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House of Lords

Wednesday, 9 October 2013.

3 pm

Prayers—read by the Lord Bishop of Oxford.

Introduction: Lord Mendelsohn

3.09 pm

Jonathan Neil Mendelsohn, Esquire, having been created Baron Mendelsohn, of Finchley in the London Borough of Barnet, was introduced and took the oath, supported by Lord Levy and Lord Janner of Braunstone, and signed an undertaking to abide by the Code of Conduct.

NHS: Health and Social Care Act 2012


3.13 pm

Asked by Lord Hunt of Kings Heath

To ask Her Majesty’s Government what assessment they have made of the cost to clinical commissioning groups and other parts of the National Health Service of tendering and legal fees in the commissioning of services under Part 3 of the Health and Social Care Act 2012.

Lord Hunt of Kings Heath (Lab): My Lords, I beg leave to ask the Question standing in my name on the Order Paper, and draw the House’s attention to my health interests in the register.

The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con): My Lords, Part 3 of the Act does not change the requirements on clinical commissioning groups when they tender health services. The rules are the same as under the Public Contract Regulations 2006, introduced by the previous Administration, and as set out in the rules for commissioners.

Lord Hunt of Kings Heath: My Lords, the noble Earl will recollect our debates on the Health and Social Care Act 2012, when repeated assurances were made by Ministers that clinical commissioning groups would not be forced to tender out services. However, all the evidence to NHS England and the advice which clinical commissioning groups are getting from their lawyers suggests that under Section 75 of the Act, they have to do so. Does the noble Earl agree that that is an awful waste of money and effort, and that all it is doing is fragmenting services?

Earl Howe: My Lords, commissioners do not have to use competitive tendering for all services. First, acute elective care—which represents the vast majority of NHS services—is not secured through competitive tendering at all, and that will continue to be the case. Secondly, a single-tender action may be justified on

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the basis that there is only one provider able to meet the clinical quality and safety standards that the commissioner requires. There will be guidance coming out on that, and draft guidance has already been published. Any confusion that exists among commissioners should be clarified by that means.

Lord Winston (Lab): My Lords, would it be fair to say that the noble Earl is somewhat between Scylla and Charybdis on this issue? On the one hand tendering is certainly more expensive but, on the other, if tendering does not take place, is there not a real risk that services will be offered at the price that the market will bear rather than the one that it really costs the health service? The health service has not always managed to cost out its treatments effectively.

Earl Howe: The noble Lord makes a good point. There is, I think, a desire on everybody’s part not to see competition result in a race to the bottom on price. That is why we have specified that commissioners must make clear what standards they expect and apply those consistently to whoever is tendering for the service in question at a price which reflects a fair value. We believe that the current rules protect the NHS but also protect those bidding. I emphasise that competition will not be pursued as an end in itself; it will be pursued as a means to drive up quality.

Lord Alderdice (LD): My Lords, it is quite clear that there are certain kinds of services that benefit from being grouped together and provided by large providers who can do so economically but to a high quality. However, there are other services that are better provided locally by people who know the circumstances and are often working in relatively small charitable bodies; for example, in the mental health sector. It is very difficult for these to tender in the way that larger companies can. Can my noble friend give me some reassurance that the Government recognise this dilemma and are trying to find ways in which smaller, local, charitable providers in certain areas can be protected, facilitated or encouraged, so that we are not simply taken over by larger corporations, which may not be in the best interests of patients?

Earl Howe: My noble friend makes an important point. I think that it is common to all sides of the House that charities and social enterprises play an important part in providing NHS care. They have done so for many years, and give patients more choice of where and how they are treated. We have a set of rules which, at least in theory, should protect those groups of providers. If a commissioner fails to take account of providers who are capable of providing a service and simply, for example, rolls over an existing contract, then it is open to the provider in question to complain to Monitor, which will be the adjudicator of any anti-competitive conduct.

Baroness Pitkeathley (Lab): My Lords, with reference to the last question, would it be possible to give voluntary and charitable groups that wish to provide services in some kind of consortia financial help and

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encouragement in order to help them form those consortia? These do not just happen because people want them; they need time and effort to be formed.

Earl Howe: My Lords, that has already happened to an extent, not least under the previous Government, who made sure that the nascent social enterprises that were formed out of transforming community services were set up on a sustainable basis. However, we have built into the 2012 Act a provision which prevents active discrimination in favour of one sector or another, so government help specifically for a particular sector is, I am afraid, not legally possible.

Lord Walton of Detchant (CB): Is the noble Earl satisfied that the commissioning processes under NHS England relating to the commissioning of highly specialised services will take full account of the important necessity of concentrating these highly specialised services in a smaller number of major centres? Is he also satisfied that the interests of the Rare Disease Consortium under the Rare Diseases Advisory Group of NHS England will be fully recognised in the processes to which he is referring?

Earl Howe: I can give the noble Lord an absolute assurance on both those counts.

Lord Naseby (Con): Surely my noble friend can confirm that, broadly speaking, the tendering processes under the Act have gone well and are broadly within budget. Although there are various dimensions to the tendering process as raised by my noble friend from the Liberal Democrat Benches, nevertheless, in broad terms, we are well satisfied with the way that it has gone. If there are differences and small amendments are necessary, will my noble friend confirm that those will be looked at speedily?

Earl Howe: My Lords, I agree with my noble friend in that I am not aware of any tendering process that has gone horribly awry. Certainly the Government are always open to looking at any provisions that are not working as they should, but I am not aware of any.

Licensing Act 2003


3.21 pm

Asked by Viscount Falkland

To ask Her Majesty’s Government whether the aims and objectives of the Licensing Act 2003 have been adequately met with regard to the control of social disorder resulting from late night drinking in residential areas.

The Parliamentary Under-Secretary of State, Home Office (Lord Taylor of Holbeach) (Con): My Lords, the Government have rebalanced the Licensing Act 2003 to give local communities stronger powers to achieve the Act’s objectives, including reducing crime

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and disorder. For example, licensing authorities can now raise a contribution from premises that supply alcohol late at night towards the costs of policing and wider action. Newcastle is scheduled to be the first area to introduce a late-night levy, as it is called, on 1 November.

Viscount Falkland (CB): My Lords, I thank the Minister; that was a more encouraging reply than I had expected. I am glad that the scenario that he describes is likely to cover all of England. The dossiers that have been compiled on matters that concerned both Houses of Parliament in 2003 are very surprising. It was a major concern of the two Houses that there would be proper protection for residents in areas where they might find their peace damaged as a result of late-night licences. In my area the offences have been quite extraordinary. If, when I spoke during the Bill’s passage, I had thought that there would be behaviour of this kind between midnight and 3 o’clock in the morning in my area in south London, I would have been much more active about it. Is there is a way to protect older and vulnerable people from the disorder that comes from late-night drinking, particularly after people come out of venues? People who live in almshouses near me tell me that their lives have been made quite impossible.

Lord Taylor of Holbeach: There may be particularly vulnerable people, of course, and old people are among them. One of the things that we have done with the existing licensing laws is to rebalance the Licensing Act so that there is a vicinity test; as long as evidence exists within a local community concerning the disruption that can be caused by late-night drinking, it is able to submit this to the licensing authorities. I can give the noble Viscount more encouragement: Milton Keynes has also voted in favour of a late-night levy, which is likely to come in next year. The Anti-social Behaviour, Crime and Policing Bill will also encourage the noble Viscount it is making its way through the Commons and will shortly arrive here, and will greatly empower communities in this regard.

Lord Avebury (LD): My Lords, the Government’s alcohol strategy puts the cost of alcohol harm to the economy as a whole at £21 billion. That includes £3.5 billion for the health service, where overstressed A&E departments, for example, have to cope with an influx of people after midnight who have drunk far too much. Has my noble friend any estimate of the benefits, in terms of reduced costs, of the Government repealing the 2003 Act altogether?

Lord Taylor of Holbeach: No, that calculation has not been made, but I can give my noble friend the figure for the cost to the health service: £7.3 billion for alcohol-related incidents.

Lord Brooke of Alverthorpe (Lab): My Lords, I acknowledge that the Government have made some changes. However, is the noble Lord content that the rebalancing has moved sufficiently? Many people believe that it has not. During the debates in the Commons on

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the Bill to which he has just referred, there have been attempts to extend the way in which licensing authorities can take into account public health issues. Given the Government’s commitment to devolution on public health issues, why will they not move on this front, in the way that the Scottish Government are now moving?

Lord Taylor of Holbeach: The noble Lord has taken a great interest in this subject. I have always valued his contributions and look forward to his contribution to the debates we are likely to have on this Bill. I am sure that these arguments will be presented when we have the opportunity. Meanwhile, I am grateful for his acknowledgment of the progress that the Government have made in this difficult area.

Baroness Browning (Con): Will my noble friend continue to liaise with the Department of Health to ensure that we reduce the number of people admitted to A&E departments who are clearly the worse for drink—often as a deliberate ploy, having had what they regard as a good night out? If we could tackle it from that end, perhaps we could help to move the culture change on even further.

Lord Taylor of Holbeach: Noble Lords will know that there have been a number of ideas on this issue. Chief Constable Adrian Lee from Northamptonshire suggested the idea of drunk tanks, which I had to read about to understand. This has generated some public debate; it is the sort of thing which clearly the Government will look at, because anything that can relieve the burden on hospitals must be a good thing.

Lord Condon (CB): My Lords, I declare my usual interest. Is the Minister aware of the excellent project in Ipswich, Suffolk, that has been going on over the past year? On a voluntary basis, retailers, major supermarkets and off-licences, working with police and others, have withdrawn the sale of the strongest canned and bottled beers and lagers. On that voluntary basis, it seems to have had a beneficial effect on the quality of life for people, particularly in the centre of Ipswich, and has reduced anti-social behaviour. Does the Minister agree that this should be encouraged in other city centres?

Lord Taylor of Holbeach: Yes, I would certainly vouch for that. There has been a lot of co-operation from the retail trade. I met representatives of the Association of Convenience Stores at the Conservative party conference, where they had a meeting. They are very supportive of retail initiatives of this sort. This morning I met Richard Antcliff, the chief anti-social behaviour officer in Nottinghamshire, and I went to Nottingham to see the work being done in that city to reduce alcohol abuse. Communities can do an awful lot on this issue and the Home Office would encourage any such initiatives.

Baroness McIntosh of Hudnall (Lab): My Lords, following on from the last question, does the noble Lord not agree that although there are obviously deficiencies in the way that the 2003 Act has operated,

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which give rise to some of these difficulties, one of the main problems is the enormously wide availability of alcohol at very low prices? Do the Government have any plans at the moment to address that?

Lord Taylor of Holbeach: Licensing of alcohol in retail outlets is, of course, in the hands of licensing authorities, but the pricing has been challenged—and, indeed, I have been challenged by noble Lords in this House on this issue. The Government have announced the policy on this; there will be a policy whereby drink cannot be sold at cost plus duty plus VAT, which in effect puts a floor on cheap sales of alcohol. I think that that should be encouraged.

Housing: Under-Occupancy Charge


3.29 pm

Tabled by Lord Knight of Weymouth

To ask Her Majesty’s Government whether they have any plans to suspend the under-occupancy charge.

Baroness Hollis of Heigham (Lab): My Lords, on behalf of my noble friend Lord Knight of Weymouth, and at his request, I beg leave to ask the Question standing in his name on the Order Paper.

The Parliamentary Under-Secretary of State, Department for Work and Pensions (Lord Freud) (Con): My Lords, there are no plans to suspend the removal of the spare-room subsidy policy. A formal evaluation of the policy is being carried out; this has already commenced and will be conducted over the next two years. To support people transitioned to this reform, we have more than trebled the discretionary housing payment fund to assist those facing extreme difficulties.

Baroness Hollis of Heigham: My Lords, two-thirds of the families affected are disabled—fact. Half of those in a recent sample are already in arrears—fact. Most local authorities are limiting discretionary payments to three months only—fact. Furthermore, there are no smaller properties to move to—fact. So disabled families cannot work, pay, obtain financial support or move. When will the Government have the guts to admit that their policy is impossible as well as cruel and follow our commitment to repeal it?

Lord Freud: My Lords, there were a lot of issues buried there. I will just point out that, when you look at the disabled figures, and if you look at the people on DLA, which is an independent measure, the figure comes down to 27% of the total. For those with the higher rate of DLA, it is 17%. I also remind the Opposition that this is a substantial saving measure. Some £500 million has to be found, and there is a degree of cynicism about whether you can find that through closing tax loopholes. I also ask the Opposition a question—

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Noble Lords: You answer!

Lord Freud: I suggest to the Opposition that they think about the challenges that they will face when they extend their extra-bedroom policy to the private rented sector, which will cost them another £500 million and rising.

Lord Forsyth of Drumlean (Con): Will my noble friend explain why the Opposition are so opposed to the changes that are being proposed on the subsidy, when it will undoubtedly help people suffering from chronic overcrowding in social housing and will help young people who find it impossible to get single accommodation? Will not the effect of removing the subsidy be to correct the market failure in social housing?

Lord Freud: My Lords, my noble friend is absolutely right. I have talked before about the 250,000 people living in overcrowded accommodation, with 1.8 million people on the waiting list. But the economic signals going on in the social rented sector are very odd. The demand from single people and couples represents each year 61%, for the latest year we have—and it has not changed much. The number of homes provided that have single bedrooms comes to only 13%. Over the past decade, the social rented sector has built virtually no new single bedrooms, at 30,000; that compares with the private rented sector, which has produced in that period 280,000. There is a real economic mismatch going on in terms of what we are encouraging the social rented sector to build, and we need to make sure that we are building the type of accommodation that people in this country actually need.

