Children and Families Bill

Debate between Lord Low of Dalston and Lord Rix

Wednesday 5th February 2014 Lords Chamber

[Lord Rix (CB)]

My Lords, I warmly welcome the government amendments to Clauses 37 and 51 on social care and redress. I thank the Minister and officials most warmly for listening to the arguments from across the House and the sector and for improving the Bill accordingly. The government amendments move us closer to the holy grail of integrated education, health and social care.

Making it clear that the provision of social care is on a statutory footing in their plans will undoubtedly aid children and young people with a learning disability and their families. The change, I hope, will mean that social care is not at risk of being an afterthought or an appendix as is currently the case in many statements.

I further thank the Minister and his officials for listening to us on the issue of a single point of appeal and for the commitment to conduct a review and pilots. As is always the case with these things, clarity is needed in a number of areas on the detail and I understand that the Special Educational Consortium and Every Disabled Child Matters will write to the department on this matter. I confirm with the Minister that the pilots will look at the possibility of hearing both appeals and complaints on education, health and care, not only complaints.

With that said, I thank the Minister again for making important and positive changes to the Bill.

[Lord Low of Dalston (CB)]

The Minister was kind enough to mention me as having taken part in the discussions on the subject to which the amendments relate, and I follow my noble friend Lord Rix in warmly welcoming the amendments to Clause 37 that the Minister has tabled. They go a long way towards dealing with the point that we raised about the language used to describe the social care required. By referring to the Chronically Sick and Disabled Persons Act, they also go a long way towards addressing the question about enforceability.

To my regret, I have to be somewhere else shortly and will not be able to take part in the debate on the other amendments, so I shall take this opportunity of expressing my appreciation not only to Ministers but to their officials for the extensive way in which they have taken part in discussions throughout the lengthy passage of the Bill, and responded fully to many of the points raised. Obviously it is not appropriate at this point to refer too far forward to other subjects of discussion but, as my noble friend Lord Rix mentioned this, I may perhaps be permitted to say that I too very much welcome the package of government amendments on the review of the appeal process. There were obviously considerable difficulties in implementing the single point of appeal, which we were arguing for, right here and now, so the Government have taken the right course in agreeing to set up a review. I look forward to welcoming the outcome of that review in due course—but that is for another day. Today, I simply warmly welcome both the government amendments and—if I may be permitted to do so—the considerable number of additional amendments that the Government have tabled, and express my warm-hearted appreciation both to Ministers and to the officials who have backed them up in the production of the amendments. I also thank them for their flexible response to the debates on the Bill in general.

Children and Families Bill

Debate between Lord Low of Dalston and Lord Rix

Tuesday 7th January 2014 Lords Chamber

[Lord Rix (CB)]

Noble Lords will have noticed, no doubt, that Amendment 38 would place a duty to deliver the social care element of the forthcoming education, health and care plans, which gives me an excuse to indulge for a short time in a worry that has bothered me for more than 30 years. In the 1980s, I began to have discussions with civil servants, politicians and administrators, particularly at the old DHSS—then located at the Elephant and Castle—about increasing co-operation between education, health and social care, and was told on many occasions that this was the recognised way forward. The will seems always to have been there, but meaningful co-ordination and collaboration on the ground has failed to emerge. It has been entirely dependent on local circumstance. We need to change that.

To the Government’s credit, they have recognised the problem and have taken the very welcome step forward of amending the Bill so that clinical commissioning groups are under a duty to provide the health element of the plan—but, alas, social care remains the poor cousin. This could easily be remedied by aligning the duty to provide social care services, as laid down in the Chronically Sick and Disabled Persons Act 1970, with the education, health and care plans that appear in the Bill. In this suggestion I am supported by not only my fellow signatories to the amendment but by the Special Educational Consortium and the Every Disabled Child Matters campaign.

Currently, many families do not receive the care they need until they reach breaking point—something to which Mencap drew attention in a recent report of that name. A duty to deliver the care elements of the plan will ensure that children, young people and their families receive services earlier, thus preventing the need for higher levels of support later. I understand that the Government are looking into this matter— something I warmly welcome, if the outcome is correct. I look forward to the Minister’s response. I beg to move.

[Lord Low of Dalston]

My Lords, my name is on the amendment and I wish to give my full support to my noble friend Lord Rix, who moved it. It would place a duty on local authorities to deliver the social care services identified in education, health and care plans. The contention of the noble Lord, myself and the other noble Lords who have their names on the amendment is that there is very little point in assessing a child or young person’s needs, identifying social care needs and putting them in the education and health plan, and then not making the plan enforceable in respect of social care as it is in respect of education provision.

