Social Care
Baroness Wheeler Excerpts(11 years, 5 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Baroness Wheeler
My Lords, I, too, thank my noble friend Lady Pitkeathley for securing this debate and for once again giving us the opportunity to place a spotlight on the growing crisis in social care provision and funding as well as on the importance of developing joined-up services between the NHS and local authorities and within and across the range of services that local councils provide. As usual, my noble friend provides us with a clear strategic overview of the situation and of the impact of cuts to NHS and local authority budgets, as well as firmly rooting the debate in the day-to-day realities faced by thousands of people and their carers who are struggling to cope without the support that they need, often for help with basic everyday tasks, such as getting up, washing and eating.
We last debated social care when the Government’s long-awaited White Paper was published in July, setting out key law and system changes in the Care and Support Bill, and the process for pre-legislative scrutiny, on which we are about to embark, but, of course, sadly ducking the issue that needs to be addressed for any new system to be implemented and for it to work; namely, social care funding and Dilnot.
Dilnot was then widely seen to have effectively been kicked into the long grass by the Government’s in principle only decision. Since then we have had a “will they, won’t they” stop/start coalition dance on the funding issue. Over the summer, our hopes were raised by media reports about U-turns, rethinks, and Prime Ministerial determination to implement Dilnot. If you fast forward to this parliamentary Session, however, there is continued confusion, with the reappearance of the unattributed leaks from government sources about the issue not being a priority, and the Health Secretary himself telling the Tory Party conference that the costs were unaffordable, while, ironically, only a few weeks later, stating his ambition to make England,
“the best place in Europe to grow old”.
He was referring to recent welcome initiatives on dementia care, but with an estimated 1 million people likely to be suffering from dementia by 2021, and 600,000 family carers currently caring for people with dementia, surely the only long-term solution for ensuring that we can address their future care and support needs is to reach agreement on social care funding. Otherwise, the current system, or the new system post the Care and Support Bill, just will not be able to cope.
Most recently, we have yesterday’s Daily Telegraph report that the coalition Government are close to agreeing a cap on elderly care, which could form a centrepiece of the coalition’s mid-term re-launch next year. Like other noble Lords, I look forward to the Minister updating us on what is going on. Does he accept that the need for a long-term funding settlement for social care has never been more urgent?
The debate today focuses on the role of local authorities in the provision of social care, housing and other care services, and it is good for us to be considering council funding and responsibilities in this wider care context. Council responsibilities run across social care, adult and children’s, mental health and learning disabilities, disability support, education, housing, welfare, leisure and transport—the services that people needing social care use or interact with. Last week’s debate on services for people with neurological and other long-term health conditions, for example, underlined the complex care pathways across NHS, council and voluntary sector care provision that need to be better integrated, including health and social care with housing and welfare.
Huge responsibility is placed on local councils to provide or jointly fund these vital services, but we have heard from noble Lords how the scale of reductions across council budgets and in social care highlighted by previous speakers are having a major impact. ADASS and LGA estimate that £1.89 billion have been taken off adult social care budgets in the past two years and that there will be a likely overall funding gap of more than £16 billion a year in overall council spending through to 2020.
There is welcome evidence that the funding transferred from the NHS budget to support social care has helped to stimulate joint working, but the reality is that the bulk of this money is being used to offset cuts to services, although to their credit, surveys show that half of the councils in England are seeking to protect adult social care from the most drastic cuts they are having to make. However, Labour’s and other surveys show that this is predominantly being achieved by holding down residential care placements and agency home care hours costs, and we know that this is simply not sustainable. One large independent sector provider has said that the multi-million pound funding shortfall between the true cost of providing quality care that meets CQC standards and the fees paid by local authorities to care home providers has increased by 16% in just 12 months.
References have been made to this year’s survey by Labour, which showed an 11% fall in the past two years of the number of vulnerable, old and disabled people having home care services fully paid for by the local authority. Eight out of 10 councils provide free care only for people with substantial or critical need. It also found that the average charge for an hour of home care had risen over the same period by 10%.
Noble Lords have underlined the impact that local authority budget cuts have on hospitals as social care funding is squeezed. One often underestimated impact is on accident and emergency services, as more people come through because primary care is becoming less accessible and social care is reduced. The system often seems as if it is in danger of falling over.
The Minister has been asked many questions and I look forward to his response. I want to touch on a couple of those questions. On personalisation, with the personal budget deadline of April 2013 fast approaching, we need to assess any potential negative impacts on existing services such as the provision of daycare centres. I welcome the comments of the noble Baroness, Lady Barker, on the need for more economic modelling on new services, and the references of my noble friend Lord Warner to ensuring that money flows to support these new initiatives.
On children’s services, the right reverend Prelate the Bishop of Liverpool referred to a potential 20% of cuts in children’s services there, and the likely impact on the NHS. On residential care, I was struck by the key quality of care test suggested by my noble friend Lady Donaghy: namely, are residents’ comfort and well-being viewed as of less import than the potential for bed-wetting? The noble Baroness, Lady Campbell, summed up integration as a complex nut to crack. I think that we all recognise this. She rightly praised local authorities that have introduced innovation into care support, even while having to make what she called terrible decisions about care provision.
I would like, in the time left, to pick up on the crucial issue of mental health. Labour has pledged to do all it can to support achieving real parity of esteem between mental and physical health, as Ed Miliband made clear in a keynote speech last month to the Royal College of Psychiatrists. He described mental health as,
“the biggest unaddressed health challenge of our age”,
and said that it affects,
“one in six people across Britain”.
Local government is a key player in mental health, in shaping and commissioning services in social and residential care and in local community services such as advocacy, mental health outreach, befriending, drop-in groups and daycare provision, working with the NHS, community and voluntary sector providers.
