Care Bill [HL]

Baroness Greengross Excerpts

Wednesday 9th October 2013 Lords Chamber

Moved by

[Baroness Greengross]

13: Clause 4, page 4, line 12, leave out “and maintain” and insert “, maintain and facilitate access to”

[Baroness Greengross (CB)]

My Lords, I shall speak to Amendment 18 in this group as well. I have already expressed my support for the Bill, which will make a huge difference to the lives of users of social care services and their families. However, a little more can be done to reform the Bill in the areas of information and advice, and also complaints and redress. I welcome the fact that the Government have recognised this issue and that the Minister has tabled amendments on their behalf. This shows that the Government accept the need for proactive engagement around information and advice, the importance of understanding when and how people access information, and the need for a focus on identifying those who would most benefit from it. These issues reflect exactly the thrust of my amendments except that, unlike the Government’s, mine relate to all information and advice about care and support, not just financial information and advice.

While I welcome the emphasis on proper access to financial advice, it seems a bit inconsistent not to apply this proactive approach to all forms of information and advice about care. For example, even when considering financial options, it is difficult to disentangle these from information that is needed about other aspects of care such as the choice of providers. It might even apply to housing, which was addressed in the debate on the amendment of the noble Lord, Lord Best.

At a time when local authority budgets are under increasing pressure, it is all the more important that people needing social care services are supported to efficiently access all existing sources of support fairly, equitably and transparently, and that local authorities are held to account for the decisions they make about distributing resources. Consumers have to feel that they are in control of their own care, understand what support they can expect and have the ability to speak up when they are treated unfairly. My amendments are designed to further these aims and I am grateful to Which? for assisting me in validating the consumer detriment aspects of this argument.

First, in Amendment 13 to Clause 4(1), as well as the local authority having the duty to,

“establish and maintain a service for providing people in its area with”—

care and support information, I would like to see the local authority having a supporting obligation to “facilitate access to” that service. Secondly, my Amendment 18 to Clause 4(4) would expand the local authority’s duty of information and advice provision beyond those to whom it is being provided to also include those,

“who would benefit from receiving it”.

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I hope that by bringing forward these amendments we are showing that we have listened carefully to the many representations we have heard on the issue of advocacy and are demonstrating the Government’s commitment to improving outcomes for some of the most vulnerable people using care and support. I hope that they will receive the support of the House. Further, I trust that noble Lords will note that we have listened carefully about the importance of financial advice and will support the amendments that we are proposing, which encourage a more active role for local authorities. Finally, I hope that noble Lords are persuaded about how important we believe the statutory guidance on information and advice to be, in which we are committed to addressing in detail important issues, such as integration with areas such as health and housing and making information accessible to all.

[Baroness Greengross]

My Lords, I start by thanking the Minister for his very detailed response to these amendments. I am encouraged by what he said. I was, in my remarks, trying to broaden this issue so that integration is about the information and advice that people need and is not always restricted to financial advice and information. It is much broader. Obviously, the proof of the pudding in this is going to lie in what actually happens, and whether we get the sort of integrated approach to this that we hope underlies the philosophy of the whole Bill.

I am sorry that this provision cannot be in the Bill, but I am less worried about that than the eventual result of these measures. The slight muddling around the word “independence” will come out when we consider the next group of amendments and discuss the difference between regulated and independent. The two can be muddled, with regard to “independent” and “regulated”, when thinking of lots of different models for financial products, for example, and “independent” from the local authority. That all needs to be very clear in the minds of those who seek advice and those who are giving advice to very frail and vulnerable people to whom this needs to be clear, broad and helpful, and as well meaning as I know the Minister has in mind for it to be. I beg leave to withdraw my amendment.

Amendment 13 withdrawn.

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[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.