As I think the noble Lord, Lord Rix, indicated, the amendment would add no new duties on local authorities to provide social care in addition to those that already exist. It merely brings together the legislation on education, health and care plans and existing social care legislation. There is currently a misconception that the social care duties in respect of disabled children are not specifically enforceable for an individual child. However, as I think the Government accept, this duty does already exist under Section 2 of the Chronically Sick and Disabled Persons Act 1970. The proposal contained in this amendment would help to correct this misconception.

The Government have argued that a proposal to create an individually owed duty in relation to social care would prioritise one group of children in need over another. However, there is already an individually owed duty to disabled children in Section 2 of the Chronically Sick and Disabled Persons Act, as I indicated, which is not enjoyed by other children in need. We had a good discussion about this in one of the Minister’s meetings with Peers, which I think we all found very valuable in developing our understanding of the Bill. I think we managed to elucidate in that discussion that if one were going to establish priorities between different groups of recipients of social care, it would have to be done at a prior stage to the formulation of the education, health and care plan. If the authority has got to the point of identifying social care needs and putting them in the plan, it really does not make any sense in terms of integrated education, health and social care provision not to make the provision identified in the plan enforceable.

--- Later in debate ---

[Lord Rix]

My Lords, Amendment 40A, supported by my noble friends Lord Low and Lady Hollins, seeks to create a single point of appeal across education, health and care. If we are to create a joined-up system across education, care and health, we must apply the same principle to an appeals process. The case was well made by noble Lords in Committee, and I know that the Minister sympathises with the arguments.

My concern is for parents whose sons and daughters have profound and complex needs that cut across education, care and health. If in September this year the provision set out in the plans is not up to scratch, parents could end up appealing left, right and centre, across three very different cultures—from the SEN tribunal, to the health ombudsman and on to the social care chamber. Ultimately, this is about making the system run smoothly so that parents can get on with just being parents—often, as I say, to children with the most complex needs. I fear that unless we do something, parents will remain knee-deep in a quagmire of different agencies, desperately battling for support so that their sons and daughters can, rightly, achieve their aspirations.

The noble Baroness, Lady Hughes, has tabled an amendment that could see a review looking at the feasibility of bringing appeals for education, health and care together. It seems that it is a case of fix now or fix later. For the sake of disabled children and young people, and their families, I hope that whatever the outcome, the fix is soon. I beg to move.

[Lord Low of Dalston]

My Lords, I have my name on the amendment and give my noble friend Lord Rix my full support in moving it. The case seems self-evidently made and I do not wish to add a great deal to what my noble friend has said.

The raison d’être of this legislation, by and large, is the Government’s attempt to sweep away the barriers of bureaucracy which, it has been well attested, have come between parents, families, children and young people and the assertion of their rights in relation to special educational provision. The Government have, very laudably, brought forward this legislation to try to tackle some of those barriers by developing an integrated system of provision through the integrated education, health and care plan.

We said in relation to an earlier amendment that it does not make much sense to put things in an education, health and care plan and give people the right to enforce provision only in one or maybe two areas but not a third. Equally, it does not make any sense to create an integrated system of provision using education, health and care plans, with a view to sweeping away barriers of bureaucracy by putting in place an integrated system of provision, and then give people a wholly unintegrated system of enforcing their entitlement to what is specified in those integrated education, health and care plans.

Care Bill [HL]

Debate between Lord Low of Dalston and Lord Rix

Wednesday 3rd July 2013 Lords Chamber

[Lord Rix]

My Lords, I wish to speak to Amendment 79D, which focuses on preventing adults at risk suffering abuse or neglect. I welcome the focus in Clause 1 on promoting well-being and the breadth of that definition, which includes protecting people from abuse and neglect. In addition, Clause 2 sets out an important duty whereby a local authority must take steps and provide services which contribute to preventing needs for care and support. However, this crucial clause on prevention makes no reference to abuse and neglect, and my amendment seeks to make this explicit.

Later in the Bill, in the safeguarding section, there is a focus on protecting people once that abuse or neglect is suspected. However, it would be hugely beneficial if local authorities and agencies were obliged and guided to prevent abuse and neglect taking place in the first instance.

