Care Bill [HL]

Baroness Tyler of Enfield Excerpts

Wednesday 9th October 2013 Lords Chamber

[Lord Mackay of Clashfern (Con)]

I warmly support that. I am happy with the parliamentary counsel’s draft, which is what the Government are going to move, and we have to understand that some lawyers are better than others at making drafts.

So far as the amendment of the noble Baroness, Lady Barker, is concerned, I hope that the Government will pay considerable attention to what has been said about it.

[Baroness Tyler of Enfield (LD)]

My Lords, I rise briefly to speak to government Amendment 2 on dignity and respect. I know that it was implicit in the well-being clause in the earlier versions of the Bill that we looked at, but I am very pleased that the need to ensure that all people are treated with dignity and respect has been brought out so explicitly. These are words that the man and woman in the street really understand; they get to the heart of some of the concerns about the type of social care that has sometimes been provided, which has fallen well below those standards, and caused some of the scare stories that we have heard so much about recently.

The noble Lord, Lord Bichard, and I raised this issue in Committee, but as he is unavoidably unable to be in his place today, I thank the noble Earl, Lord Howe, on behalf of both of us, for listening and for bringing this amendment forward.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, I am grateful to all noble Lords who have spoken and for the opportunity to discuss once again this important new well-being principle set out in Clause 1. The amendments in this group cover three important issues. The first of these relates to the application of the duty to promote well-being to the Secretary of State. In Committee we debated the link between the role of the Secretary of State and the duty of local authorities to promote the well-being of individuals. There was clear strength of feeling in the Committee that the Bill should make explicit reference to the Secretary of State having regard to the duty on the local authority to consider the well-being of the individual. An amendment in this regard is not essential because the local authority well-being duty is in any event a relevant factor for the Secretary of State to take into account when issuing guidance or regulations. However, I do recognise the strength of feeling and I am happy to clarify the position.

In response to the concerns, I have tabled Amendment 138, which explicitly requires the Secretary of State to have regard to the local authority well-being duty when issuing regulations and guidance. This achieves, I hope, the same ends as intended by the amendments tabled by the noble Lords, Lord Hunt and Lord Warner, and I trust that they will support the government amendment.

The second issue relates to the focus on dignity, to which my noble friend has just referred. In Committee, noble Lords expressed concern that personal dignity was not adequately reflected in the well-being principle, in spite of the change that the Government made to this effect following consultation on the draft care and support Bill. Let there be no doubt that the Government place the utmost importance on dignity and respect in care. These factors must be central to the well-being principle. In order to ensure that dignity is given due prominence in primary legislation, I am pleased to have been able to table Amendments 2 and 3, which give greater emphasis to personal dignity and respect as components of well-being.

The third issue in this group relates to another constituent part of individual well-being: spiritual well-being. My noble friend Lady Barker’s Amendment 4 would include an explicit reference to spiritual well-being in Clause 1(2). We debated a similar amendment in Committee. I said then, and I emphasise now, that the Government recognise the importance of spiritual well-being as a concept and understand the particular significance that it can have for some people, especially at the end of their life. We would absolutely not want an approach that excluded spiritual well-being from consideration where that was clearly of consequence to the individual concerned.

However, it is important to understand that that is not the approach which the Bill sets out. The factors included in Clause 1(2) contain high-level matters which should be interpreted broadly to fit the individual case. Spiritual well-being should be considered where it is relevant to the person’s overall well-being. Moreover, spiritual well-being is likely to be closely related to other matters, such as emotional well-being, which are listed in the clause.

In addition, local authorities must also consider the person’s views, wishes and feelings, as set out in Clause 1(3)(b). This provides a further clear direction to local authorities to have regard to personal matters, which could well include beliefs or other views that would promote an individual’s spiritual well-being. Although it is not explicitly mentioned, spiritual well-being is nevertheless accounted for.

I hope that I have reassured in particular my noble friends Lord Hamilton, Lord Deben and Lord Cormack, and indeed the noble and right reverend Lord, Lord Harries of Pentregarth—

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[Baroness Wheeler (Lab)]

My Lords, I am pleased to speak to our Amendments 7 and 10 and will speak mainly about young carers, as my noble friend Lady Pitkeathley has spoken strongly on parent carers for disabled children and the other key issues covered in this group. In Committee, we were deeply concerned at the very real danger and risk of young carers’ rights and their need for support failing to be addressed in either the Bill or the Children and Families Bill, so it is with great relief that we will be dealing today, now and later, with significant amendments relating to adult care assessments and young carers, local authorities’ duties to identify young carers and ensuring young carers are supported and are not forced to undertake inappropriate caring roles.

