Care Bill [HL]
Baroness Pitkeathley Excerpts(11 years, 6 months ago)
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Baroness Pitkeathley
My Lords, I support almost all the amendments in this group because I acknowledge their importance, particularly from the point of view of the Joint Committee, which similarly placed a great deal of store on the provision of information and advice. Indeed, it suggested that there should at the very least be a national campaign to promote the new arrangements to those who might use them.
I rise to speak briefly to Amendment 86H, to which I have put my name, along with the noble Baroness, Lady Browning. Social workers on the whole do not get a good press. They are heard of only when things go wrong. Most of the time the vast amounts of quiet, patient work that is carried out by social workers in local authorities, the NHS and the voluntary sector is ignored. We should give their skills and the vital contribution that they make to help people find their way around complex systems more recognition. The noble Baroness made it clear that she is suggesting that a social worker needs to be involved not in all cases, but just when present and foreseeable needs are classed as complex. In those cases we must take into account that people’s ability to take in information is tremendously variable, depending on their situation and state of mind at the time. I have lost count of the number of conversations I have had with service users and carers who are totally bemused by the information they are given or the access that they have even when they manage to get hold of some information.
I will never forget the carer who gave me a wonderful illustration some years ago. She said, “I feel as though somewhere out there is a great mushroom of information. If I could just find my way up the stem, I’d find out where all this information is, and it would help me. But I don’t even know where the stem begins, and nobody seems to be able to help me”. Information in its raw state is often very difficult to interpret. It is the skill of the social worker in assessing what information is needed, when and in what form it is needed in complex cases, and signposting the information and advice that is required in every case. Those particularly complex cases need social worker involvement. Such cases are not being met and will be even less well met in the future with the new system and range of information that will be available.
Baroness Gale
My Lords, I rise to speak to Amendments 83ZA and 86A, tabled in my name. For individuals entering the world of care and support for the first time, it can be a confusing, complex and protracted process. The introduction of information and advice services for those individuals will be very welcome.
I mentioned earlier that I chair the APPG on Parkinson’s and that we are currently conducting an inquiry into NHS continuing care. Continuing care is a package of care that is arranged and funded by the NHS and is free of charge to the person receiving it. The decision for eligibility rests not on a person’s condition but on whether the need for care is primarily due to health needs. While there are just over 57,000 people in receipt of NHS continuing care in England, it is unknown how many people may actually be eligible in law and have not even applied for it, or who have failed in their attempts to be assessed properly for it. As part of the inquiry into NHS continuing care, I have been hearing from people about their real problems in accessing NHS continuing care. We found during our inquiry that people with Parkinson’s and other long-term conditions are not given information about NHS continuing care. The impression that I have been given is that, because it will cost the NHS considerably, people are not encouraged to apply for it. This leaves people with no option but to go to the means-tested social care system to have their health needs met. That situation is entirely unacceptable.
As Clause 4 introduces a duty on local authorities to establish and maintain an information and advice service, it is important that all the appropriate information and advice are provided. With the further integration of health and social care, it is essential that individuals are in full possession of the facts about all aspects of the support to which they are entitled. While the list currently provides some crucial aspects for people receiving care and support, I believe that NHS continuing care is a glaring omission. We hear of the two services arguing the differences between what is a health need, which is free at the point of use, and what is a social need, which is currently charged to the individual. This can often lead to the individual either being forced unnecessarily to pay for their own care while the debate goes on or being left trapped in their hospital bed. Although NHS continuing care is part of the health system, it must be included in the list provided by the local authorities as set out in Clause 4. People who may be eligible for NHS continuing care are also likely to have such needs that they could be in receipt of support provided by their local authority. If their needs change so as to render them eligible for NHS continuing care, there should be a seamless transition to that system that does not affect the standard of support they receive.
A strong information and advice service must include information about an assessment for health provision, so that individuals can go to this service confident that they will find out everything they need about care and support. The Care Bill offers an unprecedented opportunity to address these defects within the NHS continuing care system. Including it in the list of matters about which people should be given information and advice would promote awareness of its existence and prompt councils to refer people for assessment where they appear to be eligible for NHS continuing care. I trust that the Minister will take note of the points that I have made and that he will be able to accept these amendments.
Care Bill [HL]
Baroness Pitkeathley Excerpts(11 years, 6 months ago)
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Baroness Pitkeathley
“( ) For the purposes of this section, “an individual” includes the parents of disabled children.”
Baroness Pitkeathley
My Lords, I will speak also to Amendments 79E, 79H and 88C, all of which are about parent carers, and later to Amendments 88E and 88F, which are about other aspects of carers.
The Care Bill is drafted to apply to adult carers of adults. This means that parents of disabled children are not included in the important new rights and duties introduced by the Bill. The amendments in this group seek to probe the Government’s intentions regarding parents of disabled children, and how their rights can be put on a par with those of other carers.
Under the Care Bill, a carer is an adult who provides or intends to provide care for another adult. It is therefore clear that parent carers of disabled children aged under 18 are excluded from the new entitlements. Parent carers are left with the existing statutory scheme and previous carers Acts, which are mostly Private Members’ Bills. While these Acts impose obligations on the local authority to assess parent carers’ needs, there is no statutory duty to provide services to meet carers’ needs.
In a recent report on the Children and Families Bill, published on 27 June, the Joint Committee on Human Rights acknowledged the concerns about the future of parent carers’ rights, but argued that it was a matter for the Care Bill. As these rights currently sit within children’s legislation, amendments to the Children and Families Bill are therefore needed to put the rights of parents of disabled children on the same level as those of other carers. I know that discussions are going on, and that Ministers have said that amendments will be introduced to the Children and Families Bill. However, it is important that parents caring for disabled children do not fall through the cracks, and that the Government acknowledge the need to give them parity with other carers. How will the Government ensure parity of rights for parents of disabled children, and how will they resolve the issue of whether this matter sits best within this Bill or the Children and Families Bill?
Amendment 78F includes parent carers in the well-being clause. The intention of the amendment is to include the parents of disabled children in the duty placed on local authorities by Clause 1 to promote the well-being of the adult who is carrying out functions under the Bill in relation to another adult. If anyone doubts whether this is necessary, they should remember that 72% of parent carers experience mental ill health, such as anxiety, depression or breakdown; 57% say that lack of support from statutory services means that they are isolated and not able to work as they would like; and one in five says that isolation has led to the break-up of family life.
