Adult Social Care Contracts

Debate between Baroness Campbell of Surbiton and Earl Howe

Wednesday 11th February 2015 Lords Chamber

[Earl Howe]

My Lords, whatever system is chosen for commissioning care in a local authority, there has to be a fair system for setting fees. We expect local authorities to comply with their legal duties to sustain a high-quality market of providers in their area, and that involves paying fair fees. That is a matter for local determination. It has to be because, in seeking an open market, as we do, we are also aware that local market conditions have to be taken into account.

[Baroness Campbell of Surbiton (CB)]

My Lords, many service user-led organisations—for instance, the National Centre for Independent Living—provide a high quality of service. Does the Minister accept that in order to achieve high quality and high value, local authorities may have to pay a premium in the short term to achieve long-term cost-effectiveness? If he does, can he remind local authorities of this?

[Earl Howe]

My Lords, the principle that the noble Baroness articulates is, I am sure, applicable in some areas. I hope that she will be reassured to know that the department has developed statutory guidance for the Care Act to support local authorities, including commissioning. The guidance to the Act directs local authorities to ensure that all packages of care and support that are arranged are good quality and do not undermine people’s well-being. Furthermore, the department will, with partners, be developing a set of commissioning standards which will help local authorities to improve their commissioning practices.

Learning Disabilities: Health and Care Services

Debate between Baroness Campbell of Surbiton and Earl Howe

Wednesday 3rd December 2014 Lords Chamber

[Earl Howe]

The noble Lord is quite right that progress has not been nearly as swift as we, or indeed anyone, would have liked. NHS England has stated its ambition to achieve a 50% reduction in the number of people who were in in-patient beds on 1 April this year by March 2015. Although the latest data for November shows that some 2,600 people were in in-patient settings, the number of people with a transfer date has gone up by more than 1,100 in the last three months, so progress is being made. On CQC registration, the CQC may at any time decline to register or indeed cancel the registration of a provider where it is failing to comply with the registration requirements set out in law. That includes the new duty of candour and the fit and proper persons requirement, which came into effect at the end of last month.

[Baroness Campbell of Surbiton (CB)]

My Lords, in preparing a response to Winterbourne View—Time for Change, will the Minister ensure that the needs of this group of people with learning disabilities and their carers are not confined within a joint commissioning framework, dominated by NHS England and CCGs, but are instead assessed within the provisions of the Care Act so that they benefit fully from the well-being principle, which is a more holistic, social model approach, with good entitlements and safeguards? They must not again be subjected simply to a medical model approach, or the same will happen.

[Earl Howe]

I can give the noble Baroness that assurance.

Independent Living Fund

Debate between Baroness Campbell of Surbiton and Earl Howe

Monday 12th May 2014 Lords Chamber

[Baroness Campbell of Surbiton]

To ask Her Majesty’s Government how the assessment guidance to local authorities under the Care Bill will address the particular needs of people transferring from the Independent Living Fund.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, one of the key principles of the Care Bill is that people who require care and support should have choice and control over their lives. The Bill requires that all assessments will consider the person’s needs, well-being and desired outcomes. The requirements of the Bill, and of guidance supporting implementation, will apply equally to all adults having an assessment, including those who are transferring from the Independent Living Fund.

[Baroness Campbell of Surbiton (CB)]

I thank the Minister for his considered reply but, given the Government’s emphasis on people who have direct experience of using care and support services being centrally involved in their design and delivery, will the Minister please explain why his Government think it unnecessary to set up a reference group, including disabled people, the Independent Living Fund, local authorities and civil servants, to oversee this very important ILF transition?

[Earl Howe]

My Lords, the noble Baroness will know that she and I had a very useful meeting last week and I, with my honourable colleague Norman Lamb, undertook to her that we would give that proposal serious consideration, which we will certainly do. I will be in touch with her in the coming weeks to arrange a further discussion about this. We are absolutely committed to co-production in this and to involving stakeholders wherever possible.

