Adult Social Care Contracts

Lord Laming Excerpts

Wednesday 11th February 2015 Lords Chamber

Asked by

[Lord Laming]

To ask Her Majesty’s Government what assessment they have made of the use of an auction-style process by some local authorities to tender for adult social care contracts.

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

The new Care Act directs local authorities to put the well-being of people at the centre of all decisions about care and support. Commissioning high-quality social care is ultimately a matter for local authorities. We are aware of electronic marketplace systems that, together with professional judgments by authority staff, help to embody this well-being principle by prioritising quality above cost while achieving value for money.

[Lord Laming (CB)]

My Lords, I am very grateful to the noble Earl for that thoughtful response. Does he agree that advertising a block of services in an impersonal way is entirely different from advertising a vulnerable individual, stripping them of their humanity and dignity? Would he be willing to take forward the point that he made about the legislation and examine whether these authorities are disregarding the duty placed on them by Parliament to carry out a proper assessment of need for each individual, to produce a care plan and to make sure that that care plan is related to the individual’s developing situation? Will he ask the Care Quality Commission to make unannounced inspections of these authorities to see whether they are complying with the law?

[Earl Howe]

My Lords, I make it clear that the personal details of would-be service users should not be put in the public domain. The purpose of this system is to develop a tailored care plan that best meets the person’s needs and does not undermine their well-being. Where this has been done well, it has resulted in good-quality care while also, as I said, providing value for money for the taxpayer. We would not wish to make provision for spot checks of local authorities by the CQC but, where there is clear evidence that a local authority’s commissioning practices are leading to poor-quality care—which they should not be—the Secretary of State can order the Care Quality Commission to carry out a special review.

Women: Postnatal Depression

Lord Laming Excerpts

Thursday 5th February 2015 Lords Chamber

[Earl Howe]

The role of the father, as well as of course that of the mother, is emphasised in all the guidance—certainly in the healthy child programme but also in the work done under family nurse partnerships, which targets the most vulnerable families. That programme provides intensive support to young first-time mothers and their babies. It explicitly involves fathers—and/or other family members as well—as long as the mother wants the father to take part.

[Lord Laming (CB)]

My Lords, does the Minister agree that two elements need to be addressed? First, there is the safety and well-being of the mother but, secondly, there is the important issue of helping the mother to bond with her new baby. That requires quite intensive work at a critical time in the life of the new baby and of the mother. Could he assure us that these matters are being addressed in these new arrangements?

[Earl Howe]

The noble Lord makes some extremely pertinent points. The family nurse partnership programme that I mentioned is important in this context, and our aim is to expand that to 16,000 places by April 2015. We launched the NHS Start4Life information service for parents. Parenting classes are available through the CANparent network and we are developing a population measure to show child development at two to two and a half years for inclusion in the public health outcomes framework, so that we can measure the progress we are making.

Mental Health Services

Lord Laming Excerpts

Wednesday 26th November 2014 Lords Chamber

[Earl Howe]

My Lords, both of those issues will be looked at by the task force. There have been concerns on both fronts that the noble Lord raises about access to services, and we are clear that the task force must come up with recommendations in those areas.

[Lord Laming (CB)]

My Lords, does the Minister agree that when the state assumes the parenting of a child or young person it takes on an enormous responsibility and a moral commitment to be a good parent to that child? Will the noble Earl assure the House that every effort is made for these children to be given access to all the services, including often some of the basic, ordinary health services that we assume there will be access to?

[Earl Howe]

My Lords, I fully agree with the noble Lord. He may like to know that my department is currently working with the Department for Education to revise the statutory guidance on promoting the health and well-being of looked-after children. We plan to consult on this later this month and to publish the final guidance early next year. It will make it clear that the CCGs and local authorities are responsible for providing services for looked-after children to give equal importance—parity of esteem—to their mental and physical health and to follow the concordat that I referred to.

