NHS: Innovation
Lord Sharkey Excerpts(8 years, 11 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Sharkey (LD)
My Lords, I, too, congratulate the noble Lord, Lord Wills, on securing this debate and on his compelling opening speech. Like him and all other speakers, I very much look forward to the maiden speech of the noble Lord, Lord Prior, in a few moments. I declare an interest as chair of the Association of Medical Research Charities.
In the context of the NHS, “innovation” has a wide range of applications. It covers, of course, innovations in care and treatment, but also medical research, which is where I shall focus most of my remarks this afternoon. A great many things have changed in the NHS in the last 15 years, as other noble Lords have said. Very significant advances have been made, and many of them are the fruits of the UK’s acknowledged excellence in medical research. We recognised this explicitly in our debates on the then Health and Social Care Bill in 2012, which imposed for a first time an explicit duty on the Secretary of State, NHS England and CCGs to,
“promote research on matters relevant to the health service, and the use in the health service of evidence obtained from research”.
It is generally accepted that the UK’s leading role in medical research is of enormous value to patients and the country. That leading role depends to a very large extent on the active participation and leadership of the NHS itself. The Government recognise that, and so does the NHS. In October last year, the NHS published its Five Year Forward View; this document devoted four pages to innovation, usefully not only setting out aspirations but detailing some of the steps needed to achieve those aspirations. The document explicitly confirmed continued support for the NIHR. That is a very good thing.
The NIHR is, with the AMRC and the medical research charities, one of the key funders of medical research, which in the NHS has undergone a kind of renaissance since the advent of the NIHR. It is all the more impressive when you realise that the NIHR’s budget is less than 1% of the overall NHS budget. That is a much smaller percentage commitment to R&D than is the norm for other knowledge-based organisations. There is a real business case, as I said before, for increasing the NIHR’s budget, apart from compensating for inflation. For every £1 of government and charity spend on health research there is a return of between 37p and 40p every year, in perpetuity. This is obviously a vital area. Could the Minister use his very best efforts to persuade his colleagues that a significant part of the promised extra £8 billion should find its way into the NIHR budget? While I am talking about money, when are we likely to see the guidance on excess treatment costs that was promised for before Christmas?
Despite some progress and good intentions, the research landscape in the NHS is not yet entirely encouraging. Around three weeks ago, Cancer Research UK published a report that it had commissioned entitled Every Patient a Research Patient?. The organisation stole or borrowed the title from the Prime Minister’s own stated aspiration that every patient will be a research patient. However, this report says that it has,
“found mounting and pressing concern”,
about research in the NHS. It identified a number of constraints, including,
“the ability of people to commit time to research, in the face of mounting service pressures … the availability of key skills and experience within the workforce”,
and of course generalised financial pressures.
The Chief Medical Officer, Professor Dame Sally Davies, commented on the report. She said:
“There is considerably more to do to improve the commitment, culture, capacity and capability of the NHS to promote, support and conduct research”.
Are there mechanisms in place to measure progress on the lines set out by the Chief Medical Officer? How will we know when we are making progress?
The final area I shall touch on briefly is data. Patient data, actual and potential, are an almost unimaginably important resource. Proper collection, dissemination and analysis of data will allow the next great leap forward in medical science. The NHS explicitly recognises this and has set up the National Information Board to lead the effort. We need real drive and leadership in this area. As my colleague the noble Lord, Lord Turnberg, said, the debacle over care.data has made progress very much more difficult. The Wellcome Trust noted at a recent hearing of the Health Select Committee on patient data that some researchers funded by medical research charities are experiencing significant difficulties and delays when trying to access data from the Health and Social Care Information Centre. Often these delays are more than 12 months. In some cases, researchers have not been allowed to access data at all, even when patient consent has been given and the data anonymised. I am sure the Minister is well aware that the situation is as difficult as it is urgent. Better use of patient data can lead to significantly better outcomes for those patients. I know the department is aware of this and all the other issues I have mentioned and is aware of the need for an overarching NHS research strategy and is working on that. Finally for the Minister’s list of questions, when does he expect to be able to publish a draft of this research strategy tying all these issues together?