Let me give you an example. Decisions were taken to send people with a learning disability and challenging behaviour far away from their homes to Winterbourne View, where they suffered the most horrific abuse. This could clearly have been prevented by local authorities and other agencies if they had taken the right decisions at the outset.

Prevention is recognised also in terms of disability-related harassment, and indeed the Equality and Human Rights Commission highlighted this in its report, Hidden in Plain Sight. It recommended that local authorities and housing providers work from the outset to reduce disability-related harassment by including safety and security measures in the design of social housing estates and facilities. In addition to good decision- making at the top, it is also important to consider how we can empower individuals to understand what abuse is and how they can protect themselves from it. This might be through providing information, advice and advocacy. Safeguarding procedures are vital in order to protect people suspected of abuse and I have tabled a number of amendments on this area under Clause 41. However, before safeguarding comes a strong commitment to preventing abuse occurring in the first place. I look forward to the Minister’s view on this matter.

[Lord Low of Dalston]

My Lords, I was waiting to see whether the noble Lord, Lord Hunt, was going to speak to his amendments in this group—

Health and Social Care Bill

Debate between Lord Low of Dalston and Lord Rix

Tuesday 13th March 2012 Lords Chamber

[Lord Rix]

My Lords, I wish to support Amendment 292A, tabled by my noble friend Lady Greengross. As I am sure your Lordships will appreciate, I approach this issue from the perspective of people with a learning disability and would argue that the provisions of the Human Rights Act should be universally applied and not dependent as to whether an individual receives personal care in a residential setting or in their own home. Such a disparity is both unfair and unjustified, and it is right that we take the necessary steps to clarify matters.

For example, let me remind your Lordships of the appalling abuse highlighted by the BBC’s “Panorama” programme in May of last year. Winterbourne View, near Bristol, was a privately owned assessment and treatment centre where residents with a learning disability were subject to an horrendous culture of ongoing bullying combined with physical and psychological abuse.

I make reference to the abuse at Winterbourne View because, following an amendment in 2008 to the then Health and Social Care Bill, which is now the Act, the law was changed to ensure that care homes in the private and third sectors, when providing care that is publicly commissioned, were within the scope of the Human Rights Act. This was the correct step to take and ensures that all legislation, regulations and guidance regarding personal care which is publicly commissioned and provided for in residential settings is underpinned by the tenets of the Human Rights Act.

For those who face the ongoing consequences of prejudice and discrimination every day of their lives—such as people with a learning disability—the Human Rights Act can have benefits that go well beyond the preconceptions of those who are eager to dismiss it as a dangerous irrelevance. However, while the individuals concerned who suffered abuse in Winterbourne View or any other residential setting are able to turn to the Human Rights Act in seeking recourse for what occurred, if a similar type of abuse happened while they were receiving publicly funded personal care within the parameters of their own home, it may be assumed by victims, local authorities and others that they would not be able to do so due to the lack of clarity. This is self-evidently a completely unacceptable state of affairs and we should not be willing to tolerate such an absurd inconsistency. I would also add that if the CQC had the resources to undertake a greater number of unannounced inspections in all residential settings, it would be easier to identify abuse at an even earlier stage.

When applying the Human Rights Act the principle question must be, “To what extent has an individual’s human rights been violated?”. It should not be, “Under what type of roof did the alleged abuse take place?”. In my view, abuse is abuse is abuse, and it is as simple as that. Respecting an individual’s human rights should be universally applied and not subject to arbitrary levels of determination, such as the situation in which we currently find ourselves.

The Government claim that the loophole does not exist and so there is no need for the matter to be clarified in the way that the amendment requires. What is not in doubt is that, under the current circumstances, it is explicit under statute that when receiving publicly funded personal care services in residential settings, an individual’s human rights can be upheld via the Human Rights Act. However, when that care is received in their own homes, the situation is much more ambiguous and less certain. Therefore, I remain hopeful that the support of Ministers for this amendment will be willingly and freely given.

[Lord Low of Dalston]

My Lords, I have put my name to this amendment because it seems very clear to me that we do need legislation to clarify the uncertain state of the law relating to the provision of health and social care services commissioned from the private and voluntary sectors. We know how we got to this point. Despite the intention of the then Government that responsibility under the Human Rights Act should generally follow the outsourcing of state functions, in the case of YL v Birmingham City Council the House of Lords held that a private company providing residential care under a contract with a local authority was not carrying out a public function for the purposes of the Human Rights Act. This human rights loophole was closed by Section 145 of the Health and Social Care Act 2008, but only for residential care services. The YL case did not directly deal with the question of health or home care services contracted out by the NHS or local authorities, so neither did the Health and Social Care Act 2008 in seeking to undo the YL decision. Thus there remains a lacuna in the law which needs to be addressed.

