Care Bill [HL]

Lord Hamilton of Epsom Excerpts

Wednesday 9th October 2013 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, as this is the start of Report, I declare my interests as chair of an NHS Foundation Trust, a consultant and trainer with Cumberlege Connections, and president of GS1 UK.

I am sure that the House would wish me to congratulate the noble Baroness, Lady Jolly, on her appointment to the Government and to the health team as a government Whip, and to thank the noble Baroness, Lady Northover, for her services.

The Bill places a responsibility on local authorities to promote well-being in the way in which they implement the provisions of the Bill locally. However, if the Secretary of State were to issue regulations without regard to the promotion of well-being, there is a risk that such regulations—or indeed guidance—could conflict with that well-being principle. That would put local authorities in an impossible position. This matter was the subject of considerable discussion and report by the joint scrutiny committee and we also discussed it in Committee. The Government have now responded to the points put by many noble Lords and I welcome the amendment moved by the noble Earl, Lord Howe. I also welcome Amendment 4, in the name of the noble Baroness, Lady Barker. I beg to move.

[Lord Hamilton of Epsom (Con)]

My Lords, I have added my name to the amendment in the name of the noble Baroness, Lady Barker, to add the words “and spiritual wellbeing”. This is an amendment that has been resisted in the past by my noble friend the Minister and I am somewhat confused as to why that should be. In 2002, the National Health Service was more than happy to add spiritual well-being as one of the conditions that should be applied to care that was given. I do not understand what has changed since. Has the NHS come to regret having these words in its remit? Does it find that spiritual wellbeing does not fit within the National Health Service today? Are people of faith who find that having an NHS that regards their spiritual well-being as important somehow more difficult to handle than atheists and people who have no faith at all? I should have almost thought that the reverse is true. When we come to what is euphemistically called end-of-life care, I should have thought that people of faith have something to look forward to, rather than atheists who, if they follow Richard Dawkins, are faced with a great black hole of oblivion. They might find that the end of life is rather more forbidding than do those who have faith.

I am very confused, therefore, as to why the Government find it necessary to resist this very minor and rather innocent amendment. It seems to merely add comfort to people of faith of all religions and could be inserted into this Bill without causing the Government any difficulty whatever.

--- Later in debate ---

[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—

[Lord Hamilton of Epsom]

Will my noble friend explain why the NHS has actually changed its policy on this? In 2002, new Department of Health guidance on NHS chaplaincy said that all NHS trusts should make provision for the spiritual needs of all patients and staff from all faith communities. It strikes me that the NHS is now rowing back on a previous commitment.

[Earl Howe]

First, we are not dealing with the NHS; we are dealing with local authorities and adult social care. Secondly, the NHS has not rowed back on this. We have debated hospital chaplains on many occasions and I have made very clear the Government’s view that hospital chaplains perform an important role in the spiritual context. So on the NHS front, I want to reassure my noble friend that here we are dealing with local authorities and adult social care. I was trying to explain that the way in which this Bill is framed is perhaps different from how my noble friend has construed it.