Care Bill [Lords]

Andrew George Excerpts

Monday 10th March 2014 Commons Chamber

[Mrs Lewell-Buck]

I entirely agree. The budgets of council adult social care departments are now so stretched that they fill a gap wherever they can, as cheaply as they can.

[Andrew George (St Ives) (LD)]

The hon. Lady is making an excellent point. In new clause 32, I propose that the Secretary of State should undertake a review of care standards, including hourly pay and other kinds of remuneration for home care workers. Does she agree that unless we have decent national standards for visiting times and remuneration, we shall be faced continually with a race to the bottom?

[Mrs Lewell-Buck]

I apologise for not having read the hon. Gentleman’s new clause. I have been focusing on my own new clauses and amendments, but I will look at his new clause at a later stage.

Amendments 31 to 33 would establish firm time scales for assessments and reviews of service users’ care needs. During the Bill’s passage so far, the Opposition have repeatedly tried to raise the issue of the funding gap in adult social care, which threatens some of the positive changes that the Bill would bring about. In my constituency, our local authority has been forced to make £24.3 million-worth of savings, with predictable consequences. One of the consequences for local authorities has been a decline in the regularity of assessments and reviews. I have spoken to people whose assessments have been grossly delayed; I have also visited care homes in which some residents have not been reviewed for up to three years, during which time their needs may have changed dramatically and their support may have become inadequate.

It is easy to understand how that happens. Under-resourced departments must set priorities, and routine steps such as the reviewing of someone’s care plan are often at the bottom of the list because there is no pressure for them to be taken in a timely way. However, those steps are very important, because they identify changes in a person’s condition which, if ignored, might lead them to a crisis point. The amendments would reverse a worrying trend which has seen delayed assessments rise significantly since 2010, when 18.7% of new clients waited four weeks or more for an assessment. By 2011-12, the latest year for which figures are available, the figure had risen to 22.7%. In some individual local authorities, the change is even more worrying. In one authority, the number of new clients waiting to be assessed jumped from 12.6% to 70.7% between 2010 and 2012. It is important to remember that those are not just percentages, but represent vulnerable people whose needs are not being met.

In Committee, the Minister said that he was concerned about assessments being rushed to meet the timetable, and that a simplistic time scale would not be tailored to meet individual needs. I agree that that is of concern, but it should not be necessary for the time scale drawn up by the Secretary of State to be a “one size fits all”. The timetable for more complex cases could take into account the more complex nature of the assessment and allow more time for completion. It would be much more dangerous to have no benchmark at all and for those people to have their assessments delayed and their needs not met. The amendments would improve the situation for people with more complex needs, for whom putting support in place quickly is most important.

--- Later in debate ---

[Paul Burstow]

Absolutely. That is why the duty on market shaping set out in the Bill is about stretching the local authority to take that wider population-level interest, and not only for the people for whom they will arrange care and for whose care and support needs they will pay, but for the whole population who might need care and support but will be funding it themselves. I do not see how local authorities can satisfactorily discharge that new and important responsibility if there is not also a fairly critical examination of commissioning practices themselves. That is why I have tabled the new clause.

[Andrew George]

My right hon. Friend is making an excellent case. There is another reason why it is essential that inspection in that area becomes paramount, and that is because of the drivers in the system itself that discourage avoidable hospital and community hospital admissions and seek the earliest possible discharge into the community. What we have is a scenario in which people are being cared for in their homes, in an “out of sight, out of mind” environment, so inspections become all the more important because of the need to ensure that they are safe—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. Paul Burstow.

--- Later in debate ---

[Grahame M. Morris]

The hon. Gentleman makes an interesting point which echoes a point made on the Labour Benches a few moments ago. The problem is that a number of private health care companies are also insurance companies, so it would be quite a task to ensure that data are not shared with companies that might have a commercial interest in them. To restrict access in the way we would all want is not as simple as the Government would have us believe.

[Andrew George]

The hon. Gentleman and I often agree on these issues, but I am slightly concerned. Of course we want reassurances, and while we have the pause we should seek further reassurances on the anonymisation of data and that they will not be misused. How far is he prepared to push this point? Is he prepared to push it to the extent that the initiative falls, with all the consequences for the lack of progress in advances in medical care? In 10 years’ time we could be talking about hundreds of thousands of lives that could have been saved as a result of pressing on with this very important development.

[Grahame M. Morris]

The hon. Gentleman makes an excellent point. It is not my intention to do that, but we have to recognise that the public awareness campaign—the Government’s early assurances about leaflets and letters—has been wholly inadequate. At a time when it is important for the Government to instil public confidence in the scheme, they keep doing things that undermine public confidence, for example by giving the hated company Atos—if you do not mind me using the term, Mr Speaker, because of the debacle in the Department for Work and Pensions—the contract to extract the data. There seems to have been a catalogue of errors.

I accept that this proposal has the potential to be a huge step forward. The Minister said it was not revolutionary, but I am quite often in favour of things that are revolutionary. It is revolutionary, because previous data collections from a hospital-based setting, from secondary care, have been largely episodic. This scheme will harvest data from GPs and primary care to follow the whole of the patient journey, and to identify trends and follow-ups. That is a revolutionary step forward, provided we have the necessary safeguards and assurances, and that we rebuild public trust. I am not suggesting that the scheme is unworkable and cannot be reformed, but there is a huge job to do to ensure that we restore public confidence.