As the chair of Blackfriars Settlement, a small local multi-service provider in the London Borough of Southwark, I can cite direct experience of how important the local authority role and support is, and how challenging and difficult it is for the voluntary sector to get funding to replace the reductions in funding. The settlement is one of a consortium of council funded voluntary organisations helping to deliver the borough’s mental health strategy. We have traditionally specialised in work with people with severe and enduring mental health problems, many of whom have been in the system for a long time. We are having to work hard to adapt our services to meet the new challenges on the ground. Our previous delivery model has been updated and adapted to provide a service menu for clients with personal budgets, and we are working hard to develop partnerships with local community groups on a number of projects. We have set up, with Big Lottery funding, a small social enterprise called Art to Print which provides employment and training in art and design production for local people with mental health problems, many of whom have never worked before. However, it is tough going and if we do not succeed in keeping these vital services going, our clients will just not have anywhere else to go.
The Centre for Mental Health underlines that social care input into mental health services is vital for recovery, but the information to measure and assess progress is hard to come by from local authorities because of the absence of systematic reporting on mental health spending and service provision at local level. The charity Rethink’s report, Lost in Localism, this year pointed out the difficulties of assessing the proportion of local authority social care spending on mental health, which is currently achievable only through freedom of information requests. Will the Minister outline any plans the Government have to improve data on local authority mental health spending and services which will help measure progress on how parity of esteem can become a reality?
There are significant reductions in parenting programmes’ budgets to support families at high risk, particularly parents who themselves have poor mental health. The British Association of Social Workers has estimated that around 40% of local authorities have removed, or are considering removing, mental health social workers from NHS-led mental health community and crisis teams. Action for Advocacy’s recent survey found that organisations providing advocacy services for vulnerable groups have had their funding cut by an average 36%, mainly by councils.
I was going to refer to a number of other things, but I see that time is running out. Therefore, I shall put two final questions to the Minister. Although the barriers to providing integrated services are well known, mental health has to date been one area where there have been long-standing partnership arrangements between the NHS and local authorities, including secondments and Section 75 agreements delegating functions to NHS trusts. Given this existing good platform, what are the Government doing to promote the continuation of this?
On parity of esteem, the NHS mandate commits the NHS Commissioning Board to deliver the Government’s commitment of at least 15% of adults with relevant mental health disorders having timely access to services with a recovery rate of 50%. What are the timescales, costs and funding sources for this? The Minister assured us that the mandate had been fully costed and could be carried out within these costs. Is 15% good enough?
Like the majority of noble Lords who have spoken in today’s debate, I hope that the Minister’s responses will show us that the Government understand the scale and urgency of the social care crisis and are prepared to take effective action in this Parliament to address it.
NHS: Women Doctors
Baroness Wheeler Excerpts(11 years, 5 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Earl Howe
Yes, indeed, my Lords. The noble Baroness, Lady Deech, raised that in her report as an action point. It can be done at a trust level or at a higher level in the health service. But it is certainly important to monitor—I understand that the term is “credentialing” —the skill sets of those doctors, who may move out of the health service and want to move back in again, so that jobs can be found for them more easily.
Baroness Wheeler
My Lords, I am sure the Minister will agree that recruiting women into the medical profession is just as vital as retaining them once they are trained and working. Given the high costs of university fees and the burden that these place on young people, particularly those from poorer backgrounds and those with family and caring responsibilities, how will the Government ensure that women are not put off applying to medical school?
Earl Howe
My Lords, there is no evidence that there is a problem with female recruitment into the health service. Indeed, the male-to-female gender balance over the past few years has decreased from 1.83:1 in 2001 to 1.25:1 in 2011. However, I recognise that we should not be complacent. Even with the increased participation of women in medicine, we appreciate that more can be done to improve the selection of senior doctors into senior positions.
Care and Support
Baroness Wheeler Excerpts(11 years, 9 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Baroness Wheeler
My Lords, I thank the noble Earl for the Statement. I am sure the House will agree that we have all waited a long time for this spring White Paper, and now the Government have finally managed to publish it by the skin of their teeth, with just 10 days to go before the Recess. Notwithstanding what is actually in it, we can at least take comfort that the White Paper’s publication at last fires the starter gun for the nationwide debate on the future funding of social care that we on these Benches and key stakeholders in the public, voluntary and independent provider sectors, as well as care professionals and service users—many of them forming part of the excellent Care and Support Alliance—have all been calling for.
The stakeholders know only too well the scale of the problems that have to be faced and the solutions that are needed on the full package of social care law and current and future funding. However, there is also an urgent need for social care to be pushed to the forefront of public debate and understanding as one of the biggest challenges facing Britain today. This public debate could and should have started much earlier if the Government’s stated momentum behind pushing the Dilnot commission into doing its work in six months had been maintained, and if the Government had put more energy and commitment into the cross-party talks and had seriously tried to address the critical funding issues. After all the delays, prevarication and speculation, those of us who were hoping against hope for some sense of an overall strategy, vision and action in the White Paper for dealing with the current and growing crisis in social care are sadly disappointed and let down. There is no vision of how a reformed system will work in practice or how it is to be sustained in the future in the face of growing demand and need.
At the minimum, we hoped for an outline programme and process for making key decisions on funding, including timescales and milestones for moving forward on addressing the full package of reforms that are needed. Instead, we have further consultation on issues, many of which have already been consulted on and on which there is already broad consensus. We have the failure to address the funding crisis, the prospect of the proposed care and support Bill not coming into effect until probably April 2015, and any implementation of the Dilnot options effectively long-grassed until after the next election.
