Mental Capacity (Amendment) Bill [HL]

Debate between Baroness Finlay of Llandaff and Baroness Stedman-Scott

Committee: 2nd sitting (Hansard - continued): House of Lords
Monday 15th October 2018 Lords Chamber

[Baroness Stedman-Scott]

I thank all noble Lords for their important contributions to these amendments. I agree completely with the noble Baroness, Lady Finlay, about the importance of ascertaining the cared-for person’s wishes and feelings when consulting as part of the liberty protection safeguards processes. Sometimes it is more important to listen to what is not said or expressed over and above that which is said. Watching people’s behaviour and demeanour can tell us a lot about how they are feeling. The noble Baroness, Lady Watkins, gave us a good example of somebody who lost their parents and was terribly distraught about it, although what was causing him most angst was being able to see his sister only for short periods because of the distance travelled. We must make sure, in taking through this Bill, that we do everything we can to read those signs and that people are empowered to make the best decisions.

On care home managers completing the consultation and how we ensure that alternatives are considered, I can say to the noble Lord, Lord Hunt, that a wide range of people are consulted. Previous consultations conducted by professionals often relied on things that were not meaningful or in the best interest of the individual. We want the least restrictive as a principle—a requirement of Article 5 in case law—that must be considered and will be set out in the code of practice. The code of practice will be very important.

I say to the noble Baroness, Lady Barker, that the care home manager would consider whether a decision was appropriate and the decision would be reviewed by the responsible body. Any family member, IMCA or appropriate person could challenge a decision not to consult the cared-for person. The Government are committed to making sure that the consultation around the cared-for individual is at the heart of everything. We must move heaven and earth to make sure that we understand exactly what they want and that the consultation is respectful in every way.

The Bill already outlines that the main purpose of the consultation is to ascertain the cared-for person’s wishes and feelings. This is to ensure that the liberty protection safeguards are consistent with the focus of the rest of the Mental Capacity Act, which places the wishes and feelings of the person, even if they lack capacity, at the heart of the process.

The noble Baroness is also right to highlight the importance of considering the impact of the arrangements on the person’s well-being. Similarly, we are also clear that we expect the impact of the arrangements on the person to be addressed when undertaking consultation. However, the purpose of the consultation would be to consider the impact from the person’s point of view. This is crucial to how the Mental Capacity Act works.

The concept of well-being is not mentioned in the Mental Capacity Act. It is a legal concept which has particular meaning under the Care Act and the Social Services and Well-being (Wales) Act. We are concerned that it would cause confusion if this concept were inserted into the liberty protection safeguards.

However, the liberty protection safeguards will be in place to support living and will be positive for a person’s well-being. The accompanying code of practice will outline how the model works within wider care provision, including the Care Act, which has duties in relation to promoting well-being.

The amendment in the name of the noble Baronesses, Lady Hollins and Lady Finlay, explicitly requires that the cared-for person be consulted. Noble Lords raised this issue on our previous day in Committee and I know that there is enthusiasm for this proposal, as it is felt that it will more clearly place the person at the centre of the determination of their wishes and feelings.

The Government have also heard very clearly that noble Lords felt that the person themselves must be consulted. Again, I agree. If we are to secure the improvements that we want, it is essential that the person and their voice, wishes and feelings about any proposed arrangements are placed at the heart of this model. We will make sure that the Bill reflects this. I am grateful for the expert views of noble Lords in helping to improve the Bill to put this beyond doubt.

I agree with the noble Baroness, Lady Hollins, and the noble Lord, Lord Hunt, that it is important for those deciding whether an authorisation for deprivation of liberty should be given to consider whether any less restrictive options are available. Considering less restrictive alternatives is also an important aspect of the wider Mental Capacity Act. For example, the fifth principle of the Act requires decision-makers to have regard to less restrictive options. Nothing in the Bill changes this. The code of practice will set out how the liberty protection safeguards will work within the wider framework of the Mental Capacity Act and the care landscapes more widely.

Respectfully, therefore, I maintain that there is no need to add the words suggested by the amendments because they already form an integral part of the assessment process. We have made clear that the main purpose of the consultation duty is to ascertain the person’s wishes and feelings in relation to the authorisation, and this can include the person’s views about acceptable levels of restrictions.

For example, a person might wish to receive care in a care home where they have freedom to spend time in the community rather than in a care home where there is less freedom to do this. This might be because the conditions are less restrictive. This is an essential part of the liberty protection safeguards and is delivered through the assessment process. The noble Lord, Lord Touhig, made a very valid point when he asked whether we would want this for us. We must make sure that we treat people and respect them in the way we would like to be treated and respected ourselves.

I hope I have been able to provide a satisfactory explanation, but if there are outstanding concerns, I am happy to discuss them further. I trust that the noble Baroness will be able to withdraw her amendment.

