Mental Capacity (Amendment) Bill [HL]

Debate between Baroness Finlay of Llandaff and Lord Touhig

Committee: 1st sitting (Hansard - continued): House of Lords
Wednesday 5th September 2018 Lords Chamber

[Baroness Finlay of Llandaff]

My Lords, this is really integrally linked. I have been trying to look at what would send a red flag, an alert, to an authorising body that this assessment needed to be looked into in detail and gone through with a degree of rigour—possibly with more time being able to be spent on it than can be spent currently—and that, in commissioning care, the local authority will have a care and support plan that defines what it is commissioning. It should have done a needs assessment and should commission against that and what it expects to be provided. What comes back on those assessments should mirror that care and support plan. What I have tried to do with this amendment is to highlight that, if there is not an almost identikit fit, that should not be given a margin of error but should trigger the need to visit that person and to look in detail at the care plan and its delivery. That might be the first sign that all is not well.

It may be that someone from the local authority visits and finds that the care and support plan, as commissioned, has been altered slightly because the person’s needs or ability to undertake activity have changed. It may be, in the best of circumstances, that something has been put in place that has enhanced the person’s ability to express themselves. I would use the example of music, where it has been found that by providing people’s favourite playlists, some people with really severe dementia are almost “unlocked” by the music—they are able to move in time to the music and their mobility and communication are better. Some people who have been unable to speak, even for years, recover some phrases and then, from that, begin to communicate verbally as well. And of course, we all know of people who appear to not be able to communicate but will then sing along to their favourite song, with all the words coming back again.

The purpose of the amendment is to say that, if there is not a close fit, that should be enough for the local authority to say that it is going to look at that in detail. That was the motivation behind my amendment. I beg to move.

[Lord Touhig]

This is a very small but very important amendment. Having spent 27 years in newspapers and publishing, I constantly came across issues and stories where people were having all sorts of difficulties, public services failed and systems failed because of lack of information. Certainly from my time as a councillor, as an MP and as a Minister, I passionately believe that we must be open and transparent and must share information. That is key to this part of the Bill, and we certainly strongly support the points made by the noble Baroness.

I do not intend to detain the House more than that, other than to say that the noble Baroness, Lady Finlay, may not be aware that, when I was a Wales Office Minister and she was a new Member of this House, she terrified my officials. They would come in and say, “Minister, it’s that Baroness Finlay again; she wants information on so and so”. She is pursuing her quest for information even today, which I think is very important and valuable. We strongly support her efforts in this area.

[Lord O'Shaughnessy]

I am grateful to the noble Baroness for tabling this amendment and to the noble Lord, Lord Touhig, for endorsing it. I will not detain the House other than to say that, clearly, the intention to make sure that there is not a discrepancy and, where there is, that there is a flag, is one that we share. We need to be alert to any issues of concern that would warrant further investigation, or indeed referral to an AMCP.

This is something that I think best sits within the code of practice, and I can confirm and commit that instructions along these lines will form part of the code of practice, as well as many other examples of where an authorising body should be seeing signs of concern. I am grateful for the opportunity to confirm that, and I hope that reassures everyone.

Mental Capacity (Amendment) Bill [HL]

Debate between Baroness Finlay of Llandaff and Lord Touhig

Committee: 1st sitting (Hansard): House of Lords
Wednesday 5th September 2018 Lords Chamber

[Lord Touhig (Lab)]

My Lords, I thank the Minister and his team for their engagement with Members across the House, which has been very helpful. I strongly support the attempt, on the initiative of my noble friend Lord Hunt, to have this clause stand part debate.

In the past day or so, I have spent some time looking at advertisements for care home staff and managers. They vary greatly; there is no standard at all. One advert for the role of a care home manager said, “You will assume all aspects of responsibility for your care home and have exceptional man management skills”. A minimum of two years’ experience of managing a care home, with no other qualifications, was the only candidate requirement. Another advert said that there was an opportunity for someone seeking to develop their career who must have a solid residential care background on applying. It said that applicants should have a full working knowledge of CQC requirements, possess leadership and organisational skills, and be either qualified in or working towards an NVQ level 5 in social care management, a QCF 5 or equivalent. It took more of an interest in qualifications and was a bit hit-and-miss on whether the person should be fully trained. It said that candidates should have three years’ experience of social care and it would be preferable if they had some previous management experience.

A third advert offered an exciting opportunity for a care home manager with a view to becoming a registered manager if the applicant was not one already. The skills and qualifications needed were an NVQ level 5 in leadership and management, or to be working towards that. Again, that does not mean being qualified with all the necessary education and training. A fourth advertisement sought candidates with proven home management experience, strong marketing, commercial and business acumen and a clear and thorough knowledge of CQC standards. Your Lordships should note that possessing knowledge of CQC standards came third after marketing, commercial and business acumen.

My point is that this demonstrates that there is no agreed national standard for care home manager training. With this Bill, we are proposing to give them a huge new responsibility that will affect the quality of life of many vulnerable people in our society. This really needs to be revisited. We are taking a big risk with people who have no one else to defend them if we do not start defending them here.

