London to develop I think that autonomy would help. Although Crossrail is going ahead and
will make a huge difference to London and the country, we still have the problem of the third runway at Heathrow being delayed and delayed. Our airport infrastructure is creaking. We are losing our competitiveness.
Although tourism brings in well over £100 billion to the economy of Britain and London brings in a huge proportion of that, the most photographed building in the world is the Eiffel Tower. The second most photographed building in the world is our wonderful Houses of Parliament. Why is that? Is it because we do not belong to the Schengen scheme, which would advantage this country so much? Does the Minister agree that we should join the Schengen scheme? That would bring into this country even more tourism, business and investment which would benefit London.
The other aspect that the report did not really touch on was the whole relationship between the City of London and London. Of course, we all know the joke that the lord mayor of London makes the money and the Mayor of London spends the money. We have the richest and most important square mile in the world. Even after the financial crisis, the City of London is still the number one financial centre in the world and we are proud of it. But are the Government really clear about the relationship between the City of London and London? Is that a fair relationship? The report does not address that and I would be very interested in the Minister’s view.
As regards devolution, the future of London and its success is a prize for the whole country. However, in the latest results on productivity, when London was compared with other countries in Europe for example, its productivity was average at £58,000 per worker. Cities such as Paris, Frankfurt and Brussels were higher. Stockholm was number one on the list. Yet London’s productivity is 44% above the UK average. That is a serious issue. We really need to get the productivity of this country up in a big way and London’s productivity could be so much more.
The other point is that cities are the engines of growth for an economy. The noble Lord, Lord Patten, said that we are the most dominant city. In the United States, the Olympic Games did not take place in Washington or New York. Another city was chosen. Here, the Games took place in London and we are very proud of that.
We have not spoken about Europe and the European Union. In my role as the founding chairman of the UK India Business Council, I always see Indian businesses looking on the UK as a gateway into Europe, although in fact they are looking upon London as a gateway to Europe. Again, that would help London in its competitiveness. We must remember that outside London there are other great cities in Britain. Recently, I was in Liverpool where I spoke at the Accelerate Conference. Next year, the International Festival for Business will take place in Liverpool, showcasing the whole of Britain. It is important that in promoting London and giving autonomy—I will come to that later—there is also autonomy for other cities, which will unlock the UK’s economic potential.
The other thing that the report does not really emphasise enough is that we have the best of the best in the world in professional services in London when it
comes to lawyers, accountants, insurance and banking. We need to enhance that competitiveness. However, the
Financial Times
states:
“The Greater London Authority has just one tax—the council tax—from which it receives a precept alongside the other local authorities within its boundaries, while Tokyo raises 16 separate taxes and New York has an array of levies, including property, sales and income taxes. Berlin wields a wage tax, among others, while Frankfurt receives a share of VAT. The drive by London’s authorities for greater leeway on tax is taking place amid a wider devolution movement in Britain”.
City deals are about to take place and incentives will be given to eight large urban centres in Britain. Can the Minister say why those incentives have been given to all those cities? Should they not also be given to London?
I chose London as the headquarters for my business because I think it is the best place in the world to have a global headquarters. I think what the London Finance Commission suggested would without doubt help London and our whole country. More flexibility and more autonomy would unleash London’s potential.
8.30 pm
Lord McKenzie of Luton: My Lords, like other noble Lords, I start by thanking my noble friend Lord Harris of Haringey for initiating this debate on the London Finance Commission's report, Raising the Capital.It touches on matters which spread across a range of policy areas and which have broad implications, not least for macroeconomic management of our country. Noble Lords may understand, therefore, if I forgo the opportunity of making new policy announcements this evening—however tempting—but say that we view this report as a serious piece of work that requires proper consideration and analysis. We recognise that it has strong cross-party support and, as the report suggests, its recommendations have potential application for cities beyond London.
The central proposition of the report is that London can grow faster and create more jobs if it has greater autonomy in managing its own affairs, particularly when it comes to planning infrastructure. That autonomy would come from relaxing some of the borrowing rules applicable to local authorities and from devolving certain tax revenue streams. The report’s recommendations are underpinned by research that demonstrated that, compared to other major cities, London has very little fiscal autonomy, although the report recognises that academic research is inconclusive on whether increased fiscal autonomy has a measurable effect on growth.