During the debates on this Bill in Committee, and in a subsequent letter to Peers, the noble Earl, Lord Howe, raised no objections to the Human Rights Act applying to home care provided by private and third sector organisations. Indeed, his letter maintained that publicly commissioned home care is already covered by the Act.

Similar considerations apply in relation to healthcare, because the current Health and Social Care Bill will mean more independent providers being commissioned to provide NHS services. In correspondence with the Joint Committee on Human Rights, the Government raised no policy objections to the Human Rights Act extending to outsourced NHS services. Indeed, here too the Government have indicated that providing outsourced NHS services already qualifies as a public function under the Human Rights Act, so there is no need for the law to be clarified.

The Equality and Human Rights Commission, after exhaustive legal analysis, has concluded that the matter is by no means so clear-cut. I have a detailed legal briefing here, but your Lordships will be relieved to hear that I do not intend to read it out.

Welfare Reform Bill

Debate between Lord Low of Dalston and Lord Rix

Tuesday 17th January 2012 Lords Chamber

[Lord Rix]

My Lords, as Mencap has just been mentioned, I would very much like, as president of Mencap, to thank the Minister and his colleagues for accepting this situation and the Low report. I congratulate my noble friend Lord Low on his splendid research into this problem. It is wonderful to hear the Government’s change of tack. I notice that the Minister mentioned hospitals, but I was busy chatting to the noble Baroness, Lady Hollins, at that moment. Did he mention children? I was not quite sure what the position was going to be regarding children—over 16 and under 16—in regard to this mobility component. However, apart from that, we are very satisfied in Mencap. I would like to thank, both personally and on behalf of Mencap, the Minister and his colleagues for this change of heart.

[Lord Low of Dalston]

My Lords, I promised the Minister earlier on that if he just waited long enough, sweetness and light would break out. The fact that the noble Lord, Lord McKenzie, and I have our names on another amendment in this group enables me to tell him that we have now reached that point.

There is more joy in heaven over one sinner that repenteth than over 99 just persons who need no repentance. For that reason, I greatly welcome the Government’s decision to drop their proposal to withdraw the mobility component from those living in residential care. I have been given some credit for bringing this about with the review that I was asked to lead by Leonard Cheshire Disability and Mencap, but I think, in all honesty, I must disclaim this. Half of that is because I had a very good team working with me, supported by an extremely able and hard-working secretariat from both organisations; and half because I think Ministers, to their considerable credit, largely came to their decision of their own accord. Perhaps I may have provided a little cover for a U-turn—if so, I am glad to have been of service.

It would be tedious if I were to start recycling all the water that has now flowed under the bridge by rehearsing the considerations that led both the Government and my review to come to the conclusion that it would not be appropriate to withdraw the mobility component from those living in residential care. Probably the most significant of them, as has been mentioned, was that we could not detect any evidence of the double funding that was thought to exist and the Government could not either.

The Government can be proud of the fact that on this occasion, when faced with the evidence that did not support their initial conclusion, they had the grace to acknowledge the fact and reverse that initial conclusion. This is very much to be welcomed and a matter for congratulation.

Health and Social Care Bill

Debate between Lord Low of Dalston and Lord Rix

Thursday 15th December 2011 Lords Chamber

[Lord Low of Dalston]

My Lords, I rise to move Amendment 317AA and shall also speak to Amendment 317AB, 336B and 336C and 318BA to 318BC, which are in the name of the noble Lord, Lord Whitty.

The Bill contains a number of provisions which relate to the handling of information by various bodies. Amendments 317AA and 317AB relate to HealthWatch England and Amendments 336B and 336C relate to health and well-being boards. Amendments 317AA and 317AB come in Clause 178 and seek to strengthen the safeguards against HealthWatch England publishing information which relates to the private affairs of an individual.

