Care Bill [Lords]

Anne Marie Morris Excerpts

Monday 16th December 2013 Commons Chamber

[Anne Marie Morris (Newton Abbot) (Con)]

For my constituents this Care Bill is one of the most important pieces of legislation we have seen in my time in Parliament. That is because the west country attracts a lot of people wanting to retire to our very beautiful countryside. In Newton Abbot, 23% of residents are over the age of 65, compared with the national average of 16.5%. Social care is therefore a very important issue for us.

I congratulate the Government on what they have done, because they have introduced an holistic framework that sets the scene for ongoing legislation to flesh out that framework. They have listened to Dilnot and to Francis and that is very much to their credit.

Integration of health and social care has been the watchword on everybody’s lips. All Members will have come across examples in their surgery case loads of where that does not work, and I am very pleased to see the integration—the balancing provision—that we already have in the Health and Social Care Act 2012 now reflected in this Bill.

On the adult safeguarding framework, I say well done! This is crucial. This is the first time we will have had anything like this for vulnerable adults. In my constituency, I am regularly addressed by carers who are frustrated not only by the challenges of those they care for but by the lack of support they receive. The Bill will provide the answer in the form of care plans and proper assessments. It is not often that individuals come to me who have fallen into the gap between the care plan for a child and the plan for an adult, but it does happen, and I am pleased to see that the Bill will mean that that will change.

One of the big challenges is dealing with the cost of care, and it is to the Government’s credit that they have started to look at that difficult question. How much is it right for the taxpayer to pay, and how much for the individual? This is a good Bill, but there are many things that I am sure all of us would like to see added, improved, amended or clarified. For me, one of the challenges is the role of the local authority in its commissioning and provision of care services. It seems bizarre that it should do both, because that must surely give rise to a conflict of interest. How can it commission and provide? The conflict was recognised in the NHS, and a split was introduced. It is now time to introduce such a split in this regard as well. Now that local authorities will have a key oversight role, it would be madness not to review that situation.

An important change involves the concept of true integration, and the challenge will be to identify the stakeholders who should be included in that integration. Clearly, it must involve the NHS, the local authorities and housing, but one area in which there is often no acceptance of stakeholder responsibility is that of transport. Transport to get people between care homes and hospital appointments has almost reached crisis point in my constituency, and there is huge reliance on the voluntary sector to fill the gap. There is clearly some provision for the NHS to provide that transport, but the rules are so broad that, when times are tough, transport provision becomes limited.

So who provides the transport? The volunteers in my constituency are brilliant, but they can afford only so many vehicles that are equipped to take wheelchairs, and there are only so many drivers. That issue needs to be properly addressed. In the guidance on integration that is to be given to local authorities, the NHS and other stakeholders, we must look seriously at the transport question and ensure that appropriate responsibility is taken for it and that it is properly funded. We cannot assume that the voluntary sector will continue to fill the gaps.

The assessment will form a critical piece of the jigsaw, and the Government are to be commended for trying to clarify the process, to avoid confusion and to get agreement on this. I understand their need to limit mandatory provision by a local authority to those in substantial need and above, but I fear that there could be confusion over the interpretation of the word “substantial”, and I would welcome clarification on that from the Government, in guidance or elsewhere.

Having looked at the definition of substantial need, we then need to consider who is to be involved in agreeing the care package. This is about the process of assessment, and it will be crucial for all the stakeholders to be involved. I have seen diverse levels of application in my local authorities. In some, this is very much a matter for the local authority, and it can sometimes almost seem as though a care package is being imposed on an individual. In other authorities, however, the individual, the carer, the family and the care home are all involved to ensure that the package is understood, agreed, accepted and fit for purpose. It would be extremely valuable if guidance could ensure that that always happened, when the Bill becomes law.

Having assessed the individual’s need, we need to ensure that the quality of the provision is fit to meet that need. I welcome the introduction of the new, almost Ofsted-like categorisation of quality, which will give us a real insight into what is on offer, and what “good” and “average” look like. That in turn will give rise to further questions. Once we know what they look like, we shall have to answer a much more difficult question: to what level should the taxpayer pay, after which there should be a personal top-up? That issue can be addressed only when we have some experience of those categorisations.

If there are to be different levels, the option of a top-up has to be real and available. It clearly exists, but I have seen a reluctance to make it happen in practice in some local authorities. In some ways, that is understandable. The contract is with the local authority and the care home, and not with the relatives or, more usually, the individual picking up the extra cost. The local authority will be concerned that, should there be a problem of affordability for the caring relatives, it would be left to pick up the bill. The top-up therefore needs to be reviewed. If it is to be available, it must be meaningful, and that might involve looking at whether relatives can be part of the contractual arrangement.

In the longer term, following the successful passage of the Bill, there is a lot more that could be done. The Bill will undoubtedly put in place the framework, and we can then begin to look in more detail at the strategies needed for those living in their own homes with support. Historically, we have asked what we should be doing for those in residential care or in hospitals, but once we have the framework, we will have the opportunity to look at a much more concrete strategy. That is something I would very much like to see.

Given the financial circumstances in this country at the moment, we can afford to support only those with substantial needs as a minimum requirement, but the Bill makes provision for local authorities to offer advice as well as providing services, and we should perhaps give more support to those who have only moderate needs. Their needs could be better explored, and they could be better championed and provided for.

The final word needs to be that change is not just about legislation. This is also about a culture change. That will always be a challenge, and it is incumbent on all of us in the House, whatever happens to the Bill, to follow it up and ensure that it becomes something meaningful in practice that will benefit all our residents, who very much deserve it.