We recognise, as does the report, that London is an economic powerhouse, one of the strongest growing regions in the UK and one of the world’s greatest cities —indeed, the greatest city, as my noble friend said. That success must be sustained not just in the interests of Londoners but in the interests of us all. It is, after all, our capital city. We should look to it for help to drive our national growth.
We also recognise the case that has been made for investment, which is needed as a direct consequence of population growth to provide housing, schools and primary healthcare. It is also needed to sustain economic growth through improved transport, skills, innovation
and research. This case is not unique to London, and we have long been arguing the case for a proper plan for growth and for jobs.
The question is whether the scale and complexity of London's economy and communities mean that they can be addressed only by London government rather than by—as it has been put—23 Whitehall departments. We support a localist approach but, of course, London government is not a homogeneous entity. The 32 boroughs, the GLA and the mayor collectively comprise a vast range of different communities, economic and social circumstances and political make-up. The report recognises that the different interests that the formula funding system exposed in local government could re-emerge at London level should there be greater financial devolution. There is a clear risk that this may be so.
There is an acceptance that, should there be greater financial devolution to London, existing governance arrangements would have to change. The proposition is advanced that it would require new governance systems and structures that are sufficiently robust to cope with a variety of possible situations but sufficiently simple to be efficient. That is a goal worth having, but one more easily stated than achieved, we suggest.
The report bemoans the dramatic budget reductions suffered by local government, reinforced just last week, and makes the point that revenue constraints are inhibiting capital spending. It highlights that the Treasury is imposing additional capital controls over and above the prudential borrowing code and that these could be scrapped. We have debated this issue especially in relation to housing, and it also is not an issue just for London. I believe we had a common recognition that local government had adhered to the prudential borrowing code in a responsible manner, and we were not convinced of the Government’s position that it needed two tiers of capital control. As the noble Baroness, Lady Hamwee, said, local government should make full use of the headroom that the system offers.
We agree that it is time to consider the possible removal or relaxation of the housing capital limits, but only on the basis that prudential rules would continue to apply, as would the rigour of long-term HRA business plans. Measures to shift public funding from personal subsidy to investment in built assets, referred to by my noble friend Lady King, is also something that we consider should be further explored.
The proposal to devolve or assign to London taxes that are currently collected and paid to central government is more problematic. The focus is on property and property-related taxes, so potentially it is easier to establish the locus—in or out of London. Any new boundary lines are likely to open up avoidance possibilities and there would surely be a resource issue to administer these taxes.
Retention of 100% business rates raises issues of how the arrangements would be unpicked from the newly introduced business rate retention scheme and, within London, what needs and resources mechanisms would be required. The more radical tax reforms considered have even greater technical challenges, as the report acknowledges. However, the big question underlying all of this is what it means for the rest of England. Promoting and facilitating growth in London
does not have to be at the expense of growth in other parts of the country. Indeed, quite the reverse, and other cities could follow suit. However, there will be a need to ensure that other parts of the country are not left behind, particularly rural areas.
Specifically on fairness, it is proposed that the devolution of tax streams to London could be counterbalanced by adjusting grant levels at the start of the process. However, this will do nothing to stop growing inequality after that. We should consider the effects of devolution of stamp duty land tax in a buoyant property market in London, with revenues going to London not to HMRC.
There is much else to be considered and the report has provided valuable food for thought. I thank my noble friend for bringing it before us and seeking from the Minister a practical way to examine the important issues that it raises.
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The Parliamentary Under-Secretary of State, Department for Communities and Local Government (Baroness Hanham): My Lords, I, too, thank the noble Lord, Lord Harris, for introducing the debate. Perhaps more importantly, I thank the people who produced the report, not least Professor Tony Travers, who is known to us all and who has been very influential on the London local government scene for—I had better not say a number of years, he might be offended by that—certainly some time.
The Government recognise the importance of this report. The London Finance Commission set up by the mayor has clearly carried out an in-depth study of what it thinks should be done. However, all I will say at the moment is that its potential impact on both London and, as the noble Lord, Lord McKenzie said, the wider country requires a great deal of thought and consideration.