[Baroness Finlay of Llandaff]

My Lords, to intervene fairly briefly, it is important that we remember that the current DoLS system has effectively fallen over. We have 108,000 people currently waiting to be assessed, so we have to do something. We cannot leave it running so there is an urgency to come up with some way forward. I remind the Committee that, whenever somebody is in a place of care such as a care home, the deprivation of liberty safeguards application—form 1—is a request for standard authorisation and has to be completed and sent in. That form asks about the purpose of the standard authorisation, and for a relevant care plan to be attached. It also asks why less restrictive options are not possible, and other things. So a degree of assessment is already going on at the care home and these forms are sent in. They are then sent to somebody to authorise them.

I worry that, in some of the briefings that we have had, it looks as though the care home manager will be able to authorise in totality, whereas, as I understand it—the Minister may correct me if I have this wrong—the care home manager will still be required to have the responsible body authorise. That responsible body will be able to look—and one would want them to look—at objections that may come forward from somebody. It is to be hoped they will go and visit if they feel there is a discrepancy between the care plan submitted and the original care and support plan that came from the local authority, which may have been involved in the pre-placement assessment that went on.

The idea behind these new approvals is that there is portability: the person may reside in one place, then be moved to hospital, go to outpatients, spend time in hospital and then come back to the care home. Within that portability, however, there is a requirement to review, if the circumstances change. We will come later to amendments that look at discrepancy between the care plan and the care and support plan as submitted. In other words, these are things that should trigger red flags in the mind of the authorising body, rather than the authorising body just being a rubber-stamping exercise, which is, I think, a misunderstanding that there may have been. If it is a rubber-stamping exercise, there are all kinds of dangers in that. Somehow, we have to filter out those people who really need an in-depth assessment and review from those people where the current processes are just burdensome, time-consuming and not contributing to improving their care. That filtering is really difficult. I offer that in the debate at this stage because it is worth looking at these forms, which I hope will be improved because there is not that much room to write on them.

Armed Forces Bill

Debate between Baroness Finlay of Llandaff and Lord Touhig

Wednesday 26th October 2011 Lords Chamber

[Lord Touhig]

My Lords, I welcome the statement from the Minister this evening about the Pingat Jasa Malaysia medal and the independent review of the operation of the HD committee. We have battled on this issue for years in the other place. Here in the House of Lords—I do not want to enter into the debate about a future appointed or elected House—we have achieved something that the elected House did not manage to achieve regarding the Pingat Jasa Malaysia medal. It is a great credit to all concerned that we have been able to do that.

I also think that the Minister’s statement tonight sends out the positive message to a close and dear ally in Malaysia, a Commonwealth ally, that we respect the generosity of the king and the people of Malaysia in honouring those British servicemen who fought in that country. I certainly welcome the independent review of the HD committee. I can see that it has a difficult job but I am not entirely happy with the way that it has done it.

I do not think there is anyone in this House who does not have the highest regard and affection for Her Majesty the Queen, and no one would want to put her in a difficult position regarding the question of honours. I feel that it is the actions of the HD committee that have embarrassed Her Majesty in this respect by the way it advised her that the veterans should accept the medal but not wear it. Thankfully, that is being resolved this evening.

I am a great believer in fate, in the sense that I think that sometimes one faces an issue or a problem and someone comes along and solves it. I pay tribute to the Minister because I am not sure we would have achieved this without his personal efforts. He has been hard-working, honourable and decent throughout this whole thing and has strongly represented the views of this House, and of many others outside, with regard to the veterans.

I join the noble and gallant Lord, Lord Craig, in his praise of the Minister’s team because they have assisted the Minister in bringing about this decision. I cannot speak highly enough of the regard I have—and I am sure the whole House has—for the Minister. As for the noble and gallant Lord, Lord Craig, he has led from the front. He has been persistent and pushed hard, and worked with the Minister and lobbied. I do not know how many meetings he has had with the Minister, and I have to weigh the e-mails I have had from him about the progress he has made on this issue. We owe him a great deal.

I do not wish to detain the House any longer at this late hour. I can honestly say that as a Parliament and as a country, as a result of the Minister’s statement tonight on the veterans of Malaysia, we have redeemed our honour.

[Baroness Finlay of Llandaff]

My Lords, I briefly add my thanks to those expressed by my noble and gallant friend Lord Craig of Radley to the Minister for his personal commitment to the Armed Forces and the veterans, his personal commitment to ensure that this House had a Bill that is now moving forward to become an Act in a much better condition, and the tireless way with which he and the Bill team have made themselves available to us all. Of course I am glad that he managed to negotiate that the amendment over inquests for military personnel was incorporated. The joy over that must not be diminished by disappointment over the defeat last night over the issue of the chief coroner—that is for another day. For tonight, sincere thanks are due to a Minister who has shown enormous commitment and has worked with us in this House to improve the workings. This has been this House at its best, and we are all grateful to him.