Care Bill [HL]

Debate between Baroness Campbell of Surbiton and Earl Howe

Monday 14th October 2013 Lords Chamber

[Earl Howe]

My Lords, the Care Bill will for the first time introduce a duty on local authorities to ensure that where a person is receiving care and support they can move home to another local authority area, confident that they will have services in place on the day of the move. The noble Baroness, Lady Campbell, has been a leading advocate in this area for some time, and I acknowledge that her Private Member’s Bill was a template for the provisions in this Bill.

The noble Baroness’s Amendment 63ZA looks to ensure that when the second authority is carrying out the assessment of the adult moving and, where appropriate, their carer, it meets the outcomes that they want to achieve. I reassure her that the provisions on assessment for the person needing care and their carer apply to when a person is being assessed for continuity of care. Assessments must look at achieving the outcomes that the person or carer want to achieve, and Clause 37(8) confirms that. I also give an assurance that we will emphasise this in the statutory guidance.

Amendment 63B proposes that the first authority is responsible for arranging services on the day of the move. I say immediately that I sympathise with the sentiment of the noble Baroness’s argument; neither of us wants a gap during which a person is left without services. However, our view is that the second authority is best placed to maintain continuity of care. Our reasoning is that the person will now be living in the area of the second authority and, as for anyone who has eligible care and support needs, the second authority has a duty to meet those needs. The second authority will also know its local market and will be far better placed to put in place arrangements that support the person and maintain their level of independence from day one.

My concern is that it would be difficult for the first authority to make such arrangements, particularly where the person moves a long distance away. In practice, if the first authority is responsible for making arrangements it would have to contact the second authority to discuss the local market, which raises the question of why the second authority is not responsible for putting in place services in the first instance.

For the reasons that I have explained, I believe that the second authority must be the one responsible for delivering services on the day of the move. However, in light of the concerns raised by the noble Baroness during Committee, I have looked again at the provisions in the Bill. My Amendment 63A will require the first authority to contact the second authority and maintain this relationship so that it is aware of where the second authority is with putting services in place. It will also require the first authority to keep the person involved with discussions about their services and informed of progress for putting these in place. In other words, the amendment will put the person at the centre of the process. Both ADASS and the Local Government Association have indicated that this amendment will strengthen the process.

The noble Baroness questions whether placing the responsibility on the second authority is the right approach. I believe that it is. However, I fully understand her concerns, and I commit now to my department reviewing how the continuity of care arrangements are operating three years following implementation. This will provide us with more information, which will help us to understand if the process can be improved.

We are already considering how we might implement the provisions in the Bill. The first step will be to develop the regulations and statutory guidance. Given the noble Baroness’s knowledge in this area, I hope that we can draw on her experience and that she will be able to advise us on the preparation of the regulations and guidance. I sincerely hope that in strengthening these provisions and in the commitments that I have given, I have been able to convince her not to press her amendments.

The amendments relating to ordinary residence will provide clarity in respect of three areas: the overall principle of ordinary residence; the principle of ordinary residence so that it applies to after-care under the auspices of the Mental Health Act; and finally, the cross-border placement of individuals so that service users can move between the four countries of the UK where this is deemed to be in their best interests.

The noble Baroness, Lady Wheeler, asked whether reciprocal agreements are now in place or whether there would be more changes in this area. The answer is that the basic structure is in place in terms of reciprocal arrangements on cross-border care. However, some small details remain to be finalised through regulations and statutory guidance. We will work closely with the devolved Administrations on this.

First, government Amendments 66 and 67 address a potential lacuna in respect of people who may live in England—and therefore be ordinarily resident in an English local authority—but who are treated entirely within the NHS of a devolved Administration. The amendments ensure that they would remain ordinarily resident in England. Secondly, Amendments 64, 65, 126 to128 and 132 to 136 apply consistent ordinary residence rules in England and Wales in respect of after-care under the Mental Health Act 1983, and reflect our agreement with Wales that Welsh Ministers or the Secretary of State will determine cross-border disputes according to agreed arrangements.