The report was produced by a distinguished and wide membership, which I was glad to see included people who were not from London but from what we now call the core cities, where devolution is beginning to happen. So they had an understanding of what would happen outside London, which again we need to hold on to.
The proposals would have wide-ranging effects, not only on London but on government finances and the United Kingdom. Given the legal, constitutional and fiscal questions raised, this is clearly a matter that is not going to be decided today and may not even be dealt with in the short term. We need to look forward to see how practical the proposals are not only for London but for the country. The report is London-centric, as one would expect, but, as the noble Lord, Lord Bilimoria, pointed out, there is a lot to London—not just London government but a whole edifice underneath London which supports its financial position in the world.
There are innovative proposals for a further devolution of powers, particularly in regard to finance, and well articulated reasons for this; it is a very well written report, as I would have expected. However, the recommendations have to be considered against the background of the current and perhaps future financial situation.
As to its impact on the London boroughs, I know they were represented on the commission but there is a wobbly bit in the report between London and London government, the mayor and the GLA. It nips in and out of London government and, after reading it quite closely, I came to the conclusion that London government was London and the boroughs, and that London was the mayor. Everything else—London and government and the mayor—was very clear. It is not totally clear where the main emphasis lies except, pretty clearly, with the mayor and the Greater London Authority. Any changes to the way in which the finances are delivered, controlled, measured and administered will affect London boroughs as well.
It would not be appropriate for me to anticipate the Government’s response. I accept that the Chancellor laid out the conditions of what he would want in backing this report. I have no knowledge of his view now of where to go from here but, as I have said, the Government will consider the full implications of the proposals very carefully.
We are already seeing devolution and enormous changes in governance in this country and we cannot ignore the fact that places such as Liverpool, Glasgow, Newcastle and Manchester are all beginning to develop their own core cities along devolved and different paths.
We must not forget that there has been already significant devolution to London through the mayor and, through him, the Greater London Authority. That took place in the spending review of 2010. London recently has received a fair settlement despite the necessity for the deficit reduction. It is worth remembering that as a result of the Localism Act London has gained responsibility for housing. The noble Baroness, Lady King, raised the aspect of affordable housing. London now has responsibility for housing, economic development and the Olympic legacy as well as already having responsibility for transport, planning and the police. That is quite a big raft of local government life.
The London settlement, issued in February 2012, provided the mayor with about £3 billion in unring-fenced grant for 2011-12 to 2014-15. London also has a pretty broad range of financial levers, including business rates supplements—I think Crossrail is the only supplement that has been raised so far, but it has been done—infrastructure levy and tax increment financing. I know the latter is still constrained, and we have discussed this on many occasions, but the possibility of using tax increment financing is not only available to the mayor, but to the London boroughs. London also has, of course, its own enterprise zones.
The Treasury has agreed to provide a guarantee to allow London to borrow £1 billion from the Public Works Loan Board at a preferential rate to support the Northern Line extension to Battersea. Some of the infrastructure work, therefore, is already being done.
The Government are going to create a new enterprise zone in the Battersea and Nine Elms area. Anybody who was watching the news last night will have seen that being laid out, and what a large area it is. That will supplement London’s existing enterprise zone at the Royal Docks. My department has also transferred its assets in London to the Mayor to provide an
important and financial growth lever. The Government have also contributed £25 million towards the costs of the Olympic stadium transformation.
London will also benefit from the flagship Francis Crick Institute for translational research which will open in 2015. That follows £650 million investment from the Medical Research Council, Cancer Research UK, the Wellcome Trust, University College London, Imperial College and King’s College. Finally, on the list of this there are three new catapult centres designed to commercialise new and emerging technologies, and they will be based in London.
London is not being ignored in any way at all. It is developing all the time with what it is able to do, and what there is for it to do. It is now largely independent of national government in a very significant range of policy areas, and it has greater financial autonomy than ever before. That is not to say that we should not look carefully at what has been proposed. I am not prejudging or saying that the Government have prejudged the report in any way at all. Clearly not; we have not had it for long enough. It is very detailed and it has some really important aspects to it. We will be looking at it.