The White Paper shows that the Government are completely out of touch with the scale and urgency of the care crisis. Across the country, elderly and disabled people are failing to qualify for basic personal care in their homes, or their package of care has been cut back to home visits of less than 15 minutes, or they have faced home care charges rising by 11% in some local authorities. We know, too, that the cost of residential home care is rising substantially in excess of what local authorities can pay, and people are spending their lifelong savings to pay for long-term care. The funding issues need to be faced and addressed now.
Of course we welcome the implementation of a large number of the much-needed changes to social care law proposed in the Law Commission’s excellent report of 2010. Social care law is in urgent need of reform, which is why the Labour Government set up the review in 2008. We welcome the proposals and consultation on reforming and simplifying the legal framework and ensuring that patient-centred services are better fitted to people’s lives and fit in with their need for choice and control. We strongly support new laws which help to make clear what people are and are not entitled to, and which help them to plan for the future.
In the time available, I have managed only a quick look through the documents, but it is worth pointing out to the House that an overwhelming number of the proposals were contained in Labour’s own White Paper on care, published before the last general election. Naturally, we welcome their reappearance, but it begs the question: why it has taken the Government nearly two years to regurgitate our proposals into their new draft Bill?
I stress that we also support proposals in the White Paper that take forward Labour’s personalisation of care agenda—again, as set out in our care White Paper. We support legislation to ensure the portability of social care packages, and we of course support proposals to extend carers’ respite breaks and their legal entitlements, as well as the extension of key information and advice services which we introduced through our landmark National Carers Strategy.
However, from these Benches we have repeatedly stressed that, unless these new social care laws are reformed in the context of also addressing the current and future funding problems, they will be ineffective and inoperable, and will lead to even greater unmet demand and suffering. Local authorities facing £1 billion of cuts will just not be able to afford to respond to laws designed to make care provision and eligibility consistent and more accessible across the country.
It is deeply disappointing and frustrating that the White Paper does not take the key step of recognising that there is not enough money in the system now. Not only is Dilnot implementation pushed into a further consultation and engagement process—despite the much-hyped promises of accepting Dilnot “in principle”—but the proposed transfer of funds of £300 million from the NHS to social care over a two-year period in 2013 and 2014 continues to support this fallacy: in other words, that it is all down to local authorities needing to better manage their finances and get their priorities right. Those councils are desperate for a new settlement on funding for social care, but the White Paper holds out little prospect of this happening and provides no answers to the funding crisis currently engulfing them. I cannot see any reference in the White Paper to how the Government propose to help councils to fund what seems to be their flagship proposal: to provide loans to older people so that their care costs can be paid for after they die. I should be grateful if the Minister could flesh out any of the details on this.
On long-term funding, the Alzheimer’s Society best summed it up when it said that accepting a cap on the funding contribution “in principle” is just an “empty promise”. People want to know what the contribution cap will be, when it will come in and how it will be funded. It is downright cruel to dangle in front of people the prospect of raising the savings threshold from £23,250 to £100,000 without a positive commitment and date for implementation when those people are currently struggling to self-fund their care, or part of it, and are seeing their life savings disappear now.
Labour has always been in earnest about the need for meaningful cross-party talks and entered into these last year in good faith. We meant business when we made the offer last year, and we mean it now. I ask the Minister whether his understanding of meaningful cross-party talks involves joint, two-way discussions on strategy, policy and options, and regular meetings, discussions and negotiations to reach a consensus, or whether it means irregular meetings, the last one of which was cancelled by the Government, who instead offered the Opposition a briefing just a few days before the White Paper was due to be published on what they intended to do—or not do, in this case. We know that that is what happened, although I welcome the behind-the-scenes signs over the past couple of days that the Government regret not putting more effort into making cross-party progress. For our part, Andy Burnham has pledged that if the Government offer a genuine, two-way discussion on the funding of care, with honesty about existing pressures and the difficult options, Labour will play its part.
I ask the Minister the following further questions. First, why was it not possible to reallocate to pay for social care a major part of this year’s £1.7 billion NHS underspend, which was clawed back by the Treasury? Would this not at least have been a start, providing real money behind the White Paper’s reform proposals? Secondly, will the Government be involving Andrew Dilnot himself in the implementation discussions once the consultation is completed? Does the Minister recognise that Mr Dilnot’s involvement would go some way towards building confidence among key stakeholders that the whole issue has not been long-grassed? Thirdly, can the Minister tell the House when the Government will publish an impact assessment of the cost of the overall changes proposed, and how they plan to implement the changes with no extra money and council budgets being slashed? Finally, in today’s Daily Telegraph NHS managers are warning that the NHS is at risk of collapse as cuts to social care budgets are leading to a huge rise in the number of admissions to hospital of older people who could be treated at home but cannot afford to pay for care. How do the Government propose to deal with this, and how will the White Paper proposals help to alleviate this alarming trend?
The White Paper reflects a positive sign of consensus on many of the key issues facing social care today, and some good promises about how social care should change. However, until these promises are backed by a recognition of the current scale of the crisis and proposals on how Dilnot can be implemented in the future—with firm commitments, timescales and milestones—schemes such as deferred payments and loans and pilots for end-of-life care can in effect be only interim, stopgap measures. They do not address the overall need for fairness, transparency, more resources across the whole system and long-term sustainability. Implementation of Dilnot must be the basis for that.
As a carer myself, I hope that the House will forgive me if I end by quoting the carer husband of a woman suffering from dementia who was movingly interviewed on Radio 4 this morning about his life as a 24-hour carer and the impact of social care cuts. He said:
“It’s the unknown that really gets to me … in the back of my mind is the constant feeling of uncertainty”.
In-principle decisions for implementation at some unspecified date in the future are no solution and offer no comfort, solace or relief to people who need help, care and support today.
The Government promised that they would legislate on a new legal and financial framework for social care in this parliamentary Session. The noble Earl promised that the Government would not shy away from or duck the funding issues—but I am afraid that that is exactly what they have done.