Amendments 79E and 79H are about including parent carers in the prevention clause. Clause 2 requires local authorities to take steps, including providing or arranging services which are intended to prevent, reduce or delay the need for care and support by all local people, including adults and carers of adults. These amendments seek to include parents of disabled children —referred to here as “child carers”—in this duty so that local authorities have a duty to prevent or delay the development of the need of the parent carers for support. My apologies if any confusion has been caused by the use of the words “child carers”. We often use this term to refer to young carers, who are referred to elsewhere in amendments in this group. However, I wanted to be sure that the Government understood that this was not necessarily the parent of a child—it could be a parent, a grandparent or another relative. I hope that that has not caused any confusion.
Earl Howe
My Lords, the Care Bill marks a historic step forward in improving the rights of adult carers. Although successive Governments have recognised the contribution carers make and have supported Private Member’s Bills about carers, this is the first time that the Government have included specific provision for carers’ rights to social care in their legislative programme. These provisions have been warmly welcomed.
Amendments 88E and 88F, tabled by the noble Baroness, Lady Pitkeathley, bring to the attention of the Committee the important role that the NHS can play in helping those with caring responsibilities look after their own health, identify themselves as carers and access information and advice.
Clinical commissioning groups already work with local authorities through health and well-being boards to understand and plan for identifying and supporting carers. Many clinical commissioning groups already have, or are developing, joint carer strategies. Importantly, the pooled health and care budget for 2015-16 announced last week as part of the spending round will help health and care and support to work together in supporting carers.
I quite agree that it is, of course, crucial that steps are taken to help individuals with caring responsibilities to identify themselves as carers. The Department of Health has provided over £1.5 million to the Royal College of GPs, nursing and carers’ voluntary organisations over recent years to develop training and resources to help those working in primary and community healthcare to support people with caring responsibilities. We will consider further bids to extend this work programme, including extending support to nurses working on hospital wards and outpatient departments.
I listened with care to the noble Baroness, Lady Royall, in this context and I would say that carers of people with cancer will benefit from steps which NHS England and the Department of Health are taking, some of which I have already referred to. I would also say that the current initiatives have unleashed an enormous amount of enthusiasm among frontline staff, and both nurse and GP carer champions and voluntary sector carers’ ambassadors have been recruited. They are increasing understanding about supporting carers locally at both strategic and practice levels.
In terms of identifying carers and helping them to access support, it is also critical to align assessments undertaken by other bodies, including NHS continuing healthcare assessments undertaken by clinical commissioning groups. If a carer is identified in the course of an NHS continuing healthcare assessment, the national framework for NHS continuing healthcare and NHS-funded nursing care makes clear that the clinical commissioning group should inform them about their entitlement to have their needs as a carer assessed and, where appropriate, either advise the carer to contact the local authority or, with the carer’s permission, refer them to the local authority for an assessment.
The provisions in the Care Bill provide a lower threshold for a carer’s assessment than exists now. A situation where the person whom the carer supports is being assessed for NHS continuing healthcare is highly likely to be regarded by a local authority as one where it appears the carer may have a need for support. A carer’s assessment would then be triggered. Clause 10(5) already requires a carer’s assessment to include an assessment of whether the carer is able and willing, and is likely to continue to be able, to provide care for the person needing care. Moreover, regulations under Clause 12 may make provisions for joint assessments. We will consider such particular circumstances further as we develop these regulations.
I turn now to Amendments 78F, 79E, 79H and 88C relating to disabled children. I would not wish to underestimate the challenges that families can face in supporting these young people. Policy on supporting children and families of course lies with the Department for Education. The Minister for Children and Families’ view is that there is already sufficient provision under Section 17 of the Children Act 1989 to provide for the assessment and support of children in need, including disabled children, and their parents. The Department for Education’s investment in parent carers’ forums and short breaks provision for disabled children in recent years have helped to shape family support.
In addition, the special educational needs reforms in the Children and Families Bill, which received its Second Reading in this House yesterday, are intended to give parents much more choice and control about the support they and their children receive. My noble friend Lord Nash confirmed yesterday, at Second Reading, that the Department for Education would consider how legislation for young carers might be changed. I simply ask noble Lords to be a little more patient in waiting for those proposals.
Before turning to the effect of Amendments 79F, 79J, 79M, 88H and 88K, tabled by the noble Lord, Lord Hunt, and members of the Opposition Front Bench, I would like to confirm, as I hope my words just now have, that both the Minister for Care and Support and the Minister for Children and Families are clear about the need to protect young carers from excessive and inappropriate caring by using “whole family” approaches.
Young carers should be regarded first and foremost as children and they should be assessed and supported in the context of children’s legislation. The Minister for Children and Families has confirmed that his department will look at what it can do to remove any legal barriers preventing young carers and their families from receiving the support they need under children’s legislation. We will also work to ensure that children’s legislation works with adult legislation to support the whole family in a meaningful way.
These amendments would extend the requirements on a local authority to prevent and reduce the needs of children caring for either an adult or a child. The local authority would also be required, when identifying carers in the area with needs for support, to include young carers aged under 18. One of the key principles when considering young carers is to address first what is needed to support adults in the family with care and support needs, and then see what remaining needs for support a young carer in the family has.
I hope I can reassure noble Lords that, first, through the provisions in Clause 2 to establish prevention as a core duty of local authorities, and secondly, through the provisions in Clause 12 to make regulations about a “whole family” approach to assessment of adults, we are ensuring that adult care and support makes the appropriate contribution to supporting children and young people with caring responsibilities as well.
Of course, provision of preventive services for adults would be of benefit to other family members, including children, by preventing or delaying either an adult’s needs for care and support or an adult carer’s needs for support. As it stands, without this amendment, I believe that the provisions of Clause 2 will help children and young people significantly.
Amendment 88H looks to require the Secretary of State to make regulations in all the areas listed in Clause 12(1). I reassure the noble Lord, Lord Hunt, that this is our intention, as these are essential in ensuring that the assessment is carried out in an appropriate and proportionate way. In relation to the noble Lord’s Amendment 88K, I confirm that we intend in regulations to make clear that a local authority should have regard to the needs of children in the family, and indeed we would wish to encompass other significant family relationships as well.
As I have set out, robust arrangements are in hand to ensure that carers are identified and supported by the NHS and local authorities, and that both parent carers of disabled children and young carers are adequately and appropriately supported under children’s legislation. The Department of Health and the Department for Education will continue to work closely together to ensure that children’s and adult legislation join up in respect of supporting adults with parenting responsibilities, and in the period of transition from children’s to adult services. I hope that those remarks will be sufficient to enable the noble Baroness to withdraw her amendment.
Baroness Pitkeathley
My Lords, I am grateful to all noble Lords who have spoken and for the recognition that all noble Lords have shown of the problems of carers, as well as the commitment to giving carers the support that they so much need. It is recognition of the fact that, however good a health and care system we put in place, the vast bulk of care will continue to be provided by our families and friends.