NHS: Clinical Negligence
Lord Sharkey Excerpts(9 years, 4 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Sharkey
To ask Her Majesty’s Government what are the causes of the £3.1 billion increase in the National Health Service’s potential liabilities for clinical negligence to £25.7 billion between 31 March 2013 and 31 March 2014.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, there are several factors behind this increase. These include the rise in numbers of patients cared for and the complexity of their care. In addition, there has been a general rise in litigation across a number of sectors, including the NHS, which is driven in part by no-win no-fee agreements. High costs incurred by claimants in bringing civil litigation have also played a role in the increasing clinical negligence cost and associated provisions.
Lord Sharkey (LD)
In the last five years, NHS spending has grown by 12%. In the same period, liabilities for negligence have actually doubled. With the current rate of growth, they will take only six years to reach around £50 billion. The Medical Defence Union thinks that is unsustainable and has suggested reducing liabilities by changing the law. It suggests allowing courts to take account of the fact that the NHS and local authorities can provide some of the treatments required by successful claimants. Does the Minister agree that this is part of the way forward?
Earl Howe
My Lords, moneys paid in settlement of clinical negligence claims cannot be reclaimed or recycled in the way that my noble friend appears to suggest because, in the nature of NHS care, it is free from the patient’s perspective. We are, however, concentrating on various ways to reduce the number of clinical negligence incidents and, indeed, to improve patient safety, which is of course part of the way in which we can reduce the number of claims in the first place.
NHS: Cancer Diagnosis and Treatment
Lord Sharkey Excerpts(9 years, 7 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Earl Howe
My Lords, the noble Lord is correct that although most waiting time standards are being maintained there has been a dip in the 62-day pathway standard in the last two quarters. However, survival rates are improving and we are treating a record number of NHS patients for cancer. Last year, 450,000 more patients were referred with suspected cancer than in 2009-10. That is an increase of 51%. In addition, campaigns such as Be Clear on Cancer have been exceptionally successful in raising awareness of symptoms. In large part, that is what has accounted for the pressure on the waiting time standards: in a way, the campaigns are a victim of their own success.
Lord Sharkey (LD)
My Lords, it is still true that the chances of surviving cancer can vary dramatically depending on where you live. Can the Minister say what progress has been made in understanding the reasons for those variations and what progress has been made in reducing them?
Earl Howe
My Lords, my noble friend is absolutely right. He will know that medical opinion is clear that a variety of reasons such as lifestyle and others account for regional variations. We want to see a uniformity of speedy diagnosis throughout the country. That depends on early presentation by the patient and speedy diagnosis when the GP first sees the patient. It is with those two things in mind that a lot of work has been going on, particularly to support GPs, but also to inform the public.
Health: Secondary Care
Lord Sharkey Excerpts(9 years, 10 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Earl Howe
The noble Baroness makes a very good point. We know that GPs in many areas of the country are under pressure and we know how hard they are working. It was with that knowledge that we agreed with the profession that we would remove from the GP contract for 2014-15 more than a third of the quality and outcomes framework’s indicators, which GPs told us were taking up too much time and resulting in a bureaucratic burden. The aim of that was to free up more time for GPs. On top of that we have the Prime Minister’s challenge fund of £50 million, which will test out new ways for GPs to give access to patients—for example, through innovative means such as Skype and e-mail.
Lord Sharkey (LD)
My Lords, early treatment is key to improving our low cancer survival rates. Lung cancer remains the biggest cancer killer. It has a 5% 10-year survival rate and 33% of all cases are emergency presentations. What progress has been made on improving early diagnosis?
Earl Howe
My noble friend is right. This is absolutely central to raising our performance as a country in successfully treating cancer. We are doing several things. We have piloted a tool to help GPs to identify patients whom they might not otherwise refer urgently for suspected cancer. The tool covered lung cancer, as well as others. Across England, 502 GP practices took part in the pilot. Initial indications are that the tool is extremely helpful. There is also an e-learning tool that offers accredited professional development for GPs. The Royal College of General Practitioners has also identified cancer as an enduring priority. It is working with Cancer Research UK and other partners in promoting models of best practice.