Mental Health: Beds

Lord Laming Excerpts

Tuesday 29th July 2014 Lords Chamber

[Earl Howe]

My Lords, I am certainly aware that a number of concerns have been raised about the lack of mental health beds and that there are occasions when patients do not receive care quickly enough because approved mental health professionals cannot locate an appropriate bed. As I said in my original Answer, that is essentially a failing of local clinical commissioning. However, AMHPs—approved mental health professionals—should not be put in that position. We are consulting at the moment on a revised code of practice for the Mental Health Act. That consultation includes a specific question which asks what additional guidance should be included to ensure that AMHPs are not put in that position.

[Lord Laming (CB)]

Does the Minister accept that depriving a citizen of their liberty is one of the most serious matters that can be undertaken in our society and that it should be done only for very sound reasons, certainly not because of the absence of provision for their needs? When the Minister kindly replied to a Question for Written Answer from me earlier in the year, he said:

“Local areas are expected to … deliver their own ‘Mental Health Crisis Declaration’”.—[Official Report, 18/6/14; col. WA70.]

Can he tell the House how many local areas have signed up to a declaration, and more particularly, how many have failed to do so?

[Earl Howe]

My Lords, on the very last point, I do not have up-to-date figures, but I will certainly write to the noble Lord. However, on his main question, detention as a mechanism solely to secure access to hospital treatment would not be lawful. If hospitals or local authority staff think that that is happening or feel pressurised to admit people in that way, they should report it to their trust and, if necessary, to the Care Quality Commission. Sectioning under the Mental Health Act, which denies people their liberty, is a very serious matter. It should be done only when a person is a risk either to themselves or to other people and, as the noble Lord knows, it is a legal process. A patient cannot be sectioned merely to secure a bed.

Learning Disabilities: Community-Based Support

Lord Laming Excerpts

Tuesday 22nd July 2014 Lords Chamber

[Earl Howe]

My Lords, I have every confidence that the programme will continue as we had hoped it would, and indeed with a renewed momentum. The noble Baroness is right that NHS England has asked Sir Stephen Bubb, the chief executive of the charity leaders’ network ACEVO, to head a new group of experts and advisers to develop a national guide on how we provide health and care for those with learning disabilities. We have every confidence that Sir Stephen, with his immense experience in these areas, will be able to bring everybody together to a good result.

[Lord Laming (CB)]

My Lords, will the Minister assure the House that the only criteria that will be used in making these arrangements is the way to improve the quality of life of the user of the services rather than any bureaucratic processes set by NHS England?

[Earl Howe]

The fundamental principle that must underpin and inform all decisions in this area is about ensuring that we respect people with learning disabilities as individuals who have the same rights as everyone else, including the opportunities to make informed choices about where and with whom they live. The noble Lord is absolutely right.

Health: Dementia

Lord Laming Excerpts

Monday 14th July 2014 Lords Chamber

[Earl Howe]

The noble Baroness makes a series of extremely important points about the care of people with dementia. She is absolutely right. That is why we need to place greater emphasis on professional training and awareness, not only among NHS professionals but among social care staff, so that they appreciate the full dimension of the condition. Of course, we must remind ourselves that dementia is not a single condition. There are several conditions along that spectrum and each one has its own particular characteristics. We are emphasising to the NHS and local authorities that individual care planning is vital in this area.

[Lord Laming (CB)]

My Lords, will the Minister reinforce the point that he just touched on, that dementia—as a generic term—affects individuals in very different ways? As we have already heard, individuals’ circumstances vary enormously in terms of the position of their carers. Will the Minister do everything he can to ensure that in the future services will continue to respect the unique qualities of the individual who is affected by this condition?

[Earl Howe]

Again, the noble Lord makes a central point. As he will know, dementia can range from mild cognitive impairment to difficulties in organising daily life, right through to confinement to bed and very serious cognitive impairment. Knowing this is very distressing for people in the early stages of dementia. All this is why we are laying such emphasis on NHS staff receiving training. By October 2013, 108,000 NHS staff had received tier 1 training on dementia, and more than 100,000 social care workers have received some form of dementia awareness training through workforce development funding. We are aiming to increase those numbers substantially over the coming years.

Mental Health: Social Work

Lord Laming Excerpts

Monday 23rd June 2014 Lords Chamber

[Earl Howe]

My Lords, we need more social workers, particularly in mental health. The Think Ahead programme is certainly one way in which we hope to improve the numbers. Social work is not always seen as an attractive career option. We know that there is a growing appetite among graduates to work in mental health; unfortunately that enthusiasm has not filtered through to the social work profession. We need to focus on that. Much will depend also on finding a greater number of placements in social work, particularly relevant to mental health, so that there is on-the-job training for those trainees.

