Funding of Care and Support

Lord Low of Dalston Excerpts

Thursday 24th November 2011 Lords Chamber

[Lord Low of Dalston]

My Lords, I too congratulate the noble Baroness, Lady Pitkeathley, on securing this extraordinary and interesting debate and on the comprehensive and compelling review that she gave us, which has stimulated so much creative and critical thinking from those who have followed her. I can remember three debates on social care and related issues during my first year in your Lordships’ House—so much so that I observed that social care and the importance of social work had become something of a leitmotif running through the proceedings of the House. This does not seem to have been the case so much of late. Unless I have missed something, the last debate of this kind took place on 9 December last year. It is high time we had another one.

The debate is also very timely. The Government received the Dilnot report last July and are now consulting on it. There also seems to be some disposition for cross-party talks on both sides in advance of the promised White Paper in the spring. If we could get to the point where it was possible to move forward, on a basis of consensus, with reform of the law on social care, the upgrading of social care itself and reform of social care funding, that would truly be a consummation devoutly to be wished.

The debate also does not come a moment too soon, in the sense that hardly a day goes by now without our ears being assailed by further horror stories of the neglect, abuse, dehumanising treatment and downright inhumanity to which the most vulnerable on the receiving end of social care—those in greatest need in our society—are habitually subjected. In the summer we had Winterbourne View; and only yesterday, as has been mentioned, the EHRC was reporting evidence of what it called a “systematic failure” across the country, which amounted to a breach of elderly people’s human rights. Examples that they considered amounted to cruelty included people being robbed, left hungry and unwashed, and food being placed in front of deafblind people without telling them it was there, or putting it in an inaccessible place—something, I have to tell you, that blind people routinely complain about in hospital. On the strength of this, the CQC announced the previous day that it would step up its programme of inspections of homecare services, saying that people who use homecare services often find themselves in vulnerable circumstances and the operation of homecare is not as transparent as care in hospitals and other sectors because interactions happen behind closed doors in people’s homes. The Care and Support Alliance, a consortium of more than 50 organisations representing older and disabled people to which the noble Baroness, Lady Pitkeathley, referred, has recently stated that the social care system is in crisis, unable to meet the needs of growing numbers of older disabled people and those with long-term conditions.

Since the day when I entered this House, and I am sure for some time before, we have been talking about a crisis in social care; now it has become a scandal that many predicted if action was not taken. In some ways, that is a good thing—not that we want anyone to be subjected to inhuman and degrading treatment, but it seems to be the thing that gets Ministers’ attention. Up to now, there have not been any Victoria Climbiés or Baby Ps among the elderly and disabled. My fear is that, when the funding for the deprived and disadvantaged, the most marginalised and dispossessed in our society, is cut or they are subjected to inhuman and degrading treatment, they simply disappear beneath the radar.

Coming towards the end of the debate, I speak after such big-hitting luminaries as the noble Lords, Lord Sutherland, Lord Warner and Lord Lipsey, who all, as the noble Lord, Lord Sutherland, acknowledged, have form on this subject—not all the same form but, nevertheless, considerable form. In their presence, I cannot expect my contribution to be anything more than modest, so I shall content myself with trying to drive home a few key points that seem to me pretty well ungainsayable but cannot be said too often.

We have already mentioned the crisis. As everyone has said, the Government must really bite the bullet on Dilnot now. As has become clear, there is room for a range of opinions on the precise form that the bullet should take, but bite the bullet the Government must no doubt do. Labour did some good things with social care when it was in office, but the past decade, as the noble Lord, Lord Sutherland, reminded us, has been littered with too many reports and policy statements that have remained unenacted. It was to the coalition’s credit, therefore, that it moved quickly to set up the Dilnot commission and it will be even more to its credit if it can build cross-party consensus around it and get on with implementing it. I do not disguise the fact that it is a formidable challenge; expenditure on social care has increased, though not as much as on health and education, but it has not increased enough to keep pace with rising demand stimulated by people living longer, and it needs to increase still further. That is a hard saying at a time of financial stringency, but with the number of 85 year-olds set to double in the next 20 years the level of demand will only go on rising relentlessly. I am afraid that that is just the problem that the Government have to deal with; if they do not, they will attract the opprobrium that rightly attends allowing a scandal to balloon out of control without making any serious attempt to deal with it.