Dementia
Baroness Wheeler Excerpts(11 years, 10 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Baroness Wheeler
My Lords, this has been a comprehensive and authoritative debate on one of the major health and care challenges facing us today: namely, how we provide treatment, care and support for people suffering from dementia and ensure that their families, carers and the staff in hospitals, care homes and those who come to the patient’s own home can help them have the best quality of life and care. As one would expect, many of the key concerns and questions on improving research, diagnosis, understanding, services and support have been ably put by noble Lords during the debate. I will not repeat those. I look forward to the Minister’s response.
Of course, I also pay tribute to my noble friend Lord Touhig for securing this debate and for his excellent opening speech, setting out the context, the stark facts, the progress and developments since the national dementia strategy was launched by the Labour Government in 2009, and the challenges that we still face. Most importantly, I appreciated his reference to carers of people with dementia because they are so important in the debate—whether they have 24-hour caring responsibility in their homes, are family members supporting a dementia sufferer or are supporting their loved ones in residential care.
My noble friend Lady Pitkeathley also spoke passionately about carers, as you would expect. Ensuring that the everyday experience of carers is heard in debates such as this is vitally important, and the House is better informed for it. As a trustee of our local carer support group in Elmbridge, Surrey, I know that about 70 per cent of carers we support locally are caring for somebody with dementia. The dementia ranges from people experiencing the early disturbing signs of the onset of dementia, who, with their families, are wondering what the future will hold and how they will be able to cope, through to those in the severe advance stages, still cared for at home or in residential care, either with respite or permanent care.
Speaking to just a small number of these carers, two things are particularly striking—apart from the love and dedication that it takes to cope and carry on. First, the carer never stops feeling responsible, even when the husband or relative has had to go into hospital or residential care. Secondly, it is striking how much better we need to become at understanding the range of care and support that is needed, and at providing flexible community personal support and day and residential care that treats people with dementia with dignity and helps them maintain their quality of life.
I will quote from one carer whose husband with dementia is in residential care because she could no longer cope with him at home. She said:
“I had him home this weekend, which was nice but he was very distressed when I took him back this morning because he clearly didn’t want to be there. It makes me feel so guilty and sad, because when he is with me he is full of smiles and hugs, and I feel I am betraying him by taking him back. He has become unsettled generally because one of the residents in his wing has severe dementia and shouts and swears all day long. It is having a negative effect on my husband and the staff, but when I raise my concern with the home manager, he makes it clear that there is nothing he can do”.
Why this care manager feels unable to take action is a complex mix of failing to understand the spectrum of care that is needed and failing to respect the individual’s needs and the impact their behaviour has on other people with dementia, as well as on their carers and families. It is also often about poor assessment of the patient’s needs, lack of resources, inadequate training and the low pay of staff. As Carers UK has stressed, carers often report challenges in finding appropriate services with the necessary expertise to provide the right care, environment and support—a problem faced by my noble friend Lord Wills, as he explained.
This failure to find adequate care means that it will be more difficult for families to accept practical help or take a respite break, as they do not have confidence in the quality and appropriateness of the care. Also, as evidence to the Dignity in Care Commission set up by Age UK, the NHS Confederation and the Local Government Association has shown, poor or neglectful care, even for just a few days, can have a devastating effect. Locally, I was told of a care home that billed itself as having a “specialist” dementia ward. However, the reality of the care it provided—or did not provide in this case—meant that an elderly lady admitted for respite care to give her husband a break deteriorated so badly during her short stay that she was unable to return home because she could no longer get to the toilet on her own or feed herself. She is now in permanent residential care. The respite experience pushed the husband over the edge and he was no longer able to cope.
As I always stress, there is of course good-quality care and best practice in day care, assessment centres and residential homes across the country, and the huge challenge, as usual, is to raise standards in the homes where there is poor care to their level. I pay tribute to key improvement tools such as the Age UK’s initiative, My Home Life, which promotes quality in care homes for older people. It is an exemplar programme that helps staff to optimise the quality of care in their homes and has the active support of the Relatives and Residents Association and the national provider organisations representing care homes across the UK.
For dementia, the need for more research, early diagnosis and the importance of providing integrated health and social care for people to improve services are key elements, as noble Lords have stressed. The Alzheimer’s Society’s estimate is that two-thirds of people living with dementia live in their own homes, and a third live in care homes. The reality, however, as we on these Benches have repeatedly stressed, is that current inadequacies and failures of the system will not be addressed without tackling the crisis in the funding of social care. As all key stakeholders in the voluntary, public and independent provider sectors, as well as care professionals and service users, have stressed, a full package of reforms that address legal, current and long-term funding is needed.
How can local authorities that are currently having to cut £1 billion from social care budgets provide adequate or improved community care support, not just for people with dementia but for people with other lifelong conditions such as stroke damage or diabetes, and for their carers and families? I understand that new figures revealed by the Alzheimer’s Society and MHP Health Mandate also reveal an alarming 12% increase in the number of emergency hospital admissions for people with dementia since 2006. Is this not evidence that the community services that are needed to help people live at home are woefully inadequate to meet current or future demand?
I ask the Minister if he can update the House on when spring will finally arrive and the social care White Paper will be published. What will it cover? We know it will focus on the reform of social care law, which is very important, but does he not agree that making changes to the legal rights and entitlements of elderly and disabled people without dealing with the issue of how the services are to be funded now and in the future will only create more expectation and demand that cannot be met?