I know that the Minister shares this understanding and commitment and I acknowledge the attention given to carers in this Care Bill. In the history of the carers’ movement, with which I have been associated for nearly 30 years, it is truly the most significant development that we have seen.
The hour is late and I think that many more people would have wished to speak on this had we been debating it at a different time of day. I hear what the Minister says about young carers and parent carers. We need to monitor very carefully the progress of the Children and Families Bill to see how that Bill pans out and particularly how the two bits of legislation join up, as the Minister put it. In the mean time, reserving the right to come back to these issues on Report, I beg leave to withdraw the amendment.
Care Bill [HL]
Baroness Pitkeathley Excerpts(11 years, 6 months ago)
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Baroness Pitkeathley
Baroness Pitkeathley
My Lords, in the unavoidable absence of my noble friend Lord Warner, I shall move Amendment 74 and speak also to Amendment 75.
These two amendments give an opportunity to put into the Bill further emphasis on the importance of integration. Amendment 74 requires reviews by CQC of regulated health providers to cover the integration of those services with other relevant services. Amendment 75 does the same for reviews of local authority adult social care services. They are a clear reminder in the Bill that when CQC carries out such reviews it will have to pay attention to the issue of integration of services for the benefit of patients and service users.
I shall not detain the Committee today with yet another speech of a kind that I have made many times before on the importance of integration of health and social care services from the point of view of patients, service users and their carers. We all know how important that is. The Committee is familiar with the arguments and, more importantly, so is the Minister. Indeed, the Chancellor of the Exchequer, no less, acknowledged this in his announcement in the comprehensive spending review in regard to joint budgets. The announcement has been widely welcomed, although caution has been expressed about how these budgets will operate in practice.
The amendments are a modest attempt to give some practical effect to the aspiration for integration which we all share. I hope the Minister will say that it is a good idea, “Let’s do it”, and get us off to a cracking start this afternoon. I beg to move.
Lord Hunt of Kings Heath
My Lords, I declare an interest as a chair of a NHS foundation trust and as a consultant and trainer with Cumberlege Connections. I am happy to support my noble friend Lady Pitkeathley’s Amendments 74 and 75, which rightfully push the CQC into the direction of integration of services. I also sympathise with the amendments of the noble Baroness, Lady Greengross, Amendments 76ZZA and 76ZAA, to which she will speak later.
My Amendments 74A, 76ZA and 76ZB and my opposition to Clause 80 stand part go to the core of the purpose of CQC and its approach to performance assessment in health and social care. Inevitably, recent events at that regulator in relation to Morecambe Bay and before that at Mid Staffordshire will readily come to mind. There can be no doubt that the current leadership of CQC faces a major challenge in changing the culture of the organisation and its approach to inspections. It has much to do to restore both public confidence and confidence within the NHS about the way in which it operates. That is why this clause is so important.
Clause 80 substitutes Section 46 of the 2008 Act and provides that the CQC’s duty to conduct periodic reviews, assess performance and publish reports of such assessments, which are henceforth to be known as “ratings”, is to apply in respect of any regulated activities and any registered service providers as may be prescribed in regulations. In addition, where regulations so provide, the CQC must also review and assess the performance of the provision and commissioning of adult social services by English local authorities. CQC is to be given responsibility for determining the quality indicators against which services and providers will be assessed. This may include measures of financial performance and governance if the CQC deems this appropriate. Different quality indicators, methods and frequency in periods may be used for different types of cases. The CQC may also review the indicators of quality and method statement from time to time as it sees fit.
Let me say at once that I support the broad intention of these clauses to make the CQC responsible for rating providers and local authorities. I say again that one should not underestimate the task. It is important that the CQC is not put under undue pressure to rush to change the way that it operates and to introduce new ratings without proper pilots being done and without having enough time to do it.
I refer the noble Earl to the Nuffield Trust’s work. As he knows, the Nuffield Trust was commissioned to carry out a review for the Secretary of State into the possibility of rating providers of health and social care. It argued that the new ratings must be given adequate time to work together with a range of stakeholders in developing a system which enables both patient choice and professional leadership to drive up standards of quality. That is vital. Yet I am concerned by the document issued by the CQC recently that indicates that it is to start inspecting and regulating NHS acute hospitals, in the ways that it set out in that document, from October 2013. Indeed, from December 2013, it will begin to rate NHS acute trusts and NHS foundation acute trusts, aiming to complete them before the end of 2015.
Have Ministers put pressure on the CQC around the timing of those ratings? Secondly, does the noble Earl not think that there is a risk that the CQC will be forced to rush into a new system without proper consideration? I remind him that the chairman of the CQC has recently made a number of statements. First, he has said that the approach to inspections by the previous leadership was wrong; it was wrong to go for generalist inspections. He also says that the culture of the organisation was wrong. Given that there are about 1,000 people employed by the CQC, although I am not absolutely certain, how on earth is the culture going to change in a short period of three or four months? I just do not think it is going to happen.
I have great admiration for the current leadership of CQC, but the risk is that it is going to be forced into a new system too quickly and it could fall over. As a result, its credibility will be very much damaged. Let us face it; it is almost starting from a negative position. I must confess that I am surprised that such an ambitious timetable has been set.
Who will be assessed? As I have already intimated, the clause provides for the Secretary of State to draw up regulations laying out exactly which services the CQC will rate. They are likely to be hospitals, GP practices, care homes, domiciliary care services across both the public and privates sectors and local authorities. Will the noble Earl confirm that? Will he say why this is not specified in the Bill? Does he not consider it important enough for Parliament to decide which bodies should be assessed, and to do so in primary legislation rather than through regulations?
I asked at Second Reading whether clinical commissioning groups are to be assessed. If not, why not? The Bill allows for local authorities to be assessed for their performance in the commissioning of adult social services, so I cannot really see why NHS commissioners—the CCGs—should not be similarly covered. The same logic then applies to NHS England which, after all, has been given a massive commissioning budget in relation to specialist services. If it is appropriate for local authorities to be assessed for their commissioning responsibility, surely all health commissioners should be similarly assessed. That must apply to NHS England because otherwise I do not see who will hold it to account for the mammoth amount of resources it will spend on commissioning specialist services.
I am particularly interested in local authority assessment, particularly in the way that services are commissioned. Can the noble Earl tell me whether this is intended to be a priority for the CQC? He will know that there is real concern about the practices of many private sector providers in social care in using zero-hour contracts and allocating only 15 minutes with each client. It is vital for the CQC to be able to investigate the way in which local authorities commission those services. We will come to this in Clause 5 but it would be very useful if the noble Earl could confirm that the commissioning responsibilities of local authorities will be a priority for the CQC.
