Care Bill [Lords]

Liz Kendall Excerpts

Monday 10th March 2014 Commons Chamber

[Paul Burstow]

I am grateful to the hon. Gentleman for that intervention. He makes an important point. If one looks at the trends, one sees that there is no doubt that there are questions to be asked about why some people are not receiving the service that one would expect. Some of that—although I do not pretend that this covers anywhere near all of it—can be explained by the changes to the way in which services are organised. Some of it can be explained by the need to do more to re-able people and to enable them to maintain their independence. I do not say that to evade the question. That is why I have put new clauses 7 and 9 before the House. I genuinely think that whoever is in government in future will have to have a much more systematic approach to making decisions about how we meet demand.

That brings me on to new clause 7, which simply says that the Government should take a longer-term view. It states that every five years, the Government should look 20 years forward and take an independent assessment of the future demand for care and health services. That could be done by the Office for Budget Responsibility. It could provide modelling for the whole health and social care system that looks at the impact on demand, technology, demography and health status, and at the balance between all those factors. It could also look at the interactions between health and care, primary and secondary care, physical and mental health, and treatment and prevention. That would finally implement a recommendation that was made by Derek Wanless in his review for the Government in 2000. That is supported by the King’s Fund, which has suggested much the same thing.

In Committee, neither the Government nor the Opposition were able to make any funding commitments about part 1 of the Bill. I entirely understand why that is the case. However, we know that as the eligibility criteria are drawn more tightly, more people are excluded from help. In the long run, that does not save money, but shunts the costs. It pushes people away from living an independent life and towards a life of dependency. I hope that all parties will, in the end, sign up to something like new clause 7 as a good part of the future sound governance of our health and social care system. I hope that the Minister will support that.

I apologise to the House for speaking at such length, but I have put forward a number of issues that I hope will provide a framework for debating this important set of reforms. I look forward to the Minister’s response.

[Liz Kendall (Leicester West) (Lab)]

We are discussing a huge number of new clauses and amendments, and I will try to keep my comments brief to allow Back Benchers on both sides time to speak. I want to start with our new clauses 17 and 18, which deal with the critical issue of linking the quality of care with standards in the care work force. New clause 17 would require the Secretary of State to review the economic and financial factors affecting the employment of care sector workers, including their recruitment, training, employment and retention, and the extent to which the policies of care providers were making it more or less likely that the aims of the Bill were being achieved.

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[Jonathan Edwards (Carmarthen East and Dinefwr) (PC)]

The Social Services and Well-being (Wales) Bill is going through the Welsh Parliament. My party tabled an amendment to the Bill that would have prohibited the use of zero-hours contracts in the care sector in Wales, but the Labour Government there voted against it. How disappointed is the hon. Lady with her colleagues in Wales?

[Liz Kendall]

I am sure that my colleagues in the Welsh Assembly want to do everything they can to improve care and support. Today we are discussing the care sector in England, and I hope that the hon. Gentleman will give his support to what we are proposing.

[David T. C. Davies (Monmouth) (Con)]

Will the hon. Lady give way?

[Liz Kendall]

I am really sorry, but I want to make a bit more progress. I have a lot of new clauses to get through, and Back Benchers have also tabled new clauses and amendments.

We also know that many care workers do not even get the minimum wage at the end of the week, because they are not paid for their travel time, among other things. Her Majesty’s Revenue and Customs recently undertook an evaluation of minimum wage enforcement in the social care sector. It found that a staggering half of all care providers had failed to pay the minimum wage to at least one of their employees, yet despite Ministers’ insistence that such people will be named and shamed, not a single provider in the care sector has so far been identified.

We need to look at all those employment issues, which I think have a fundamental impact on the quality of care. If the Bill is to promote well-being, shift services towards prevention and improve standards, we must get to grips with those issues; otherwise, it will not work. New clause 17 would require the Secretary of State to conduct an overall review of the economic and financial factors affecting employment, publish the results and consult on the findings.