Public Health Responsibility Deal
Lord Sharkey Excerpts(10 years, 4 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Sharkey
To ask Her Majesty’s Government what progress they have made in persuading further fast food chains to sign up to the Public Health Responsibility Deal pledge on calorie reduction.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
We are working hard to persuade other fast food chains to join the wide range of food businesses which have already signed up to the public health responsibility deal calorie reduction pledge and to sign up to other food network pledges. Eleven fast food partners are signatories of the responsibility deal and are taking action in a range of areas including calorie reduction. These partners cover most of the food sold in the fast food sector.
Lord Sharkey (LD)
I think the Minister will agree that these public health responsibility deal pledges are very useful. Given the dangers of excessive sugar in our diets, will the Minister consider adding a specific sugar-reduction pledge to the current list—with specific targets, as is already the case for salt—and will he help reduce sugar consumption by following the latest advice of Dr Susan Jebb, chair of the department’s public health responsibility deal food network, and removing fruit juice from the five-a-day recommendations?
Earl Howe
My Lords, I shall take my noble friend’s final question back with me. We will certainly look at it. However, I stress that our current emphasis is on overall calorie reduction, of which sugar can form a part. The scope for a reformulation to reduce sugar levels varies widely depending on the food and a reduction in sugar levels does not always mean that the overall calorie content is reduced—for example, when sugar is replaced by starch or other ingredients. The Scientific Advisory Committee on Nutrition—SACN—is currently undertaking a review of carbo- hydrates and is looking at sugar as part of that. Its report will inform our future thinking.
Care Bill [HL]
Lord Sharkey Excerpts(10 years, 6 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Lipsey (Lab)
My Lords, I remind the House of my interest as the unremunerated president of the Society of Later Life Advisers. Why has this matter come up again at Third Reading? It is because there were discussions in progress between the Minister, the two co-signees of this amendment and me, which had not yet concluded and the Minister generously agreed that we could bring it up at Third Reading. I think that the time has been well used. Certainly on the principles of the matter there is now complete accord between the Minister and ourselves. We are all agreed that taking financial advice must not be compulsory but equally we are agreed that it is not enough for the local authority just to hand over a list of names of advisers and say, “Take it from there”. In the fashionable words of today, we are agreed that they have to be nudged into doing what is invariably in their own interests as well as that of the council.
We are agreed that there is an important role for independent, regulated financial advisers in this field. We are agreed—despite the fact that I have tabled an amendment—that there is no need to put this in the Bill: it makes very good sense to spell it out in regulations. However, we are also agreed, and the Minister will confirm this, that it would be valuable, not only for this House but for outside interests, if he were to spell out in a little more detail the Government’s intentions in this regard. We have reached a position of great harmony. I thank him for all the time he and his officials have devoted to it and the sooner the House hears from the Minister, after one or two comments, the quicker this issue will be seen to have been satisfactorily resolved. I beg to move.
Lord Sharkey (LD)
My Lords, I will speak very briefly in support of the amendment. The noble Lord, Lord Lipsey, spoke with his usual clarity in moving the amendment and I shall not repeat his arguments, which seem to me to be compelling. However, I will point out that the amendment now before us is in effect the last remaining part of a discussion that started at Second Reading, continued in Committee and on Report and in private meetings with the Minister and his officials. At the start there were, broadly speaking, two concerns about information and advice. The first was about the Dilnot recommendation that there should be an extensive public awareness campaign about the facts and the implications of the cap. Our concern was essentially about the leadership, the scale and the monitoring of this campaign. I am very grateful to the Minister and his officials for all the discussions that they have had with us over this issue.
Care Bill [HL]
Lord Sharkey Excerpts(10 years, 7 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Sharkey (LD)
My Lords, I will speak to the first part of this amendment, but before I do so I will register my strong support for the remarks made by the noble Lord, Lord Lipsey, a moment ago, especially with regard to the provision of independent and regulated financial advice.
I think it is common ground that the Dilnot reforms will fail unless the public understand what they are and what their implications are. I think it is also common ground that there need to be vigorous communication campaigns to make sure people do in fact know about and understand the implications of the reforms. Where there seems to be a difference between the Minister and those who supported a similar amendment to this in Committee is over who should be directly responsible for ensuring that these campaigns take place and that they have an effective form, and over how their effectiveness is assessed.