The Bill already contains some safeguards, but I do not believe that they are adequate. Clause 178(4) states that,

“any matter which relates to the private affairs of an individual”

and,

“would or might seriously and prejudicially affect that individual’s interests”,

should be excluded from the reports that HealthWatch England is empowered to produce. But it states that information should be excluded only when it “seriously” prejudices an individual’s interests, not if it prejudices their interests less than seriously—and who decides what is serious and what is prejudicial—and that it should be excluded only “so far as practicable”. It is not clear to me why information that relates to the private affairs of an individual should be published at all. It seems to me that the prohibition should be absolute and that, in Clause 178, proposed new Section 45B(4) should simply read:

“Before publishing a report under subsection (1)(b) or (3), the committee must exclude any matter which relates to the private affairs of an individual”.

That is what Amendments 317AA and 317AB would bring about. Paradoxically, this is a case where no safeguards would be better than the inadequate ones we have in the Bill.

Similarly, health and well-being boards are given wide powers under Clause 196 to request information—powers that are clearly wider than they need to be. As the Bill stands, a health and well-being board can ask a local healthwatch organisation for details of people who have complained or raised concerns about a service and, as the Bill stands, a healthwatch organisation would be obliged to disclose that information. Amendments 336B and 336C would stipulate that no information be requested which would require the disclosure of personal information within the meaning of the Data Protection Act.

The noble Lord, Lord Whitty, will speak in more detail to Amendments 318BA, 318BB and 318BC, which come in Clause 179, but I would like to indicate my support for these amendments. I am aware of concerns that have been raised about the independence of local healthwatch organisations arising from the fact that they will be both funded by and accountable to the local authority. It is explained in paragraph D35 of the integrated impact assessment that this is based on the importance of localism. Paragraph D106 of the integrated impact assessment states:

“There is a risk that tying local HealthWatch into local authorities could reduce their independence and effectiveness”.

So it seems that the imperatives of localism trumped those of independence and effectiveness.

The integrated impact assessment goes on to recognise that the duty on local authorities to fund local healthwatch arrangements may be perceived as giving rise to a conflict of interest for local authorities, given the role of local healthwatch organisations in relation to scrutiny. It is stated that work is under way to map out the concept of independence for local healthwatch organisations, and to use this to promote the arrangements as accountable to local government for performance and to local citizens for the issues raised with commissioners and providers, but we do not know the outcome of this work as yet. The Bill does not provide any detail on the membership of local healthwatch organisations. It is left to regulations to specify who makes appointments to these bodies, and how. It would be extremely helpful if the Minister could give some indication of how this separation of accountabilities, which is evidently envisaged, is to be realised and institutionalised.

In any case, however, the fact that the local authority holds the purse strings remains a risk to the independence of local healthwatch. There is therefore a strong case for local healthwatch organisations not to be funded by the local authority. The argument that the importance of localism requires accountability is not as strong as the need to have effective, independent local services. These amendments would make local healthwatch organisations responsible for their own activities and accountable only to HealthWatch England, rather than the local authority, but I fear the risk from local authority control of the purse strings would still remain.

[Lord Rix]

My Lords, I shall speak to Amendment 324, tabled in my name and those of my noble friends Lord Tenby and Lord Wigley, in this rather Christmas stocking grouping of amendments. This regards the provision of independent advocacy services for people who are in the process of making a complaint against the NHS. This amendment is particularly relevant to the needs of disabled people, including those with a learning disability, and I would like to take this opportunity to declare an interest as president of the Royal Mencap Society.

For those who are unfortunate enough to encounter it, the NHS complaints system is deeply flawed and ineffective. It is complex in its make-up and lengthy during the course of its deliberations. I welcome the Government’s proposal for local authorities to make appropriate provision to support people in the complaints process, through the use of advocacy services. Effective and high-quality advocacy services are of course an essential prerequisite for many families to secure the answers they want and the justice which they really require.

Without this amendment, there is a risk that advocacy support could be started and then abruptly halted some time before any conclusion to the ongoing complaint which has been made. As I have already mentioned, the NHS complaints system is a lengthy and complex process and the level and scope of advocacy support made available by local authorities should reflect this.

I am also aware that in some cases advocacy support services have been denied to families, as the level of support deemed necessary has been regarded as too onerous and burdensome on the provider. This is an unacceptable state of affairs, where people are denied the help they need on the basis that they may need too much help. At a time when families could be dealing with the emotional upheaval and distress of coping with the loss of a loved one, any uncertainty about the level and period of advocacy available to them is, to put it somewhat generously, an unhelpful distraction. This is why I believe it necessary to ensure that advocacy support during the NHS complaints system is not restricted in length and type for those families who need it. This amendment would help to provide such a guarantee.