Older Persons: Human Rights and Care

Lord O'Shaughnessy Excerpts

Thursday 16th November 2017 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health (Lord O'Shaughnessy) (Con)]

I congratulate the noble Lord, Lord Foulkes, on securing the debate and I pay tribute to all noble Lords who have contributed to what has been a very interesting and challenging debate at times. The Government were pleased to see the publication of the Council of Europe report on this important issue in May this year; as the noble Lord pointed out, we have had a chance to discuss it before. He is to be commended for leading such a high-quality piece of work; we would expect nothing less. I also welcome the noble Baroness, Lady Thornton, back to her role on the Front Bench. I look forward to many more of these exchanges in the months ahead; she is clearly going to keep me on my toes.

The human rights of older people are what are in question here and, of course, they are no different from those of other citizens. What differs are the means needed to uphold those rights because of the specific needs of older people themselves including, critically, the care available to them later in life. As all noble Lords have pointed out, an ageing population presents the UK, in common with the developed world, with one of our most profound challenges. It raises critical questions as to how, as a society, we enable all adults to live well into later life and how we deliver sustainable public services that support them to do so. But it presents huge opportunities, too—socially, economically and dare I say it, morally. The care and respect that we provide to older people is the litmus test of the values that we hold as a society.

I believe that the Government recognise the scale of this challenge and are responding to it. I hope that the noble Lord—indeed all noble Lords, though I have a sense that they may not have—will have seen that, at 2 pm today, my right honourable friends the First Secretary of State and the Secretary of State for Health published our plans to produce a Green Paper on social reform by summer next year. The announcement makes it clear that, to achieve reform where previous attempts have failed, we must take a broad view. The Green Paper will cover: social care funding and, of course, issues of means testing; social care services, including continuity of care, as the noble Baroness, Lady Cavendish, mentioned; wider networks of support, such as the role of carers; the role of housing; and interaction with other public services. It will consider how technology, innovation and new workforce models can deliver better quality and value. It will be underpinned by the 2014 Care Act, which introduced national eligibility criteria for access to adult care for the first time, and by £2 billion in additional funding over the next three years to support social care. Part of the purpose of that funding is of course to reduce delayed transfers of care—what the noble Baroness, Lady Thomas, quite rightly described as, in the pejorative term, bed-blocking. I completely agree with her that that is not a term that we want to use or endorse.

To take forward the work towards the Green Paper, a group of independent experts, including Sir Andrew Dilnot and Dame Kate Barker—who have both led reviews into social care in the past—and, from our own House, the noble Baroness, Lady Lane-Fox, will support government engagement with a range of stakeholders including, first and foremost, care users, their families and those providing care in whatever setting, to debate the issues and build consensus. Noble Lords are a treasure trove of expertise on this issue and it is critical that their voices are heard. That is why the First Secretary of State has written to invite the chairs of all relevant all-party parliamentary groups to meet him, so that he can to listen to their views.

An interministerial group has already been established to oversee the policy development process. Our aim is to build consensus around reforms which can last. Once the Green Paper is published there will of course be a full public consultation to provide further opportunities for all interested parties to add their perspective. The Government’s plan is bold in intent and ambitious in scope. I hope that everyone who has an interest in social care sees this as a fantastic opportunity to achieve the lasting and sustainable change that has so far eluded us.

Reform of this vital sector has been a controversial issue for many years but the realities of an ageing society—as noble Lords have pointed out—mean that we must reach a sustainable settlement for the long term. It will no doubt require difficult choices about what that system should provide and how it is paid for. But getting this right promises a better system that everyone can have confidence in, where people understand their responsibilities, can—critically—prepare for the future and know that the care they receive will be to a high standard and will help them maintain their independence and well-being.

As these plans for social care reform show, this Government’s ambition is to make the country a good place for everyone to grow old. The noble Lord, Lord Foulkes, accused me—somewhat unfairly, I thought—of lacking specifics in previous answers, so I am going to give some very concrete examples of what we are doing to support older people. We as a country are proud to lead the world in tackling age discrimination. The Equality Act provides robust protection against both indirect and direct discrimination in employment, and in February the Government published a strategy called Fuller Working Lives, which aims to increase the retention, retraining and recruitment of older workers by bringing about a change in the perception and attitudes of employers.

