Care Bill [HL]

Lord Lipsey Excerpts

Tuesday 9th July 2013 Lords Chamber

The last thing I want to propose is that the Government should look at the tasks that a care worker has to do in order to make a visit to a person needing care worth while. The noble Lord, Lord Hunt, also talked about this. In most cases, they cannot manage to do everything that is necessary in around 15 minutes, plus make the journey to and from the person being visited. It is physically impossible. As we know, it is largely a breach of human rights simply to pop in, try to clean someone who may not have had a visit for many hours, serve a meal and talk to the person, change their clothing and the bedding, and do those things that are considered to make up a reasonable quality of care provision in 15 minutes. That needs to change. It should be necessary to adhere to specific minimum standards, not to the length of time taken to make a visit. It should be the qualifying tasks that matter, not the time it takes to do the work. We have to change things around so that it is what needs to be done that matters, not the time taken. These amendments, together with an adjudicator, would ensure that that happens.

[Lord Lipsey]

My Lords, I rise to support the amendments of my noble friend Lord Hunt and the remarks just made by the noble Baroness, Lady Greengross.

There have been a number of scandals, both about care at home and care in care homes, over the past year. I am astonished that the situation is not much worse than it is. When you see the pay and conditions imposed, and the people working under absurd and exploitative conditions in this sector—I use that old-fashioned word, exploitative, because it is the only one that applies—it is quite remarkable how many of them still care and still work their heads off for the people for whom they care We should pay due tribute to all those people.

Approaching this objectively, and it has been this way for some time, we have a situation that would be solved readily in a free market. The supply of people providing care is going down, and it will continue to go down, largely because of the Government’s crackdown on immigration; many of the workers in this sector are immigrants, as can be seen when visiting nearly any care home. The demand is going up year after year, if only for demographic reasons. What you would expect to happen would be for pay to go up, attracting more and better workers to the sector, thus resolving the situation. However, that is not happening.

Why? Because, in effect, there is a monopoly purchaser: the local authority. However, the local authority can only buy with the money it is allowed by the Government. As we know, the amount available for care, which should have been going up, has been going down. You can call on the CQC or local authorities to pay more but they are in an impossible position. If they do not connive in the appalling conditions inflicted on these workers, they will not be able to provide the services at all. So they try to get through another year and accept a lower tender or another company, even though they know that their standards are appalling. This is not the fault of the local authority. It is the fault of our national failing to put money into care while we have continued to ring-fence money for health and education.

I was once asked by a Care Minister, if I had money to spend in the care sector—having studied it quite a bit on the royal commission—how I would spend it. I said that I would give them all £1 an hour more and improve the standards of their training. I would say exactly the same thing today. I am supportive of the Dilnot proposals; I think that it is wonderful that we are spending more than £1 billion to help richer people not to be wiped out by their care costs. It is a great thing. However, it is not as great a thing as it would be if, at the same time, we were providing the money to allow local authorities properly to look after and provide basic services to people who need them, and to provide the money that would enable those providing those services to live decently and with pride in the wonderful job that they have been given to do.

[Lord Low of Dalston]

My Lords, I support Amendments 86N and 86Q tabled by my noble friend Lady Greengross, to which I have added my name.

This is a very important debate. As has been said, these amendments are all about quality and speak to many of the concerns to which the noble Lord, Lord Hunt, has just given powerful expression. The Care Bill introduces a number of important new duties and responsibilities to help place the right values at the heart of our care system. The well-being clause, for example, provides a foundation stone for the principles that should inform the whole of social care. However, our social care system is only as strong as the services that are actually commissioned. With budgets getting tighter and tighter, and demand getting ever greater, local authorities all too often commission care and support services based solely on finding the cheapest possible option. Unless we can ensure that the way in which services are commissioned drives the quality outcomes that we all want to see, important changes such as the well-being principle will remain simply a pious aspiration.

Amendment 86N would oblige local authorities to adhere to minimum standards in the way that they commission services and would give the Government power to make regulations for appropriate minimum standards. Amendment 86Q would provide for regulations to ensure that care visits lasted long enough to deliver the support needed. This would exert an important influence on the quality of services for disabled and older people. Focusing too much on cost creates an unacceptably high risk that care will be of the poor quality that we have heard too much about of late, which does not meet the basic needs of vulnerable people for support to enable them to live with dignity.

There are some fantastic examples of high-quality services across the country, despite severe budgetary constraints, and much can be learnt from how some local authorities have been able to build quality into what they do. However, there are also too many examples of people suffering as a result of poor-quality commissioning and receiving totally insufficient support, which consists simply of fleeting visits from carers who barely have time to say hello, let alone get to know and understand the needs of the person they are supporting.

I have heard of many cases of care workers rushing in to deliver care in visits of 15 minutes or even less. Fifteen minutes is not long enough to help people wash, get dressed, prepare a meal and use the bathroom. It is hardly long enough to take your coat off. It certainly is not long enough to promote people’s well-being. Care visits can be the only contact that socially excluded and vulnerable people have in a day. It is sobering that Leonard Cheshire Disability has recently announced that it will not accept contracts that provide for visits of 15 minutes or less.

A recent survey of local authorities found that 90% still pay providers according to the time they spend with the service user rather than the outcomes they achieve. This simply encourages a race to the bottom. The Bill needs to contain provisions that will help to ensure that quality of service is a key consideration in commissioning decisions. There must be checks and balances in the commissioning process and quality must be part of the equation. If we want a society that provides care based on need and not merely that which can be provided at the lowest cost, we need to support these amendments.

Ministers in the Department of Health have made a number of positive statements about improving quality in care. I hope that the Minister might be willing to accept these or similar amendments, but I ask him at the very least to clarify what the Government intend to do to make the positive rhetoric on quality a reality when it comes to commissioning services.