On the question of improving early diagnosis, can the Minister update the House on what progress has been made by local NHS organisations in developing plans to improve diagnostic rates, as set out in the Prime Minister’s dementia challenge? The challenge also made £54 million available through the dementia Commissioning for Quality and Innovation—CQUIN—programme to hospitals offering dementia risk assessments to all over-75s admitted to their care. Can the Minister update the House on how many hospitals have received payments under this scheme and how many hospitals have offered such risk assessments to all over-75s?
On the issue of keeping track of how the national dementia strategy is being implemented, I understand from the Mental Health Foundation that Andrew Lansley at last year’s Dementia Action Alliance event promised that there would be an annual report on progress. This would be a really important lever to help drive through improvements. Can the Minister advise us on when the first annual report will be published?
Finally, as regards the White Paper, can I press the Minister, when he updates us, to advise us on whether it will set out a clear timetable for addressing the recommendations of the Dilnot report, as well as a full government commitment to the cross-party talks on this, and to standing by the Prime Minister’s pledge to deal with social care funding in this Parliament? As he knows, the Minister has promised the House that the Government will not shy away from tackling this issue. I have pressed him on this matter on a number of occasions, and I must say that his responses have become increasingly expansive as we have gone on.
On 11 June, he assured me that the Government are,
“absolutely committed to introducing legislation at the earliest opportunity in this Parliament to establish a sustainable legal framework for adult social care”.—[Official Report, 11/6/12; col. 1137-8.]
That much we of course knew by then but, on 18 June, the Minister assured me that the Government’s,
“aim has been and remains to legislate in this Parliament to create a fairer, more just and better funding system for social care”.—[Official Report, 18/6/12; col. 1542.]
So today I am hoping that he will be able to go the extra mile and commit the Government to producing a timetable in the very near future for consultation on the Dilnot recommendations, and for implementation of long-term funding proposals in this Parliament.
Care Homes
Baroness Wheeler Excerpts(11 years, 10 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Baroness Wheeler
To ask Her Majesty’s Government what action they will take in the light of the finding of the Care Quality Commission’s recent unannounced inspections of care homes and treatment centres for people with learning disabilities, that around half of those inspected were not meeting essential standards of care.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the CQC’s findings show unacceptable levels of care. On Monday a Department of Health report set out 14 national actions to improve care and support for people with learning disabilities or autism and behaviours that challenge. All parts of the health and care system have a role to play in driving up standards, stopping abuse and transforming local services.
Baroness Wheeler
My Lords, in its inspection of care homes and assessment centres in the light of the serious abuse and appalling standards of care at Winterbourne View hospital for people with learning disabilities, the CQC found that of the 150 inspections it carried out, independent healthcare providers were twice as likely to fail to meet the required standards as NHS providers. How does the Minister account for that? Can he say specifically what steps he will be taking to ensure that clinical commissioning groups tackle the problems the commission found over lengths of stay in services, failure to review care plans so that residents can be moved on to community-based services, and the very worrying overuse of restraint of patients?
Earl Howe
My Lords, it is true that CQC inspectors found that for the kind of services they inspected, there was more non-compliance in services run by the private sector. But the information the CQC gathered for its report does not enable it to analyse the reasons for that. I would simply say that all providers of services, whether in the independent sector or the NHS, need to ensure that they comply with essential standards. The noble Baroness summarised a number of the areas where the CQC found failings and I endorse her view that there is a fundamental failing across the system, not just in providers but in terms of commissioning as well. The examples of poor care show up a fundamental need for commissioners to review commissioning plans and care plans, and make sure not just that the providers are capable of offering and providing care to the right standards but that they are actually doing so at the right level for the patients and service users they look after.
Older People: Health and Social Care
Baroness Wheeler Excerpts(11 years, 10 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Earl Howe
I come back to the point that I made to the noble Baroness, Lady Finlay. Domain 4 of the NHS outcomes framework is about ensuring that people have a positive experience of care and reflects the importance of providing that positive experience, including treating patients with dignity and respect. Domain 5, which is about treating and caring for people in a safe environment and protecting them from avoidable harm, also relates to that area. These areas will be centre stage in the way that the NHS CCGs in particular are monitored by the board.
Baroness Wheeler
My Lords, the recommendations of the Delivering Dignity report focus on tackling the underlying causes of poor care in hospitals and residential care. As the Minister knows, there is widespread concern among key stakeholders, including voluntary organisations, care professionals and care providers, about the serious impact that the growing crisis in social care funding is having on providing good-quality care in residential homes. Does this not make it even more vital for the Government to stand by the Prime Minister’s pledge to deal with social care funding and with the recommendations of the Dilnot commission in this Parliament?
Social Care: Legislation
Baroness Wheeler Excerpts(11 years, 10 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Baroness Wheeler
To ask Her Majesty’s Government what is the timetable for the draft Bill to modernise adult care and support in England announced in the Queen’s Speech and to what extent the proposals in the Bill follow the recommendations of the Dilnot commission.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the Government have committed to publishing a draft Bill for pre-legislative scrutiny this Session, and will outline plans for transforming care and support in the forthcoming White Paper. The Dilnot commission’s recommendations are hugely valuable. However, implementing them would have significant costs, which must be considered in light of the growing demand for social care, and of other priorities. We will set out the way forward in the progress report alongside the White Paper.
Baroness Wheeler
I thank the Minister for his response. However, with local authorities having to cut £1 billion from current social care budgets, does he not agree that there must be a package of reforms that will embrace current and long-term funding solutions, as well as the legal framework proposals expected in the White Paper and Bill? Will he reassure the House that the progress report accompanying the White Paper will contain a clear timetable for consultation on funding issues? Will he also reassure us that the Government intend to honour the Prime Minister’s pledge to deal with social care funding in this Parliament?
