Health and Care Bill

Baroness Wheeler Excerpts

Lords Hansard - Part 1 & Committee stage
Monday 31st January 2022 Lords Chamber

[Lord Davies of Brixton (Lab)]

I was going to oppose the question that Clause 80 stand part of the Bill, but I thought the order of speakers was going to be somewhat different. I am sorry—I am looking to my Front Bench for guidance.

[Baroness Wheeler (Lab)]

My noble friend wrote to the Table Office and said that he did not want Clause 80 to stand part and that he wanted Amendment 217, which I shall be moving, to start this group, as it did originally.

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Moved by

[Baroness Wheeler]

217: After Clause 80, insert the following new Clause—
“Social care needs assessments
(1) A social care needs assessment must be carried out by the relevant local authority before a patient is discharged from hospital or within 2 weeks of the date of discharge.(2) Each integrated care board must agree with all relevant local authorities the process to apply for social care needs assessment in hospital or after discharge, including reporting on any failures to complete required assessments within the required time and any remedies or penalties that would apply in such cases.(3) Each integrated care board must ensure that—(a) arrangements made for the discharge of any patient without a relevant social care needs assessment are made with due regard to the care needs and welfare of the patient, and(b) the additional costs borne by a local authority in caring for a patient whilst carrying out social care needs assessments after a patient has been discharged are met in full.(4) The Secretary of State must publish an annual report on the effectiveness of assessment of social care needs after hospital discharge, including the number of patients readmitted within 28 days.”Member’s explanatory statement
This amendment would create protections for the provision of social care needs assessments. It includes requiring an assessment to be carried out either before a patient is discharged from hospital or within two weeks of discharge; and requiring ICBs to agree a process for the provision of assessments.

[Baroness Wheeler (Lab)]

I am sorry about the confusion and I thank my noble friend Lord Davies for helping to clear it up.

Amendment 217 seeks to tighten up important safeguards for patients and their carers by adding a new clause after Clause 80. Clause 80 repeals current provisions under the Community Care (Delayed Discharges etc.) Act 2003 and regulations for hospital discharge, and paves the way for the discharge to access approach used particularly during the pandemic. I thank my noble friend Lord Davies for allowing me to move this amendment and not opposing the question that this clause stand part. I know he will want to speak at some point during the debate.

We know that during the pandemic the discharge to access approach led to some very welcome and innovative practices in getting patients out of acute settings in hospital into safer environments. The approach also led to tragedy, when untested patients or patients with Covid were transferred into care homes, causing the rapid spread of infection and, sadly, hundreds of deaths that could and should have been avoided. Evidence from key stakeholders to the Commons committee dealing with the Bill reflected a very mixed experience of this new process. In some areas the perennial and disruptive issues around delayed transfer had eased and the process was working relatively well, while others sought much tougher safeguards or the end to the discharge to access process altogether.

Amendment 217 seeks to ensure the vital safeguards needed, which are particularly important since Clause 80 repeals key provisions but is not exactly clear on what replaces them. We are therefore seeking to add a new clause after Clause 80, ensuring that social care needs assessments take place by the local authority either before a patient’s discharge from hospital or within two weeks of discharge. It also requires the ICB to agree a process for the assessments with the local authority.

The amendment covers the need to have due regard to the care needs and welfare of the patient and ensures that the NHS meets in full local authority costs of caring for a patient while a social care needs assessment is taking place if the patient is discharged without one. It provides for the ICB to agree the social care needs assessment process with the local authority, including timescales and reporting on any failures, and the remedies and penalties that would apply if assessments were not carried out in the required time. We also call for monitoring and reporting to Parliament annually by the Secretary of State on the effectiveness of social care needs assessments after discharge, including information on patients who have had to be readmitted after 28 days.

Our amendment fully complements the remaining important amendments in this group, which seek to ensure effective safeguards before and during the hospital discharge process for carers as well as their loved ones under Clause 80, and for young carers under Clause 148. We fully support Amendment 219 providing an “NHS duty to carers” and ensuring that

“their health and wellbeing is taken into account”.