The noble Lord asked me whether we would be setting up technical reviews. It is too early to say, but I am sure that one way or another this report has got to be studied very carefully by experts across the field. Whether that is a technical review or not, I am not sure, but if I can get any better than that for the noble Lord then I will let him know.
The noble Lord, Lord Bilimoria, was talking about London’s position in the world, and I think that we would all accept that it is now one of the most important cities. We recognise that; it is the fifth largest city in gross domestic product and it is a global city that is instantly recognisable. The mayor is instantly recognisable —I think both mayors have been instantly recognisable. It staged a fantastic Olympic Games and London is rightly ambitious for its future. We do not want to forget that the mayor has himself penned an attractive vision for London in 2020, and that is with this other report. It sets out a long-term plan for major investment in infrastructure.
We recognise the importance of investing in infrastructure. The Chancellor has announced that the Government will continue to provide the funding to get the £14.5 billion Crossrail project finished on time. There will be feasibility funding for London's Crossrail 2 project. We will continue to invest in transport and the Transport for London grant is now £1.5 billion.
I think that London has developed enormously over the last 10 years in terms of its independence and devolution. Further devolution, also part of this report, is something that we need to look at carefully on the basis of not only London but of other cities in the country. The noble Lord, Lord Patten, spoke about constitutional changes. Of course, further arrangements such as this would amount to a constitutional change.
Most of our expert speakers this evening recognised and supported the report. We had some excellent speeches on the subject, all of which were slightly different, so I am not going to refer to all of them.
The noble Lord, Lord Patten, asked about rough sleepers, which takes us slightly away from the report, and we have had several Questions on this subject in the House recently. Yes, the number of rough sleepers did go down. Yes, it has increased again. I am interested in the noble Lord’s identification by nationality of those who were within his immediate sight. The figures that we have suggest that about 53% of rough sleepers are from eastern Europe—that does not excuse the fact that they are there. There is co-operation between the mayor and my department to ensure that there are projects set up for them, not least the mayor’s No Second Night Out programme, which means that people should not be on the streets for a second night. There is a phone line for people to ring if they are concerned about them.
The noble Lord, Lord Bilimoria, asked me a question right at the end, which I am afraid I missed—I have to be honest. So if I may look at Hansard and produce an answer for him in writing, I will do so. I was getting overexcited by that time.
I thank the noble Lord again for introducing this debate. We accept totally that this is an important report. I am almost certain that this will not be the last time that we have the opportunity to discuss it or London’s position in the world.
Care Bill [HL]
Committee (4th Day) (Continued)
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78C: Clause 1, page 2, line 7, after “support” insert “or need for health provision and the importance of reducing needs of either kind that already exist,”
Baroness Greengross: My Lords, I will also speak to my Amendments 79C, 79G and 79K.
Amendment 78C is about trying to strengthen the provisions to ensure that we have an integrated approach to care planning. This would happen if we could ensure that local authorities consider how to prevent or delay healthcare needs, as well as care and support needs, when providing or arranging the provision of services, facilities or resources for care. We have talked about this previously but I think that the Bill should require local authorities to have regard to the potential to prevent, delay or reduce health needs as well as care needs when providing or arranging care and support services. This duty would have wider benefits because it would strengthen the requirements on local authorities to prioritise integrated care services in line with Clause 3 of the Bill. It should also improve cost efficiencies for local authority budgets at a time when social care budgets are being squeezed, as we have heard, by reducing the need for more intensive and costly forms of care.
Similarly, Amendment 79K tries to enshrine the duty of prevention. We know, and have heard from other noble Lords, that many people reach a crisis point
when the person for whom they are caring is critically ill, or has a fall, or the partner dies, or something else happens. There is a panic and the wrong sort of care or very expensive acute care is provided. If appropriate identification, awareness and assessment of needs could be made before people reach this point, it would be absolutely brilliant at avoiding some of these acute costs of care. Enshrining prevention in the Bill is very important. Accordingly, it is imperative to ensure that the prevention duty focuses on what a local authority must do to prevent deterioration in well-being, to underpin the imperative to prevent, delay and reduce the need for care and support.