Earl Howe
I completely understand the noble Lord’s point. He will remember that in the registration requirements for providers of health or social care, the existence of a complaints system is one factor on which the CQC will need to satisfy itself. On the quality of the complaints-handling system within that provider, my answer is that it is a powerful point and an important area, but in the end it is one on which we should let the CQC decide as it develops its methodology. I do not in any way dismiss the noble Lord’s suggestion, but it is one for the CQC to take forward.
Baroness Pitkeathley
My Lords, this has been a wide-ranging and well informed debate. It has focused on anxieties about the role and competence of the CQC. The anxieties seem to focus on questions about whether the job of the CQC is doable at all, doable in the very short timescale, or doable with current resources. Suggestions about how to address the anxieties and concerns have included piloting new structures, but there has been much support for the CQC being given time to improve its strategy and performance—although with strong reservations from my noble friend Lord Campbell-Savours. I am grateful for the support for my amendments on integration, and sorry that the Minister was unable to accept them. Given the concern and strength of feeling about the CQC, I am sure that we shall return to this matter on Report. For the present, I beg leave to withdraw the amendment.
Baroness Jolly
My Lords, I am very sorry that the noble Lord, Lord Warner, is not in his seat. He tabled Amendment 79 to express the strength of feeling of Members of this House who were sitting on the scrutiny committee about the Secretary of State’s the duty to have regard to well-being. Were there room for more than four names to the amendment, there would have been more Members of your Lordships’ House on that list.
To put this in context—and the noble Lord, Lord Hunt, has taken us through quite a lot of this—this Bill was widely consulted. It was probably the coalition’s most widely consulted Bill; somebody might be able to tell me to the contrary. At each stage, people welcomed the well-being principle. Perhaps I may remind the House that in the majority report on the Bill, one of the recommendations was that the Secretary of State should have due regard. When the final Bill was produced, many in the sector approached me, and I suspect many others, to express their disappointment that that was not included in it. When the Secretary of State came to give evidence with the Minister for Care and Support, the right honourable Norman Lamb, he was very positive about it. According to the transcript of the session, Norman Lamb said:
“We absolutely want the wellbeing principle to apply comprehensively”.
The well-being principle is around the change of culture and it puts the person at the centre. It is absolutely critical that that happens, and next week we will debate the whole business of assessment and how we are undertaking it. However, unless the Secretary of State has to have regard to the same principle as local authorities, there is an opportunity for future Secretaries of State when making regulation to disregard well-being and just make regulation in the old way. One thing that sets this Bill aside from many others is that it is written in plain English and throughout its intention is pretty clear.
I ask the Minister if he is able to offer any assurance to the House, to the sector and to those for whom the Bill is written—the service users and the carers—that the Government will think again about the decision not to include in the Bill a duty on the Secretary of State to take well-being into consideration.
Baroness Campbell of Surbiton
My Lords, I apologise for not being able to bound in as soon as the noble Lord, Lord Hunt, sat down. At that moment my papers cascaded to the floor. I rise to support Amendment 78D. For logistical and physical reasons, as my noble Lords can probably hear, I was unable to put this amendment down myself and the noble Lord, Lord Hunt, has done miracles to articulate our conversations in such a lucid manner.
I feel, however, that I must give your Lordships a very clear example of why I believe this amendment is so necessary. Why do health and social care practitioners need this further direction in this amendment?
It is true that health and social care consumers enjoy greater personal control now, which affords a small percentage support to live independently in the community. I am an example of the few who live with complex health and social care requirements and live a life just like any other: pursuing a career, tending the family, or in my case revising legislation.
We remain, however, an exception, rather than the rule. Let me give your Lordships a couple of examples. Just over a year ago, I led a JCHR inquiry into Article 13 of the UNCRDP, a right to independent living. When we launched the findings, I dedicated the report to a disabled young man who had secured optimum control over his own life using social care direct payments. He lost everything within a couple of months, after his support needs changed, due to requiring a tracheostomy. He had graduated from university and was about to start his first job .
Baroness Pitkeathley
My Lords, I apologise to the noble Baroness, Lady Campbell. I was so eager to follow the noble Baroness, Lady Jolly, on Amendment 79, and I did not know that she was wishing to speak.
I particularly wanted to follow the noble Baroness, Lady Jolly, in speaking in support of Amendment 79, on which my name appears as well as hers and the noble Lord, Lord Warner, who was unavoidably absent today, and indeed the noble and learned Lord, Lord Mackay.
It will not have escaped the notice of the Committee that we are all members of the Joint Select Committee which scrutinised this Bill. We were very keen to have in Clause 1 the recommendation that when making regulations or issuing guidance, the Secretary of State must have regard to these principles, as must as local authorities.
We put this issue to the Secretary of State and the Minister as the noble Baroness, Lady Jolly, has mentioned, when they appeared before the Joint Committee. They appeared to be very favourably inclined towards it. We were very hopeful that this would be in the Bill. The civil servants were clearly less eager about this, so perhaps it was no surprise that it did not appear. However, we took away from the evidence session the understanding that Ministers were sympathetic to the idea. That is one of the reasons this amendment has been tabled.
Sadly, the official line now seems to be that used by the Minister at Second Reading on 21 May, when he said that,
“the well-being principle in Clause 1 is intended to apply at an individual level, when a local authority makes a decision. This individual focus on the specific well-being and outcomes for that person is at the heart of the way that the Bill has been drafted. It is not intended to apply in a more general way. Given that we do not think it would be appropriate for the Secretary of State to be subject to the same duty, the Secretary of State does not make decisions at the individual level”.—[Official Report, 21/5/13; col. 829.]
Nobody could disagree with the first part of that statement but the second part simply does not follow on, because the Secretary of State’s actions in regulations and guidance determine to a great extent whether local authorities can discharge their duties under Clause 1.
If the Secretary of State asks so much of local authorities without adequate funding being available, they will simply be unable to discharge their duty. Only if the Secretary of State is bound by the same duty as the local authorities can there be any realistic chance that, over time, he will avoid making unreasonable demands of local authorities in the instructions that he gives them. The way that the Bill is drafted, the Secretary of State can simply pass the buck back to the local authorities, which differs from his position in relation to the NHS, where he is required to act in accordance with the NHS Constitution. If it was the Secretary of State’s intention, as he seemed to be saying in his oral evidence to the Joint Committee, to support the well-being principle in practical terms, this amendment should be acceptable, and I hope it will be.