We support Amendment 221 on protecting carers’ rights and ensuring full consultation with them before discharge as well as consideration of their needs in terms of safety, information, services and support. We support Amendment 225 on the definition of carers, which restates the current and hard-fought-for legal rights of carers and young carers under the Care Act 2014 and the Children and Families Act 2014, including those relating to the parents and carers of disabled children. We also support Amendment 269 on the important right of young carers to needs assessments under the Children Act 1989 and the essential need for local authorities to consider the appropriateness of discharging a patient from hospital into the care of a young person.

Like other noble Lords, I am very grateful to the excellent briefings from Carers UK and from young carers. I look forward to the contributions of noble Lords. On hospital discharge, we know the original discharge to access guidance was twice published without any reference to carers. I suppose we must be grateful that the two paragraphs that have subsequently been added reinstate the Care Act Part 1 references and provisions for carers.

But this is not enough to maintain and protect the hard-fought-for rights of carers. Hospital discharge can be one of the most difficult points in the care system for both existing and new unpaid carers, who are often taking on caring responsibilities without the right information and support or consideration of the impact on the carer as well as the loved one. Indeed, this can be the most traumatic time for new carers other than, of course, the shock of, and coming to terms with, their loved one’s sudden illness or disability. I can certainly endorse that from my own experience and my discussions with many other carers I meet. I know that carers still have many serious concerns about the current guidance and I will leave it to my noble friend Lady Pitkeathley to vent the anger and frustration that is felt over some aspects of the guidance.

Amendments 221 and 225 seek to retain carers and young carers’ current and legal rights under the Community Care (Delayed Discharges) Act 2003—which contains a direct requirement to identify and consult the carer before issuing a discharge notice—and other key legislation, including the Children Act and the Children and Families Act, relating to young carers and parent carers of disabled children. I have added my name to Amendment 225. I feel particularly strongly about the need to include a definition of “carers” in the Bill and to stop the Government in particular but also the media and others using “carers” when, in fact, they are referring to care workers and not unpaid carers. As Carers UK says, absolute clarity and getting the terms right means a great deal to carers, especially when they have so few concrete rights. The two roles are not the same; they are different. There is huge frustration on this issue among carers as it feels as if we are going backwards rather than forwards. I want to know from the Minister what the Government are going to do to address this situation.

On young carers, with recent research showing that there could be as many as 800,000 children providing regular care, Amendment 269 from the noble Lord, Lord Young, to which my noble friend Lady Merron has added her name, takes on even greater importance to ensure that arrangements for discharging patients without a care needs assessment do not unduly impact young carers. It would also ensure that assessments by councils include consideration of whether it is appropriate for a younger carer to provide care. As well as that, support services must be in place for the safe discharge of the parent. We know that caring for parents, siblings and other relatives will have a significant impact a young carer—on school attendance, exam results and on their well-being and future careers. Every classroom in the country is likely to have at least one carer, and we must ensure that they are fully supported.

This is an important group of amendments and I look forward to the debate in the hope that the Minister will recognise the need for the important issues outlined in the amendments to be included in the Bill. To remind noble Lords, at the height of the pandemic, there were an estimated 13.6 million unpaid carers in the UK, 1.4 million of whom provide more than 50 hours of unpaid care a week. They are more than twice as likely to be in poor health than those without a caring responsibility, and 72% of carers did not have a break from caring during the pandemic and are exhausted and worn out. Carers deserve better than this—there is much to do. These amendments would at least ensure that their existing legal rights are protected and built on. I beg to move.

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[Lord Kamall (Con)]

I thank the noble Lord for his question. The goal is to make sure that the NHS and local authorities work better together. The noble Lord talks about resources. One of the reasons for the levy—whatever one thinks of it—is to help plug that gap and to make sure that there is more money going into social care as well.