In order to make sure that happens, Amendment 80B ensures that local authorities have regard to NICE clinical guidelines and equality standards. This came to me through chairing a committee which produced a report on autism as it now affects a lot of older people. This is a fairly new phenomenon, because fortunately people live longer—not just healthy people, not just sick people, not just frail people, but people who have conditions such as autism. We know that NICE’s remit will be extended—in fact it has been extended since April of this year—to include social care services. It has the potential for a new focus on evidence-based decision-making. For example, the NICE guidelines on adults with autism states that investing in employment support is cost-effective.
This, and similar findings, should be taken into account by local authorities when they are providing services, including preventive services. All of these together would help to provide a range of preventive care. In order to make that happen, I hope we can encourage local authorities to look at more than one-year budgeting, because preventive services need longer than that. Local authorities need to be encouraged to take a longer view. If you are running a business and invest in something, you do not expect a return immediately. If you invest in preventive services, you will not necessarily get a return in one year, you have to give things a longer time span to reap the benefits. That also applies in these cases.
Amendment 87G makes sure that local authorities assess preventable needs and look to reduce these needs as an integral part of their duties in relation to the assessment progress. Briefly, that explains this group of amendments. I beg to move.
Lord Touhig: My Lords, I speak in support of Amendments 79K, 80A, 80B and 87G. At the outset, I pay tribute to the noble Baroness, Lady Greengross, who did an excellent job in chairing the commission on ageing and autism. We look forward to the publication of the report very shortly. It was certainly an eye-opener for a great many of us, and the many who thought they knew a lot about support and social care learnt a great deal during that time.
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Social care must no longer be the service of last resort. Under the current system, too many people become eligible for support only when their needs become acute and they require intensive high-level care and crisis management. Here, I declare an interest as a vice-president of the National Autistic Society,
whose recent research shows that only 10% of people with autism said that they receive social skills training, yet 55% would like to receive it; that only 10% people with autism said that they receive employment support, but 53% would like it; and that just 17% of people with autism said that they have access to social groups, yet 42% would like to have it.
Many adults with autism would benefit greatly from low-level services such as befriending or social skills training. These would help them to avoid isolation and allow them to participate fully in society. A lack of access to these services can have a devastating impact. A third of adults responding to a previous National Autistic Society survey said that they developed serious mental health problems as a result of a lack of support. Crucially, evidence from the National Audit Office shows that providing low-level services is cost-effective and prevents people developing more complex problems—a point just made by the noble Baroness, Lady Greengross. Its report stated:
“Beside the negative impact of such crises on a person’s life, acute services are also expensive, with inpatient mental health care costing between £200 and £300 per day”.
New economic modelling by Deloitte, published earlier this month, shows that every £1 invested in support for people with autism—and any other difficulty—who have moderate needs can generate a return of £1.30. The benefit is spread across central government, local government and disabled people and their families. Services such as the National Autistic Society’s Horizons day centre, which is based in Surrey, support adults with autism to develop social and communication skills, to access the job market, to improve health outcomes and to prevent the development of further needs.
Enshrining prevention in the Bill is important also where older people are concerned—that will certainly show up when the report of the commission of the noble Baroness, Lady Greengross, is published. Many middle-aged or older people reach a “crisis point” when their parents or carers pass away. Appropriate identification, awareness and assessment of needs before this point is reached are vital. I welcome the emphasis on the principle of prevention that is already in the Bill, but for it to have a real impact on the provision of services, it must be further entrenched. I hope that the Minister will see the wisdom of the amendments proposed by the noble Baroness, Lady Greengross.
Lord Rix: My Lords, I wish to speak to Amendment 79D, which focuses on preventing adults at risk suffering abuse or neglect. I welcome the focus in Clause 1 on promoting well-being and the breadth of that definition, which includes protecting people from abuse and neglect. In addition, Clause 2 sets out an important duty whereby a local authority must take steps and provide services which contribute to preventing needs for care and support. However, this crucial clause on prevention makes no reference to abuse and neglect, and my amendment seeks to make this explicit.