Lord Foulkes of Cumnock (Lab): My Lords, the Minister is paying no attention to the effects on the people involved. Has he seen the report in the Daily Record, which says:

“The Tory minister in charge of the bedroom tax has told Scots with motor neurone disease to take in a lodger or have their benefits cut.”?

Will he apologise for this insensitivity and rethink this measure, that being just one of its many iniquities?

Lord Freud: My Lords, I have not, of course, made any specific recommendations to people. Let me just go through the point. We are monitoring this change very closely. It is in its early stages as people start to adjust. We have put in a lot of discretionary housing payments; the total is £180 million this year. The early returns—and I stress they are early returns—show that local authorities are either managing those well or are underspending at this particular time.

Baroness Sherlock (Lab): My Lords, does the Minister accept that last week the courts ruled that a woman with multiple sclerosis was entitled to have a bedroom separate from her husband because otherwise her human rights were breached? The courts have now ruled that disabled children and disabled adults can have their own rooms. These savings are vanishing before our eyes, and there are no rooms for people to

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move into because there are no smaller properties. Do the Government accept that the National Housing Federation has described this policy on its six-month anniversary as being a “cruel failure”? Is that not right, and will the Government not change their mind now?

Lord Freud: First, I congratulate the noble Baroness on moving to her new position. I look forward to many constructive exchanges with her, although perhaps not this one. We are currently moving to ensure that disabled children who need spare rooms will have them, and regulations on that are going through consultation. In the case of disabled adults where there was a judicial review, the judges decided that the policy was appropriate and did not breach any equalities duty.

International Day of the Girl


3.36 pm

Asked by Baroness Hussein-Ece

To ask Her Majesty’s Government what action they are taking to promote the education of girls around the world ahead of International Day of the Girl on 11 October.

Baroness Northover (LD): My Lords, the UK Government place a high priority on girls’ education. In 2012-13 UK aid supported 2.8 million girls in primary education and helped 270,000 to go to lower secondary school. In addition, the UK’s flagship Girls’ Education Challenge will help a further 1 million of the world’s most marginalised girls to receive an education.

Baroness Hussein-Ece (LD): I thank my noble friend for the informative Answer. However, she will be aware that 67% of illiterate people in the world are women and girls. Many have been denied access to education due to forced child marriage. This is a violation of girls’ basic rights and can lead to terrible consequences, such as death in childbirth. What is being done to ensure that Governments, particularly those in the Commonwealth and those in receipt of aid, are working to eliminate this appalling practice?

Baroness Northover: My noble friend is right in what she says about child marriage. It is of course a reflection of the low status of women and girls, which is why investing in education and the long-term cultural changes that result from it is so important. Evidence shows that education may be the single most important factor in reducing child marriage. We address this explicitly, for example in our programme in Ethiopia, and we have other programmes in development in the DRC, Yemen and Zambia, because we recognise the importance of this issue.

Baroness Crawley (Lab): What is the Government’s ongoing policy on ensuring equal treatment of girls and boys a little nearer home, in our own state-funded free schools in this country?

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Baroness Northover: As the noble Baroness knows, we have the Equality Act, by which the law protects the equal status of girls and boys in the United Kingdom.

Baroness Deech (CB): Will the Minister tell us what measures are being taken in this country to make sure that girls under 16 are not removed from school and sent abroad during the summer vacation for arranged or forced marriages? Will there be check-ups on girls to see who has not returned to school in the autumn term after such a practice?

Baroness Northover: The noble Baroness is right to highlight this issue. This is something that has come increasingly to our attention. There have been programmes of engagement with schools—she may know of the one in Bristol—and there is engagement elsewhere. Teachers have been asked to look out for girls who travel in the holidays and may not return, because it is extremely important that this issue is tackled.

Baroness Jenkin of Kennington (Con): My Lords, perhaps the House would consider it appropriate to congratulate Malala on her extraordinary contribution to this debate. I would be grateful if my noble friend could update the House on the Girls’ Education Challenge, which is designed to help up to 1 million of the world’s poorest girls access education.

Baroness Northover: I echo the support for Malala. Friday is the International Day of the Girl Child. That is the day when the Nobel prize in question may be announced. Of course, many of us hope that Malala’s contribution will be recognised. She has been extremely brave in maintaining her position, and has done so very eloquently. My noble friend mentioned the Girls’ Education Challenge. In the United Kingdom we have the world’s largest global fund dedicated to girls’ education, which will reach more than 1 million girls in the world’s poorest countries. That is extremely welcome and shows that we recognise the importance of investing in girls’ education.

Baroness Uddin (Non-Afl): My Lords, the noble Baroness will accept that no one will have been unmoved by Malala’s address to the UN. Malala talked about the fact that she was not the only young girl who lacked education or who was campaigning for education. How far is the noble Baroness’s department working to ensure that Malala’s and other girls’ dreams are realised, particularly in Afghanistan? Is her department supporting two of the girls who were attacked at the same time as Malala Yousafzai?

Baroness Northover: Malala has, indeed, emphasised that there are many others in her situation. It is those girls whom we wish to help. The noble Baroness will be well aware of the investment by DfID in both Pakistan and Afghanistan, particularly in education and especially in girls’ education. Often in poor families it is the sons who are sent to school first, if anyone is sent at all. One of the areas that DfID has been working on is ensuring that girls, too, go to school;

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that there are bursaries; that girls are safe in school and on their way to school; and that their education is then supported.

Lord Loomba (LD): My Lords, thousands of young girls are the victims of trafficking in south Asian countries. They miss out on school and never get the education that is their birthright. How can the UK Government help these poor and helpless girls?

Baroness Northover: I pay tribute to my noble friend Lord Loomba for his work in this area. He will know that DfID works particularly in fragile states where girls are most likely to be in marginal communities. Those countries are very much recipients of our assistance.

Baroness Afshar (CB): My Lords, is the noble Baroness aware that in England, as well as elsewhere in the world, girl pupils are not choosing science and mathematics for further studies? This is a new turn, and what is extraordinary is that it is usually girls from minority communities who prefer these options. Is there something about attitudes in the classroom and of those teaching science and mathematics that discourages girls?

Baroness Northover: We are very much encouraging girls to go into the so-called STEM subjects. It is extremely important both for them and for the future of the country that those subjects are supported. If there is a particular problem in terms of particular groups not heading in that direction, I will look into that and get back to the noble Baroness.


Private Notice Question

3.44 pm

Asked by Baroness Royall of Blaisdon

To ask Her Majesty's Government whether they support the extension of the badger cull licences in Somerset and Gloucestershire and how long they would anticipate such extensions to last.

Baroness Royall of Blaisdon (Lab): My Lords, I beg leave to ask a Question of which I have given private notice.

The Parliamentary Under-Secretary of State, Department for Environment, Food and Rural Affairs (Lord De Mauley) (Con): My Lords, the Somerset pilot cull concluded on 6 October and current indications are that the pilots have been safe, effective and humane in delivering a reduction in the badger population of just under 60%. Natural England is considering an application from Somerset for a short extension of the culling period, as provided for under the agreement with the company there. In doing so, Natural England will take into account the practicalities on the ground. It expects to make a decision later this week.

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Baroness Royall of Blaisdon: My Lords, I declare my interest as a resident of the cull area, where the excellent police force is hugely overstretched as a consequence of the cull. The House will be aware that the Government have been unable to see the wood for the trees on this issue, ignoring their own scientific advice that a cull would be both costly and ineffective in tackling bovine TB, and I dispute the Minister’s statistics. As we now have new evidence that this ill thought-through policy is not working, does the Minister agree that extending the cull will only compound the Government’s error of judgment?

Lord De Mauley: The purpose of the cull trials was to establish that this could be undertaken safely, humanely and effectively. The judgment on these will be made by an independent panel but our initial view is that they have been met. The contractors have worked under difficult conditions and considerable provocation and have been scrupulous in their attention to safety, which is the absolute number one priority. A figure of 60% is a significant achievement and the Chief Veterinary Officer endorses that this will lead to a reduction in the disease in cattle.

Lord May of Oxford (CB): My Lords, this cull went ahead against the balance of advice from the scientific community, in particular that such a limited experiment was unlikely to yield much in the way of useful information. Does the Minister agree with me, however, that we have indeed learnt something important? We have learnt that those responsible for this so-called experiment are so incompetent that they could not even make a reliable estimate of the number of badgers.

Lord De Mauley: My Lords, I simply cannot agree. I repeat what I said in answer to a similar question earlier this year. The report following the visit to the United Kingdom by the European Commission’s bovine tuberculosis subgroup in March 2012 stated:

“It is however of utmost importance that there is a political consensus and commitment to long-term strategies to combat TB in badgers as well as in cattle ... There is no scientific evidence to demonstrate that badger vaccination will reduce the incidence of TB in cattle. However there is considerable evidence to support the removal of badgers in order to improve the TB status of both badgers and cattle”.

Lord Hamilton of Epsom (Con): My Lords, is it not very early days to be saying that this experiment is not working? The trial has only just begun. Surely we have to wait until some time after the cull has ended to see whether the incidence of TB in cattle has dropped. At that stage, will the Government also look at other forms of wildlife and see whether there is a recovery in the numbers of hedgehogs and ground-nesting birds which have been ravaged by badgers in the past?

Lord De Mauley: My noble friend makes an important point. As I said in answer to the noble Baroness, Lady Royall, these judgments will be made by an independent panel. However, as I also said, our initial view is that so far the humaneness, safety and effectiveness tests have been met. I am grateful to my noble friend for his suggestions.

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Lord Winston (Lab): Will the Minister give an assurance that hedgehogs do not encourage tuberculosis in cattle?

Lord De Mauley: That is an extremely interesting and important question, so much so that I will have to write to the noble Lord. I thank him for raising it.

Baroness Parminter (LD): My Lords, the Minister said that the culls can be regarded as a success because they have met the criteria of being “safe, humane and effective”, but they have not been effective. The pilot culls have now failed one of those three in that they were set up within six weeks to meet the legal licensing target. What evidence do the Government have that any extension of the cull could increase TB infection, which would add weight to the calls to abandon these pilot culls?

Lord De Mauley: No, my Lords, I am aware of no such evidence. Indeed, as I said just now, the Chief Veterinary Officer endorses that what has happened so far will lead to a reduction in the disease in cattle, and that any more we can do will further contribute to a reduction.

Lord Elystan-Morgan (CB): My Lords, I accept that badger-borne bovine TB is the despair of the agricultural industry, but has the ministry ever made any calculation of how much bovine TB is non badger-borne? If it has not, how can it possibly indulge in detailed experiments, including culling, unless this information is to hand?

Lord De Mauley: I am grateful for that question because it gives me the opportunity to say that work by Professor Crystl Donnelly has shown that as much as 50% of the incidence of TB in high-risk areas can be attributed to badgers.

Baroness Symons of Vernham Dean (Lab): My Lords, does not the Minister have to reflect on the point raised by the noble Lord, Lord May? We were told by the experts that there were 2,700 badgers in the area concerned, and we are now told that the experts think there were actually fewer than 1,400. If the experts who supported the policy got the numbers so wrong in the first place, does that not undermine public confidence in the policy as a whole?

Lord De Mauley: I do not think that it should. Our policy is evidence-based and we have taken every opportunity to acquire the latest and most up-to-date information from the pilot areas to refine the estimate of the badger population. All wildlife population estimates have uncertainty around them. Appropriate steps were taken to audit the process, including data checks and independent audits of these figures.

Lord Rotherwick (Con): My Lords, does my noble friend recognise the vulnerability of deer in deer parks? Does he agree that they have to be looked at separately from the way that you look at cattle that succumb

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to TB? You cannot lock up deer from a deer park in a shed and humanely shoot them; they have to be slaughtered by high-powered rifles. What is my noble friend doing about the situation regarding the vulnerability to TB of deer in deer parks?

Lord De Mauley: My noble friend asks a specific question and I will, if I may, take it away to consider the point about deer in parks. As regards the suggestion that deer may be a reservoir of TB in wildlife as well, we have established that badgers are a particularly good—if I may use that word—host for TB. They are the part of wildlife on which we really have to focus.

Lord Clark of Windermere (Lab): My Lords, will the Minister confirm that there is general scientific agreement that the badgers that are left after a cull have a greater propensity to carry over and pass on TB to cattle and that it is a fine balance between the numbers killed and those that survive? Is he aware that there is deep concern that the figures we are provided with are not robust and that the result may be an increase in TB, not a decrease?

Lord De Mauley: My Lords, with the greatest of respect, I do not think that the noble Lord’s proposition is correct. The randomised badger-culling trials showed something quite different, which was that above a certain percentage of badgers culled—indeed, the first-year trials in the randomised badger culls were in the 30s of per cent—there was nevertheless a significant effect on the incidence of TB in cattle.

The Earl of Erroll (CB): My Lords, can we add the humble bumble bee to the list of animals and creatures that are being threatened by the badgers? Bumble bees nest underground, are a great source of delight for the badger to eat and are under threat.

Lord De Mauley: I am very interested in what the noble Earl has said because he will know that we will be launching a national pollinator strategy later this year. Perhaps we can discuss what he suggests in the context of that.

Cohabitation Rights Bill [HL]

First Reading

3.54 pm

A Bill to make provision for certain protections for people who live together as a couple or who have lived together as a couple, and to make provision about the property of deceased persons who are survived by a cohabitant, and for connected purposes.

The Bill was introduced by Lord Marks of Henley-on-Thames, read a first time and ordered to be printed.

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Care Bill [HL]

Care Bill [HL]

Report (1st Day)

3.55 pm

Clause 1: Promoting individual well-being

Amendment 1

Moved by Lord Hunt of Kings Heath

1: Clause 1, page 1, line 4, at end insert—

“( ) The Secretary of State in making regulations or issuing guidance 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.”