Time is running out. Reforming the funding of social care is not the same as undertaking the upgrading of social care that is needed, so Dilnot is not enough. There will be more to do. I realise that it cannot all be done at once but, in addition to Dilnot, it will be imperative for the Government to commit to embracing a wider agenda. Workforce development is critical, but the proportion of care delivered by the private and voluntary sector has gone up from 56 per cent to 84 per cent in the past 10 years. Much of this will be concerned to keep costs to the bare minimum in order to turn a profit. The noble Baroness, Lady Bakewell, devastatingly laid bare, in the Second Reading of the Health and Social Care Bill, how this issues in a jumbo scandal of its own, with the Southern Cross debacle. This poses real challenges in recruiting a sufficiently high calibre of staff.

Finally, Dilnot’s fourth recommendation says:

“Universal disability benefits for people of all ages should continue as now”.

With the Welfare Reform Bill, that kind of joined-up thinking would appear to have gone by the board already.

There is need for some serious rethinking here. It is not yet quite too late.

Health: Healthcare Assistants

Lord Low of Dalston Excerpts

Monday 24th October 2011 Lords Chamber

[Earl Howe]

I agree with my noble friend and it is why we are proposing a system of assured voluntary registration that would provide those training standards. We need to bear it in mind that the health and social care sectors are already subject to numerous tiers of regulation, including the important requirement on employers who are providing regulated activities to use only people who are appropriately trained and qualified. That means taking up references, having proper induction processes and so on. No national set of arrangements absolves employers of their responsibility to ensure that the people they are employing are suitable for the roles that they are fulfilling.

[Lord Low of Dalston]

My Lords, does not the problem lie with nursing having been made a wholly graduate profession, whereby nurses are taught nothing but theory and not how to nurse people at all? Indeed, I recently heard a nurse on the radio complaining that being asked to minister to the needs of patients was very inconvenient because it got in the way of completing their paperwork. Should it not be the case that nurses are taught the traditional skills of nursing that are directed at meeting patients’ needs, and that if nurses are to be helped by healthcare assistants it is important that the job of nurses is not simply delegated to the kind of untrained people that the noble Baroness, Lady Gardner of Parkes, was talking about?

[Earl Howe]

I can agree in part with what the noble Lord says. I do not agree that the training of nurses is skewed against what one might call the traditional caring activities that we associate with nursing, because my understanding is that the division is around 50:50 between the academic and practical elements of the training. We recognise the important contribution of nurses, not just in the new roles that they have taken on but in the fundamental aspects of care. They have the reach and relationships to improve outcomes and experiences for patients. We are doing our best to support them by various means.

Care Homes

Lord Low of Dalston Excerpts

Tuesday 7th June 2011 Lords Chamber

[Earl Howe]

My Lords, I am sure the noble Baroness’s concerns will be echoed throughout the House. We have seen distressing reports in recent days of the treatment of certain patients in private hospitals, but the worry over Southern Cross relates much more to its financial situation and the future of its residents. I can assure the noble Baroness that we are taking this situation very seriously. We are in touch, as I have said, with all the relevant parties—and have been for the last several months. We are making sure that everybody is aware of their responsibilities in this area, not least towards the residents concerned. As regards Southern Cross, we are now in a critical period when restructuring is being explored, and we wish those efforts well.

[Lord Low of Dalston]

My Lords, does the Minister agree that the problems besetting Southern Cross are an object lesson in the dangers of market failure attending the privatisation of public services?

[Earl Howe]

My Lords, I do not agree with that. For many years, successive Governments have relied upon private care providers in social care. In general, this has been entirely satisfactory. It has given people wide choice in the care available and Governments have encouraged that. Financial issues for one provider—albeit a major one, I concede—do not undermine the entire principle of independent care provision.

Health: Preventable Sight Loss

Lord Low of Dalston Excerpts

Tuesday 29th March 2011 Lords Chamber

Asked By

[Lord Low of Dalston]

To ask Her Majesty’s Government what is their assessment of the level of preventable sight loss in the United Kingdom; and whether they will include that issue in the proposed Healthy Lives, Healthy People strategy.