The amendment before us gives the Secretary of State a duty to ensure through national public awareness campaigns that there is a high level of public awareness and understanding of the terms and implications of the cap on the cost of care. In his reply to a similar amendment in Committee, the Minister simply noted that the Bill as it stands places a duty on local authorities to provide information and advice, including on the cap system. In later correspondence, for which I am very grateful to the Minister, he expanded on the point. He noted that, first, the funding reforms create a shared interest on the part of local authorities, government and the financial services industry to make sure that people are aware of the reforms and have access to the right information and advice at the right time so that they can plan and be prepared to meet their care and support needs. Secondly, the Government want to act in partnership with these key stakeholders to get this right, building on the effective relationships already established. Thirdly, the Government are seeking views in a consultation on the design and technical implementation of the funding reforms, which includes addressing the best way to proceed to raise awareness of these reforms nationally and locally.
The Minister’s remarks make it clear that there are lots of interested parties in this communications endeavour, but they entirely overlook the question of leadership. A campaign as vital as this needs leadership. I maintain that that leadership can come only from the Secretary of State. Local authorities, almost by definition, cannot easily lead in any national sense. As for the financial services industry, it is convinced that the information campaigns need clear, well defined leadership, and is quite clear that it cannot come from that industry. Who would believe facts on the reforms presented by somebody trying to sell you something? In fact, the ABI has told me that it believes that the public information initiative should be led by the Government. That is what part 1 of this amendment would do—give the Secretary of State leadership and responsibility.
The other areas where the Minister may differ about a communications campaign are how high to set the bar and how to explicitly make it plain that it is not just the terms of the reform that have to be understood but the implications of the terms of the reform. It is not much good being aware of the facts if you cannot work out what the facts mean for you. However, the difference over how high to set the bar for a communication campaign is critical. As the noble Lord, Lord Hunt, pointed out a moment ago, the Bill states only that local authorities must establish and maintain a service for providing information and advice. The Bill does not set any measure for whether anyone actually receives or understands this information and advice. It does not set targets of any kind.
You can easily see a situation in which local authorities can, at least technically, fulfil a duty to provide advice and information without providing much of it, or knowing how many people are reached by it and how many of those reached understand it and the implications it has for them. That would be an entirely unsatisfactory outcome and certainly not what the Government intend. We need to make sure this does not happen and that is what part 1 of the amendment would do. It calls for,
“a high level of public awareness and understanding of the terms and implications of the cap on the cost of care”.
At Second Reading, the Minister said:
“The Government will adopt a strategic approach to maximising the public’s understanding of the new care and support system”.—[Official Report, 21/5/13; col. 827.]
The key word is “maximising”. The amendment gives written substance to the idea of maximisation.
The first part of the amendment contains a paragraph which would require the Secretary of State to publish annually a report on the levels of awareness and understanding of the reforms,
“including the results of a representative poll of adults”.
When we discussed this requirement in Committee and subsequently, the Minister felt that reviews of understanding and awareness would naturally follow in the normal course of things, and I am sure that is the case. However, the special nature of these reforms and the need to be able accurately to measure progress in informing people and keeping them informed calls for a more definite and more regular assessment. The Minister also felt that the kind of annual survey we proposed might be very expensive. I have had extensive experience of these surveys in business over the past 20 years and I can reassure the Minister immediately that the kind of annual survey this amendment proposes would have an essentially trivial cost. That is why, for the sake of clarity, the amendment makes reference to a “representative poll of adults”. This kind of survey would, in fact, cost very little, would be very easy to administer and would be exceptionally quick in delivering results.
I will close by saying that I strongly believe a large-scale national information and advice campaign is necessary for the success of our reforms. I believe that any such campaign must have appropriate targets and that we should see on a regular basis how these targets are being met. I believe that any such campaign must have clear leadership, and that direct responsibility for that leadership should be the duty of the Secretary of State, as the amendment proposes. I very much hope that the Minister will be able to agree with at least some of it.
Baroness Greengross
My Lords, I fully endorse what my two esteemed colleagues said regarding the need for appropriate financial advice. I am still of the opinion that people should be referred to regulated advisers, who are best placed to advise them on the full range of solutions open to them. However, to avoid repetition, I will briefly concentrate on the paragraph in Amendment 20 dealing with other areas of concern about which we have already talked in some depth, such as housing. People with specific medical conditions and complex needs are reliant on suitable housing provision. We should also not forget the needs of their carers in this regard. The local authority will need to engage with agencies and organisations such as the CABs and Age UK in an integrated way. This should be part of providing a relevant local advice and information envelope.