Lord Black of Brentwood
My Lords, I shall speak to Amendments 78E, 87K and 88J, which are in my name. They raise the issue of companion animals—mostly cats, but dogs as well—and the positive role that they can play in the care of elderly, vulnerable and sick people, whose welfare is at the heart of the Bill. I should declare an interest as president of the Printing Charity, as it runs two homes providing sheltered accommodation and financial support and care for people from the printing industry.
Amendment 78E includes the positive contribution of a companion animal to an individual’s well-being in the list of factors to which a local authority must have particular regard in exercising its functions under Part 1. Amendment 87K includes identifying the role of companion animals in the care and support of an individual when a local authority is assessing their needs and those outcomes that an individual wishes to achieve in day-to-day life. Finally, Amendment 88J deals with the issue of companion animals in regulations under Clauses 9 and 10. Taken together, their purpose is to ensure that the benefit which companion animals can provide to well-being, a subject not currently covered in the Bill, is not overlooked by those implementing and interpreting it.
It is estimated that 25% of people over retirement age own one or more pets. For the elderly and vulnerable, the companionship that cats and dogs can bring cannot be overstated. Academic research over many years has documented this. One study by Brooks, Rogers and others, published just last year, highlighted the emotional and practical impact that companion animals offer. Noting that they provide unconditional support and love, as we all know, the study concluded that,
“the policy implications of this study suggest that pets might usefully feature alongside consideration of the usual support systems associated with the management of long-term conditions and in planning how needs might be ... creatively met”.
That, of course, is precisely what this Bill is designed for and what these amendments are crafted to deliver.
Cats in particular can help those who are vulnerable, through age or health, in three ways. First, there is a powerful body of evidence about the contribution of cats to physical health. According to one study published recently in the Journal of Vascular & Interventional Neurology—not a magazine I look at frequently, but it is there—they contribute to a reduction of fatal cardiovascular disease by around 30%.
Secondly, the ownership of a cat brings positive benefits to an individual’s mental health. Research conducted in 2011 for Cats Protection and the Mental Health Foundation among people with a mental health problem found that 76% of people who owned a cat felt they could cope with everyday life much better as a result, and that 87% said it had a positive impact on their well-being. Cats can be especially helpful for depression during the winter period—a particularly important point since, as we now know, this goes on for about nine months of the year. As the Cinnamon Trust, which works tirelessly to support the elderly and their pets, summarises it:
“Pets have the ability to bring happiness and laughter and lift depression. Communication with other people is often easier when a pet is present for reassurance”.
Thirdly, cats make particularly suitable companion animals for those with chronic health problems, including those who are immobile or disabled. I know that this is a charge always made against cat lovers, so I am not forgetting our canine friends. I highlight, for instance, the excellent work of the innovative Dementia Dog Project, which helps to keep people in the early stages of dementia active and engaged with their local community, as well as providing a constant companion to reassure those suffering from dementia in new or unusual situations. This project in particular shows that a dog may aid a sufferer to stay on longer in his or her home—an important ambition that many noble Lords have highlighted in this debate—and may even slow the onset of this terrible disease.
Real-life examples of how cats promote well-being and play a vital role in an individual’s care appear regularly in the excellent magazine, The Cat, which is a publication I do look at regularly and is published by Cats Protection. In recent months, there have been stories about how their cats helped an owner to cope with epileptic seizures, helped a seven year-old boy to deal with the debilitating problem of selective mutism, and comforted a 17 year-old girl confined to bed with the life-long incurable condition of Behçet’s syndrome. One particularly moving story related to how a visit from a cat to an elderly lady who was in a hospital ward and suffering from severe dementia got her to speak for the first time in three months.
There are many other examples. Indeed, I think of the experience of my own mother. In the last year of her life, she was widowed, immobile and more or less housebound. Her faithful cat, Toby, was her constant companion. She talked to him, laughed with him and moaned and shouted at him; he cared for her in return. Indeed, he lay on her bed as she died. That companionship is a priceless gift, which this legislation should protect. Let me explain briefly how these amendments might help, as I ask my noble friend the Minister to consider these three issues.
First, one of the many problems that those who are elderly with a pet can face is how to care for it when they go into a care home. There are some amazing care and retirement homes which welcome pets but others do not have a policy on them, which can cause anxiety and distress to those who need to enter one. For a person to have to give up what might be their sole companion is a tragedy for an owner and for the pet. It also adds to the growing burden on many animal charities, which are having to take increasing numbers of abandoned pets as economic problems have bitten hard in so many families.
Secondly, it would encourage those at the front line of care—GPs, in other words—to become aware of the role of a pet in an individual’s life. Many GP surgeries include in their information about the over-75s whether a companion animal forms part of the client’s household. The signal sent from amending the Bill would encourage many more GPs and clinical commissioning groups to ensure that this important information is routinely collected for all age groups, including the elderly.
Finally, the Bill needs to be drafted widely enough in its definitions of well-being and needs assessments to allow for money, whether budgets or direct payments, to be used where necessary to support an individual who perhaps wishes to retain a pet but is having problems due to health. Professional pet-sitting or feeding may be needed when an individual is hospitalised and where there are no friends or family to help. Knowing that a pet is being cared for can help encourage otherwise reluctant individuals to go into hospital for treatment and relieve anxiety. Equally, in cases where a care assessment shows that a companion animal would bring individual health benefits, money may be needed to help an individual obtain a companion animal. There are many examples of such budget programmes in other countries—most notably, I think, in Australia—where health and local authority budgets are pooled to provide companion animal support programmes. This principle should be embedded in regulation and statutory guidance for all relevant implementing bodies.
Most importantly of all, these amendments would ensure that the role of companion animals is given proper recognition and protection through an individual’s care journey. Some may be too vulnerable or frail to request that their beloved pet is taken into account when their care is planned. Others may need help or assistance in retaining their companion. Others still may not be aware of how a cat or a dog could improve their quality of life, ease their loneliness or help tackle a chronic disease. The amendments I have tabled would ensure that this happens as a matter of routine and is not left to chance in the way that, tragically, too often happens now.
Care Quality Commission: Morecambe Bay Hospitals
Baroness Pitkeathley Excerpts(11 years, 6 months ago)
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Earl Howe
The right reverend Prelate makes an extremely important point. The Government have been very supportive of the concept of hospital chaplains, who play an enormously important role in supporting not just patients but staff. I am concerned because I have heard anecdotally that in some hospitals there are moves to dispense with hospital chaplains. I am in touch with one of his right reverend colleagues about this. Once again, we have a mechanism—if I may call them a mechanism—that could be deployed to good effect in this context.
Baroness Pitkeathley
The Government’s support for the current leadership and the newly launched New Start consultation will be welcome to all those of us who know the current people. Can the Minister assure the House that the Government will stand firm in this support when the tabloid press starts calling, as it surely will, for more heads to roll? Will he further assure the House that he believes that the last thing that the CQC needs is more change at the top?