Thirdly, Amendments 68 to 75 relate to cross-border placements. The cross-border provisions in the Bill reflect the outcome of solid collaborative work with Scottish, Welsh and Northern Irish colleagues to remove legal barriers restricting the placement of an individual from one territory of the United Kingdom to another. These amendments make technical adjustments to those provisions, following further discussion with the devolved Administrations about the detail of the arrangements.

The purpose of the amendments on cross-border placements is threefold. First, they ensure that the established principle that the placing authority retains responsibility for the care of those individuals placed cross-border is not interrupted should the individual receiving care require a period in hospital or other healthcare accommodation. Secondly, they enable regulations to provide for the cross-border placements provisions to apply to individuals who receive direct payments. Thirdly, they provide a regulation-making power that would allow our cross-border provisions to apply to individuals placed in a setting other than a traditional care home—for example, supported living arrangements.

The noble Baroness, Lady Wheeler, also asked about the impact of cross-border placement provisions on cost pressures. It is our understanding that the number of placements between countries of the UK is likely to be minimal, certainly in terms of the overall budget. However, we will work closely with colleagues in the devolved Administrations to further understand and bottom out the financial implications.

This group of amendments provides further necessary clarity to enable people to receive care and support in locations that suit their needs and I commend them to the House.

[Baroness Campbell of Surbiton]

My Lords, I thank noble Lords and the noble Baronesses, Lady Wheeler and Lady O’Loan, for speaking in support of my amendment. I warmly thank the Minister for his thoughtful reflections on my amendments and for tabling his amendments to meet some of my concerns—followed up at the last minute by a very good, timely review. Although I had hoped to see both my amendments on the statute book tonight, I am happy to acknowledge that the Government’s proposal is a ginormous step in the right direction to full portability. If it reduces the prospect of a cliff-edge scenario, it will achieve its purpose. I know that disabled people will feel encouraged to move instead of staying put.

Finally, I am grateful to the Minister and especially his officials for their positive approach to this issue, which I have raised in Committee and, quite frankly, over the past three years. We have burned a lot of midnight oil together and I have been very impressed by their efforts to find practical solutions. It bodes well for our continued collaboration on this landmark reform—and it is a landmark. Do not forget, we were tied to our local authorities since time began and this is the first time that disabled people will have the right to freedom of movement if they require support. I will be pleased to be involved in the regulations and of course I will be there. Frankly, you could not stop me. I beg leave to withdraw my Amendment 63ZA.

Social Care: Sustainable Funding

Debate between Baroness Campbell of Surbiton and Earl Howe

Tuesday 17th July 2012 Lords Chamber

[Baroness Campbell of Surbiton]

My Lords, is the noble Earl aware that while these complex funding matters are being considered, many local authorities are severely reducing the levels of support provided to disabled people in ways that can curtail their independence, prevent them from working and participating in public life and, in some cases, force them into residential care? Is he aware, for example, that Worcestershire County Council proposes to radically restrict the maximum value of an individual disabled person’s care package, offering them no other choice than to enter residential care if they cannot meet the shortfall? Surely the Minister agrees that this runs entirely counter to the White Paper and government policy?

[Earl Howe]

My Lords, I am not aware of the Worcestershire example. What I will say is that the best local authorities are those that enter into a two-way dialogue with service users to see what is best and most appropriate for them in their circumstances. I recognise that this is a challenging settlement for local government, but if local authorities are prepared to reform their services and drive down costs, we believe that the additional investment from the NHS to social care, which we announced in the spending review, will enable local authorities to protect the care that people receive. Many councils are making the necessary changes to ensure that there is no drop in eligibility criteria.

Care and Support

Debate between Baroness Campbell of Surbiton and Earl Howe

Wednesday 11th July 2012 Lords Chamber

[Baroness Campbell of Surbiton]

My Lords, I must briefly declare an interest. I am a 24-hour social care service user, and long may it last. Temporarily ignoring the social care funding elephant in the room, I feel there is much to welcome in this White Paper, which concentrates on independent living, empowerment strategies, and supporting people to stay at home and contribute to their communities instead of the current safety-net crisis interventions. That has been my life’s work.