Plainly, there is no point in getting appropriate financial advice if, through no fault of the adviser, faithfully following that advice cannot be guaranteed to lead to good care outcomes. Those outcomes may be consequent upon ensuring that things such as the suitability of the individual’s housing and accommodation are included in any wider fact-finding conducted by the local authority alongside any care or financial assessments it performs. That housing suitability will probably depend on the complexity of the care package that the individual’s needs disclose. Those needs will probably derive directly from the specific set of conditions and symptoms that the individual faces.
No one would expect a local authority to be familiar with every possible combination of health and social circumstances that an individual may face, which is why close working alongside local agencies and organisations such as the CABs and Age UK in assuring the existence of a complete, competent advice and information envelope is so important. Indeed, it is my firm view that the quality of that integrated approach to care management may well be the key determinant on which successful outcomes depend. I urge the Minister to adopt our amendment, as we believe that it would go a long way to ensure more effective and efficient outcomes for both the service user and the taxpayer.
NHS: Children’s Congenital Heart Services
Lord Sharkey Excerpts(10 years, 10 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Sharkey
To ask Her Majesty’s Government what assessment they have made of the recommendation of the Independent Reconfiguration Panel in its report of 30 April on children’s congenital heart services that NHS England must ensure that any new review process properly involves all stakeholders.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, NHS England is taking forward the new national review of congenital heart services as quickly and effectively as possible, basing its actions on the recommendations of the Independent Reconfiguration Panel. I am advised by NHS England that it will ensure that all stakeholders have a chance to contribute to its review. Any decisions must carry the confidence of the public and be focused on the best outcomes for all patients.
Lord Sharkey
My Lords, the now discredited Safe and Sustainable review proposed closing the Royal Brompton Hospital children’s heart surgery unit, yet over the past three years this unit, along with Newcastle, has been the best performing in the country. Will the Minister reassure me that, before there is another proposal to close this or any other unit, he will publish a detailed model showing exactly what factors will be taken into account in any future proposal and how each factor will be weighted?
Earl Howe
My Lords, the first point to emphasise to my noble friend is that the new review is the responsibility of NHS England. It is not a piece of work that Ministers are in charge of. NHS England’s advice to me is that it is too soon to describe what the exact process will be. However, I can say that NHS England is developing a process that is, in its words, “rigorous, transparent and inclusive”, particularly in the use of evidence and data. As I have said, there will be opportunities for all stakeholders to participate in the review—including, importantly, the current providers of children’s congenital heart services.
Care Bill [HL]
Lord Sharkey Excerpts(10 years, 10 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Dubs
My Lords, I shall speak to two amendments in this group, both of them amendments to Clause 25 —Amendments 92ZZH and 92ZZJ. I must say that I do struggle with all these initials; they make it hard to spot which amendment is which—but it may be that there is no better way of doing it.
Amendment 92ZZH is about people who have fluctuating needs for support because their condition is not constant. A fluctuating condition is a chronic condition, physical or mental, of which a characteristic feature is a significant variation in the overall pattern of ill health and/or disability. There are many millions of people in the UK with fluctuating conditions. Those could include MS—I am an officer of the All-Party Group for Multiple Sclerosis—rheumatoid arthritis, HIV, Crohn’s disease and colitis, epilepsy and Parkinson’s disease; there may also be others. Those conditions cover a large number of people.
The problem is that when people have fluctuating conditions it will be much harder to plan ahead on the basis of the present drafting of Clause 25. There is not the flexibility to enable account to be taken of the ups and downs associated with fluctuating conditions. If the plan could take account of fluctuating conditions, individuals could be assured that they would get the level of care they needed, consistent with the fluctuations in their condition. By allowing for that, we can also prevent costly hospital admissions. That in itself is an important aim both for the well-being of the person concerned and, in terms of cost, for the health service.
For example, a snapshot survey of individuals showed that 30% of respondents with rheumatoid arthritis had been admitted to emergency care as a result of a flare-up of the disease in the past year—of which, of course, no account is taken by the Bill. The benefit of my suggestion is that it would make it possible to plan ahead for variations in care and support, in advance of those variations being required.