Earl Howe
I agree fully with everything that the noble Baroness has said. We have in the CQC the right team to take it forward. They are very clear that there needs to be a complete refresh of the senior team where doubts emerge about the individuals concerned. We are already seeing a complete refresh of the board. I share her worry about the tabloid press and calls for heads to roll. Nevertheless, it is appropriate, in the particular context of Morecambe Bay, for there to be a close look at the role of certain individuals: exactly what they did, what they knew, when they knew it and whether what they did was either wrong morally or against the law.
Care Bill [HL]
Baroness Pitkeathley Excerpts(11 years, 7 months ago)
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Lord Warner
My Lords, the purpose of this amendment is to require HEE to give attention to ensuring that, in educating and training staff for the NHS, it also ensures that, as far as possible, staff can work across the health/social care boundary in an integrated way. I welcome the fact that the Government have inserted into Clause 88(1) paragraph (h), which states that Health Education England must have regard to,
“the desirability of promoting the integration of health provision with health-related provision and care and support provision”.
That strengthens the Bill from its draft version, but the Bill should go further, hence my amendment.
I would like to ensure that when separate regulations are made under Clause 85 for particular groups of staff, Health Education England is also required to try to use particular regulations to promote integration in accordance with the Clause 88 provision. For example, if there are to be regulations on community nurses or healthcare assistants, the issue of training them or recognising qualifications or registration, Health Education England should act in a way that facilitates integration of services by enabling those staff to carry their training and qualifications across employment in as wide a range of settings as possible. In short, it is to help secure an integration through portability of training and qualifications provision.
We are very good at mouthing platitudes about integration and swearing undying fealty to that great god, but we are rather less good at removing the blockages to it. One of those blockages can be training and education that prevents staff from working in a range of settings, with qualifications that are not always recognised by a range of employers. We need to do our best when we have the opportunity to remove those blockages and secure more people who are equally at home working in a predominantly health or a predominantly social care setting and can easily move between those settings for the benefit of services users. These staff need to be alert also to the importance of integrating care for individual service users across organisational boundaries. I want to ensure that Health Education England is in no doubt that this approach is important for tomorrow’s workforce. That is what my amendment seeks to achieve.
I recognise that there may be better ways of reflecting my intentions in the Bill than the precise wording of my amendment. However, I think we should go further than the broad duty in Clause 88 and relate it specifically to regulation-making powers for particular groups of staff. I would certainly be happy to discuss other ways of achieving this in the best interest of patients. I beg to move.
Baroness Pitkeathley
My Lords, I speak in support of the amendment. It is absolutely vital from the point of view of the patient and the family that the workers with whom they come into contact have an understanding of the whole of their situation. The training and experience of such workers has to encompass that whole situation. For example, a person who is admitted to hospital quite suddenly with a stroke has contact with social care services, finance departments of local authorities, charities of all kinds, reablement services, private care providers, as well as all the health services concerned with the actual condition.
Most people in that situation have none of the hinterland that some of us in the House have. We start with knowledge that, for example, health and social care systems are differently funded and that there is no commonly understood framework for integration. Most people experiencing services do not have that pre-existing knowledge. If such a person is going to have the opportunity for choice, to which we are all committed, it is absolutely vital that the workers with whom they deal have the broadest range of knowledge and experience. People’s experience of health and social care does not come in discrete packages. It is vital that the experience of workers does not come in discrete packages either.
As this is the first day of Carers Week, I will add a further point about carers. The report published today by Carers UK, Prepared to Care?, shows that every day 6,000 people take on a caring responsibility, often without any preparation, information or advice. Therefore, I hope that the Minister will agree that the responsibilities of the workforce across all services should include training and awareness of the needs of carers. The promotion of integration contained in the amendment would also address that issue.
Care Bill [HL]
Baroness Pitkeathley Excerpts(11 years, 7 months ago)
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Lord Turnberg
My Lords, I strongly support my noble friend’s amendments, which would ensure that local authorities and, in particular, patients and carers can be represented on the LETBs. I have three amendments in the group. Amendment 38 adds to the list of bodies from whom LETBs need to seek advice—namely, the local university medical and nursing schools. I know it is hardly likely that their advice will not be sought since they are so intimately involved in delivering educational programmes, but in case that message is not clear, we need to have it clarified somewhere in the Bill. I recognise that there has not always been unlimited delight felt by the trusts about the way the universities, particularly the nursing schools, have provided education suiting their products to the trusts’ needs. Nevertheless, it would be clearly wrong to ignore them.
Amendment 41 draws attention to the need to include postgraduate deans in the local education and training boards’ activities. It surprises me, to say the least, that the deans are not mentioned at all in the Bill, despite the fact that they are absolutely crucial to the oversight of education and training. I am sure they will be involved but we must have the comfort of knowing that their crucial role is acknowledged by seeing them clearly mentioned in the Bill.
Amendment 50 makes it a requirement for LETBs to include in their list of bodies from whom they need to take advice, the local universities in their patch. It is not enough to include these bodies in the catch-all phrase of subsection (4)(e),
“such other persons as the LETB considers appropriate”.
The medical schools need to be named in that list.
Baroness Pitkeathley
I speak in support of Amendment 51 on the patient and carer voice. I know that there is sometimes resistance to patient and carer representatives on bodies such as this. One often hears professionals say, “They only speak from their own experience”. Yes, they do speak from their own experience—and that is actually the powerful and most informative bit. That is not to say that patients and carers can only speak from their own personal experience; they speak from the wider experience too of other patients and carers with whom they are in contact. That is the most important voice and we should give it a hearing, because very often it is a way of approaching a situation entirely differently from the way in which the professionals would come at it. I am sure that there is a great deal that most professionals, either trained or in the process of being trained, could learn from that.
Baroness Cumberlege
My Lords, I wish to say a word about these issues. There is a danger, when we are setting up on the face of the Bill, the component parts of something like the LETB boards. As I understand it, the principle was that the majority of members of the board are local providers. That seems sensible because clearly they are the people who are going to have the knowledge and will inform the LETBs. Simply adding new members, each with a representative function, does not really aid the ability of a board to make decisions. It can become less effective and efficient, purely due to the numbers of people around the table.