On young carers, it is somewhat frustrating that the Government amendments, which are an integral part of the package on young carers that locks in the links between the Bill and the Children and Families Bill, are to be taken in a later group. We need to see the picture on young carers as a whole to be reassured and clear about how the two Bills interact to secure young carers’ rights on support and assessment. Under the two Bills, the Care Bill links adult assessment where a young carer is supporting an adult with the young carer’s assessment, which will be undertaken under the Children and Families Bill. The ministerial Statement on the latter from the Department for Education sets out how it sees this working in practice, and we broadly support this. Our Front-Bench team on the Bill will be probing this further in Committee, which, of course, commences today.

We welcome all these developments. We have worked closely with the excellent National Young Carers Coalition and it has led calls for key changes in the two Bills. I am sure the Minister will agree that the NYCC has done a great job of bringing the plight of young carers to the attention of the House and to Ministers. I am pleased that the Government have now taken steps to ensure a twin-track, joined-up approach between the two Bills.

As the Bill has progressed, we have heard extensively why children and young people caring for a family member, parent or sibling can be so vulnerable to losing out on their education and on the things that they want to do with their lives and how their health can suffer as a result of having to undertake significant caring responsibilities. However, it is a shocking fact that too often young carers do not get the help they need. One of the reasons for this is that, under the current assessment process, the person they are caring for does not receive enough support and the needs of the whole family are often not taken into consideration.

We must remember that this can have a devastating impact on both the young carers and the cared-for person. As a trustee of our local carer support group in Elmbridge, I can say that we see this from both ends. Many of our registered young carers are delivering hands-on support and may be the only other person in the house. For example, if their parent has mental health problems—very often the most hidden of caring roles—the child may have to look after themselves on a daily basis, make their own meals and get off to school, as well as being supportive of the parent and carrying out tasks for them. At the same time, a disabled parent does not want to see their child overburdened with caring duties; they feel desperate and guilty when they require care and support that is not forthcoming as part of the care package, and the child just has to help—and usually wants to anyway. That is a dilemma.

That is why we sought to amend the Bill in Committee so that adults with care and support needs are assessed in relation to the presence of a young carer, so adult needs are met sufficiently and children are prevented from undertaking levels of caring that put their well-being, health and development at risk. The government amendments now put this into effect in the Bill and we fully endorse them as part of the package of changes that are needed.

That is also why our Amendment 7 to Clause 2 must be an important part of the package. We believe that the Care Bill is the right place for the law to be clear that adult services need to assess and meet adult needs first, but with a view to whether a child may be caring for them and providing the support as required. Children should not be picking up the pieces and left to provide part of the care package as a result of the failure of adult services to see and support them alongside children’s services.

Our essential aim has been to ensure that local authorities provide or arrange services to prevent young carers from developing needs for care and support, as well as preventing and reducing needs for adults and adult carers. We cannot have a situation where people have unmet care and support needs, which results in children and young people having to meet those needs.

Our Amendment 10 specifically deals with the issue of local authorities’ duty to identify young carers. We know that currently, adult social care services and health services routinely fail to identify children who may be caring for an adult, even when the adult is assessed, and that also applies to schools. As a result, children can continue to undertake harmful caring roles and end up developing needs for care and support themselves. The lack of a co-ordinated response between children’s and adult services remains an ongoing difficulty for young carers and their families. I hope that the noble Earl will recognise the need to address this problem.

On the other amendments in the group, we strongly support the intentions of Amendments 6, 8 and 9, which seek to emphasise parent carers of disabled children, both in respect of the well-being principle and in terms of preventing them undertaking inappropriate caring. Amendments 46, 47 and 58, in the name of my noble friend Lady Pitkeathley, seek to address the very real fears of carers and their organisations over carers being charged for key services that they are not currently charged for. My noble friend’s amendments represent an excellent opportunity to put carers’ minds at rest on this issue once and for all, and I hope that the Government will be sympathetic to this.

Finally, my noble friend’s Amendment 48 addresses the important issue of carers generally—not just young carers—being required to undertake inappropriate caring. We dealt with this issue in relation to the assessment process extensively in Committee and we strongly support this amendment. Support from family and carers should be considered as a way of meeting needs rather than as a reason for deciding that the person does not have needs or is not eligible for care. Carers must not be pressurised to provide care that they do not feel able to provide. I look forward to the Minister’s response on this.

[Baroness Tyler of Enfield]

My Lords, I rise very briefly to speak to Amendment 34 in my name. The purpose of this amendment relates to the definition of a carer, to ensure that it could include a young person as well as an adult. I wish to explain that I tabled the amendment before the extremely welcome Statement by the Secretary of State for Education earlier in the week, and the tabling of the new amendments on young carers. As other noble Lords said today in the Chamber, I very strongly welcome this. I know, from talking to both departments—the Department for Education and the Department of Health—that a lot of very effective work has gone on over the summer that has been very effective both at official and ministerial levels. I also very much welcome the fact that the National Young Carers Coalition has been very much involved in these changes, and I know that it has issued a statement welcoming them.