Care Bill [Lords]

Debate between Baroness Laing of Elderslie and Norman Lamb

Monday 10th March 2014 Commons Chamber

[Norman Lamb]

I am sorry; I must ensure that I get through all the amendments.

On new clause 13, I am clear that the current lack of good information on deferred payment agreements is not acceptable, given the importance of the scheme. That is why we are working with national partners in local government and the National Association of Financial Assessment Officers to develop a range of questions that will improve and expand the data we already have. The new clause is therefore unnecessary as we already have plans under way to achieve a similar goal.

On new clause 4 on local authorities making “reasonable charges”, the Government’s proposal to set a clear amount beyond which a person’s income cannot be reduced is much clearer and provides stronger protection. I have written to my right hon. Friend the Member for Sutton and Cheam and other Committee members on this subject, and I would be happy to share the letter with other Members. I have nothing to add to that analysis and do not agree that the new clause is required.

On amendment 21 and new clause 15, the Bill makes it clear that local authorities must work to maintain a sustainable market that delivers a wide variety of high quality services for people who need care and support in the local area. Local authorities’ own commissioning is an important part of this process. Additionally, local authorities will have to have regard to the well-being of individuals when commissioning services. Therefore, any local authority that commissions inappropriately short care visits or does not consider the actual cost of care when setting fee levels is highly unlikely to be fulfilling their duties. These matters will be set out fully in statutory guidance. It would not be appropriate to have a nationally set formula that would lead to standard rates or “tariff prices” for care and support, as this is best left to local negotiations in the open market.

On new clause 24, local authorities are already under a duty to work with their local clinical commissioning groups and others through the health and wellbeing boards to undertake joint strategic needs assessments and to develop joint health and well-being strategies. Statutory guidance published in March 2013 makes it clear that these must be published and have specific regard to

“what health and social care information the community needs, including how they access it and what support they may need to understand it”.

Awareness-raising will be an important part of the Bill’s implementation. The Department will co-ordinate involvement of wider interests, including local authorities and the private and voluntary sectors, to raise the public’s awareness of the new arrangements, specifically on the need for people to plan for care costs. We will add to what is already available to monitor the effectiveness of information and advice, public accessibility and public awareness.

On new clauses 22 and 23 about financial advice, the Financial Conduct Authority already has a responsibility to keep under review the financial advice market as regards how it is serving customers, and qualifications for advisers, and this includes those looking to fund long-term care costs. These requirements are published in FCA rules. Such an addition to the Bill would therefore be unnecessary.

I understand the intention behind new clauses 17, 18 and 32—it is to ensure fair payment for care sector workers. In response to the Cavendish review, statutory guidance for the Bill will include guidance to local authorities on commissioning services and arranging contracts that will explicitly require them to have regard to ensuring that provider organisations adhere to minimum wage legislation, including, crucially, the payment of travel time between social care visits. We are also working closely with Her Majesty’s Revenue and Customs to ensure that the national minimum wage guidance is appropriate to the care sector. We have amended the Bill to enable specified bodies to provide training standards for groups of workers, initially focusing on health care assistants and social care support workers. This will form the core of the new care certificate.

New clause 31 is outside the remit of Health Education England, which has a delegated duty under the National Health Service Act 2006. The duty relates to education and training in relation to persons working, or considering working, in connection with the provision of services as part of the health service in England. The duty does not extend to regulated social care, which is taken to mean social care delivered by providers registered with the Care Quality Commission.

On new clause 5, given the inherent complexity presented by the different legislative frameworks operating in the different territories of the United Kingdom, we will look to develop principles on cross-border continuity of care that achieve the same practical effect as further legislation. I absolutely agree with the hon. Member for Edinburgh East (Sheila Gilmore) about the importance of this issue. We have started discussions with colleagues in the devolved Administrations and we will aim to publish the principles by November. I hope that that helps her.