Earl Howe
My Lords, this is the first reform of social care law in more than 60 years. It is a unique opportunity to get the legal framework right. That is why we have deliberately taken time to engage fully with those who have experience and expertise in care and support. Many people in the sector have called explicitly for scrutiny on a draft Bill, so publishing a Bill in this way demonstrates our commitment to working in partnership. We remain absolutely committed to introducing legislation at the earliest opportunity in this Parliament to establish a sustainable legal framework for adult social care. The draft Bill will be the critical next step in delivering the reform agenda.
Care Homes
Baroness Wheeler Excerpts(11 years, 11 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Earl Howe
The noble Lord made a very good point. As he will know, there are existing oversight and regulatory frameworks, with the CQC regulating the quality of care and support services and local authorities overseeing local providers. The point made by the noble Lord is a major part of why the Government are engaging with the sector, as I described just now to my noble friend. The main point to stress is that under the existing system no one will be left homeless should a provider fail. In an emergency, local authorities have a duty to provide accommodation to anyone, whether they are publicly funded or self-funded, who has an urgent need for it.
Baroness Wheeler
My Lords, this summer the Care Quality Commission is conducting thematic inspections of dignity and nutrition in 500 care homes with nursing provision. Does the Minister agree that these will be vital in providing evidence and guidance to ensure improved standards of care? Will he assure the House that these inspections will go ahead despite the commission’s increased responsibilities and workload resulting from implementation of the Health and Social Care Act and other government policy initiatives?
Earl Howe
My Lords, the noble Baroness is right; this is very important work. I am led to understand by the CQC that the programme is due to proceed as planned. We will place a great deal of reliance on its findings. In the light of recent distressing and unfortunate stories about the absence of dignity in certain care settings and the shortcomings in care quality, it will be important to learn lessons from the CQC’s programme.
NHS: General Practitioners
Baroness Wheeler Excerpts(11 years, 11 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Baroness Wheeler
My Lords, at the conference this week we heard the growing concern of GP leaders and delegates that grass-roots GPs were being excluded from involvement in clinical commissioning groups. How will the Minister address this, and will he ensure that CCG guidance includes best practice on how their involvement can be ensured?
Earl Howe
My Lords, each GP practice will have a GP or other health professional who will represent the practice in dealing with the CCG. Other GPs may be involved in the clinical design of local services, building in some cases on existing GP involvement in practice-based commissioning. Most day-to-day commissioning activities are likely to be undertaken by staff within CCGs, but part of the rationale for this is clinical engagement and involvement. I would be very concerned to hear of instances where GPs felt that they were being shut out of the process of development that is now under way. If the noble Baroness could draw my attention to any such instances, I would be grateful.
Health and Social Care Bill
Baroness Wheeler Excerpts(12 years, 1 month ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, I shall speak also to the other 41 amendments in this group, some of which, I stress, are minor, technical or consequential.
Part 9 establishes the information centre in primary legislation, setting out its powers in relation to the collection, analysis, publication or dissemination of information. Several noble Lords, as well as the British Medical Association and the NHS Future Forum, have expressed a keen interest in the need to ensure an appropriate balance between the protection of patient information and the use and sharing of information to improve patient care. For example, I recall that the noble Baroness, Lady Wheeler, stressed the need to provide,
“safeguards that are strong enough to protect patients”.—[Official Report, 21/12/11; col. 1802.]
She is, of course, absolutely right. We are sensitive to these concerns.
Your Lordships have already approved amendments that raise the threshold required for the board and CCGs to disclose personal information. Government Amendments 268, 280 to 282, 284, 285 and 287 to 289, which are supported by the BMA, further strengthen the protections in the Bill in relation to confidential personal information. Government Amendment 268 would in effect restrict the bodies that are able to request the centre to collect confidential personal information to the principal bodies—that is Monitor, NICE and the CQC—or any other body prescribed in regulations. It also restricts the making of such requests to a person to whom information may be lawfully disclosed—for example, because they have obtained consent or have a power in statute to require such disclosure—or where the information may be lawfully disclosed to the centre.
Government Amendment 272 limits the circumstances in which the information centre may require provision to it of confidential personal information. Government Amendments 280, 281, 282, 284, 285, 287 and 288 clarify when dissemination by the information centre of information which identifies or enables the identity of an individual to be ascertained would be permitted, and when the information centre may be directed to disseminate or not to disseminate information. Government Amendment 289 would require the information centre to publish a code of practice for health or social care bodies or anyone providing publicly funded health or social care on how to deal with person-identifiable or other confidential information.
We believe these amendments strike the right balance between appropriately protecting an individual’s confidential personal information and ensuring that the wider benefits of safely and securely sharing information, which include improvements in the quality of services and treatments, can be realised. There are also a number of minor and technical amendments to improve the drafting of the clauses and to ensure that they can be effectively exercised in practice.
Government Amendments 291A to 291D and 297A to 297D are intended to provide a further degree of future-proofing to ensure that the exact requirements for the future development and delivery of informatics systems to support the health and care sector can be met. Last week, my right honourable friend the Secretary of State for Health highlighted our approach for delivering informatics systems in the future. We intend that the board and the Secretary of State will be supported in the management of informatics systems and services by a lean delivery organisation that will take over from NHS Connecting for Health from April 2013. We are currently looking at where these delivery functions will sit, with the information centre as an option to house some or all of this work. These amendments would enable provision to be made so that the centre could exercise the functions of the Secretary of State or the board in relation to delivering these systems. The amendments will also help to future-proof the legislation so that the provisions can support a more flexible, agile approach to delivering informatics systems in the future. I beg to move.
Baroness Wheeler
My Lords, I welcome and support the government amendments in this group. In Committee, I stressed our strong support for placing the Health and Social Care Information Centre on a firmer statutory footing and replacing the current special health authority. The centre, male-midwived by my noble friend Lord Warner, as he put it, was set up by the Labour Government and has enjoyed a large measure of success, particularly in developing the bedrock quality improvement initiatives in the NHS. I stressed then that if we are able to get the patient confidentiality issues right, the UK has a huge opportunity to lead the world in health research.