Later in the Bill, in the safeguarding section, there is a focus on protecting people once that abuse or neglect is suspected. However, it would be hugely beneficial if local authorities and agencies were obliged and guided to prevent abuse and neglect taking place in the first instance.
Let me give you an example. Decisions were taken to send people with a learning disability and challenging behaviour far away from their homes to Winterbourne View, where they suffered the most horrific abuse. This could clearly have been prevented by local authorities and other agencies if they had taken the right decisions at the outset.
Prevention is recognised also in terms of disability-related harassment, and indeed the Equality and Human Rights Commission highlighted this in its report, Hidden in Plain Sight. It recommended that local authorities and housing providers work from the outset to reduce disability-related harassment by including safety and security measures in the design of social housing estates and facilities. In addition to good decision- making at the top, it is also important to consider how we can empower individuals to understand what abuse is and how they can protect themselves from it. This might be through providing information, advice and advocacy. Safeguarding procedures are vital in order to protect people suspected of abuse and I have tabled a number of amendments on this area under Clause 41. However, before safeguarding comes a strong commitment to preventing abuse occurring in the first place. I look forward to the Minister’s view on this matter.
Lord Low of Dalston: My Lords, I was waiting to see whether the noble Lord, Lord Hunt, was going to speak to his amendments in this group—
Lord Hunt of Kings Heath: Would the noble Lord find it helpful if I went next?
Lord Low of Dalston: Yes, please.
Lord Hunt of Kings Heath: Thank you very much. My Lords, I think this is a very interesting group of amendments and the noble Baroness, Lady Greengross, in her Amendments 78C and 79K—to which I have added my name—and her other amendments makes some very important points about the need for a preventive approach, including its health dimension. My noble friend Lord Touhig has added his powerful voice to it.
In Amendments 79K and 80A there is a real issue here about the national minimum eligibility threshold. It would provide some certainty for some adults about whether their care needs will be met, but we know there will be many people whose needs remain just below the level at which local authorities will at a minimum need to meet through the national eligibility criteria. We know the Ending the Other Care Crisis report produced by Scope with four other charities estimates that 105,000 working-aged disabled adults will in fact continue to rely on universal services. This places greater responsibility on local authorities to put in place the necessary services to help prevent, delay or reduce care needs.
There is an argument for framing Clause 2 more positively to encompass the many diverse forms of preventive support that local authorities could put in place to prevent deterioration in the well-being of adults in their area. We want local authorities to be more ambitious and to think about prevention more positively.
While understanding the pressures that undoubtedly local authorities will be under, these amendments would give a very powerful voice to the need to go down the preventive route.
My Amendment 79A, to which the noble Lord, Lord Low, has added his name, continues the same theme on placing a general duty on local authorities to prevent, delay or reduce the need for care and support. We know that in Clause 2 there is a requirement on local authorities to look at how they can make the best use of community facilities to prevent, delay and reduce needs for care and support. That is very welcome indeed but the question is: to what extent are local authorities geared to put that into practice? Hence I have tabled this amendment. I think we need give a push to local authorities to take this seriously. I hope the noble Earl will be sympathetic to agreeing to some form of amendment which would reflect this in Clause 2.
The noble Lord, Lord Low, has a number of other amendments in this area which I would very much wish to support, although I have not lent my name to them. They are very well framed and important. Coming back to the issue we discussed in the debate just before the dinner break, this legislation may well stay on the statute book for many years to come, so it is really important to get it right. The emphasis that the noble Lords, Lord Low and Lord Rix, have given to these points bears careful consideration, so I am very happy to support them.
Lord Low of Dalston: I thank the noble Lord for his anticipatory support of my amendments, and perhaps I may return the compliment by saying that my name is on five amendments in this group and I have the most copious set of notes I have ever had in any debate. I hope that noble Lords will bear with me at this time of night, but with five amendments, there is quite a bit to go through.
As the noble Lord, Lord Hunt, said, I have put my name to his Amendment 79A and to that tabled by the noble Baroness, Lady Greengross, and in the names of the noble Lords, Lord Hunt and Lord Touhig, Amendment 79K. There are the same group of Peers on Amendment 80A, but Amendments 80C and 87F are in my name only, so I shall obviously spend a bit more time on them.
