Care Bill [HL]

Debate between Lord Campbell-Savours and Baroness Emerton

Tuesday 9th July 2013 Lords Chamber

[Baroness Emerton]

My Lords, I support the amendments of the noble Lord, Lord Best. I also support what my noble friend Lord Rix said about closing the large institutions and providing the necessary housing. The reason the necessary housing could be found, either through charities or local authorities, was that it was clearly spelled out in government policy. I therefore strongly support the need for this provision to be in the Bill. Without that background, I would have found the job of closing two large institutions extremely difficult, because there was resistance from local authorities and local communities to providing suitable accommodation. However, as it was government policy, we were able to persuade and influence the local authorities to do it. Therefore, I support the amendments in this group.

[Lord Campbell-Savours]

My Lords, I will speak primarily to Amendment 88, in the wider context of Clause 9, and put an idea to the Minister that dawned on me during conversations with local authorities that are faced with problems in this area. Clause 9 deals with the assessment of an adult’s needs for care and support. It states:

“Where it appears to a local authority that an adult may have needs for care and support, the authority must,”

carry out an assessment. The clause goes on to list what the assessment must include. Amendment 88 would add,

“housing options to contribute to the achievement of those outcomes”.

What struck me as an outsider looking into these matters is that, irrespective of the changes to which the noble Lord, Lord Rix, referred, problems still arise where elderly people—perhaps in their 80s, 90s or whatever—have to transfer out of their homes, which they may well own, or from hospital into some kind of care environment, perhaps a nursing home. I wonder whether it would be possible for that process to be made more seamless in circumstances where a local authority took on the responsibility of marketing—I shall come on to what I mean by “marketing”—the home for sale, clearing the home and making all the arrangements for the transfer of that resident, be it from their home or from hospital, into a care environment.

It may be that a local authority could offer a package. At the moment, that package, in part, is offered by some of the charities. I have spoken to charities, such as Age Concern, which carry out various components in this process of transfer but I wonder whether money could be raised by local authorities through taking a proportion of the commission on the sale of properties by estate agents. In other words, a local authority would advertise within its area and estate agents could tender for the right to handle the properties for which the local authority took responsibility in this process of seamlessly transferring people from their homes to a caring environment.

As estate agents would not necessarily know whether they would get that business if it was organised in the wider market, if they knew they were going to get all the business provided by the local authority—in other words, that they would be the estate agent responsible for carrying out the process of transfer in a particular district—they might be prepared to share their commissions with the local authority because they had access to business which they might not otherwise have had. It would provide a revenue stream.

As we introduce amendment after amendment to the Bill, I keep thinking, “Where is the money coming from?”. It has to come from somewhere. It is all right Parliament passing legislation placing all these new responsibilities on authorities but, at the end of the day, the local authority has to find a way of raising the revenue. If local authorities could somehow attach themselves to the revenue from the sale of houses, it might well provide an income stream—and what better way to do so than to provide a package for the seamless transfer of the elderly into a more caring environment? I put it simply as a proposition that the Minister might wish to consider over time.

Care Bill [HL]

Debate between Lord Campbell-Savours and Baroness Emerton

Monday 10th June 2013 Lords Chamber

[Lord Campbell-Savours]

My Lords, I should like to say a few words. My experience in all this is very much as a layman and as a tri-weekly visitor to see my mother in a nursing home. In discussion with health assistants working in the nursing home, I have found that there is a transfer between hospital settings and social care, and there are clearly disciplines and learning requirements that apply in both settings. Sometimes, in either setting, you see people who would have benefited from the training available in the other setting, particularly in the area of elderly care. To take nutrition, cleanliness and the changing of bedding, clearly the same standards apply. Often, simple tasks require a common training programme. I hope that the Minister takes the amendment very seriously.

[Baroness Emerton]

I entirely support the amendment on integration, particularly across the boundaries between acute and primary care. When we consider discharge policies and mechanisms, it is terribly important that those working in the acute sector understand what they need to look at to integrate with the services that will take over the care. There is division where, through the education programme, we need a holistic approach to the patient pathway.

--- Later in debate ---

[Baroness Emerton]

My Lords, I will make a few comments on the contributions made so far by noble Lords. During the passage of the Health and Social Care Act I was very strongly in favour of the regulation of healthcare support workers. We have moved on in time, and in terms of the setting up of Health Education England and the role that the other bodies are taking. There is no doubt about all the points made by my noble friend Lady Greengross, and those about Winterbourne View and people being given prison sentences; most of them were registered nurses, not support workers. We want to ensure the safety of patients. For various reasons the Government now take the view that regulation is not possible through the Nursing and Midwifery Council. Regulation is possibly a step too far at this stage.

The Francis report recommended the creation of a registration system, under which no unregistered person should deliver care to a patient, whether that be in the community or in hospital. I agree that we need to have some form of certification, and some form of safeguard that will ensure that anyone delivering care will be able to be examined. Amendment 23A, which is grouped with Amendment 23, further sets out my view, which is shared by the noble Lords, Lord Willis of Knaresborough and Lord Patel, that basic training should be given with certification, and that it is important that employers take that into account.

[Lord Campbell-Savours]

My Lords, from what I hear and from what I have been told, the problem seems to be that no one wants to do this job. A number of organisations have been approached, and many of them have made it clear that registration would be an impossible task. However, when you talk to healthcare assistants in nursing homes or wherever, you find that among them are some who strongly believe in it, because they want to see weeded out the people who they believe should not be practising. If they want it, and they believe that it potentially defends their professional position, why can they not be given some organisation, some kind of structure to which they can belong and be registered with, which would give them confidence within their working conditions?

I understand that the Government’s response will be the vetting and barring scheme. However, despite that scheme, there is still strong support for the principle of a registration scheme. Perhaps the Minister might give his response to that, setting out the reasons why some people do not have confidence in this vetting and barring system.

Finally, in the event that we do not make progress on this matter during the course of this Bill, the best way to deal with it might be to refer it to the Liaison Committee when it is next considering applications for ad hoc committees. Perhaps those who are interested in this subject can make a joint application to the Liaison Committee to set up a House of Lords inquiry into what the blockage has been historically, what the benefits would be, and to look at the way forward in the future.