[Lord Laming (CB)]

My Lords, does the noble Earl agree that the very least we must do for social workers operating in this very complex area of work is to ensure that they all have the appropriate training, which is not just about classic mental health problems but about the abuse of drugs and alcohol, and indeed now extends into the great impact that dementia has on patients and their relatives?

[Earl Howe]

The noble Lord is quite right. The importance of mental health knowledge across social work in its entirety—adults, children, adolescents and families—is vital. Mental health is a key factor for people with substance abuse problems and other complex social and health needs that defy neat categorisation. The Chief Social Worker for Adults, Lyn Romeo, is working with the Chief Social Worker for Children and Families, Isabelle Trowler, to produce a statement of the knowledge and skills required across children’s and adult services and the need for students and qualified social workers to be able to work with mental health issues in all contexts.

Independent Living Fund

Lord Laming Excerpts

Monday 12th May 2014 Lords Chamber

[Earl Howe]

My Lords, I do not have that figure in my brief but the number of people receiving payments from the Independent Living Fund is relatively few in comparison to the total number of people receiving adult social care and support. If I have any further figures that I can supply to the noble Baroness, I shall be happy to write to her.

[Lord Laming (CB)]

Will the noble Earl share with the House the objections to ring-fencing this fund during the initial period to make sure that we have certainty that the money will be used for the purpose for which it is intended?

[Earl Howe]

My Lords, the issue is that we essentially have a two-tier system. That is at the heart of why the ILF is being disbanded over the next year or so. As a result of that, we know that there is some cross-subsidisation, with local authorities using ILF money to off-set the cost of social care. We are rechannelling that money to local authorities in the expectation that they will use it for adult social care, as I have said. It is not, however, ring-fenced.

NHS: Bed Capacity

Lord Laming Excerpts

Thursday 20th March 2014 Lords Chamber

[Earl Howe]

My Lords, many hospitals have been under pressure, particularly during winter, as they always are. It is telling that if one looks at the tell-tale signs of pressure, such as bed occupancy, the rates have remained stable for a number of years. In fact we have more clinical staff on the front line, particularly in A&E, than we had a few years ago. There is no doubt that there are times when hospitals feel acutely under pressure. However, despite rising demand, average waits for assessment in A&E are around 30 minutes at the moment, compared with over 70 minutes in 2009-10.

[Lord Laming (CB)]

My Lords, would the Minister use his good offices to reinforce again with the National Health Service that all unplanned moves that are not determined by clinical need, be it during the day or at night, have the potential to cause disorientation to patients and considerable distress to their relatives?

[Earl Howe]

The noble Lord is absolutely right. That is why my ministerial colleague, Dr Poulter, has written to Sir Bruce Keogh. This issue lies at the heart of the NHS constitution: the patient’s dignity and shaping care around the needs and preferences of patients is absolutely at the centre of the constitution. This is why it is entirely appropriate for Ministers to make their views known and for Sir Bruce to ensure that all hospitals are aware of this principle.

Professional Standards Authority

Lord Laming Excerpts

Thursday 7th November 2013 Lords Chamber

[Earl Howe]

My Lords, as my noble friend knows, this is a complex policy area. There have been delays to the Government’s original proposals around the regulation of herbal medicine practitioners. One of our main concerns here is to ensure safety for those who wish to use the products. Given that complexity, my honourable friend Dr Poulter announced his intention to set up a working group to consider matters relating to patient protection when using unlicensed manufactured herbal products. Officials are currently working through the details of that group, including its terms of reference.

[Lord Laming (CB)]

My Lords, will the Minister use his good offices to ensure that the Government continue to keep an open mind in respect of complementary medicines, and allow patients the greatest possible choice in these matters?

[Earl Howe]

Yes, my Lords. The Department of Health does not maintain a position on any particular complementary or alternative medicine treatment. It is for patients, in conjunction with their medical practitioner, to decide whether a treatment is appropriate for them.