Before that, I shall say a few words on Amendments 79A, 79K and 80A. Clause 2 would be stronger if local authorities were also placed under a general duty to take prevention into account in exercising any of their functions under Part 1, not just those relating to direct provision of care. Amendment 79A would ensure that local authorities act to “prevent, delay or reduce” individual care needs across every one of their functions. Amendment 79K would ensure that the prevention duty focuses on what a local authority must do to prevent a deterioration in well-being, in addition to preventing, delaying or reducing the need for care and support. Amendment 80A would oblige authorities to have regard not just to the importance of identifying adults and carers with needs for care and support and the services available to meet those needs, but,
“the steps it could take to improve and enhance the provision of services, facilities or resources in its area”.
The idea would be to ensure that local authorities actively consider what more they could do to prevent needs for care and support above and beyond identifying existing services, facilities and resources in the authority’s area.
The Bill currently stops short of that, which is bad news for the hundreds of thousands of older and disabled people who are not deemed eligible for adult care and support. It is also bad news for the Government’s aspiration to rebalance the system away from crisis interventions in a more preventive direction. The amendments suggest a more strategic approach which, by putting in place services at the community level, not just directed at individual care, could ensure that those who did not reach the eligibility threshold were, nevertheless, not bereft of support entirely. In other words, they provide a means of enabling available resources to go further by deploying them strategically in aid of prevention.
The kind of preventive services I am thinking of might be of six types. First, there are enabling services, preventing harm before it occurs—as you might say, working well away from the cliff edge. Secondly, there are services that prevent care needs from developing: for example, reablement or specialist rehabilitation to help an adult with sensory loss or a falls prevention service for older people discharged from hospital. Thirdly, there are prompt interventions, detecting and responding to early signs of difficulty, forestalling problems which could lead to more serious consequences —as you might say, working just over the edge of the cliff. Fourthly, there are services that help to delay care needs once they have started to emerge, for example, home adaptations for those no longer independently mobile or befriending services for the recently bereaved, perhaps funded by the local authority but delivered by a local Age UK. Fifthly, there are services that reduce care needs once they have started to intensify, for example, a stroke rehabilitation service provided alongside the NHS to help adults to regain control over key activities of daily living.
Sixthly and finally, there are acute interventions reducing the impact of a situation spiralling down—working well down the cliff, you might say. Wales furnishes an example in the Social Services and Well-being (Wales) Bill, which is currently before the Welsh Assembly. I hope the Minister might be willing to take a look at that. The corresponding section of that Bill, Section 6(4), explicitly states that a local authority must, in the exercise of its other functions, have regard to this preventive services clause in the Bill.
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I turn now to the amendments in my name only. Amendment 80C is a probing amendment aimed at drawing out the Government’s thinking about creating an accountability mechanism for the prevention duty. The suggestion is to use the legal framework contained in the Local Government Public Involvement in Health Act 2007. I remember it well. Local authorities have responsibilities under that Act to produce joint needs assessments and joint health and well-being strategies under Section 116 of that Act. This amendment would lay on them, in partnership with clinical commissioning groups, a duty to have regard to their duty to prevent care needs as part of discharging those responsibilities.
Successive Governments have produced ambitious plans to rebalance our care and support system away from crisis interventions in favour of preventive support. Some of these have succeeded to a degree, but what all these strategies have had in common is a desire to prevent individual care needs from developing or getting worse, providing early support that makes sense for the individual adult, their carer or family, but also makes more efficient use of public resources. Notwithstanding this, we still have a care and support system where all the legal duties and funding structures are aligned towards meeting acute or, for want of a better word, substantial care needs.
The recent ADASS survey reveals a startling lack of attention paid to preventive forms of health. Only 37 councils—that is 25% of those which responded to the survey—had formally agreed a plan on how to spend reablement money transferred from local health services as part of the 2010 spending review.
Spend on prevention of £588 million in 2013-14 represents only 4.2% of adult social care budgets. This is the consequence of the tough budget settlement for local authorities, but it is also about the inattention local authorities inevitably pay to prevention when all their legal responsibilities are focused around acute interventions—in other words, not preventing but meeting care needs.