[Baroness Finlay of Llandaff]

My Lords, I must admit that during the Minister’s very positive response, my hopes were up that she was going to accept the amendment and the change of title of this paragraph in the new Schedule. The reason I say that is that words matter: they set the tone. It would be very useful to be able to discuss this further so that we might take out the word “Consultation”, which has connotations of medical consultations and other things, and that we might state on the face of the Bill as a heading that there is a, “Duty to ascertain the wishes and feelings of the cared-for person”.

The noble Baroness, Lady Hollins, reminded us of the importance of wishes and feelings and that we should not slip back in time to old-fashioned, awful institutional care. The well-being Act in Wales was behind some of the wording as well, and the reason for moving that part of the Bill higher up.

The noble Baroness, Lady Barker, asked some very valid questions. Best-interest decision-making should be a process, not a one-off, and for that process to happen, it is very important that the person is consulted because their previously expressed wishes and feelings might no longer be their wishes and feelings now that they are in a different situation, but they might need help expressing those wishes and feelings as they are now. That process should also include their beliefs and values, some of which they might still hold on to and some of which they might have abandoned over time. There are other factors that the person might be likely to consider if they were able to consider them: their current views and past views might be expressed by others who know them well and care about them.

I hope that we can pursue the discussion further, but, at the moment, although I will withdraw the amendment, I would like to reserve the right to come back to this on Report, because unless we get wishes and feelings up there, in bold type as a heading, we might well find that, inadvertently, we fail the very people for whom we are arguing. I beg leave to withdraw the amendment.

Mesothelioma Lump Sum Payments (Conditions and Amounts) (Amendment) Regulations 2018

Debate between Baroness Finlay of Llandaff and Baroness Stedman-Scott

Tuesday 27th February 2018 Grand Committee

[Baroness Stedman-Scott]

The usual channels. I will find out who they are now I am in my new role.

The noble Baroness, Lady Finlay, expressed an ongoing concern about asbestos in schools. I had a good look at this, because I thought it was important, so I can tell noble Lords that the Department for Education and the Health and Safety Executive are proactive in promoting good asbestos management in schools. They run an asbestos in schools steering group made up of experts and campaigners. In 2015, they published a policy review on asbestos management in schools which says what the Government are going to do; developed better and more targeted guidance; published refreshed guidance in 2017; and enhanced the scrutiny on duty holders for managing asbestos in schools by asking all responsible bodies to provide an assurance on schools compliance. An assurance process is now being developed with an aim to publish in early spring 2018—so any minute now. We are looking at ways in which to improve the evidence base and are continuing to fund the removal of asbestos where appropriate, directly and indirectly through our funding programmes for rebuilding and refurbishing schools. The final point on this is about encouraging more academies to join the risk protection arrangement, which is a government-backed alternative to commercial insurance for academy trusts.

[Baroness Finlay of Llandaff]

I take this opportunity to thank the Minister for the way she is handling our questions and to congratulate her on her role. I shall make a small point and ask a question. The scheme she is talking about relates to England. The problem we have is who is responsible for paying for refurbishment in Wales. The Welsh Government believe that it is the Health and Safety Executive, which covers England and Wales, and the Westminster Government have said that this is a devolved issue because it comes under education, which is devolved. There is a problem there and somewhat of a gridlock. I do not expect the Minister to give me an answer today, but I would be most grateful if we could pursue this outside the Committee. Oddly enough, I think it fits completely into the need for there to be national frameworks for issues that are covered between the devolved Governments and the Westminster Government, which we will be dealing with in a much larger context in relation to the European Union (Withdrawal) Bill.

[Baroness Stedman-Scott]

I am very happy to undertake to meet the noble Baroness and others to discuss that and, I hope, to resolve it without it costing lots of money. I am told that the social care disregard is complex, but in broad terms the lump sum is treated as capital, not income, and is disregarded for income-related benefits for a period of 52 weeks. I think I have dealt with asbestos in schools.

I think I have touched on the point made by the noble Lord, Lord McKenzie, about research. I will have to write to the noble Lord on the actual level of payments. I think the answer is in my notes, but I will keep Members of the Committee for ever if I try to find it. The combined cost of the 1979 Act scheme and the 2008 scheme payments outweighs the money received from compensation recovery. There is an overall cost to the Government. In 2016-17, £27 million was recovered and just over £50 million was paid out. Civil damages under the new tariff compensation payments have risen to match 100% of average civil claims, which is up from 80%. I was asked how the 1979 Act scheme and the 2008 scheme are funded. The 2008 scheme was set up on the basis that it would be funded by compensation recoveries from civil claims and the 1979 Act scheme is funded partly by civil compensation recoveries and partly by the department. The net cost to the department of making payments under both schemes in the past financial year was £23 million, which is the difference on that.

If I have missed anything out—I am sure I will find out—I will come back to noble Lords. In the meantime, I commend the uprating of the payment scales for these schemes and ask for approval to implement them.

Motions agreed.