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

My Lords, the Government recognise that sight loss is a serious issue and that risks rise in an ageing population. The Health and Social Care Bill proposes that NHS sight testing will be the responsibility of the NHS Commissioning Board. The new public health system will help to prevent sight loss. We have proposed that Public Health England will design and fund some specific public health services, including diabetic retinopathy screening. We have also proposed that local authorities should have new responsibilities in relation to public health and health improvement.

[Lord Low of Dalston]

I thank the Minister for that response. However, given that half of the sight problems experienced by around 2 million people in the UK could be prevented by regular sight tests and early diagnosis and treatment, what plans do the Government have to communicate this important public health message to local commissioners, health and social care professionals and the public? Does the Minister agree with me that reducing such a high prevalence of avoidable sight loss through regular sight tests and better access to eye care services should be included in the public health outcomes framework, and that specific attention should be focused on minority ethnic groups who exhibit a particularly high incidence of some sight-threatening conditions?

[Earl Howe]

My Lords, I quite agree with the noble Lord that sight tests allow an invaluable opportunity to review all aspects of eye health, including investigations for signs of disease. The uptake of NHS sight tests is, I am glad to say, increasing. As regards messaging, the department has worked, and continues to work, with NHS Choices on the development of articles and videos to raise the profile of visual health and promote the importance of regular sight tests. Looking ahead, and as part of their new public health responsibilities, we propose that local authorities will have primary responsibility for the health improvement of their local populations. They could well choose, if they wished, to promote eye health and work to improve the wider aspects of health and lifestyle that contribute to improved eye health. We are currently consulting on the public health outcomes framework, as I am sure the noble Lord is aware. We are also consulting on the scope of the evidence base for public health and the interventions that will work best.

Autism

Lord Low of Dalston Excerpts

Tuesday 7th December 2010 Lords Chamber

[Earl Howe]

My Lords, clearly, local government grants will come under pressure over the coming years. To my mind, that makes it even more important that decisions about priorities are taken at a local level and the joint strategic needs assessment is, of course, the tool which will enable local authorities to decide on their priorities locally.

[Lord Low of Dalston]

My Lords, training for awareness of autistic spectrum disorder among frontline professionals is key to improving services. Following the publication of the guidance, when does the Minister expect that all lead professionals involved in commissioning community care assessments and GPs will have received autism training?

[Earl Howe]

My Lords, the statutory guidance that already exists—it has been revised in light of the response to the consultation—makes it explicitly clear that in addition to general autism awareness-raising training for staff, local areas should develop or provide specialist training for those in key roles who have a direct impact on access to services for adults with autism, such as GPs, community care assessors and commissioners and service planners.

Contaminated Blood (Support for Infected and Bereaved Persons) Bill [HL]

Lord Low of Dalston Excerpts

Friday 22nd October 2010 Lords Chamber

[Lord Low of Dalston]

My Lords, I am glad to follow the noble Lord, Lord Corbett of Castle Vale, because I identify so strongly with the points of principle that he has made. However, I fear that I will be unable to articulate them with anything like his eloquence.

I add my voice in support of the Bill. I shall be brief. It is unnecessary to go over the whole sorry history of this tragedy—indeed, this scandal—which, as several other speakers have mentioned, has been described by the noble Lord, Lord Winston, as the worst treatment disaster in the history of the National Health Service. It is a textbook illustration of the truth of the great Richard Titmuss’s warnings about the dangers of allowing commercial factors to operate in something like the supply of blood products. Nor shall I go in any detail into the recommendations of the Archer inquiry or the Bill based on them, which is before us today. The noble Lord has done that for us already. I join other speakers in paying tribute to the noble Lord, Lord Morris, and the noble and learned Lord, Lord Archer of Sandwell. It is only the tireless persistence of the one and the dedicated and the meticulous investigation, analysis and documentation of the issues by the other, together with a clear-sighted prescription as to what a civilised society ought to do, that have brought us to this point.