On new clauses 3 and 19 about NHS work to identify and promote the health of carers, I can confirm that the guidance will absolutely reinforce the importance of co-operation between the NHS and local authorities on local authorities’ duty to identify carers. NHS England is developing its own action plan for identifying and supporting carers. In addition, our vision for out-of-hours hospital care, which will be published in April, will build on changes to the GP contract for 2014-15. All patients aged 75 and over will have a named accountable GP with responsibility for their care, and we will consider how we can extend this approach to all people with long-term conditions. The plan will emphasise the importance of GPs identifying carers and supporting them in their caring role by directing them to information, advice and support.

On new clauses 20 and 21, a legislative approach that compels schools, universities and colleges to identify young carers and student carers would not be in keeping with the Government’s drive to reduce burdens. The Department for Education has already been doing a lot in this regard, and it is now working with the National Governors Association in raising awareness in schools. The Department of Health has invested in many initiatives to help to identify and support young carers. We have trained over 150 school nurses as young carers’ champions. Along with other Departments, we will also explore the factors that are challenging in young adult carers’ transition from school to college or university. Along with ministerial colleagues, I will shortly write to Universities UK and the Association of Colleges to seek their engagement in this work.

Amendment 20, tabled by the hon. Member for Islington North (Jeremy Corbyn), is not required because the scope of the new powers in clause 12 already allows for the collection of such information if we choose to require it.

On amendments 31 to 33, we have carefully considered the issue of time frames in the care planning process, including reviews. On balance, we feel that a flexible approach is best. It is important for local authorities to retain the ability to be proportionate to the needs to be met. For some people—[Interruption.]

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. The Minister must be heard. Hon. Members are being rude in speaking.

[Norman Lamb]

Thank you very much, Madam Deputy Speaker.

For some people, the care planning process may be relatively simple, but for people with complex needs it is important that the plan is carefully produced and agreed with the person in order to meet their care and support needs effectively and appropriately.

Accident and Emergency

Debate between Baroness Laing of Elderslie and Norman Lamb

Wednesday 18th December 2013 Commons Chamber

[Norman Lamb]

Thank you, Madam Deputy Speaker.

The then Secretary of State, now the shadow Secretary of State, missed the target in this very week when he was in charge. We know that the winter is tough, and that performance always dips at this time of year. We also know that the staff are under a lot of pressure. The truth is that we inherited a dysfunctional system that was crying out for reform, with too many people ending up in hospital because of crises in their care, as my hon. Friend the Member for Bracknell (Dr Lee) made clear. For years, I have argued the case for a different approach.

We are supporting the NHS to enable it to manage better in the short term. For this winter, we are investing an additional £400 million in total—more than ever before. In the longer term, we need to look afresh at how we organise urgent care. That is why Bruce Keogh’s report into urgent and emergency care is so important, and I hope that the hon. Member for Mitcham and Morden (Siobhain McDonagh) will accept the case for a clinically led review in order to achieve the right approach. We will work closely alongside NHS England in putting these reforms into practice. The hon. Member for Stretford and Urmston (Kate Green) was absolutely right to say that we have to communicate better with the public and ensure that the process is a good one.

In the longer term, we need to do more to prevent people from ending up in hospital as a result of avoidable crises. As my hon. Friend the Member for St Ives (Andrew George) said, we need to make two big shifts. The first involves a move to a much greater focus on preventing ill health and the deterioration of health. The second involves a shift from a fragmented system to one that is integrated and joined up. That is the approach that we must follow.

Integrated pioneers around the country, such as those in south Devon and Torbay, Greenwich and Labour-led Barnsley, are doing great work, joining up care, collaborating with the voluntary sector, providing better care and keeping people out of hospital. That is the vision of the health service for the future. These pioneers will help the rest of the country to make the best possible use of the £3.8 billion better care fund. The fund will encourage organisations: to act earlier to prevent people from reaching crisis point; to offer seven-day services; and to deliver care that is centred on people’s needs. I am grateful to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) for welcoming that important new fund. We are also introducing named, accountable GPs for the over-75s and improving access to general practice.

We are addressing both the short-term and long-term challenges, giving the NHS the support it needs. I want genuinely to thank the excellent staff throughout our health and care services who are tackling these issues head-on. The measures and changes we have outlined today will support staff to deliver the best possible care, even in the most difficult of circumstances.

Question put.

The House proceeded to a Division.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

I ask the Serjeant at Arms to investigate the delay in the No Lobby.