Lord Hunt of Kings Heath (Lab): My Lords, as this is the start of Report, I declare my interests as chair of an NHS Foundation Trust, a consultant and trainer with Cumberlege Connections, and president of GS1 UK.

I am sure that the House would wish me to congratulate the noble Baroness, Lady Jolly, on her appointment to the Government and to the health team as a government Whip, and to thank the noble Baroness, Lady Northover, for her services.

The Bill places a responsibility on local authorities to promote well-being in the way in which they implement the provisions of the Bill locally. However, if the Secretary of State were to issue regulations without regard to the promotion of well-being, there is a risk that such regulations—or indeed guidance—could conflict with that well-being principle. That would put local authorities in an impossible position. This matter was the subject of considerable discussion and report by the joint scrutiny committee and we also discussed it in Committee. The Government have now responded to the points put by many noble Lords and I welcome the amendment moved by the noble Earl, Lord Howe. I also welcome Amendment 4, in the name of the noble Baroness, Lady Barker. I beg to move.

Lord Hamilton of Epsom (Con): My Lords, I have added my name to the amendment in the name of the noble Baroness, Lady Barker, to add the words “and spiritual wellbeing”. This is an amendment that has been resisted in the past by my noble friend the Minister and I am somewhat confused as to why that should be. In 2002, the National Health Service was more than happy to add spiritual well-being as one of the conditions that should be applied to care that was given. I do not understand what has changed since. Has the NHS come to regret having these words in its remit? Does it find that spiritual wellbeing does not fit within the National Health Service today? Are people of faith who find that having an NHS that regards their spiritual well-being as important somehow more difficult to handle than atheists and people who have no faith at all? I should have almost thought that the reverse is true. When we come to what is euphemistically called end-of-life care, I should have thought that people of faith have something to look forward to, rather than atheists who, if they follow Richard Dawkins, are

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faced with a great black hole of oblivion. They might find that the end of life is rather more forbidding than do those who have faith.

I am very confused, therefore, as to why the Government find it necessary to resist this very minor and rather innocent amendment. It seems to merely add comfort to people of faith of all religions and could be inserted into this Bill without causing the Government any difficulty whatever.

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Lord Deben (Con): My Lords, I support what my noble friend has just said. I have to say to the Minister that this amendment is rather necessary because there is a generalised belief that forces in our society are determined to marginalise that which has actually made our society and has had such an influence on the provision of healthcare for our people. The history of healthcare in Britain shows that it was fundamentally founded by those of faith. That does not say anything about anyone else, but it does say that if we want holistic medicine—I am not a great believer in anything other than orthodox medicine, so I am not encouraging all kinds of what I consider to be alternatives, which are best left alone—we have to understand that it is about the whole person, and for many people this is a most important part of the whole person. For this not to be in the Bill will be seen by many as another example of society specifically seeking to marginalise an important section of our community on whom we depend widely for many of our voluntary activities, and certainly on whom we have depended and do depend for our health services. I hope very much that the Minister will take this point seriously.

Lord Cormack (Con): My Lords, I would like very briefly to support what my two noble friends have just said. Surely this is not the Government conceding to a secular society and surely they recognise that for many sick people, the spiritual dimension is extremely important. It is not a question merely of healing physical ills and curing physical diseases, it is a question of recognising that many people, particularly as they near the end of their lives, have a great need to fall back upon their faith, and that should be recognised and encouraged. For the life of me, I cannot see what the Government are doing here and I hope that my noble friend will be able to give us a satisfactory answer. I am only sorry that the Bishops’ Benches appear to be empty this afternoon because one would have liked to have heard a contribution from them.

Lord Harries of Pentregarth (CB): My Lords, as someone who remains a Bishop, on behalf of my old friends on the other side of the Chamber, I would like to support this amendment. As the Bishop of Oxford, I remember visiting one of the brand new universities, which thought of itself in very secular terms. Nevertheless, the university was adamant that it should have a chaplain because it believed in whole-person care, and an essential element of whole-person care was the spiritual dimension. We need to take that into account.

We also need to take into account the fact that we now live in a multifaith society, and for those of some religions in particular, it is very important that they

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have someone with religious authority in contact with them in the final stages of their life. There are good reasons for supporting this amendment.

Baroness Barker (LD): My Lords, I apologise for not being in my place for the start of this debate. As noble Lords will know, on these occasions such amendments are often tabled by myself and the noble Lord, Lord Hunt of Kings Heath. We do so because we support the right of Christian Scientists to have their beliefs respected, in particular their right to refuse treatment. That said, when we discussed this matter in Committee, while at that point the Minister was as sympathetic as always, he failed to draw a distinction that is important to people of faith, which is that between the use of the words “emotional” and “spiritual”. People of faith believe that matters which are spiritual are of a different order from those matters which are emotional. I have a degree of sympathy with their view. However, I also have a degree of sympathy with the Minister, who does not wish to put things into legislation that are unnecessary. I hope that he will, in this case, perhaps be a bit more sympathetic to the arguments that are being put forward.

The noble and right reverend Lord, Lord Harries of Pentregarth, is right that as a society not only are we becoming much more diverse, but in our everyday life we understand the importance of faith and spiritual matters to other people. For example, we would not for a moment think it acceptable to present somebody with a diet that was not reflective of their cultural and religious beliefs. In our modern day health and social care services we are increasingly adept at recognising people’s differences and accommodating them. All told, this is a small amendment which costs nothing but means an awful lot. I hope that the Government will be able to take it on.

Lord Warner (Lab): My Lords, as the chairman of the All-Party Group on Humanism, I am not sure that I should actually be following the previous speakers. However, Amendment 5 in this group is in my name and I want to be nice to the Minister instead of telling him off. The Minister has listened to the concerns that we expressed in Committee about applying the requirement to pursue the obligation on local authorities in Clause 1 to the Secretary of State in his actions, particularly regulations and guidance, to promote well-being.

I congratulate the Minister on listening to those concerns and tabling government Amendment 138, which effectively meets the concerns that we have. I suspect that my co-signatories, the noble and learned Lord, Lord Mackay of Clashfern, and the noble Baroness, Lady Greengross, would say that the Minister’s amendment may not be quite as elegant as ours, but we are not going to have a competition about aesthetics; he has met the point and I thank him very much for what he has done.

Lord Mackay of Clashfern (Con): I warmly support that. I am happy with the parliamentary counsel’s draft, which is what the Government are going to move, and we have to understand that some lawyers are better than others at making drafts.

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So far as the amendment of the noble Baroness, Lady Barker, is concerned, I hope that the Government will pay considerable attention to what has been said about it.

Baroness Tyler of Enfield (LD): My Lords, I rise briefly to speak to government Amendment 2 on dignity and respect. I know that it was implicit in the well-being clause in the earlier versions of the Bill that we looked at, but I am very pleased that the need to ensure that all people are treated with dignity and respect has been brought out so explicitly. These are words that the man and woman in the street really understand; they get to the heart of some of the concerns about the type of social care that has sometimes been provided, which has fallen well below those standards, and caused some of the scare stories that we have heard so much about recently.

The noble Lord, Lord Bichard, and I raised this issue in Committee, but as he is unavoidably unable to be in his place today, I thank the noble Earl, Lord Howe, on behalf of both of us, for listening and for bringing this amendment forward.

The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con): My Lords, I am grateful to all noble Lords who have spoken and for the opportunity to discuss once again this important new well-being principle set out in Clause 1. The amendments in this group cover three important issues. The first of these relates to the application of the duty to promote well-being to the Secretary of State. In Committee we debated the link between the role of the Secretary of State and the duty of local authorities to promote the well-being of individuals. There was clear strength of feeling in the Committee that the Bill should make explicit reference to the Secretary of State having regard to the duty on the local authority to consider the well-being of the individual. An amendment in this regard is not essential because the local authority well-being duty is in any event a relevant factor for the Secretary of State to take into account when issuing guidance or regulations. However, I do recognise the strength of feeling and I am happy to clarify the position.

In response to the concerns, I have tabled Amendment 138, which explicitly requires the Secretary of State to have regard to the local authority well-being duty when issuing regulations and guidance. This achieves, I hope, the same ends as intended by the amendments tabled by the noble Lords, Lord Hunt and Lord Warner, and I trust that they will support the government amendment.

The second issue relates to the focus on dignity, to which my noble friend has just referred. In Committee, noble Lords expressed concern that personal dignity was not adequately reflected in the well-being principle, in spite of the change that the Government made to this effect following consultation on the draft care and support Bill. Let there be no doubt that the Government place the utmost importance on dignity and respect in care. These factors must be central to the well-being principle. In order to ensure that dignity is given due prominence in primary legislation, I am pleased to

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have been able to table Amendments 2 and 3, which give greater emphasis to personal dignity and respect as components of well-being.

The third issue in this group relates to another constituent part of individual well-being: spiritual well-being. My noble friend Lady Barker’s Amendment 4 would include an explicit reference to spiritual well-being in Clause 1(2). We debated a similar amendment in Committee. I said then, and I emphasise now, that the Government recognise the importance of spiritual well-being as a concept and understand the particular significance that it can have for some people, especially at the end of their life. We would absolutely not want an approach that excluded spiritual well-being from consideration where that was clearly of consequence to the individual concerned.

However, it is important to understand that that is not the approach which the Bill sets out. The factors included in Clause 1(2) contain high-level matters which should be interpreted broadly to fit the individual case. Spiritual well-being should be considered where it is relevant to the person’s overall well-being. Moreover, spiritual well-being is likely to be closely related to other matters, such as emotional well-being, which are listed in the clause.

In addition, local authorities must also consider the person’s views, wishes and feelings, as set out in Clause 1(3)(b). This provides a further clear direction to local authorities to have regard to personal matters, which could well include beliefs or other views that would promote an individual’s spiritual well-being. Although it is not explicitly mentioned, spiritual well-being is nevertheless accounted for.

I hope that I have reassured in particular my noble friends Lord Hamilton, Lord Deben and Lord Cormack, and indeed the noble and right reverend Lord, Lord Harries of Pentregarth—

Lord Hamilton of Epsom: Will my noble friend explain why the NHS has actually changed its policy on this? In 2002, new Department of Health guidance on NHS chaplaincy said that all NHS trusts should make provision for the spiritual needs of all patients and staff from all faith communities. It strikes me that the NHS is now rowing back on a previous commitment.

Earl Howe: First, we are not dealing with the NHS; we are dealing with local authorities and adult social care. Secondly, the NHS has not rowed back on this. We have debated hospital chaplains on many occasions and I have made very clear the Government’s view that hospital chaplains perform an important role in the spiritual context. So on the NHS front, I want to reassure my noble friend that here we are dealing with local authorities and adult social care. I was trying to explain that the way in which this Bill is framed is perhaps different from how my noble friend has construed it.

Lord Deben: If it does not make any difference to add this to the Bill, why cannot the Government accept that many people would feel much reassured by its addition?

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I have been in my noble friend’s position—and he knows with how much respect I view him—and I cannot remember an occasion when I have said, “This does not make any difference” that it did not quite mean that. What worries me here is that it does not quite mean that. I should be much happier if he would please look again at this, because it is a matter which does concern people. If it makes no difference, surely we can do these things in order that people should not be concerned? Their not being concerned would make a difference.

4.15 pm

Lord Cormack: If this is explicit for the National Health Service, why can local authorities not be treated in precisely the same way?

Lord Warner: I am trying to help the Minister. If he does agree to provide the assurances sought by noble Lords to look again, could he see whether if he moved in the direction they suggest, he would be discriminating against humanists?

Earl Howe: I can do no other than to look at this again, but I want to reassure my noble friends that their concerns are groundless because of the way that this clause has deliberately been framed. It is framed in terms of high-level principles. It is not designed to exclude any form of well-being whatever. It is designed to look at the person holistically and to ensure that no aspect of well-being is overlooked. I shall of course have a fresh look at this question, but I ask my noble friends, and the noble and right reverend Lord, Lord Harries of Pentregarth, to understand that this clause has been framed in a particular way quite deliberately, not to exclude any form of well-being but to encapsulate all forms of well-being.

In other words, the provisions allow consideration of this and indeed many other matters where relevant. I hope that with these assurances the noble Lord will feel able to withdraw his amendment, and indeed to support the amendments which I have tabled.

Lord Hunt of Kings Heath: The noble Baroness, Lady Barker, will respond to the point in relation to Amendment 4. Part of the confusion arises because the Department of Health seems to equate spiritual well-being with emotional well-being. I do not think that that would be generally held to be appropriate. Whether you have a faith or none, it does seem to me that by classifying spiritual belief within emotional well-being, the department has fallen into a pit of its own digging. I hope the noble Earl will indeed go back, and I assume that means this could be debated at Third Reading. Clearly noble Lords would wish to come back to it.

Whether this is for the noble Baroness, Lady Barker, or for the noble Earl, taking up the point raised by my noble friend Lord Warner, the chairman of the All-Party Humanist Group, my assumption would be that the duty on a local authority in relation to spiritual well-being would apply only when a person had a belief. Whether one defines humanism as spiritual I do not know—we

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are getting into deep waters here. I assume it is not intended that a person of no religion be required to be treated by the health service or local government as having a spiritual need.

We welcome Amendments 2, 3 and 138, and I beg leave to withdraw Amendment 1.

Amendment 1 withdrawn.

Amendments 2 and 3

Moved by Earl Howe

2: Clause 1, page 1, line 8, at end insert—

“( ) personal dignity (including treatment of the individual with respect);”

3: Clause 1, page 1, line 9, leave out “, emotional well-being and personal dignity” and insert “and emotional well-being”

Amendments 2 and 3 agreed.