Amendment 92ZZJ is about the period over which care will be made available before the need is reviewed. The current wording of Clause 27 gives local authorities the power to,
“keep under review generally care and support plans”.
“Generally” is an all-purpose word which can mean anything. Local authorities are not required to specify when they expect such reviews to take place. Anyone who is subject to something “generally” lives in uncertainty, and what I would like to achieve with my amendment is some element of certainty.
The key benefit of the care and support planning process would be to allow a discussion between the local authority and the person concerned about the best way their care needs could be met. Then there could be an agreement between the local authority and the adult or carer. It is important for such an adult to be confident that their care will remain consistent until their circumstances change. Under my amendment they would not be subject to an early review if there was no need for it, but when things happened, that could be reflected in their care plan. The amendment would give that adult the confidence that their care would continue as agreed until the specified date, or until the adult himself or herself chose to request a review in line with Clause 27(1)(b). That may seem a small change but it would be important to the individuals affected.
Lord Sharkey
My Lords, I shall speak briefly to my Amendment 92ZZS. Its purpose is to ensure that the direct payment system works well. In particular, it would ensure that all parties to the decision to use direct payments fully understood the implications of that decision.
I raised this matter at Second Reading because I was concerned that some successful applicants for direct payments may underestimate the difficulties involved in administering those payments. I was concerned that there was no clarity about exactly how local authorities would make the decision about who was and was not a suitable recipient for direct payments. For example, it is likely that many in receipt of direct payments will want to employ people directly. Will they understand how very complicated it is to employ even one person? How will they find out? Exactly how will local authorities assess their ability to do this, and will people properly understand any contractual arrangements they may enter into? Who will help them understand? Exactly how will local authorities assess their likely abilities in this area?
I suggested at Second Reading that a way of dealing with this was to give local authorities an obligation for friendly oversight of the administration of direct payments for an initial period of six months or so. In his very thorough and helpful letter of 5 June to those who spoke at Second Reading, the Minister pointed out that Clauses 31 and 32 set out that, before a direct payment is made, the local authority must be satisfied that the adult or someone nominated on their behalf is capable of managing the direct payment. He felt that these and other provisions in Clause 4 should ensure that direct payments are used appropriately.
I am sure that these provisions will be very helpful, but they would be more helpful if the local authority had to explain to applicants on what basis their capability was being assessed and the exact criteria for assessment. It would be more helpful still if the explanation was in written form and followed by discussion with the applicant. That is what my Amendment 92ZZS would put in place. It simply requires the local authority to make known in writing and discuss with the applicant the criteria that it uses to satisfy itself that the adult is capable of managing a direct payment. This would have the effect of bringing about a proper discussion of the implications for the applicant of managing direct payments and provide a proper and informed basis for the local authority to make a judgment. I hope that it would also ensure that the criteria for judgment were clear, understandable, user-friendly and completely transparent. Making this simple change would greatly improve the chances of correctly matching direct payments with those who understand the implications and can effectively manage the system. I very much look forward to hearing the Minister’s thoughts on the matter.
Baroness Wilkins
My Lords, I speak to Amendment 92ZZSA, which stands in the name of the noble Baroness, Lady Campbell of Surbiton. The amendment seeks explicit clarification from the Government that nothing in the Bill lessens the strong duty on local authorities to offer direct payments to those requiring care and support services. A right to request direct payments is a welcome encouragement to those who would like to arrange their care and support with the autonomy that direct payments bring. However, it should not undermine the duty of local authorities to offer direct payments as enshrined in the Health and Social Care Act 2001 and regulations. It would be unhelpful to shift the onus on to individuals to know about and request direct payments and away from local authorities’ duty to offer them.
In general, case studies in this area show that where people already have a care package and then want to convert to direct payments, a battle is often involved. Care services recipients need a clear indication that direct payment is one of the support options available. The Bill requires local authorities to tell an adult which, if any, of the needs can be met by making direct payments. It is vital that local authorities understand that they must always provide information about direct payments. This information must include how to request one, the conditions, and advice and brokerage services.
Local authorities need to provide support to help the adult to manage direct payments. As the Bill stands, they can refuse a request if the adult has no help available to manage the payments. Could the Minister make the Bill’s intentions clear in this regard? It is important that the rights and duties enshrined in the original Act, which have proved so beneficial to many disabled people, are not, as it were, lost in translation, and some reassurance on this matter would be very welcome.