Turning to the points made about the term “carer”, we believe that the term is used to capture the whole spectrum of carers, including children and adults who care, unpaid, for a friend or family member. By not imposing a statutory definition, we avoid inadvertently excluding groups, and ensure that ICBs and NHS England promote the involvement of all types of carers and representatives.

Turning to the last amendment in this group, existing legislation already requires local authorities to carry out an assessment of need for all young carers upon request or on the appearance of need. This assessment must consider whether it is appropriate or excessive for the young carer to provide care, in the light of the young carer’s needs and wishes. Indeed, as some noble Lords have said, sometimes what happens is that the hospital may decide it is appropriate but those who are supposed to be doing the caring at home do not feel they have the ability.

We hope that under this, as part of the discharge planning, the current discharge guidance can set out any considerations that should be given to young people in the household who have caring responsibilities. We want to strengthen current processes in respect of young carers too. We are also working with the Department for Education to ensure that protections for young carers are reflected in the new guidance, including setting out where young carers should have a needs assessment arranged before a patient for whom they provide care is discharged, or as soon as possible afterwards.

Given the comments from noble Lords, especially the noble Baroness, Lady Pitkeathley, and the noble Lord, Lord Warner—sorry, I should say, General Pitkeathley and Major Warner—clearly there are still some concerns over how this will work. It would be worthwhile having some more conversations on this issue to better understand how we see integrated care working, where there may well be gaps in our understanding and whether we can help to close the gaps between the two sides.

[Baroness Wheeler (Lab)]

My Lords, it has been an excellent debate and I thank all noble Lords for their contributions, all strongly supporting this important group of amendments, which would ensure that the needs of both patients and carers were fully taken into account in the discharge process and that Clause 80 does not just wipe away carers’ rights—legal rights that have been hard-fought for. Although I am pleased that the Minister talked about further guidance being developed and co-produced, I cannot see how that will address the problem of replacing carers’ rights, which are being taken out of this Bill and need to be included in it.

I am also a bit disappointed that the Minister did not respond to my noble friend Lady Pitkeathley or give her the reassurances that she was seeking over the deep concerns about the expectation in the current guidance that unpaid carers will need to take on even more unpaid work. She made her views quite clear on this: it is paid work that unpaid carers need, not to be forced on to or to stay on benefits. They can take up jobs only if they get the care and support that is needed in the home or from the services that they need.

Noble Lords have made it clear that the discharge to assess model has to be matched with proper funding and community and healthcare services. The noble Baroness, Lady Hollins, reminded us of the importance of this in respect of the carers of people with learning difficulties, who face particular problems in caring. It is also overwhelmingly clear that noble Lords strongly support the establishment and the carrying forward into the Bill of existing carers’ rights.

I hope the Minister will meet urgently with my noble friend Lady Pitkeathley, Carers UK and others involved in these amendments, both to address the fundamentally wrong assumptions in the guidance about the role of unpaid carers and to ensure that their existing hard-won legal rights that have been taken away will be included. He also needs to provide the evidence called for by my noble friend on the overall assumption the Government are making that the discharge to assess process is better for carers than the existing rights that they have; it is not. This is a key issue that we will return to on Report, so I hope some action will be forthcoming from the government discussions between now and then.

On my own amendment, I would like to have heard a lot more reassurances about the timescales and timelines involved in the discharge process. I thank the noble Baroness, Lady Altmann, and in particular the noble Lord, Lord Scriven, for his support, and for explaining why this issue is important and how, practically, it would work with local authorities. On young carers, I particularly thank the noble Lord, Lord Young, and everybody who has participated in that.

I remind the Minister of the point from the noble Baroness, Lady Meacher: in the discharge process and in the assessments of carers it is really important that the question be asked whether they are able to care and whether they want to care. I would like the Minister to take up that issue. I know that carers feel strongly about this, but quite often, even if they are asked, no notice is taken and they just have to get on with it and nothing else happens. I would particularly like to see a response to that.

On those few points, I beg leave to withdraw my amendment. I hope the Minister acts quickly to meet carers and their representatives.

Amendment 217 withdrawn.