Amendments 4 and 5 not moved.

Amendment 6

Moved by Baroness Pitkeathley

6: Clause 1, page 2, line 34, at end insert—

“( ) For the purposes of this section, “an individual” includes a person with parental responsibility for a disabled child.”

Baroness Pitkeathley (Lab): In the unavoidable absence of the noble Baroness, Lady Finlay, and at her request, I shall move Amendment 6 and speak to Amendments 8 and 9 tabled in her name and mine, and speak to my Amendments 46, 47, 48 and 58.

The first group of amendments concerns parent carers. The Care Bill is drafted to apply only to adult carers of adults. This means that the new rights for carers included in the Bill will not apply to adults caring for disabled children or to children caring for disabled adults. The Government have committed to address this disparity for young carers by bringing forward very welcome changes in how they will join up this Bill and the Children and Families Bill to meet the needs of young carers and their families. This is extremely welcome, but it will leave parents of disabled children as the only group of carers whose rights to assessments and support will be left behind.

Carers UK and other carers organisations have been deeply disappointed that parent carers’ rights are not being given the same recognition as other carers’ rights and that the legislative technicality of their rights falling under the remit of children’s rather than adults’ legislation risks them being left with inferior rights. These amendments include parent carers in three key places in the Bill in order to probe the Government’s intentions regarding parents of disabled children and how they intend to address the disparity with the rights of parent carers. The Government have put forward an approach which joins up the Care Bill and the Children and Families Bill for young carers—which is very much to be welcomed and on which the Government are to be congratulated—and these amendments call for them to do the same for parents

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of disabled children. If nothing is done about this, parents of disabled children will be left with lesser and inconsistent rights to assessment and support. The rights of certain groups of carers will be left at different levels in different pieces of legislation, which will be confusing for many people, and parents of disabled children, who already have difficulty accessing support, will find it even harder to participate in work and their community in any way at all.

In this Bill, the Government are improving the rights of carers for adults by removing the need to provide regular and substantial care in order to receive an assessment, removing the need to request an assessment of their needs, placing a duty on local authorities to provide services to the carer following assessment when they meet the eligibility criteria, and introducing a new well-being principle. All this is very welcome, but parents of disabled children also need support. They have often struggled to establish rights as individuals on a par with other carers, and they are at particular risk of having their own rights overlooked as individuals. Too often, they are seen only as parents and their needs as carers are not identified or supported. This was summed up for me this weekend in a conversation I had with a parent carer known to me. He and his wife have been caring for their 30 year-old, very disabled son who is physically and mentally disabled. They have been caring for him for more than 30 years and have had the usual struggle in trying to find any support. When trying to access respite care when the wife, who has diabetes, was severely ill, they were told, “But you’re not carers. These rights don’t apply to you. You’re only parents”. They are not only parents. Normal parents do not have to look after their child and do everything for him for 30 years.

It is three times more costly to bring up a disabled child than a non-disabled child. Parent carers are more likely to be reliant on income-based state support, and 34% of sick or disabled children live in households where there is no adult in paid work. They are also more likely to suffer relationship breakdown and divorce, and they are three times more likely to suffer ill health and health breakdown than parents of non-disabled children. They are also commonly very isolated and unable to get support that fits the whole family.

The Law Commission, I remind the House, recommended that existing duties to assess parent carers should be amended to make them consistent with the adult social care statute. The Government, I am afraid, have so far failed to act on this recommendation. I tabled similar amendments during the Committee stage of the Care Bill and the Minister responded. However, the Government’s response did not address the disparity that will arise for parent carers, who will have lesser rights to an assessment of their need for support and will not have the same rights to support services as other carers.

These amendments try to address that. In brief, they include parent carers in the well-being clause. The intention of the first amendment is to include the parents of disabled children in the duty placed on local authorities by Clause 1 to promote the well-being of individuals. They also want to prevent parent carers’ need for support arising in the first place. Too often

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parent carers reach crisis point, leading to high-cost interventions. In addition to the negative impact on outcomes for the whole family caused by mental or physical breakdown in the parent, relationship breakdown and unemployment, there are also substantial costs to local authorities, commissioners and indeed to the economy. The costs of mental ill health, as we all know, are rocketing. The cost of family breakdown is estimated to range from £20 billion to £40 billion every year.

The other amendment includes parent carers in the duty to make the assessment. The Bill is making it easier for adults to receive a carer’s assessment by creating an automatic right to one and removing the requirement that they provide regular and substantial care. When I see that in legislation I want to stand up and cheer. That is a great development. However, unless similar changes are brought forward for the parents of disabled children, they will still need to request a carer’s assessment from their local authority and do not have a right to one unless they are providing regular and substantial care. This disparity means that parent carers will be the only carers to have these additional barriers to support in front of them. This amendment seeks to include parents of disabled children in the duty on local authorities in the Care Bill to assess carers, which creates a lower bar to assessment than the current legislation.

I hope that the Minister will look favourably on these amendments. Will the Government give assurances that parents of disabled children will not be left with lesser rights? How will the Government ensure parity of rights for parents of disabled children and how will the Government act to join together the Care Bill and the Children and Families Bill—being considered in the Moses Room as we speak—to ensure that the families of disabled children are able to access support? Will the Minister commit to working with the Children’s Minister to ensure that the rights of parent carers are not left behind? Will the Minister assure me that, having worked so effectively with the Department for Education to strengthen the rights for young carers, he will do so again to strengthen the rights of families with disabled children?

My Amendments 46 to 48 and 58 are about charging for carers’ services. They are supported by Carers UK and the Carers Trust. The current law includes the power to charge for meeting the needs of carers but very few local authorities use this power. As well as continuing to give local authorities the power to charge carers, the Bill includes a power to charge carers for arranging services for them. Local authority adult and social care budgets are under ever-increasing pressure and we must be concerned that carers may be looked to as a source of revenue. Carers already contribute a huge amount, often at great personal cost, as caring has a negative impact on their finances, health and well-being, and opportunities to engage in work and education. I make no apology for repeating the figure that I have quoted many times in your Lordships’ House—Carers UK has calculated that the contribution of carers is worth £119 billion a year in savings to the Exchequer. Charging a carer for support to meet their needs, often in order to help them continue in caring, risks being counterproductive by preventing carers

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accessing services and may even discourage carers seeking support. As a result, the adoption of charging policies would result in additional costs to local authorities.

4.30 pm

Carers and the person or people they are looking after—we should remember that many carers look after more than one person—may not have the same income. In many cases, carers have had to give up work or live on a reduced income as a direct result of their caring responsibilities. They may not have access to the same income that enables the person they care for to self-fund their care and support. The cost of supporting individual carers is frequently minimal but the financial benefit to local authorities can be significant. The Government have identified that carers are the first line of prevention, and that properly identifying and supporting carers will prevent escalation of demand on statutory services. The Government’s own impact assessment of the Care Bill set out evidence on the cost-effectiveness of supporting carers: for example, by preventing or delaying hospital or residential care admission; by sustaining the caring role; by improving the health and well-being of carers; and by assisting carers to remain in or return to work.

A number of local authorities have individually examined the value of their care and support services and have concluded that supporting carers is very cost effective. Surrey County Council, for example, did a cost-modelling exercise which concluded that supporting carers helps prevent breakdown of caring situations, provides help in a manner that many families appreciate and avoids far greater costs for the provision of more expensive and intrusive care packages. This was also the conclusion of Herefordshire County Council, which recently reversed its decision to charge for carer services. It found that charging would risk increased pressure on social care budgets and that no additional income would be raised by the council because of carers’ low income. No advantage could be gained because of the negative effects of charging. I should declare an interest as patron of Herefordshire Carers Support, but I am sure that that had nothing at all to do with the decision not to charge carers.

I must also mention carers and the care account. Unlike for older and disabled people, the cost of services for carers will not accrue towards a care account. This means that, unlike disabled or older people, any services which carers pay for themselves, or which they are given through public services if they are deemed eligible, will not count towards the care account. In the care account model, any unpaid support that a carer provides for eligible needs will reduce the amount that the public will have had to contribute towards the capped-costs model. In other words, a carer’s contribution is counted several times over, yet they themselves may have to make increasing financial contributions which would not go towards their own care account for the future. There is nothing in the capped-costs model which recognises the contribution of carers and many carers will feel that it is unfair that they provide unpaid care and must pay for support which enables them to continue to do so. By any judgment, that is unfair.

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The simplest way to resolve the issue of the care account not applying to carers is to remove charging for carer services completely. A care account for carers would be a hugely complex exercise in any case, and it would arguably be easier at this stage simply to protect carers from being charged for services. What is the Government’s rationale for leaving carers out of the care account? Do the Government agree that it would be far easier and more equitable if the Government removed charging for carers altogether?

Finally, I turn to Amendment 48; I apologise for delaying the House with all these amendments, but I might as well speak to them while I am on my feet. Amendment 48 is about services of an intimate nature which can only be provided to the disabled person. We considered this in Committee. There is no clarity in the Bill about what a disabled person’s service is and what a carer’s service is, which will lead to confused decision-making and carers being increasingly, or wrongly, charged for services. Under the current legislation—the Carers and Disabled Children Act 2000, which I had the honour of taking through your Lordships’ House—services provided to the disabled person in order to meet the needs of the carer cannot include services for the disabled person that are of an “intimate nature”. This ensures that disabled people keep control of their own services while protecting carers from being charged for services. This is a vital protection which is critical for carers. This amendment seeks to reintroduce this wording into the Bill with several clear purposes. The first is to ensure that disabled people will keep control of personal services. The second is to ensure that decision-making is made clearer for front-line professionals. The third is to protect carers from increasingly being charged for services.

Currently, the Carers and Disabled Children Act 2000 specifies that services provided to the disabled person in order to meet the needs of the carer cannot include services “of an intimate nature”. The Bill, as we know, introduces new rights to assessment for carers; new duties to provide services to carers following assessment; and the power to charge for services to carers that are provided to them and to charge for arranging these services. Disabled people can be charged for services provided to them, including if the services meet the needs of carers, but currently there is no definition of whom a service belongs to. This was a recommendation in the Joint Committee’s report when we scrutinised the draft care and support Bill: that the Government protect carers from being wrongly charged by including the wording at Clause 14.

This wording is very welcome because it prevents wrongful charging, but the Bill still leaves wide open the issue of how a practitioner decides to whom the service is provided and thus potentially charged. The new wording of the Bill opens up the possibility, I fear, that intimate care services for a disabled person could be provided to the carer and a whole new scale of charging developed. I do not believe that that was the Government’s intention when they changed the wording of the Bill, so that the definition of intimate care should be retained, with more detailed guidance to assist local authorities and carer centres in using the legislation. The reason this clarification matters even further is because of what I referred to earlier about

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the care account. There will be negative consequences if further clarity is not provided so I very much hope that the Minister will accept this and my other amendments and I beg to move.

Baroness Wheeler (Lab): My Lords, I am pleased to speak to our Amendments 7 and 10 and will speak mainly about young carers, as my noble friend Lady Pitkeathley has spoken strongly on parent carers for disabled children and the other key issues covered in this group. In Committee, we were deeply concerned at the very real danger and risk of young carers’ rights and their need for support failing to be addressed in either the Bill or the Children and Families Bill, so it is with great relief that we will be dealing today, now and later, with significant amendments relating to adult care assessments and young carers, local authorities’ duties to identify young carers and ensuring young carers are supported and are not forced to undertake inappropriate caring roles.

On young carers, it is somewhat frustrating that the Government amendments, which are an integral part of the package on young carers that locks in the links between the Bill and the Children and Families Bill, are to be taken in a later group. We need to see the picture on young carers as a whole to be reassured and clear about how the two Bills interact to secure young carers’ rights on support and assessment. Under the two Bills, the Care Bill links adult assessment where a young carer is supporting an adult with the young carer’s assessment, which will be undertaken under the Children and Families Bill. The ministerial Statement on the latter from the Department for Education sets out how it sees this working in practice, and we broadly support this. Our Front-Bench team on the Bill will be probing this further in Committee, which, of course, commences today.

We welcome all these developments. We have worked closely with the excellent National Young Carers Coalition and it has led calls for key changes in the two Bills. I am sure the Minister will agree that the NYCC has done a great job of bringing the plight of young carers to the attention of the House and to Ministers. I am pleased that the Government have now taken steps to ensure a twin-track, joined-up approach between the two Bills.

As the Bill has progressed, we have heard extensively why children and young people caring for a family member, parent or sibling can be so vulnerable to losing out on their education and on the things that they want to do with their lives and how their health can suffer as a result of having to undertake significant caring responsibilities. However, it is a shocking fact that too often young carers do not get the help they need. One of the reasons for this is that, under the current assessment process, the person they are caring for does not receive enough support and the needs of the whole family are often not taken into consideration.

We must remember that this can have a devastating impact on both the young carers and the cared-for person. As a trustee of our local carer support group in Elmbridge, I can say that we see this from both ends. Many of our registered young carers are delivering hands-on support and may be the only other person in

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the house. For example, if their parent has mental health problems—very often the most hidden of caring roles—the child may have to look after themselves on a daily basis, make their own meals and get off to school, as well as being supportive of the parent and carrying out tasks for them. At the same time, a disabled parent does not want to see their child overburdened with caring duties; they feel desperate and guilty when they require care and support that is not forthcoming as part of the care package, and the child just has to help—and usually wants to anyway. That is a dilemma.

That is why we sought to amend the Bill in Committee so that adults with care and support needs are assessed in relation to the presence of a young carer, so adult needs are met sufficiently and children are prevented from undertaking levels of caring that put their well-being, health and development at risk. The government amendments now put this into effect in the Bill and we fully endorse them as part of the package of changes that are needed.