What I find particularly deplorable is the complacency displayed by the authorities when what had happened came to light. The journey from the promise of self-sufficiency to its attainment took five years in Ireland but 13 years in England and Wales. This reflects discreditably on the administration of our health services and is something that makes us all feel ashamed. Equally shaming is the heartlessness, obfuscation and prevarication shown by successive Governments, and the cheese-paring and obstructive nature of their response. This is an indictment of the whole of our official culture in this country. Successive Governments had recourse to the device of Crown immunity, requiring sufferers to sign a waiver in respect of hepatitis C in circumstances where they did not know they might have it but the department knew they were at risk. There was resistance to the disclosure of documents to the multi-party group. There was the refusal to hold an inquiry or co-operate fully with the inquiry of the noble and learned Lord, Lord Archer, and then disingenuous reliance on the fact that there have been no findings of fault against the British Government. There was a reliance on discretionary trust funds, rather than a system of benefits as of right, to provide a measure of compensation. There was a failure to recognise the claims of widows. There was a suggestion that, unless a Government are in some way responsible for a misfortune that befalls a group of their citizens, they are under no obligation to relieve it. All these things and more can bring only shame on the reputation of this country and its handling of this tragedy, which has been so much less open and generous than that of numerous other countries.

Two things stand out particularly. One is the reliance on a system of ex gratia and discretionary payments to provide a measure of compensation, rather than a system of direct financial provision as recommended by the Archer inquiry. This smacks of the mentality of the Poor Law. Secondly, most shocking of all is the way that the state has sought to shuffle off responsibility for making amends to those who, through no fault of their own, have suffered as a result of state action or the actions of organs of the state.

The past cannot be undone. Nothing can rescue the victims and their families from what they have suffered. All we can do is make amends as best we can, and as far as measures of compensation can, at the earliest opportunity we have. The previous Government’s response fell significantly short of full implementation of the Archer report. The least this Government can do is take the first opportunity they have to right the wrong that has been done to the victims of this tragedy. The Coalition Government have already shown that they have an honourable record of doing the right thing where other Governments have done their best to obfuscate, prevaricate and shuffle off responsibility in the way that Governments do. The Government’s response to the Saville inquiry into Bloody Sunday, and the way they have grasped the nettle in relation to those who lost out as a result of the collapse of Equitable Life, gives one confidence that their instincts are sound; that they know what is the right thing to do; and that they are able to face up to their responsibility and act on it when they know it.

As we have heard, the Parliamentary Under-Secretary of State for Health, Anne Milton, has said that she hopes the matter will be sorted by Christmas. The best way for the Government to achieve this would be to give the Bill a fair wind. I very much hope that they will.

Mid Staffordshire NHS Foundation Trust

Lord Low of Dalston Excerpts

Wednesday 9th June 2010 Lords Chamber

[Earl Howe]

I pay tribute to the noble Lord for his work, in particular for his work with the National Patient Safety Agency. As he will know, hospital standardised mortality ratios are something of a vexed topic. Professor Sir Bruce Keogh, the NHS medical director, has established a working group that will review how those ratios are derived and recommend what method should be used consistently for the NHS in future. The aim is to provide simple, practical guidance on how the ratios should be interpreted and used with other sources of information. Once the technical basis for this work has been developed, it is planned that patients and patient groups will be invited to become closely involved.

[Lord Low of Dalston]

My Lords, the Minister referred to seeing to it that, following the experience of Mid Staffs, more information will be given to patients. He will no doubt recall from debates in this House during the passage of the Equality Bill that research carried out by Dr Foster for RNIB, of which I am a vice-president, showed that as many as 72 per cent of patients were given information by their GP that they could not read. Even higher figures were uncovered in relation to the rest of the NHS. Will the noble Lord give a commitment that the Government will take steps to ensure that information is given in accessible formats to patients who have difficulty in reading information in ordinary print? To assist in doing this, the Government will have at their disposal the strengthened rights of access to information in accessible formats included in the Equality Bill before it passed into law.

[Earl Howe]

I am grateful to the noble Lord for his question, which is spot on target—if I dare use that word. The need to create more accessible information for patients is central to the Government’s agenda for creating choice. Choice is meaningless unless it is informed choice, which means rolling out choice to every patient, including those who are visually disabled. We are determined to make more information about care and safety standards and performance available to the public and staff. That should be published online and in formats accessible to all patients. I assure the noble Lord that we will bear these points closely in mind as we develop our plans.