There are many groups of workers and, indeed, patients who have got a case, but there are other ways of involving them. I very much accept what the noble Lord, Lord Turnberg, said about having due regard to universities and deans of medical schools. I am happy about the idea that one should have regard to advice that has been given, but I am not sure about having specific representatives that HEE decides are good for a local area on the board. Some areas want to do it differently. To me, that is fine. The size of the LETBs varies enormously; they can be the size of the whole of the north-west and the whole of the south-west, yet Wessex and Thames Valley are separate. These are to be local education and training boards; they need the freedom and flexibility to reflect the local area. Although I understand that people are anxious to ensure that the LETBs are efficient and represent local areas, views and constituent parts, it should be left to their flexibility and judgment.
Health and Social Care
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Earl Howe
The essence of the answer to that is that improved outcomes will be achieved only when all parts of the system work together. If you have shared measures within the outcomes frameworks and measures that are complementary to each other, you will shine a light on areas of inequality and inform local and national action to advance equality. This focus on outcomes rather than processes enables an innovative approach to health and care services that is driven essentially by the needs of the local population. I will just add that local Healthwatch has a role to play in working with partners to make sure that the views of vulnerable and seldom heard groups in the population are heard.
Baroness Pitkeathley
My Lords, is any work being done on the outcomes of preventive work? I speak, for example, of installing a handrail to prevent a fall that results in an unnecessary and expensive hospital admission. These are often overlooked in terms of outcomes. Will the Minister tell the House if any work is being done on preventive work?
Care Bill [HL]
Baroness Pitkeathley Excerpts(11 years, 7 months ago)
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Baroness Pitkeathley
My Lords, like the noble and learned Lord who has just spoken, I—and several noble Lords speaking today—was a member of the Joint Scrutiny Committee. Like the noble and learned Lord, I join the thanks to the officials, the chairman and my fellow members. I very much welcome the changes that the Government have made to the draft Bill as a result of the committee’s report.
Your Lordships will many times have heard me and others—whom I have a habit of referring to as the usual suspects—detail how inadequate social care systems are for meeting the needs of the increasing numbers who need them. “The system is not fit for purpose”, “out of date”, “confusing” and “a lottery”—all those are familiar phrases to your Lordships’ House. So it is a great pleasure to welcome a Bill which attempts to address some, though by no means all, of the problems. Importantly, it addresses the issue of the law relating to social care. It encapsulates proposals made by the Law Commission report in May 2011. The Law Commission pointed out that the law relating to adult social care stretched back to the Beveridge reforms of the 1940s and included a plethora of other Acts, including the National Assistance Act 1948, parts of which are still in force. The law relating to people with disabilities and carers, as we have heard, is similarly contained in a variety of parts of Acts and Private Members’ legislation.
The Law Commission originally proposed that there should be a tightly defined process for determining the scope of adult social care. But when it consulted very widely, it decided instead to define the purpose of adult social care as promoting or contributing to the well-being of the individual. That recommendation was accepted by the Government and is central to the new policy. The whole of the new policy structure is shaped by the well-being provision, although I share with the noble and learned Lord, Lord Mackay, anxiety about the accountability of the Secretary of State for Health in this regard.
The enactment of the Care Bill will not just consolidate and streamline into a single statute 60 years of piecemeal law-making, it will place on a statutory footing for the first time both the principle and practice of self-directed personal care based on individual assessment. Particularly pleasing is that the well-being principle is also to be applied to the individual’s carers. It is around carers that I want to base the majority of my remarks this afternoon.
In the draft provisions it was not clear whether the important duty on local authorities to put the promotion of well-being at the heart of their delivery of care and support also applied to carers. The new reference to “individuals” rather than to “an adult”, which appeared to refer to an adult receiving care, now rectifies this and removes any doubt that carers are qualified. This is an important and welcome distinction.
The Bill also adds a new landmark duty that local authorities should have a duty to ensure that they plan for sufficient care and support services when enabling carers and disabled people to be supported, especially with regard to them being able to undertake paid employment.
A Private Member’s Bill was introduced by another member of the Joint Committee, Barbara Keeley MP, which would have put in place this sufficiency of support duty. Although the Bill did not progress, its vision has now been accepted by the Government who have responded in the Care Bill by placing a new requirement on local authorities to ensure that there are sufficient care and support services to meet current and future needs. This would have a particular focus on supporting carers to undertake paid work and caring where this is possible, although when we come to the issue of carers’ resources to provide that sufficiency, we will no doubt have many debates.
The new provisions in the Bill set out a framework for the development of more modern services that can help family members. As well as being hugely important in preventing financial hardship for families, this can also be seen as of great benefit to the wider economy. It has been estimated that carers giving up work costs the economy up to £5 billion a year.
Another very important change that has been made for carers is with regard to finance. The draft Bill did not make it clear that, as in the case of the person with care needs, a carer’s need for support should be assessed before their financial circumstances are considered. I am pleased to see that the Bill has been amended to put an assessment of support needs before financial assessment. Again, that is very important.
The draft legislation could have meant that carers could be wrongly charged for services provided to the person they care for. The Government have said that this was not their intention and they have made it clear that carers must not be charged. However, what is a carers’ service and what is a service for an older and disabled person are not yet clearly set out in the Bill. We will need to make further changes that will define what they are and prevent confusion and disputes down the line.
Two other areas about carers will need careful scrutiny as the Bill goes through and I hope that the Minister will comment on these. The first is the issue of young carers, as has already been mentioned. The Joint Committee that scrutinised the legislation called for amendments to ensure that young carers get equal rights to assessments and support in law, both in this Bill and the Children and Families Bill currently before Parliament. The Government have made some limited changes that mean that where a young person receiving care is in transition between children's and adult services, the circumstances where they or a young carer would be covered by provisions in the Bill would ease this transition.
However, the changes do not alter the fact that young carers will have lesser rights to assessment and support than adults caring for adults. The same thing will apply to parent carers, because we have to ensure that parent carers—those who look after disabled children—do not also end up with lesser rights, because the changes made for carers, and we hope for young carers, are very positive. Parent carers now have an imbalance of rights because they are not included, and we shall need to give this careful attention as the Bill proceeds.
Others have commented on the Dilnot proposals and I will not do so, except to say that, for many of us, the level of the proposed cap is disappointing. The effects of bringing many who are currently self-funders into the assessment system have not yet been sufficiently recognised.
In conclusion, there is no doubt that the Care Bill has the potential to make major improvements to how social care is delivered. However, we shall have to focus very carefully on several issues, apart from those I have mentioned already, if it is to achieve that potential. I will just list them now. The first is national eligibility criteria and where they are to be set: there is a great deal of anxiety about that. The second is the role of advocacy in helping people negotiate a system which, by the Government’s own admission, is complex and difficult to understand. The Joint Committee thought that advocacy ought to be part of the element of information and advice, but the Government have not accepted that. There is also, of course, the old issue of integration of health and social care, which we all know is so vital; the Government have recently made renewed commitments to such integration. Also under this heading, we need to look at the role of prevention, which is similarly such a vital part of integrated services. There is also the vexed issue of funding, on which I look forward to spending many happy hours. In order to make the vision encapsulated in this Bill a reality, the Government and the nation simply have to make resources available. Not to do so is a false economy and will store up many more problems for the future.