That is also why our Amendment 7 to Clause 2 must be an important part of the package. We believe that the Care Bill is the right place for the law to be clear that adult services need to assess and meet adult needs first, but with a view to whether a child may be caring for them and providing the support as required. Children should not be picking up the pieces and left to provide part of the care package as a result of the failure of adult services to see and support them alongside children’s services.

Our essential aim has been to ensure that local authorities provide or arrange services to prevent young carers from developing needs for care and support, as well as preventing and reducing needs for adults and adult carers. We cannot have a situation where people have unmet care and support needs, which results in children and young people having to meet those needs.

Our Amendment 10 specifically deals with the issue of local authorities’ duty to identify young carers. We know that currently, adult social care services and health services routinely fail to identify children who may be caring for an adult, even when the adult is assessed, and that also applies to schools. As a result, children can continue to undertake harmful caring roles and end up developing needs for care and support themselves. The lack of a co-ordinated response between children’s and adult services remains an ongoing difficulty for young carers and their families. I hope that the noble Earl will recognise the need to address this problem.

On the other amendments in the group, we strongly support the intentions of Amendments 6, 8 and 9, which seek to emphasise parent carers of disabled children, both in respect of the well-being principle and in terms of preventing them undertaking inappropriate caring. Amendments 46, 47 and 58, in the name of my noble friend Lady Pitkeathley, seek to address the very real fears of carers and their organisations over carers being charged for key services that they are not currently charged for. My noble friend’s amendments represent an excellent opportunity to put carers’ minds at rest on this issue once and for all, and I hope that the Government will be sympathetic to this.

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Finally, my noble friend’s Amendment 48 addresses the important issue of carers generally—not just young carers—being required to undertake inappropriate caring. We dealt with this issue in relation to the assessment process extensively in Committee and we strongly support this amendment. Support from family and carers should be considered as a way of meeting needs rather than as a reason for deciding that the person does not have needs or is not eligible for care. Carers must not be pressurised to provide care that they do not feel able to provide. I look forward to the Minister’s response on this.

Baroness Tyler of Enfield: My Lords, I rise very briefly to speak to Amendment 34 in my name. The purpose of this amendment relates to the definition of a carer, to ensure that it could include a young person as well as an adult. I wish to explain that I tabled the amendment before the extremely welcome Statement by the Secretary of State for Education earlier in the week, and the tabling of the new amendments on young carers. As other noble Lords said today in the Chamber, I very strongly welcome this. I know, from talking to both departments—the Department for Education and the Department of Health—that a lot of very effective work has gone on over the summer that has been very effective both at official and ministerial levels. I also very much welcome the fact that the National Young Carers Coalition has been very much involved in these changes, and I know that it has issued a statement welcoming them.


Lord Mackay of Clashfern: My Lords, I particularly support the amendment of the noble Baroness, Lady Pitkeathley. It is obviously important that the situation regarding children who are carers is properly focused. As your Lordships know, I am a vice-president of the Carers Trust and have an interest from that point of view. I have difficulty understanding exactly the scope of the clauses here, because the clause dealing with well-being talks about the “individual”. I assume that this includes the disabled child as well as the carer, and that the same is true even when the child is not disabled. If one has a carer, the child will be an “individual”, I assume. The adult definition comes in the next clause, Clause 2. Clause 1 refers to an “individual”, so I assume that children are included in that clause and therefore that the local authority, in performing its functions, has an obligation to have regard to the well-being of children.

Earl Howe: My Lords, as my noble friend Lady Tyler said, Amendments 7, 10 and 34 in this group about young carers provide an opportunity within our debates to welcome the Written Ministerial Statement yesterday from my right honourable friend the Secretary of State for Education about the Government’s proposed amendments to the Children and Families Bill on the assessment of young carers. They give effect to the Government’s stated intentions to consolidate and simplify legislation relating to young carers’ assessments, making rights and duties clearer to both young people and practitioners. In the Government’s view, these provisions sit most appropriately within children’s legislation.

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The right to an assessment of needs would be extended to all young carers under the age of 18, regardless of who they care for, what type of care they provide or how often they provide it. Local authorities would have to carry out an assessment of a young carer’s needs for support on request or on the appearance of need. The amendments also enable local authorities to align the assessment of a young carer with an assessment of an adult that they care for.

I believe that the government amendment will achieve the desired effect of my noble friend Lady Tyler’s amendment to Clause 10 by putting a young carer’s entitlement to an assessment on a similar footing to the provisions in the Care Bill for an adult carer’s assessment. I have also tabled an amendment to Clause 12 of the Care Bill, which we will debate shortly, that makes it clear that a local authority may combine an adult assessment with a child’s assessment, including a young carer’s assessment, provided all parties agree. The government amendment to the Children and Families Bill will also achieve the desired effect of Amendment 10 by requiring local authorities to take steps to identify the extent to which there are young carers within their area who have needs for support.

Amendment 7 would extend to young carers provisions in Clause 2 that require a local authority to provide services, facilities and resources to prevent or reduce needs for support among adult carers. Prevention is an important matter to highlight, but the Bill already makes sufficient provision on this issue, as it requires local authorities to have regard to overall family circumstances when fulfilling their duties under the Bill.

Clause 1 requires local authorities to promote an individual’s well-being in exercising all their Part 1 functions, including those in Clause 2. Domestic, family and personal relationships are specifically included, and such relationships could encompass parenting responsibilities, the adequate functioning of the family and the household and the impact of providing care and support on other members of the family. We do not think that it would be appropriate to refer to preventing the needs of young carers specifically. One means of preventing their needs will be, of course, to meet or delay the needs of those whom they care for, and this is clearly covered by the existing provision. There may be other means, which could include the provision of services directly to the young carer. However, such routes would not be appropriate for adult care and support to take, and we do not believe that a duty should sit within adult legislation.

We will make it clear in statutory guidance that all these provisions should take into consideration family relationships and circumstances, and I am happy to make a commitment that such guidance will refer specifically to the importance of preventing children undertaking inappropriate or excessive caring responsibilities. In addition, in drafting regulations about an adult’s assessment under the regulation-making powers in Clause 12, we will make it clear that a whole-family approach should be adopted, where appropriate. An adult’s assessment should then take into account the functioning of the family and the household, and the impact of providing care and support on other members of the family, including children.

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I turn to the position of those with parental responsibilities for disabled children, which is an important issue. However, we do not consider it appropriate to include provisions within the Care Bill about the assessment of parent carers of disabled children, as proposed in Amendments 6, 8, 9 and 35 from the noble Baroness, Lady Pitkeathley. In the Government’s view, the main provision for assessing and supporting those caring for disabled children should be in children’s legislation, so that the family’s need for support can be looked at holistically. In most cases, the best way of supporting a parent carer of a disabled child and other members of the family is by the provision of support directly to the child concerned. It would not be appropriate for adult care and support to be undertaking an assessment of those needs, when adult support is not best placed to meet them. The view of the Minister for Children and Families is that there is already sufficient provision under Section 17 of the Children Act 1989 to provide for the assessment and support of children in need, including disabled children and their parents.

I turn to Amendments 46 and 58 from the noble Baroness, Lady Pitkeathley, about charging carers for support. We remain of the view that local authorities should retain the power that they have now to charge carers for support provided directly to them. Many local authorities do not impose charges on carers because they, of course, recognise the valuable contribution that carers make to society. However, some may choose to impose a nominal fee to cover a proportion of the costs of providing a particular form of support for carers—for example, a relaxation class or gym membership—and we do not think it appropriate to remove that discretion and flexibility. Indeed, removing the ability to charge even a small amount could result in the withdrawal of such services altogether.

The noble Baroness argued that the cost of caring should not count towards the care account within the cap arrangement. Local authority assessments take the support provided by carers into account in determining the care package. We are clear that the care package should count towards the cap, because that should ensure that all people receive the support that they need. We have heard from the care and support sector that the cap will provide carers, as well as care users, with the financial support to help them decide on the right care for them to help provide, and to reassure them that their families will not face catastrophic care costs.

I have some concern about the noble Baroness’s Amendment 48, which proposes that the provision of intimate services to a person needing care cannot be provided to meet a carer’s need for support. This would create a legal barrier that could significantly hinder the provision of a much-needed type of support to carers. Let me provide one example. It may be appropriate to meet a carer’s needs by providing a service direct to the person cared for. If some type of replacement care is provided to allow the carer to take a break from caring, it may look like home care delivered to the adult needing care, even though it is provided to meet a carer’s needs. The amendment would seriously limit the ability of local authorities to make such arrangements because it would provide that the care workers could carry out some activities,

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but not others of an “intimate nature”. That could leave a situation where the care worker was able to sit with an adult needing care but not take them to the toilet. That is likely to lead only to confusion, I suggest. We accept that clarity is needed about when a type of support should be considered to be provided directly to the carer, and when to the adult needing care. We will produce guidance on this matter, but we cannot support an amendment that sets such an inflexible rule in primary legislation.

I also reassure noble Lords that the Bill is already very clear that carers should not be charged for any form of support that is provided directly to the person needing care. Clause 14(3) makes it absolutely clear that local authorities cannot charge carers for services provided to the person being cared for. This would include services of an intimate nature.

I hope that I have reassured noble Lords that, together, the Care Bill and the Children and Families Bill provide a clear legislative framework to support local authorities to consider the needs of young carers and protect them from excessive or inappropriate caring roles. On the important issue of assessing those with parental responsibility for disabled children, we remain of the view that they are best supported through the provisions of the Children Act 1989. However, I have noted the concerns raised about those who care for disabled children having the same entitlement to a carer’s assessment as young carers and adults caring for adults will have through the respective provisions of the Children and Families Bill and the Care Bill. Department of Health officials will explore further, with officials at the Department for Education, the issues raised by the noble Baroness. I know that my noble friend Lord Nash is always willing to listen to the concerns of noble Lords on these and other matters.

I hope that I have also reassured noble Lords that the Bill is already very clear that carers should not be charged for support provided directly to the person needing care. However, I am conscious that I have not directly answered an issue raised by the noble Baroness, Lady Wheeler, about the need for identification of carers to ensure that there is no unmet need. It is important to support people to identify themselves as carers so that they can access information, advice and support in their caring role. My department is funding the Royal College of General Practitioners to raise awareness among health professionals. Health and well-being boards should also be identifying the numbers of carers in their local population through joint strategic needs assessments.

My noble and learned friend Lord Mackay asked whether children were already covered in the scope of Clause 1. They are covered in terms of the functions set out in Part 1 of the Care Bill. The local authority must have regard to the well-being principle in discharging any function under Part 1 that relates to children. They would be “individuals” in the case of the exercise of that function—for example, in the provisions relating to the assessment of children in anticipation of their transition to adulthood. I hope that that is helpful.

I have taken a little while to reply to these amendments, but I hope that I have been sufficiently illuminating to encourage noble Lords not to press them.

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Baroness Pitkeathley: As we were on a roll there with the Department of Health and the Department for Education working together so successfully on the young carers issue, I rather hoped that we might do it also with regard to parent carers. I am very grateful that the Minister has not entirely closed the door on that. I will read very carefully what he said, but I reserve the right to come back to this issue at Third Reading. I am very encouraged by what he said about taking a whole-family approach, but I believe that it should include parent carers as well as young carers. I am grateful to him, too, for saying that there would be more clarity in guidance about the charging issues. As I said, I will read what he said very carefully, but I reserve the right to bring some of these issues back at Third Reading. In the mean time, I beg leave to withdraw the amendment.

Amendment 6 withdrawn.

Clause 2: Preventing needs for care and support

Amendments 7 to 10 not moved.

5 pm

Clause 3: Promoting integration of care and support with health services etc.

Amendment 11

Moved by Lord Hunt of Kings Heath

11: Clause 3, page 4, line 3, at end insert—

“( ) NHS bodies must exercise their functions—

(a) with a view to ensuring the integration of services for the purposes of enhancing the health and well-being of people, in keeping with the duty on Health and Wellbeing Boards enshrined in section 195 of the Health and Social Care Act 2012; and

(b) without hindering the efforts of a local authority to fulfill its duty under subsection (1) above.”

Lord Hunt of Kings Heath: My Lords, in moving Amendment 11, I wish to speak also to Amendment 30. I also support the amendments in this group tabled by the noble Lord, Lord Best, but may respond to those later.

In Committee, we debated amendments promoting further integration of health and social care. As my noble friend Lady Wheeler said, we supported the view of the Association of Directors of Adult Social Services and the Local Government Association that the Bill should include a specific duty on NHS bodies equivalent to the duty on local authorities to integrate services and that this shared involvement should be enshrined in the Bill. Joint strategic needs assessments and joint health and well-being strategies should provide a strategic overview of how the health and well-being of local communities can be improved and health inequalities reduced. ADASS has long maintained that local health and well-being boards are pivotal in the delivery model in this respect and that the Bill must reflect this to bring about a wholly integrated accountable system that meets identified local needs and objectives.

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The noble Earl, Lord Howe, said in Committee that he had no argument with the sentiments expressed by my noble friend and relied on Clauses 3 and 6 of the Bill and various other pieces of legislation, including Section 116 of the Local Government and Public Involvement in Health Act, which requires local authorities and clinical commissioning groups to have regard to the relevant joint strategic needs assessment and joint health and well-being strategy in exercising any of their functions, which would include their duty to co-operate and promote integration. The noble Earl also prayed in aid the prominence of health and well-being boards being strengthened through their role in signing off joint plans required as part of the £3.8 billion pooled fund between local authorities and the NHS to support joined-up and integrated working.