I am also pleased to see that the Government are obviously keen to incorporate my Private Member’s Bill on social care portability. Naturally, I must ask the Minister whether the Government intend portability to offer an “equivalence of support” outcome so that disabled people feel confident that they can continue with their chosen occupations, responsibilities and lifestyle wherever they go, because this will put an end to the postcode lottery.

[Earl Howe]

My Lords, I pay tribute to the noble Baroness for all the work that she has done in this area, particularly on portability. This is a good news story. We are committing in the White Paper to breaking down the major barrier to portability: that people’s care is disrupted when they move local authority area. The draft Bill contains a clause that puts a duty on to local authorities to ensure that when a person—and their carer, if applicable—moves local authority area, their needs continue to be met until they are reassessed by that local authority. The clause also sets out that local authorities are under a duty to share information, and the receiving local authority has the power to assess the individual—and carer, if applicable—before they move. This seeks to ensure that the move is as seamless as possible. I do not doubt that this is an area that we shall debate over the coming months.

Care Homes

Debate between Baroness Campbell of Surbiton and Earl Howe

Wednesday 27th June 2012 Lords Chamber

[Baroness Campbell of Surbiton]

My Lords, in 2008 the Joint Committee on Human Rights produced a shocking report which highlighted some of the most degrading experiences endured by adults with learning disabilities in health and residential care settings. Four years on we are debating the same human rights abuses—this time highlighted by the CQC report, which shows excessive use of restraint and seclusion in assessment and treatment facilities. Will the Minister assure us that he will return to the JCHR and CQC reports and tell us what measures the Government will take now to protect the liberties and safety of this highly vulnerable group so that we do not sit here again in four years debating how we have failed for a third time?

[Earl Howe]

The noble Baroness’s remarks will resonate with many noble Lords. We have been here before. One of the emerging issues from the review is around poor practice on the use of restraint, as she rightly mentioned. CQC inspectors found that only 73% of locations met requirements on physical intervention or restraint. There was ineffective monitoring of restraint data and learning from incidents. Staff were not always trained and restraint was not always delivered in line with the care plan. There are real lessons to be learnt by providers about the use of restraint. We have flagged this up as one of the actions that we will take in the department to work with the Department for Education, the Care Quality Commission and others to drive up standards and promote best practice in the use of positive behavioural support and ensure that physical restraint is only ever used as a last resort. The report published on Monday is an interim report and we will be publishing a final report later in the year.

Health: Contaminated Blood Products

Debate between Baroness Campbell of Surbiton and Earl Howe

Wednesday 2nd June 2010 Lords Chamber

[Earl Howe]

My Lords, obviously, I cannot speak on statements made by Ministers of the former Administration. However, I can confirm to the noble and learned Lord that the compensation scheme in the Republic of Ireland was set up in the light of evidence of mistakes made by the Irish Blood Transfusion Service Board. That has been confirmed to us by officials in the Republic of Ireland’s Department of Health and Children. It is important to understand that the events that gave rise to the people in Ireland becoming infected through contaminated blood transfusions were quite dissimilar to the sequence of events that occurred here. There were specific circumstances in Ireland, and quite different circumstances in the UK.

[Baroness Campbell of Surbiton]

My Lords, I declare an interest as the widow of a haemophiliac who died from contaminated blood products 16 years ago. Is the Minister aware that many of the widows, widowers and children of people who were infected and died received very little compensation—in fact, many do not receive a penny in support from the state? Does he not agree that it would have been wiser to spend the Department of Health’s money used to fight the High Court case on supporting those bereaved families, many of whom have lost their breadwinner?

[Earl Howe]

My Lords, I am well aware of the noble Baroness’s personal interest in this matter and feel deeply for her. She is of course correct that the Skipton Fund was not designed to support bereaved relatives. It was designed to alleviate the suffering of those infected with hepatitis C. Sympathetic as I am towards those who have lost their loved ones in this tragedy, that fund does have a specific purpose and it would require a major review to alter that purpose. However, I note her concern on this matter.