[Mr Redwood]

I quite agree that we need a high quality work force who are well trained and supported, but if the review concludes that they are not, is the hon. Lady saying that controls should be imposed on local authorities from the national level?

[Liz Kendall]

If the right hon. Gentleman reads our new clause 18, he will see what our approach is. Local councils commissioning social care and having to fulfil their obligations under the Bill will need to look at employment terms and conditions. We have tabled the new clause because unfortunately the Government are removing the Care Quality Commission’s role in assessing how well councils are commissioning services, which I think is a mistake.

[Alison McGovern (Wirral South) (Lab)]

Given the point my hon. Friend has just made, does she agree that it is all the more important that councils up and down the country follow the lead that Labour Wirral has shown in sticking to the principles of Unison’s ethical care charter, which tries to rid us of 15-minute appointments and limit zero-hours contracts?

[Liz Kendall]

I know about the approach that has been taken in Wirral and think that it is an excellent example. If we kept the CQC’s role in assessing how well councils are commissioning services, that is just the sort of thing that it would be able to spread. It is a real problem that that role is being removed. We will come later to our amendments that seek to return it to the CQC.

I will now turn to a group of new clauses on how better to identify and support carers. They stand in the name of Opposition Front Benchers, but really they are the work of my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), who has made sterling efforts in this regard. We have tabled them to give carers the focus and attention they deserve. They pick up on some of the points that the right hon. Member for Sutton and Cheam (Paul Burstow) made. New clause 19 would ensure that all health bodies have effective procedures in place to identify people who are or are about to become carers and ensure that they get the help and advice they need. New clause 20 would require local authorities to take all reasonable steps to ensure that schools in their area identify young carers and put support in place. New clause 21 would require universities and colleges to do the same.

As the right hon. Member for Sutton and Cheam said, family carers—unpaid family members looking after the people they love—are the absolute backbone of our care system. They need and deserve more support. They are looking after their relatives because they want to, but they really need help. One in five family carers provide more than 50 hours of care every single week, and their own health suffers as a result. One in three have to give up work or reduce their hours, which means their income suffers and the cost to the taxpayer goes up.

The Bill puts in place welcome new rights for carers, building on the approach taken by the previous Labour Government, but they will be meaningless if carers are not identified in the first place. Many carers do not actually come into contact with local authorities. Macmillan Cancer Support has made a powerful case, showing that 95% of the over 900,000 carers of people with cancer in England have not received a carer’s assessment—only one in three of them have even heard of it. That is because they are mostly in touch with the health system. Unfortunately, hospitals and GPs still do far too little to identify carers of people who have cancer and other conditions, such as stroke and heart disease. I understand that GPs identify only around 7% of carers, and other health professionals, particularly in hospitals, identify only one in 10. We need clear duties on those bodies and proper processes in place, because too often at the moment there is just a tick-box approach. I recently had to move GP practice, and the form I filled out contained two pages on how much alcohol I drank, which was welcome, and a little box that asked, “Are you a carer?” I knew what that meant—but did it mean a paid care worker, or a health care worker? That is not good enough and needs to be thought through.

I also stress the need to do far more to identify young carers, who we know can see their lives and life chances suffer because of what they do to help look after sick or disabled parents. Many schools might not understand if kids are not doing their homework or not turning up on time because of their responsibilities. If young carers are lucky enough to get to university or college, they may find their studies hard because they are travelling to and from home to try to help support their loved ones. We believe there should be clear duties on those bodies to identify young carers.

New clauses 22, 23 and 24 are about getting people the right financial advice—an issue we discussed a lot in Committee. The Bill introduces a new and complicated system of social care funding with the so-called cap on care costs and new deferred payment schemes. It is complicated and I have lost track of the number of times people have said to me, “Well, it’s okay because at least my care costs will be capped at £72,000 now”, and I have to go through the process of explaining to them that that is not actually the case. People are unaware of the new system, and if they are looking at financial products to help them cope with later costs, they need decent financial advice.