I certainly accept and understand those points but I would like us to go further. I argue that the measure should be much more explicit in the Bill in relation to the National Health Service’s duty of co-operation. We know that the current crisis in accident and emergency services which seems to be extending through the early autumn period is symptomatic of a health and social care system that is under huge pressure. If reductions in social care funding and support for the third sector mean that patients cannot be discharged from hospital that has a knock-on impact throughout the whole system. This Bill places major responsibilities on local authorities. Without the full co-operation of the National Health Service they will be very hard pressed to discharge those responsibilities.

The noble Earl is relying on this Bill and existing legislation but the fact is that so far this has not been sufficient. I refer him to a report published today by the University of Birmingham and Birmingham City Council entitled Turning the Welfare State Upside Down? The report says that our social care system is broken and increasingly unfit for purpose and that we need a big and bold response to tackle the crisis and ensure a decent and fair system for the future. The report is right to emphasise the need for close co-operation between social care and the NHS and to shape services around the needs of the individual. The problem is that the Government through their 2012 Act have created a disintegrated system instead of an integrated one and a system where fragmentation is rejoiced at and where the operation of a market is meant to drive a wedge between people who ought to be co-operating together.

I do not want to go back over this afternoon’s Oral Question, but clinical commissioning groups would have been surprised to hear the noble Earl suggest that it was entirely up to them whether or not services were put out to tender. They have been absolutely pressurised by NHS England to do that. NHS England is clearly under the direction of the Secretary of State: how could it not be when, according to government briefings over the last two weeks, the appointment of its chief executive is going to be the Prime Minister’s decision?

There is real concern that we have conjured up a very fragmented sector. As the noble Earl knows, we already have a system where physical health, mental health and social care have found it very difficult to integrate their services. As we have more older people

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with vulnerabilities and co-morbidities, the need for the systems to work together becomes ever more paramount.

Amendment 11 would put in the Bill an explicit requirement for the NHS, through the health and well-being boards, to play its full part in the integration of services. In Committee, the noble Earl was sympathetic to these sentiments but not to the amendment. I hope that, in the spirit of accepting wise words in this House, he will be prepared to be more sympathetic on this occasion. I beg to move.

Lord Best (CB): My Lords, I rise to speak to the two amendments in my name and in the names of the noble Lord, Lord Hunt, and the noble Baronesses, Lady Eaton and Lady Barker. These amendments are carried forward from five which I tabled in Committee, all of which sought to give more prominence in the Bill to housing. I declare my interest as chairman of the Hanover Housing Association, which works exclusively for older people, and as president of the Local Government Association.

The overarching case for these amendments is that everyone's care needs are inseparably connected to the place where they live and where, for most older people, they spend all their time. The right accommodation can sustain our independence and well-being even if we face the illnesses or long-term conditions that afflict many of us in older age. The right accommodation can pre-empt and prevent the need for domiciliary and residential care and hugely reduce costs to the NHS and local authority social services. For younger adults with care needs, the right accommodation can enable a fulfilling life within the community, not hidden away in an institutional setting. The wrong accommodation can cause accidents and, indeed, mental health problems; keep people in hospital because their home will not have them back; and can force people into costly residential care.

This Bill is the chance to incorporate housing into the health and care equation so that these three interlinked dimensions can really work together. The noble Earl has worked hard over the recess to bring back improvements to the Bill. In relation to the housing issues, the noble Earl has noted that our concerns are shared by a number of Peers who feel that the Bill gives insufficient emphasis to the question of housing. He fully accepts the integral role of housing in helping meet care and support needs, and has told us that he sympathises with the arguments he has heard. I am very grateful to the noble Earl for the two amendments he has tabled to give greater prominence to the link between health, social care and housing. His response will be greatly welcomed by the Care and Support Alliance and, within that group, the National Housing Federation, which drafted the original amendments.

Government Amendment 28 to Clause 6 extends the duty of local authorities to co-operate with partners so that this duty will encompass housing associations—registered providers of social housing—which is a very significant step in absolutely the right direction. Government Amendment 12 to Clause 3 ensures that, in terms of the integration of services, housing will be classified as “health related” and will therefore be

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taken on board by clinical commissioning groups and the NHS Commissioning Board, NHS England. Both these changes are really positive and I congratulate the noble Earl for his farsightedness, once again, in improving the Bill in these two ways.

At the risk of appearing slightly churlish, however, perhaps I could press the noble Earl on the two issues that remain outstanding and are covered by the two amendments in my name, which have support from all parts of the House. In relation to advice, Amendment 15 to Clause 4 would ensure that people have access to good information on the options available to them in relation to housing requirements, spelling out both ways in which their current home could be made more suitable and the choices that they could make about a move to supported or retirement accommodation, such as assisted living and extra care housing.

Although the Bill ensures that advice on care services will be made available, the Joint Committee on the draft Bill strongly recommended that advice on housing options also be included. So far, this recommendation has not been taken on board. It is not an onerous extra requirement to include housing advice in the mix, particularly given that many local authorities already ensure that people get this advice. Indeed, the Local Government Association supports this amendment. The Minister pointed out in Committee that information and advice on specialist housing options should be included when housing information is supplied. This amendment adds the prompt for such housing advice also to be included when guidance is given on care matters.

A move to a more suitable place can be suggested for a younger adult with care requirements. Sources of support for helping an older person to downsize, perhaps in decluttering the attic or sorting out the garden shed, can be recommended. For those who stay put, there is often so much to be done of a practical nature in making life easier for an older person and reducing their dependency on paid carers or family carers. From replacing hard-to-turn taps with long-handle lever taps for someone with arthritic hands, or fitting firm banister rails to the stairs, right through to converting the bathroom to fit a walk-in shower or installing a stair lift, all such adaptations can delay or prevent the need for more intrusive and expensive care provision. With good advice, paying for those adaptations can be covered by disabled facilities grants or equity loans, just as advice for a younger adult with care needs can be given on how the costs of renting a more suitable home can be covered.

Last Friday, I had the great pleasure of visiting the brilliant Centre for Independent Living in Knowsley, jointly funded and staffed by the health, social care and housing services in this borough. The centre brings together all the key elements of a truly holistic service. The occupational therapists are there, as are the care and repair team who can organise reliable builders and advise on grants, the wheelchair and aids teams, and the handy persons who do small improvement jobs. All the different disciplines and specialisms come together in Knowsley’s centre. It helped some 5,700 people last year. About half were referred by GPs, and health needs are therefore often the trigger, but the solution may well be in meeting the individual’s requirements

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within their home or, indeed, in pursuing a housing solution elsewhere, such as a move to extra care. So when a local authority gets it right, as in Knowsley, it really can do a fantastic, joined-up health, care and housing job. Good advice that covers the housing dimensions is the start of this process.

Amendment 23, the second amendment in my name and those of the noble Lord, Lord Hunt, and the noble Baronesses, Lady Eaton and Lady Barker, would complete the picture. This amendment again does not add significantly to the burden of responsibilities for local authorities. It falls within the “have regard to”, not the “must”, part of Clause 5, but would mean that in seeking to manage the market for care provision, local authorities should have regard to the housing situation facing those with care needs in their area. It raises the profile of housing in this context so that the different parts of local government all take it into account in their policies and strategies.

The amendment would mean that those within local councils responsible for social care would concern themselves with housing requirements, no doubt by feeding the necessary information into the planning system to influence future housing provision. In devising their strategies, health and well-being boards would consider whether more and better housing should be a priority, whether more disabled facilities grants or support for home improvements could play a greater part in preventing the need for intensive personal care, or whether extending a handy person service would not pay for itself almost instantly. This amendment would mean integrating housing considerations into the shaping of care markets, as well as integrating care considerations into the shaping of housing markets. That would benefit everyone.

I congratulate the Minister on the two important government amendments which give added emphasis to housing. I hope that he is able to go further and take on board these relatively modest but entirely sensible additional changes to the Bill.

5.15 pm

Lord Shipley (LD): My Lords, I rise to support Amendments 15 and 23. I would draw attention to a welcome tribunal judgment in Middlesbrough last week concerning the decision by Redcar and Cleveland Council on the under-occupancy charge. A woman, who is disabled, won an appeal against the decision of her local council which the council claims it took in line with DWP guidance. The tribunal concluded:

“In considering whether there is under-occupation of the appellant’s property, the local authority have not taken into consideration her disabilities and her reasonable requirements, as a result of these, to sleep in a bedroom of her own”.

Redcar and Cleveland Council said that it had properly applied the law as it stood when it decided this case but that the tribunal had introduced an additional test of reasonableness which did not appear in the Department for Work and Pensions guidance. Amendments 15 and 23 would remove a great deal of the doubt that has now been raised. Amendment 23, which refers to access to suitable living accommodation, must include access to suitable sleeping accommodation. That requires there to be a separate bedroom if reasonably required.

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Amendment 23 would also make it clear that there is a requirement on a local authority to provide access to suitable living accommodation for a person who needs a specific amount of accommodation to enable them to lead a full life.

There is now a great danger for the Government in a large number of tribunal hearings as a consequence of the decision that was made in Middlesbrough last week. One way of avoiding this is for the Government to give a clearer definition of what “reasonableness” is. Amendments 15 and 23 define what is reasonable. I hope that the Minister will agree to look further at this issue in order to ensure that adults who have care and support needs have access to suitable living accommodation. That is clearly not the case at present and it is unfortunate that a large number of people with disabilities are being placed in an impossible situation because of the under-occupancy tax.

Baroness Eaton (Con): My Lords, I rise to support Amendments 15 and 23 in the name of the noble Lord, Lord Best. Contemplating the need for changes in lifestyle, managing illness and losing the ability to live independently are very daunting and stressful experiences for many elderly people. The proposals in Clause 4 for local authorities to provide information and advice are crucial in enabling people to have the knowledge they need to make decisions with which they feel comfortable. It does seem that the Bill as drafted has a major omission—the absence of advice on housing options.

I worked as a councillor in a northern metropolitan area for many years. I noticed on many occasions that elderly people were totally unaware of some of the opportunities that were available to protect them. I will give the House one example. An elderly lady asked whether I could help her by getting the electricity board to repair the light on the other side of the footpath across her garden. When I pursued the case, it transpired that because this lady was physically infirm, she was unable to reach her bathroom and lavatory, so she was crossing her garden in the depths of winter to use an outside lavatory. The reason she needed the light was in order to get to it. She was totally unaware of the possibility of making adaptations, with help from the local authority, to provide her with a downstairs bathroom. These kinds of incidents reflect the reality of what elderly people know about in terms of services. It is not good enough to say, “They will find out about them somewhere”. If it was part of this provision, that would be a great advantage to all.

My elderly parents lived at home until they were in their 90s. My father was 96 when he died, and my mother was 95. They were fortunate because I was aware of the adaptations that could be provided for them—small things such as grips, handrails and the like. They enabled my father to cope with the infirmities of my mother and for the two of them together to enjoy independent living. But, as I have said, most elderly people are not aware of this provision. When looking at options for care, most people would not think of asking the local authority about housing options. As a local authority person, I am always cautious of giving extra tasks to local authorities, but I know that this part of the Bill would not create a

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huge burden because local authorities already provide information about the care-related housing options that are available in their area. The point is that those options are not joined up and they do not come under the provision that this clause as drafted would give. I strongly support the amendments of the noble Lord, Lord Best.

The issue of the shaping of markets under Clause 23 is also important. We are always in danger of the right hand not knowing what the left hand is doing. Criticism is made of departments doing one thing on the one hand and another thing on the other. There is now a requirement on planners to look ahead and make provision for the numbers and types of homes that are needed. Surely the two things should be brought together as indicated and that health provision should advise and direct the planning process in terms of what will be needed in the future. I warmly support both amendments.

Baroness Masham of Ilton (CB): My Lords, I apologise for having only just come into the Chamber, but I have been at an important meeting with representatives from a children’s heart unit. However, this Bill is also important, particularly these amendments. What the Minister gives us assurances about in this House does not always happen on the ground. The matter of housing provision for disabled people has caused aggro up and down the country. People are worried about it. If the Minister can be helpful today, that will do a lot of good.

Lord Hunt of Kings Heath: My Lords, I support the noble Lord, Lord Best, in relation to Amendments 15 and 23. Obviously, we welcome the government amendments to which the noble Earl, Lord Howe, will speak shortly, but it seems that the amendments tabled by the noble Lord, Lord Best, point to areas where the government amendments do not really meet the needs. Amendment 15, on making available information about housing adaptations and on specialist and accessible housing as a key requirement of a local authority’s information service, was a clear recommendation of the Joint Committee. The noble Baroness has just illustrated why making such information available is so important. It could be very helpful in terms of avoiding the need for people to receive long-term care. We should not underestimate the challenge people face when simply trying to find their way through the system. We find it complex, so how much more difficult must it be for those with little experience of the care sector and the housing system? I believe that Amendment 23 is critical to the success of the Government’s own housing amendment. It would ensure a three-way integration that would be an explicit part of a local authority’s duty to promote efficient and effective local markets for meeting care and support. It would particularly ensure that it has regard to the importance of adults’ access to suitable living accommodation.

We know that many local authorities are doing this without any prompting from the noble Lord, Lord Shipley, or my noble friend Lord Beecham. I recently came across the housing for an age-friendly city programme. It seemed to be a really good illustration of how, if a recognition of the changing needs and

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support of older people is at your core, and you supply a range of care and support housing options as an alternative to residential care, it makes the essential connection between, for example, managing a long-term illness and living in the right accommodation, and the importance of extra care housing schemes that enable people to live independently for longer.

