Health and Care Bill

Baroness Keeley Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

[Matt Hancock]

It happens on an ad hoc basis, but it is not a right. The NHS is a great British institution, and access should apply right across the board.

Finally, in my last few seconds, may I simply say how strongly I agree with my right hon. Friend the Member for Maidenhead (Mrs May) about amendments 93 to 98?

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I rise to speak to amendment 73, which would introduce safeguards around the discharge-to-assess process.

The discharge-to-assess process may have been a necessary element of the NHS’s pandemic response, but it contains gaps in safeguarding that leave unpaid carers vulnerable to financial impact and risks to their health. Many unpaid carers have to begin caring overnight, when their relative or friend, who may be quite unwell, is discharged from hospital without a plan for their care at home. Without a carer’s assessment to check whether a person has the capability or capacity to take on such a commitment, weeks can pass before any plan is made, leaving carers and the people they care for struggling in a desperate situation.

The Government’s own impact assessment on discharge to assess states baldly:

“There is an expectation that unpaid carers might need to allocate more time to care for patients who are discharged from hospital earlier. For some, this could require a reduction in workhours and associated financial costs.”

Organisations that support unpaid carers are outraged by that statement. The Government’s expectation that carers can just drop everything to take on a new caring burden is insulting, particularly given the extra caring burden that 3 million people have already taken on during the pandemic.

I recently queried that point with the Secretary of State at the Health and Social Care Committee. In response, the he wrote to the Committee to say that the Government do

“not expect unpaid carers to need to give up work or reduce their working hours to look after friends or family while their long-term health and care needs assessments are completed”.

When the impact assessment says one thing and the Secretary of State, after being questioned about it, says another, I have to question the understanding in the Department and among Ministers of the discharge-to-assess policy and its impact on the 13 million carers in the country.

[Daisy Cooper (St Albans) (LD)]

Does the hon. Member agree that it would be helpful if the NHS had a duty, as I have attempted to capture in new clause 63, to identify carers, so that their health and wellbeing is taken into account when decisions are made about the people for whom they care? Does she agree that it would be helpful if the Minister responded to new clause 63 in winding up?

[Barbara Keeley]

I do indeed. The hon. Member may not know that, a few years ago, I introduced a Bill to try to persuade the Government to accept that the NHS should have a duty to identify carers. I have tried to introduce it on two more occasions since then, and I will send her a copy. I hope that the Minister will respond to what she has said.

Carers UK has reported high levels of fatigue and stress among unpaid carers, three quarters of whom feel exhausted and worn out because of' caring responsibilities during the pandemic. It would constitute a poor recognition of the sacrifice and dedication of those carers if discharge to assess was left without adequate safeguarding measures for them. Although discharge guidance already states that unpaid carers must be involved in discharge planning decisions when a patient has new or additional care needs, more than one in four are not consulted prior to discharge, and 60% say that at the point of discharge they received insufficient support to protect the health and wellbeing of the patient, or their own health.

Amendment 73 would protect carers from being left waiting an indefinite amount of time for care plans it would ensure that integrated care boards held responsibility for monitoring and reporting on any failures. I support its inclusion in the Bill, and, like the hon. Member for St Albans (Daisy Cooper), I hope that the Minister will respond to these points when he sums up the debate.

[Mr John Baron (Basildon and Billericay) (Con)]

Thank you for calling me, Mr Deputy Speaker, and I thank Mr Speaker for selecting my new clause 19. I also thank all those who have kindly supported it.

It remains an inconvenient truth that although our cancer survival rates are improving, we continue to lag behind international comparators. The primary reason for this is that the NHS does not diagnose cancers early enough. New clause 19 seeks to put that right by placing improved outcomes—that is, survival rates—at the heart of the NHS.