Currently, financial advisers must have studied a range of different financial and regulatory subjects, and they must sign up to a statement of professional standing and a code of ethics and conduct. Has the Minister talked to the Financial Conduct Authority about whether the training of financial advisers should change as a result of the Bill? Is he confident that all financial advisers can give people advice about the products they might want to take out to protect themselves against future costs, on the basis of the Bill?

I am concerned that unless people get high quality, proper financial advice, we could be in for another mis-selling scandal because the issue is complicated. People will have to figure out how much their average local authority rate will be for their area in five, six or seven years’ time, and how different that will be from what private providers charge. Will people’s care needs enable them to start counting towards the cap on care costs if they are not defined as “substantial”, as under current eligibility criteria? I would struggle to figure out all those finances, and we must ensure that financial advisers are properly trained.

New clause 22 states:

“The Financial Services Consumer Panel at the Financial Conduct Authority”

should publish an annual report on the

“availability, quality…and effectiveness of financial advice”

available to care users and their families. New clause 23 states that the FCA should consider raising the level of qualifications that financial advisers must have. We must ensure that people get high quality financial advice so that they are not mis-sold any products.

We also want much greater efforts to raise public awareness of the new capped cost model introduced by the Bill. Under the Bill, local authorities have a duty to raise awareness, but new clause 24 would make that much stronger and require them

“to prepare, publish, consult on and implement”

a proper plan for raising awareness among their local residents. That is important so that people know about the new system and what it means for them.

I support new clause 11, which would ensure that all users of publicly funded or arranged care have direct protection under the Human Rights Act 1998. Under the law as it stands, the fundamental protection and access to individual redress offered by the Act are not applied equally in all care settings. In the other place, Lord Low tabled the former clause 48, which sought to close that loophole. There was a long discussion on it in Committee—the clause was passed in the House of Lords but the Government voted to remove it in Committee. The Minister’s argument was that it went too far, because it would mean that the Human Rights Act applied to entirely privately funded and arranged care. He also claimed that the clause was not needed because the CQC could deal with the problems.

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[Mr David Ward (Bradford East) (LD)]

Will the hon. Lady give way?

[Liz Kendall]

Perhaps the hon. Gentleman will let me finish this point.

For working-age disabled people, the level at which the eligibility criteria are set is crucial and could mean the difference between being able not just to get access to training and a job but to spend time with their family or go out into their community—things that we take for granted. As hon. Members know, Scope and other organisations have warned that the Bill could risk shutting more than 100,000 disabled people out of the system, with all the human and economic costs that that entails.

The Minister will know that in Committee many hon. Members cited the economic modelling that has been done by organisations such as Deloitte, which shows that shifting the focus of investment and resources up front can save more money further down the line. The Deloitte modelling predicts that for every £1 invested in care for disabled people with moderate needs, savings of £1.30 per person are created. It predicts £700 million of savings for central Government from helping disabled people and their family carers to get work, and £570 million of savings to local NHS and local council services by avoiding the use of more expensive residential and crisis care and by reducing the need for more expensive medical care.

Such a long-term approach, whereby we assess the true costs and benefits over a longer term, is a good framework for making decisions about where priorities lie—

[Mr Ward]

Will the hon. Lady give way?

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. Before the shadow Minister considers taking further interventions, she may not have realised that although the House appreciates that she is making some important points on a complex matter, she has spoken for some 24 minutes. She will not be aware, but I am, that a very large number of colleagues wish to speak in this debate and there is a limited time, so she might consider bringing her remarks to a close.

[Liz Kendall]

Thank you, Madam Deputy Speaker. I have two more paragraphs. I agreed that I would speak for 25 minutes, so at 24 minutes I am almost in.

New clause 9 would help secure that shift in approach. I ask hon. Members to consider the new clause seriously because we need to introduce the up-front prevention, help and support, which requires a change in the way we look at the costs and benefits in the system.

[Several hon. Members]

rose—