I also just came across a One Housing Group initiative in Islington. It is a scheme designed for 14 people who spend a maximum of 14 days in the centre as an alternative to acute NHS admissions. It has a drop-in centre and an emergency helpline, and this crisis recovery house helps 550 people a year. It keeps 87% out of hospital admissions. It was commissioned by the health service but it shows the interconnection between housing and health.

In responding to the noble Lord, Lord Best’s amendments, I hope that the Government might be prepared to reconsider this and come back at Third Reading with further amendments.

Lord Warner: My Lords, I am sorry that I missed the beginning of this debate but I was with the noble Baroness, Lady Masham, listening to Sir Bruce Keogh explaining how the mess around paediatric surgery was going to be sorted out.

I lend my support to Amendments 11 and 15. I remind the House that many years ago, in the good old days, housing and health were together in the same ministry; there was a united ministry covering both health and housing. We have lost something by that separation. I think that the NHS needs to be given a push on integration, so I very much like the amendment of my noble friend. Too often the NHS forgets that it could help itself by working more closely with other interests, and it would be a timely reminder in this piece of legislation to get that message across. As the noble Lord, Lord Best, has said, we have missed many opportunities over a long period of time, to bring housing into the party as the population has aged. All it has done is increase the burden on adult social care and the NHS. It would be a missed opportunity if we did not rectify some of that now.

Earl Howe: My Lords, I very much agree with noble Lords that housing, along with health, and care and support, should be considered as the three legs of the stool. In relation to housing we are clear about two things: first, many types of housing can be provided as a means of meeting or preventing care and support needs—for example, extra care housing. That is why accommodation is listed as a way of meeting needs in Clause 8.

Secondly, housing is a wider determinant of health; simply having a roof over your head can have an enormous impact on your health and well-being. To reflect this, the “suitability of living accommodation” is listed as part of well-being in Clause 1(2). I hope that those two points in particular will serve to reassure the noble Baroness, Lady Masham.

Amendment 12 clarifies that housing is a “health-related” service, and that both local authorities and the NHS are required to promote integration between care and support, health and housing. This makes the

9 Oct 2013 : Column 107

importance of housing explicit not only in the integration duty in this Bill but in the comparable duties on the NHS in the 2006 Act. I hope noble Lords will welcome that.

In Committee, noble Lords also expressed the view that we needed to clarify that local authorities are required to co-operate with providers of services, including providers of housing services. Amendment 28, again in my name, does just this. The non-exhaustive list of the types of “other persons” we expect local authorities to co-operate with would now include certain providers of health, care and support, and housing services. However, we cannot add these bodies as “relevant partners”, as public law is limited in the extent to which it can place duties on such private bodies.

5.30 pm

I hope I can reassure the noble Lord, Lord Best, and my noble friends Lord Shipley and Lady Eaton that it is a key principle of the Bill that where any type of housing is provided in relation to a person’s care and support needs, that must be considered part of “care and support”. It follows that where housing or accommodation is provided to meet—or indeed prevent, delay or reduce—needs for care and support, local authority duties to provide information and advice, and shape the market, must include such types of accommodation. I undertake that these matters will be made clear in statutory guidance.

However, we must be clear where the boundaries lie between responsibilities for care and support, which will include many types of housing, and for general housing that is not related to care needs. Amendments 15 and 23, tabled by the noble Lord, Lord Best, risk blurring this divide and creating overlap and confusion between housing and care and support. In that respect, there is, I am afraid, a fundamental problem with these amendments. Providing information and advice about general housing options and ensuring that there is sufficient suitable housing available is clearly the responsibility of the local housing authority, which is not always the local authority responsible for care and support in that area. It simply is not reasonable to ask local authorities, in their care and support functions, to carry out those other functions.

Turning to the amendments tabled by the noble Lord, Lord Hunt, it is incontrovertible that local authorities and relevant partners must co-operate in order to ensure both integration and safe and timely transfers of care; indeed, the Bill already requires this. Clause 6 requires that local authorities and relevant partners co-operate with one another where relevant to care and support. Subsection (5) of this clause sets out some key examples of when this duty should be used. There can be no question that this duty would also apply to promoting integration.

With respect to integration, Clause 3 requires local authorities to promote integration while carrying out their care and support functions. Consequently, this applies to Clause 6. Further, the co-operation duty requires the relevant partners, including NHS bodies and local authorities, to co-operate with one another in the exercise of their respective functions. Such co-operation is inexorably linked to the integration duty.

9 Oct 2013 : Column 108

I am in complete agreement with the noble Lord, Lord Hunt, in his Amendment 11 that it is imperative that NHS bodies are also under a duty to promote integration. That very thing is achieved by Sections 13N and 14Z1 of the NHS Act 2006, as amended by the 2012 Act, which Clause 3 is intended to reflect. Far from the legislation driving fragmentation, it is actually shot through with duties around integration of services. Although I appreciate the noble Lord’s intention to add further symbolic focus on integration, I do not consider it necessary to make further provisions in this regard, and I am sure he will appreciate that we should not be populating Acts of Parliament with provisions that are legally unnecessary.

That is not to say that integration of services is not important. As part of the spending review in June, we announced the £3.8 billion integration transformation fund, which will provide the biggest ever financial incentive to integrate services. The disabled facilities grant, which funds housing adaptations, is part of that fund. This will make housing a central part of local plans to integrate services.

The current discharge guidance, Ready to Go?, is clear that discharge planning should begin at or before admission, that patients should be assessed by a multi-disciplinary and multi-agency team and that certain matters should be taken into account when performing such an assessment. Further, the assessment required by Schedule 3 is the same as the one specified by Clause 9. As a result, Amendment 39 would give the power to specify in regulations that such an assessment should be carried out jointly, and Clause 12(1)(b) allows regulations to specify what the local authority must have regard to in carrying out that assessment.

Amendment 31 adds the relevant Minister for Jobcentre Plus to the list of relevant partners who are under a duty of reciprocal co-operation with local authorities. This is so that jobcentres and local authorities work together to help adults and carers access employment or training where this is one of their desired outcomes of day-to-day life. Co-operation between local authorities and jobcentres in aligning personal budgets and welfare payments was considered a positive aspect of the right to control pilots.

My noble friend Lord Shipley referred to the spare room subsidy. To recognise that some people need additional space in their home due to their needs for care and support, the Government have trebled the discretionary housing payment scheme. This includes an additional £25 million to support those affected by the removal of the spare room subsidy. That is in addition to £20 million for which disabled adults who do not live in specially adapted accommodation may apply.

I hope that I have convinced the House of the strength of the provisions for integration and co-operation between health, housing, care and support and that the co-operation duties support discharge planning and assessment, and where appropriate support people into employment and training. I hope that I have also convinced the House—and the noble Lord, Lord Best, in particular—of the need for a clear boundary between care and support and housing generally in relation to information and market shaping. I hope that he will be sufficiently satisfied with my explanations.

9 Oct 2013 : Column 109

Baroness Barker: When would it be safe to anticipate the statutory guidance which he mentioned?

Earl Howe: I apologise to my noble friend. I cannot give her a precise answer, but I shall endeavour to do so as soon as possible. I do not think that the guidance will be available before the Bill leaves this House.

Baroness Masham of Ilton: Would Amendment 28 be more acceptable if “may consider” were replaced by “shall consider”? There is a big difference between “may” and “shall.”

Earl Howe: My Lords, Amendment 28 is in my name and therefore I consider it to be well shaped and well drafted. I am not about to suggest improvements on the hoof, but I shall take the noble Baroness’s suggestion away with me.

Lord Hunt of Kings Heath: My Lords, it is good to know that after due consideration the noble Earl is satisfied with his own amendment. On the housing amendments, the noble Lord, Lord Best, will make up his own mind, but it struck me that he is relying on the difference between the local authority as the local housing authority and the local authority as the care authority. He is of course right to say that in county shire areas in some places it is a different function. However, there remains a concern, given that in relation to care and support we are talking about difficult circumstances, often with vulnerable people, over whether the appropriate advice and support will be given. No doubt the noble Lord, Lord Best, will reflect on that.

On my Amendment 11, on integration, the noble Earl relies on existing duties of co-operation on the NHS, and Clauses 3 and 6. Where I fundamentally disagree with him is on the impact of the 2012 Act. The noble Earl may not be aware of just how difficult it now is for the NHS to put a cohesive plan and programme together in every locality, because the current incentives do not encourage that integration. I know that he warns us against putting what he thinks is a superfluous clause in the Bill—but this Care Bill is vitally important. It revises social care legislation and adds the foundations of the implementation of the Dilnot commission. It would be very helpful if there were an explicit duty of co-operation on the National Health Service, because we will not bring about integrated care without the full support of the National Health Service. On due reflection, I would like to test the opinion of the House.

5.41 pm

Division on Amendment 11

Contents 206; Not-Contents 224.

Amendment 11 disagreed.

Division No.  1


Adams of Craigielea, B.

Adonis, L.

Allenby of Megiddo, V.

Anderson of Swansea, L.

Andrews, B.

Armstrong of Hill Top, B.

Bach, L.

Bakewell, B.

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Barnett, L.

Bassam of Brighton, L. [Teller]

Beecham, L.

Best, L.

Bilston, L.

Birt, L.

Blackstone, B.

Boothroyd, B.

Borrie, L.

Bradley, L.

Bragg, L.

Brennan, L.

Brooke of Alverthorpe, L.

Brookman, L.

Browne of Belmont, L.

Browne of Ladyton, L.

Butler-Sloss, B.

Cameron of Dillington, L.

Campbell of Surbiton, B.

Campbell-Savours, L.

Carter of Coles, L.

Chester, Bp.

Christopher, L.

Clancarty, E.

Clark of Windermere, L.

Collins of Highbury, L.

Corston, B.

Crawley, B.

Crisp, L.

Cunningham of Felling, L.

Davies of Coity, L.

Davies of Oldham, L.

Davies of Stamford, L.

Dean of Thornton-le-Fylde, B.

Deech, B.

Desai, L.

Donaghy, B.

Donoughue, L.

Drake, B.

Dubs, L.

Elder, L.

Elystan-Morgan, L.

Emerton, B.

Evans of Parkside, L.

Evans of Temple Guiting, L.

Evans of Watford, L.

Farrington of Ribbleton, B.

Faulkner of Worcester, L.

Finlay of Llandaff, B.

Foulkes of Cumnock, L.

Gale, B.

Gibson of Market Rasen, B.

Glasman, L.

Golding, B.

Gordon of Strathblane, L.

Goudie, B.

Gould of Potternewton, B.

Grantchester, L.

Greengross, B.

Grenfell, L.

Grocott, L.

Hameed, L.

Hanworth, V.

Hardie, L.

Harris of Haringey, L.

Harrison, L.

Hart of Chilton, L.

Haskel, L.

Hayman, B.

Hayter of Kentish Town, B.

Healy of Primrose Hill, B.

Henig, B.

Hennessy of Nympsfield, L.

Hilton of Eggardon, B.

Hollins, B.

Hollis of Heigham, B.

Howarth of Breckland, B.

Howarth of Newport, L.

Howe of Idlicote, B.

Howells of St Davids, B.

Howie of Troon, L.

Hoyle, L.

Hughes of Stretford, B.

Hughes of Woodside, L.

Hunt of Chesterton, L.

Hunt of Kings Heath, L.

Hylton, L.

Irvine of Lairg, L.

Janner of Braunstone, L.

Jay of Ewelme, L.

Jay of Paddington, B.

Jones of Whitchurch, B.

Jones, L.

Jordan, L.

Kennedy of Southwark, L.

Kerr of Kinlochard, L.

Kinnock of Holyhead, B.

Kinnock, L.

Laming, L.

Lane-Fox of Soho, B.

Layard, L.

Lea of Crondall, L.

Levy, L.

Liddle, L.

Lipsey, L.

Lister of Burtersett, B.

Listowel, E.

Low of Dalston, L.

Lytton, E.

McAvoy, L.

McCluskey, L.

McDonagh, B.

McFall of Alcluith, L.

McIntosh of Hudnall, B.

MacKenzie of Culkein, L.

Mackenzie of Framwellgate, L.

McKenzie of Luton, L.

Mar, C.

Masham of Ilton, B.

Massey of Darwen, B.

Mawson, L.

Maxton, L.

Meacher, B.

Mendelsohn, L.

Monks, L.

Moonie, L.

Morgan of Drefelin, B.

Morgan of Ely, B.

Morgan of Huyton, B.

Morgan, L.

Morris of Aberavon, L.

Morris of Handsworth, L.

Morris of Yardley, B.

Neuberger, B.

Noon, L.

Nye, B.

O'Loan, B.

O'Neill of Bengarve, B.

Pannick, L.

Patel of Blackburn, L.

Patel of Bradford, L.

Pendry, L.

Pitkeathley, B.

Plant of Highfield, L.

Ponsonby of Shulbrede, L.

Prosser, B.

Radice, L.

Ramsay of Cartvale, B.

Rea, L.

Reid of Cardowan, L.

Richard, L.

Robertson of Port Ellen, L.

Rooker, L.

9 Oct 2013 : Column 111

Rosser, L.

Rowlands, L.

Royall of Blaisdon, B.

Sandwich, E.

Sawyer, L.

Scotland of Asthal, B.

Scott of Foscote, L.

Sherlock, B.

Simon, V.

Smith of Basildon, B.

Smith of Finsbury, L.

Smith of Gilmorehill, B.

Snape, L.

Soley, L.

Stair, E.

Stevenson of Balmacara, L.

Stoddart of Swindon, L.

Stone of Blackheath, L.

Symons of Vernham Dean, B.

Taylor of Blackburn, L.

Taylor of Bolton, B.

Tenby, V.

Thornton, B.

Touhig, L.

Tunnicliffe, L. [Teller]

Turnberg, L.

Turner of Camden, B.

Uddin, B.