I hope our debates will enable us to look at a broader vision too, such as that encapsulated in the Ready for Ageing? report from the committee chaired by my noble friend Lord Filkin. If anyone imagines that the Bill before us today provides a long-term solution to all the problems in social care, they are very much mistaken. I hope the Minister will be able to acknowledge this. Recently I gave a lecture at King’s College entitled, “Social Care: Our Biggest Problem or Greatest Opportunity?”. My conclusion was that it was both. My noble friend Lord Filkin’s report is the clearest call yet that we have had for a new vision for social care—a different settlement for the older people we will all become. This is not just a matter for health and social care, but for whole communities, the whole of government and all political parties. This Bill is a welcome first step towards that new vision—or new settlement—but we must never lose sight of the fact that it is only a first step.
Mid Staffordshire Foundation Trust Inquiry
Baroness Pitkeathley Excerpts(11 years, 9 months ago)
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Earl Howe
I reassure the noble Baroness that all the concerns that she rightly raised are very much in our sights, not least the need for proper supervision of nurse trainees and the practical aspects of having the right level of support on the ward. This is why we believe that this idea should be piloted first, so that lessons can be learnt. Yes, we will involve the NMC, and indeed the Royal College of Nursing, in these plans. As regards ratios, having the right staffing in terms of numbers and skills is clearly vital for good care, but minimum staffing numbers and ratios, if laid down in a rigid way, risk leading to a lack of flexibility or organisations seeking to achieve staffing levels only at the minimum level. Neither of those is good for patients. However, I do not dismiss the general concept. It is ultimately up to local organisations to have the freedom to decide the skill mix of their workforce, based on the health needs of those on the wards.
Baroness Pitkeathley
My Lords, the principle of putting the needs of patients first will be welcomed by every Member of this House. However, does the Minister agree that this means looking at care in an integrated way, since the patient experience is very rarely one of either hospital or social care but a mixture—sometimes a very haphazard mixture—of the two? Can the Minister therefore give the House more detail about how the government proposals will facilitate the integration of care services across health and social care, particularly as there will be two separate inspectors and as the ability of the CQC to put the shortcomings right is apparently going to be passed to Monitor?
Earl Howe
My Lords, the main drivers and levers for increased integration will come from other directions, such as: the systems we are putting in place at local authority level and health and well-being board level; more sophisticated tariffs; better commissioning arrangements between the NHS and social care; and the financial imperative that all commissioners and providers now face. That will mean an imperative to ensure that resources are not wasted and are deployed to the best effect of patients.
We must also remember that the NHS outcomes framework will be the benchmark by which the success of the service is judged, just as the social care outcomes framework will act in that sphere in an equivalent way. The major domain in both areas is the patient experience. If we believe that integration is above all to be defined by reference to the patient’s experience, we can expect commissioners across the piece to address commissioning in a way that avoids disjointed care.
Care Services: Elderly People
Baroness Pitkeathley Excerpts(11 years, 10 months ago)
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Baroness Pitkeathley
My Lords, I am grateful to my noble friend Lord Turnberg. When I knew I was going to be able to speak in this debate, I went back to a book I wrote in 1988 and there I found a quotation from Kathleen Jones in 1972. This is what she says about community care:
“To the politician, ‘community care’ is a useful piece of rhetoric; to the sociologist, it is a stick to beat institutional care with; to the civil servant, it is a cheap alternative to institutional care which can be passed to the local authority for action—or inaction; to the visionary, it is a dream of a new society in which people really do care; to social services departments, it is a nightmare of heightened public expectation and inadequate resources to meet them. We are only just beginning to find out what it means to the old”,
and “the chronic sick”. When I read that, I was so depressed that I thought, “Have we moved on at all since 1972?”.
What has changed hugely, as many noble Lords have reminded us, is the numbers. There are many more people now in need of community care, but we can agree that the key thing needed for the care of the so-called rising tide is a sufficient supply of good quality community care focused on the needs of the user and their carers. I hope the Minister will agree that this is the most urgent problem facing our society today. It is bigger than education, defence or, above all, the acute sector of the NHS, although sometimes one feels like a traitor for saying that.
The Francis report on Mid Staffs may be a very worthy document, but I submit that it has done us no favours by focusing our attention on the care of elderly people in hospital. Just sort it out, goes the view: appoint a hospital supremo and all will be well. As we all know, that is nonsense. Hospital care provides a tiny proportion of the need, and the real problem so far as older people are concerned is that far too many of them languish in hugely expensive hospital beds, as we have heard, simply because not enough care in the community is available. As one of the witnesses to the Joint Committee on which several of our colleagues have been serving said, community care is always the poor sister of the NHS. The social care system is in crisis, as we have heard, and we shall never solve it, perhaps, unless we learn to rebalance spending and attention between NHS care and social care.
Social care is very good value if we do it right. Am I hopeful? Do I still feel as depressed as I did when I read that quote from Kathleen Jones? I think some progress has been made. The Government have made a step—perhaps a small one—towards accepting the proposals of the Dilnot commission. The Care and Support Bill will come to us during the course of this year, we hope, which gives not only new rights for users and carers but new responsibilities to local authorities to give information, advice and advocacy when assessments are being done. The committee called more than 60 witnesses, and every one of them raised the issue of resources.
When it comes to community care, we always hear that we cannot afford it, but as Andrew Dilnot has powerfully said, it is not a question of cannot afford it but of will not afford it. The noble Lord, Lord Turnberg, has given us some ideas about how we could find the money, and I remind the Committee, as I have done before, that when we accepted the proposals of the Beveridge committee, we were absolutely skint as a nation. We were in the middle of the Second World War and had no money and no prospect of getting any, but we still accepted that visionary report. I maintain that we can do it again. I also maintain that getting care in the community right could be a vote winner because it is no longer about poor services for poor people. It touches everybody. I am sure that everybody in this Room has experienced trying to find community care for themselves or their relatives—or they will within the course of the next year or so. I believe it is something that affects everyone, and therefore it is a very attractive idea for political parties to embrace as we approach a general election. I am sure many of us will be looking at what is said in manifestos about that.
Finally, care in the community, however we improve it, largely means care by the community, and community largely means your family, so I must point out, as I do at every opportunity, that the contribution of unpaid carers is £119 billion. It makes sound economic as well as moral good sense to support them as the main providers of care in the community.