Care Bill [HL]
Lord Sharkey Excerpts(10 years, 10 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Sharkey
“( ) The Secretary of State has a duty to ensure that there is, through national public awareness campaigns, a high level of public awareness and understanding of the terms and implications of the cap on the cost of care.”
Lord Sharkey
My Lords, my Amendment 89E covers the same ground as, and is very similar to, Amendment 90 in this group standing in the name of the noble Baroness, Lady Greengross. I entirely agree with the spirit of the noble Baroness’s amendment except that I do not think that it goes quite far enough.
The question of public awareness of the terms of the cap on care costs is obviously critically important. However, as I said at Second Reading, the Dilnot report views communication to be central to the success of the entire scheme. Dilnot makes two recommendations in this area. The first is:
“To encourage people to plan ahead for their later life we recommend that the Government invests in an awareness campaign”.
The second is:
“The Government should develop a major new information and advice strategy to help when care needs arise”.
In his reply at Second Reading, the Minister said:
“Legislation is not required for that but the Government agree on the need to raise public awareness. The Government will adopt a strategic approach to maximising the public’s understanding of the new care and support system, and that is a crucial part of our plans to implement Dilnot”.—[Official Report, 21/5/13; col. 827.]
I was very glad to hear that the Government plan to maximise public understanding of the new system. Maximisation is a strong word and this is a very strong and very welcome commitment. I agree that legislation is not necessary in order to implement an awareness campaign. However, while legislation may not be necessary, I think that in this case it is highly desirable and probably even essential.
I believe that it is highly desirable for four reasons. First, it is a binding and unambiguous commitment; secondly, it allows for a national campaign, so that there should be no unsatisfactory variations in achievement by local authority area; thirdly, only central government is really likely to spend the amount of money needed to truly maximise public understanding; and, fourthly, it is the only efficient way of holding someone to account for failure to achieve maximisation. As I mentioned, where I slightly part company with the noble Baroness, Lady Greengross, is over whether her amendment goes far enough.
I have had a great deal of experience of devising and running very large-scale information and advice campaigns, some of the largest being for government departments, and I know that successfully providing information and advice is never enough. It is critical that this information is understood but it is also critical that there is awareness and understanding of the implications of that information and advice. Awareness of facts is not in itself worth very much if we do not understand what those facts mean or what their implications are for you. That is why my amendment is slightly stronger than Amendment 90. It imposes a duty on the Secretary of State not only to run a national awareness campaign but to ensure that there is a high level of public awareness and understanding of the terms and implications of the cap on the cost of care.
Earl Howe
My Lords, potentially, everyone in need of care and support may benefit from these reforms. We want to make it as widely known and as apparent as possible that planning is an important matter, whatever a person’s means. If I have misunderstood the noble Lord’s question, I will review that answer and write to him, but that is the main point.
I come back to the point I made earlier: this is just the beginning and it is why we will shortly be consulting on all these implementation issues. With those comments, I hope that my noble friend will feel able to withdraw his amendment and that other noble Lords will not press theirs.
Lord Sharkey
My Lords, I thank all noble Lords who have spoken in favour of a comprehensive, national and centrally funded information and advice campaign under the direct control of the Secretary of State. I am sorry that my noble friend the Minister did not seem entirely convinced by that. I was very puzzled by one thing that the Minister said about the cost of an annual report on how well we were making progress in generating awareness of the terms and implications of Dilnot. I cannot see that the cost could be anything but essentially trivial. I may be wrong about that, but I should be very grateful if the Minister would clarify, perhaps in writing later, why he thinks that the cost would be substantial at all.
I continue to feel that the whole issue of providing information and understanding is much too important to be left to local authorities and for the Secretary of State not to have direct responsibility for it. The task facing any information campaign in this area is enormous. The last survey that I saw showed, for example, that only 17% of UK adults understand what a percentage is—even that may be an overstatement—and Dilnot’s implications are much more complicated than that. We need the best communication with the most money and we need obvious accountability. That means central government and the Secretary of State having responsibility.
Given the opinions expressed around the Chamber today, we may well want to return to this issue on Report. I beg leave to withdraw the amendment.