Wall of New Barnet, B.

Walpole, L.

Warner, L.

Warwick of Undercliffe, B.

Watson of Invergowrie, L.

Wheeler, B.

Whitaker, B.

Wigley, L.

Williams of Baglan, L.

Williams of Elvel, L.

Williamson of Horton, L.

Wills, L.

Wood of Anfield, L.

Woolmer of Leeds, L.

Worthington, B.

Young of Hornsey, B.

Young of Norwood Green, L.


Aberdare, L.

Ahmad of Wimbledon, L.

Allan of Hallam, L.

Anelay of St Johns, B. [Teller]

Armstrong of Ilminster, L.

Arran, E.

Ashcroft, L.

Ashdown of Norton-sub-Hamdon, L.

Ashton of Hyde, L.

Astor of Hever, L.

Attlee, E.

Avebury, L.

Baker of Dorking, L.

Barker, B.

Bates, L.

Benjamin, B.

Berridge, B.

Bew, L.

Bilimoria, L.

Black of Brentwood, L.

Blencathra, L.

Borwick, L.

Bowness, L.

Brabazon of Tara, L.

Bradshaw, L.

Bridgeman, V.

Brinton, B.

Brittan of Spennithorne, L.

Brooke of Sutton Mandeville, L.

Brougham and Vaux, L.

Browning, B.

Burnett, L.

Buscombe, B.

Byford, B.

Caithness, E.

Carlile of Berriew, L.

Cathcart, E.

Cavendish of Furness, L.

Chadlington, L.

Chalker of Wallasey, B.

Chidgey, L.

Clement-Jones, L.

Colville of Culross, V.

Colwyn, L.

Cope of Berkeley, L.

Cormack, L.

Cotter, L.

Courtown, E.

Cox, B.

Craig of Radley, L.

Craigavon, V.

Crathorne, L.

De Mauley, L.

Deben, L.

Deighton, L.

Dobbs, L.

Doocey, B.

Dundee, E.

Dykes, L.

Eaton, B.

Eccles of Moulton, B.

Eccles, V.

Eden of Winton, L.

Edmiston, L.

Elton, L.

Empey, L.

Falkner of Margravine, B.

Faulks, L.

Feldman, L.

Fellowes, L.

Flight, L.

Fookes, B.

Forsyth of Drumlean, L.

Fowler, L.

Framlingham, L.

Freeman, L.

Freud, L.

Garden of Frognal, B.

Gardiner of Kimble, L.

Gardner of Parkes, B.

Garel-Jones, L.

Glenarthur, L.

Glendonbrook, L.

Glentoran, L.

Gold, L.

Goodlad, L.

Goschen, V.

Grade of Yarmouth, L.

Greenway, L.

Grender, B.

Griffiths of Fforestfach, L.

Hamilton of Epsom, L.

Hamwee, B.

Hanham, B.

Harris of Peckham, L.

Harris of Richmond, B.

Henley, L.

Hill of Oareford, L.

Hodgson of Astley Abbotts, L.

Hooper, B.

Horam, L.

9 Oct 2013 : Column 112

Howard of Rising, L.

Howe of Aberavon, L.

Howe, E.

Howell of Guildford, L.

Hunt of Wirral, L.

Hussain, L.

Hussein-Ece, B.

James of Blackheath, L.

Jenkin of Kennington, B.

Jenkin of Roding, L.

Jolly, B.

Jones of Cheltenham, L.

Jopling, L.

Kakkar, L.

King of Bridgwater, L.

Kirkham, L.

Kirkwood of Kirkhope, L.

Lamont of Lerwick, L.

Lang of Monkton, L.

Lawson of Blaby, L.

Lee of Trafford, L.

Lester of Herne Hill, L.

Lexden, L.

Lindsay, E.

Lingfield, L.

Liverpool, E.

Livingston of Parkhead, L.

Loomba, L.

Luke, L.

Lyell, L.

McColl of Dulwich, L.

McNally, L.

Maddock, B.

Marks of Henley-on-Thames, L.

Marlesford, L.

Montrose, D.

Morris of Bolton, B.

Moynihan, L.

Naseby, L.

Nash, L.

Newby, L. [Teller]

Newlove, B.

Noakes, B.

Northbrook, L.

Northover, B.

Norton of Louth, L.

Oppenheim-Barnes, B.

Palmer of Childs Hill, L.

Parminter, B.

Perry of Southwark, B.

Phillips of Sudbury, L.

Popat, L.

Rana, L.

Randerson, B.

Rawlings, B.

Rennard, L.

Ribeiro, L.

Ridley, V.

Risby, L.

Rix, L.

Roberts of Llandudno, L.

Rodgers of Quarry Bank, L.

Rogan, L.

Roper, L.

Rotherwick, L.

Rowe-Beddoe, L.

Ryder of Wensum, L.

St John of Bletso, L.

Sassoon, L.

Scott of Needham Market, B.

Seccombe, B.

Selkirk of Douglas, L.

Selsdon, L.

Shackleton of Belgravia, B.

Sharkey, L.

Shipley, L.

Shrewsbury, E.

Shutt of Greetland, L.

Skelmersdale, L.

Slim, V.

Smith of Clifton, L.

Stedman-Scott, B.

Steel of Aikwood, L.

Stephen, L.

Stewartby, L.

Stirrup, L.

Stoneham of Droxford, L.

Storey, L.

Stowell of Beeston, B.

Strasburger, L.

Strathclyde, L.

Taverne, L.

Taylor of Goss Moor, L.

Taylor of Holbeach, L.

Tebbit, L.

Thomas of Gresford, L.

Thomas of Winchester, B.

Tope, L.

Tordoff, L.

Trefgarne, L.

Trimble, L.

True, L.

Tugendhat, L.

Tyler of Enfield, B.

Tyler, L.

Ullswater, V.

Verma, B.

Waddington, L.

Wakeham, L.

Waldegrave of North Hill, L.

Wallace of Saltaire, L.

Wallace of Tankerness, L.

Walmsley, B.

Walton of Detchant, L.

Warsi, B.

Wasserman, L.

Watson of Richmond, L.

Wei, L.

Wheatcroft, B.

Wilcox, B.

Williams of Crosby, B.

Wolfson of Aspley Guise, L.

Younger of Leckie, V.

5.56 pm

Amendment 12

Moved by Earl Howe

12: Clause 3, page 4, line 10, at end insert—

“( ) For the purposes of this section, the provision of housing is health-related provision.

( ) In section 13N of the National Health Service Act 2006 (duty of NHS Commissioning Board to promote integration), at the end insert—

9 Oct 2013 : Column 113

“(5) For the purposes of this section, the provision of housing accommodation is a health-related service.”

( ) In section 14Z1 of that Act (duty of clinical commissioning groups to promote integration), at the end insert—

“(4) For the purposes of this section, the provision of housing accommodation is a health-related service.””

Amendment 12 agreed.

Clause 4: Providing information and advice

Amendment 13

Moved by Baroness Greengross

13: Clause 4, page 4, line 12, leave out “and maintain” and insert “, maintain and facilitate access to”

Baroness Greengross (CB): My Lords, I shall speak to Amendment 18 in this group as well. I have already expressed my support for the Bill, which will make a huge difference to the lives of users of social care services and their families. However, a little more can be done to reform the Bill in the areas of information and advice, and also complaints and redress. I welcome the fact that the Government have recognised this issue and that the Minister has tabled amendments on their behalf. This shows that the Government accept the need for proactive engagement around information and advice, the importance of understanding when and how people access information, and the need for a focus on identifying those who would most benefit from it. These issues reflect exactly the thrust of my amendments except that, unlike the Government’s, mine relate to all information and advice about care and support, not just financial information and advice.

While I welcome the emphasis on proper access to financial advice, it seems a bit inconsistent not to apply this proactive approach to all forms of information and advice about care. For example, even when considering financial options, it is difficult to disentangle these from information that is needed about other aspects of care such as the choice of providers. It might even apply to housing, which was addressed in the debate on the amendment of the noble Lord, Lord Best.

At a time when local authority budgets are under increasing pressure, it is all the more important that people needing social care services are supported to efficiently access all existing sources of support fairly, equitably and transparently, and that local authorities are held to account for the decisions they make about distributing resources. Consumers have to feel that they are in control of their own care, understand what support they can expect and have the ability to speak up when they are treated unfairly. My amendments are designed to further these aims and I am grateful to Which? for assisting me in validating the consumer detriment aspects of this argument.

First, in Amendment 13 to Clause 4(1), as well as the local authority having the duty to,

“establish and maintain a service for providing people in its area with”—

care and support information, I would like to see the local authority having a supporting obligation to “facilitate access to” that service. Secondly, my Amendment 18

9 Oct 2013 : Column 114

to Clause 4(4) would expand the local authority’s duty of information and advice provision beyond those to whom it is being provided to also include those,

“who would benefit from receiving it”.

6 pm

These amendments would ensure that in fulfilling their duties relating to information and advice, local authorities have a proactive strategy to reach out to those in their area who would benefit from such information and advice, recognising that not everybody will request it and may not proactively approach the local authority. The focus for the local authority should be on improving outcomes through targeted information and advice that people can access at the right time and in the right way. The first of these amendments was raised in Committee and the Government responded that statutory guidance would make it clear that in order to fulfil the duty around information and advice, local authorities will need to facilitate access to it. However, I believe that this does not go far enough—the principle of proactive outreach should be a central part of this duty and therefore should be in the Bill.

The second amendment pertains to the same aim. Clause 4(4) was added to the revised Bill in response to concerns raised by the draft Care and Support Bill Joint Committee that the Government’s plans for information and advice provision by local authorities were too focused on online provision when we know that many older and, indeed, many younger people prefer to access information through different channels, such as by telephone or face to face. This addition, which states that information and advice must be,

“accessible to, and proportionate to the needs of, those for whom it is being provided”,

was intended to address this and concerns raised by the committee—I was privileged to be a member of it—that people who need it would not have a right to more intensive forms of support, such as advocacy.

Research for Which? has shown that often the problem is that people do not know what they need to know. One carer said, “It’s a chicken and egg process—before you can find the answer you’ve got to know that you’ve got a question that needs answering.” People also need information and advice at key pinch points; we know this. This amendment would ensure that local authorities consider these when designing their information and advice strategies. For example, people often see their general practitioner as a focal point for information and advice about care, and while the GP may not always be in the best position to give this advice, local authorities can proactively engage with GPs and other health services in their area in order to ensure access to information and advice about care for those who would otherwise slip under the radar. I beg to move.

Baroness Meacher (CB): My Lords, I support the amendments of the noble Baroness, Lady Greengross. She is so right in saying that people very often have no idea what questions they need to ask and what services they may be entitled to and therefore this aspect of the Bill is far more important than it sounds.

However, I shall speak to Amendment 21 which, in a way, takes us a step further and would ensure that vulnerable people with current or foreseen complex

9 Oct 2013 : Column 115

needs receive information and advice in a way that they can understand; also that the information and advice takes full account of their complex personal position. This may sound simple enough, but, in fact, an untrained person with a leaflet on local services, probably including lots of irrelevant information, is quite likely to leave someone more confused than they were before the visit. In fact, if local authorities do not want people to find their way to services that they need, a rather weak and unstructured approach to information and advice is probably the best way to achieve that result, but in the longer run, such a cynical approach will be highly costly.

My few remarks are based on a briefing from the College of Social Work, which has had the benefit of input from front-line social workers, managers, recent directors of adult care and academics, all of whom are very conscious of and concerned about the efficient use of resources. They would not say lightly that one should be developing a service such as this for information and advice unless it were really important. For people without dementia or other disorders which make it particularly difficult to comprehend the world around them, information and advice can probably be provided by less trained people without any great loss.

As was said in Committee, the aims and principles of the Bill are welcome. The College of Social Work is concerned, however, that many of these principles will not be fulfilled in practice. We hope, with the aims and principles in mind, that the Minister will agree to some further clarification in the Bill, or in regulations, on the key role of skilled social workers in supporting and protecting some of the most vulnerable people in society through their involvement at the information and advice stage.

Key stakeholders were grateful that, in Committee, the noble Earl, Lord Howe, recognised the point of this amendment. He said that,

“some authorities have also used qualified social care staff as the first point of contact and have found that this can be effective, efficient and timely, helping people to the care and support that will help them most”.

At that stage he envisaged that,

“guidance will set out the clear expectations of what the local authority’s service should cover or what it should seek to do in order to ensure that the information and advice is sufficient”.—[

Official Report

, 9/7/13; col. 216.]

The aim here is to ensure, by including the appropriate wording in the Bill or in regulations—I fully accept that having it in regulations would be perfectly satisfactory—that professionally qualified social workers will be deployed in sufficient numbers, including at the information and advice stage, for people who really need that level of expertise. As I have already said, those with complex needs may be a relatively small number of people. This should ensure that these particularly vulnerable people are put in touch with the most appropriate services for them. This could avoid the need for more intrusive and expensive interventions at a later stage.

Lord Lipsey (Lab): I shall make most of my remarks on the subject of advice and information on Amendment 20, which is a more broad-brush amendment,

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but I shall just comment on the government amendments in this group, on advice—that is Amendments 16, 17 and 19. I remind the House that I speak as the unremunerated president of SOLLA, the Society of Later Life Advisers, which accredits, to a gold standard, advisers who can help old people on financial matters.

It would be churlish not to say that the government amendments mark a small step forward, in that for the first time they represent a recognition that independent financial advice can be necessary. To that extent, I welcome them. However, I have to say right away that it is impossible to read the briefings we have had without realising that they have caused great disappointment, particularly among financial service people who are determined to get this right. The Equity Release Council says that the government amendments do not go far enough.