The government amendments go a long way towards meeting the concerns expressed by me and other noble Lords on safeguarding patient confidentiality and the need to place a greater emphasis on obtaining consent from the patient when this information is collected or published. The information centre now has to obtain consent before it publishes information that could identify a person.
The new clause in Amendment 268, in particular, which establishes what type of information is confidential and how the information centre must deal with information, is a major step forward, as is the new clause outlined in Amendment 289 requiring the information centre to develop a code of conduct on confidential information.
The noble Earl quoted me from Committee stressing the need for safeguards that are strong enough to protect patients. As that is the first time that I have ever been quoted by the Government, I think I can legitimately claim credit for the subsequent amendments. The extra safeguards to protect patients—for example, detailing when the Secretary of State can request information and who can request the information centre to collect information, and ensuring that consent must be obtained where the information is deemed confidential—are all vital to ensure public and patient confidence that information will be properly acquired, stored, used and published.
We also strongly support Amendment 268, limiting the range of bodies that can request that the information centre collect personal or confidential information to principal bodies, such as Monitor, CQC or NICE, which are able to make a mandatory request because they have obtained consent and have the power under statute.
On the code of conduct, I hope that the noble Earl will assure us that there will be widespread consultation on the development of a code. I should also be grateful if he could reassure the House that the code will provide further detail about the proposed mechanisms that the centre will need to obtain the consent of patients. It is obviously important that we get this issue right. What will be the process for obtaining consent where people are unable to provide it—for example, patients who are unable to make decisions for themselves under the Mental Capacity Act 2006?
Finally, the Government’s Statement in the House on 6 December on UK life sciences announced their intention to share much more patient information with the private and independent sectors in an anonymised form to aid medical research and development. I believe that there are to be discussions with the BMA and other appropriate organisations on that matter to ensure strict safeguards that will instil public confidence. We particularly want to be clear how the Government will judge to which companies they will make that information available and what criteria they will use in those circumstances. I should be grateful if the Minister could update the House on progress on that issue.
Earl Howe
My Lords, I am very grateful to the noble Baroness for her broad welcome for this group of amendments. She is absolutely right: they improve the provisions for patient confidentiality and, at the same time, the sharing of information where that is appropriate. I also welcome her endorsement of our approach to the information centre, which, as she rightly said, was set up under the previous Government and, we believe, has proved its worth in the mean while.
She asked a number of questions. On the first one, relating to consultation, yes, we will work with a range of groups in developing the code and will publish proposals in due course. On her other questions about the mechanisms for consent and obtaining consent from patients who are unable to give it because of mental incapacity, I hope that she will allow me to write a letter to save the time of the House but also because I want to get my answers absolutely correct, and I fear that I would leave important things out if I tried to answer her now.
Baroness Wheeler
My Lords, before the noble Earl sits down, what about the point relating to UK life sciences and the information given to the private and independent sectors?
Lord Newton of Braintree
Having listened to the debate, I differ a bit from the noble Lord, Lord Wills. I have heard enough from the two distinguished lawyers who spoke beforehand to come to the view that my noble friend would be very unwise to rush down this path without more time than whatever there is—less than a week—before the intended Third Reading of the Bill to sort out the issue.
As always, my head has been left spinning by the lawyerly contributions from my noble and learned friend here and my noble friend down there. I just want to raise a couple of innocent layman’s questions that may even be a bit naive but which relate to the point that the noble Lord, Lord Lester, raised: what is the definition of all this?
I observe that the heading of the new clause does not talk about provision at the request of a public body, just provision of certain services, implicitly by anybody, whether or not commissioned by a public body. The first sentence reads:
“A person who is commissioned to provide”,
these services, undefined. Private people commission private services from private bodies in many areas—private hospitals, private residential care homes, private chiropodists, private this, that and the other. As far as I can see, the amendment extends the definition of public body to bodies that are not public by any reasonable definition and are not commissioned by public bodies to provide a service. That seems to me to be the natural construction. This is at least as much a question for the noble Baroness, Lady Greengross, as for the Minister, but that is how I read it. If that is its purport, it is not sensible and we should not rush into it.
Baroness Wheeler
My Lords, these Benches strongly support the amendment tabled by the noble Baroness, Lady Greengross, and the noble Lords, Lord Low and Lord Rix, to which I have added my name. It is frustrating that we appear to have moved no further forward from Committee, when the noble Baroness, a plethora of respected organisations representing older people, mental health, disability and human rights organisations, as well as the Equality and Human Rights Commission, were saying that there was a real problem which needed to be addressed by primary legislation. There are powerful arguments for amending the Bill in line with the amendment. They have again been ably made by noble Lords and I do not need to go over them again.
I believe that my noble friend Lord Wills addressed key points raised by the noble and learned Lord, Lord Mackay, and other noble Lords—as far as I was able to follow as a non-lawyer—and indeed acknowledged that this was unfinished business on the part of the previous Government. We amended the Health and Social Care Act 2008 to address this issue in respect of residential care. What has changed dramatically since then is that well over two-thirds of home care services are now provided by the private and voluntary sectors and this Bill is likely to increase the proportion of contracted-out provision still further.
The Government’s view, expressed in Committee, that any further legislation would cause uncertainty in other areas outside health and social care is a strange one. In this light, the obvious counter-argument is that the 2008 Act has already opened the door and, in my view, that factor only strengthens the case for the loophole to be closed off. Analysis by key human rights lawyers, counsel for the Equality and Human Rights Commission, key charities and civil liberties organisations have all endorsed this approach and stressed that case law does not support the Government’s view. As we have heard only recently, the Joint Committee on Human Rights’ report on independent living again called for the current Bill to be amended to extend the public function definition to the provision of care at home. For me, that is the key point. All these organisations still argue strongly that there is a loophole that needs to be addressed.
Moreover, the Government’s argument, again in Committee, that the YL v Birmingham City Council judgment has not been challenged to demonstrate that home care services are not covered by the Act or existing legislation is also weak, in my view, and does not inspire confidence in what might happen in the future. My understanding is that the subject of the YL judgment was residential care and the scope of the 2008 Act is therefore limited to that.
I hope that the noble Earl will have good news for us that the Government have rethought this issue and recognise the very real problem and concern that exist for the future. I hope that he will accept this amendment. We all agree about the importance of taking a human rights approach to care provision, with dignity and respect for older people embedded. The current loophole in the provision of personal care in the home by third or voluntary sector providers is of deep concern to thousands of recipients of home care. We need to ensure that this key opportunity to achieve clarity in this matter in the current Bill is not missed.
Earl Howe
My Lords, we have heard many excellent speeches in this debate, not least from the noble Baroness, Lady Greengross. I know that the noble Baroness and all those supporting her are motivated by a determination to ensure that everyone who uses publicly funded health and social care services is protected from abuses of their human rights. I want to make it clear that I absolutely share that determination.
It is crucial that we ensure that vulnerable people are protected, no matter what age they are, no matter whether they have a disability, and no matter where they happen to live or where they happen to be at any given time. The requirement for people to have their human rights protected and respected is not negotiable. This is absolutely fundamental in a civilised and democratic society. The question we have before us today is how best to achieve that, and whether the proposed amendment would help or hinder us in doing so.
Amendment 292A is intended to provide certainty about the coverage of the Human Rights Act with respect to healthcare and home care providers. I understand the noble Baroness’s arguments for her amendment, and I completely agree about the importance of the Human Rights Act and the public sector equality duty. It may provide reassurance if I state clearly and unequivocally that the Government’s view is that all providers of publicly funded health and care services should indeed consider themselves bound by the Act and the duty. This is the position that we expect private and third sector providers to follow and the position that we would argue for if a case were to be brought; and we think there are good arguments with which a court would agree.
Of course, legislative provision is far from the only mechanism we have for ensuring protection for those using healthcare and domiciliary care services and for improving the quality of that care. In fact, we would argue that in order to ensure that users of those services are protected from the kinds of tragic abuses that the noble Baroness and others have spoken about so eloquently, we need to focus efforts on changing the culture and practice of services which provide poor care. We are working hard on several fronts to drive improvements in the way that people, including older people, experience health and social care services. We know that this is essential, and much of it predates the excellent EHRC report that resulted from the inquiry led by the noble Baroness, Lady Greengross.
To offer just a couple of examples of the work that we are doing to this end, we have made the Care Quality Commission responsible for assuring quality of care from April. The CQC will undertake a programme of inspections of 200 home care providers that will specifically look at supporting home care workers, the care and welfare of those receiving home care, and the involvement of people in planning and managing their own care. The new disclosure on barring service will replace the vetting and barring scheme in November this year and will make it easier for home care employers to check the suitability of their staff by providing a seamless service and introducing portable criminal record checks.
We know that legislation has a role, which is why we intend to put adult protection on a firm statutory basis for the first time ever by requiring local authorities to convene and manage local safeguarding adult boards, by legislating for their key roles and responsibilities, and by requiring them to be in touch with and accountable to local communities. We expect to see much better sharing of information and action that will help to drive up the safety and quality of services. The forthcoming White Paper on social care, which we intend to publish later this spring, will set out the broader strategic context not only on safeguarding adults but on improving quality in care services overall. The Government also intend to respond to the Law Commission report on adult social care law by creating a single statute for social care supported by statutory principles which place the well-being of individuals at the centre of the decisions made about people.
To return to the amendment itself, I am afraid that, despite the persuasive case put by the noble Baroness and others, I am not able to support it, and I hope that noble Lords will allow me to set out why. The problem is that while, on the face of it, this amendment simply provides helpful certainty about the coverage of the Human Rights Act with respect to health and homecare providers, in reality it has very serious and unhelpful implications for the wider interpretation of the Act. This may sound like a rather dry, legal argument, but it is an extremely important one with very practical consequences. By stating expressly that providers of healthcare and homecare services were covered by the Act, we would cast doubt on whether all the areas beyond health and social care were covered by it. However we framed it—whether we made it an avoidance of doubt provision or a deeming provision—we would weaken the applicability of the general test, suggesting that a narrow interpretation of the Act was appropriate and raising doubt about the Act’s applicability to all those bodies that had not been specified explicitly in the legislation.
We would also encounter the significant problem, referred to by my noble and learned friend Lord Mackay, of how to ensure that a specific provision of this type did not have the unintended consequence of making the situation less clear with respect to healthcare and homecare services. When noble Lords think of the wide range of services that fall under the banner of homecare services, I am sure they will appreciate the difficulty of drafting legislation that covers all relevant services and avoids any potential loopholes. My noble friend Lord Lester made a similar point. We can see how the proposed amendment, as drafted, makes the situation unclear. It is not clear how it applies to a person receiving care in the home of a family member—a point made by my noble and learned friend—or whether it applies to services provided under direct payment arrangements rather than being commissioned by a local authority or NHS body.
It is for those reasons that the Human Rights Act is quite deliberately designed to make broad provision that applies to all public bodies across the whole range of services. As my noble friend Lord Lester said, the Act is very carefully put together. Any amendment of the Act must be done by looking at it in the round, otherwise we risk destabilising its careful construction. That brings me to another point mentioned by my noble friend Lord Lester.