Many older people want to carry on working, and of course the coalition Government abolished the default retirement age and extended the right to request flexible working to all. It is therefore hugely encouraging that the number of older workers is at a record high—and not just because of the growing size of the House of Lords. I should add that I am doing my bit. Just yesterday, as happens every Wednesday, I had my parents looking after all three of my children—so I am keeping them active in their retirement, too.

Huge progress has been made under successive Governments. The noble Lord, Lord Lipsey, mentioned pensioner poverty. It is still too high, at 16%, but that is compared with 40% in the 1980s. The pension credit provides a guaranteed minimum income to help tackle pensioner poverty in Great Britain, and over time the new state pension will reduce the need for means testing.

Beyond social care, we are taking action in a number of areas to support the comprehensive care of older people. One of these is the inclusion, by 2020, of training in geriatrics and prescribing for older people within all medical curricula, so that there will be additional support throughout every part of the NHS. The 2017-18 GP contract set out a requirement for the identification and management of patients aged 65 and over with frailty, to ensure that they receive an annual medication review. Where clinically appropriate, the GP will discuss whether the patient has fallen in the past 12 months, and provide any other clinically relevant interventions.

Of course people want to be at the centre of their own care, making sure that it responds to their own needs—which is why the Government have simultaneously extended both personal health budgets and integrated personal commissioning, as well as promoting the integration of health and care services through the sustainability and transformation programme that is the centrepiece of the NHS’s five-year forward view.

The noble Lord, Lord Haskel, and the noble Baronesses, Lady Thomas and Lady Thornton, raised the issue of integration of care. All parties are aiming towards that. There are different versions of this, but bringing together care for people who experience it, and who do not want to have to distinguish between primary, secondary, community, social and so on, is essential as the health needs of our population change around ageing and comorbidity.

Personalisation is therefore behind these ambitious plans, as well as our plans to digitise health services—a passion of the Secretary of State’s. The potential for mobile technologies to support an ageing society, to combat loneliness—which, as the noble Lord, Lord Sawyer, pointed out, has such a pernicious effect in old age—and to provide real-time diagnostics is a rich seam that has only just started to be explored. New services, such as the GP at Hand pilots, hold huge opportunities for older people who need to see a GP but may be too frail to leave home.

Home is at the centre of providing for good care and for the human rights of older people. At heart, growing old safely and happily needs a good home. We know that most older people would prefer to live at home in their later years, which is why we have seen an increase in domiciliary care and sheltered housing. Others will want or need to be in a residential or nursing home, so the quality of that home and the care provided within it are everything. As the noble Lord, Lord Cashman, pointed out, the Care Quality Commission’s October State of Care report said that about four-fifths of residential homes achieve good or outstanding ratings—although I accept that only 2% or 3% are outstanding, and that could be better. For domiciliary care services the figure was 83%, and for community social care 88%.

The noble Baroness, Lady Greengross, talked about the work she did, when only 50% of care was judged to be good enough. I am not sure what year that was, but I hope that we have seen an improvement. The fact that those inspections are happening is helping to drive quality. The State of Care report highlights variation, and points to some evidence of deterioration. The CQC is looking at this quality, including the deterioration of good and outstanding providers, but it is reassuring to see that 82% of providers that had been rated inadequate had improved by their next inspection.

Providing good care in the home means supporting carers as well as care workers. That is why it is so positive that the role of carers has been wrapped into the overall social care reform programme that I described earlier. I pay tribute to all those, paid and unpaid, who look after older people and provide the dignity and respect that they deserve. Adults with dementia are particularly vulnerable, so I am sure all noble Lords will welcome the fact that over 2 million people have been trained to be dementia friends to support sufferers of this horrible disease.

As several noble Lords have pointed out, making sure that there is good care also means rooting out and, where necessary, taking professional or legal action against the despicable minority who abuse vulnerable older people. That is one reason that we introduced a new crime of wilful neglect, which came into force in April 2015. Looking ahead, the draft Domestic Violence and Abuse Bill will strengthen the Government’s powers to respond to physical, psychological and economic abuse in domestic settings, and we will launch a consultation on proposals soon. However, it is important to emphasise that this is only a minority and that the vast majority of people looking after older people work with great dedication and compassion.

Before concluding, I take the opportunity to respond to some specific questions that I have not yet had a chance to answer. I hope that I have given some specific examples to the noble Lord, Lord Foulkes, and done so politely. I say to him that there is no need to wait for a Labour Government to act on these things. Indeed, as the noble Baroness, Lady Cavendish, pointed out, we want to avoid the political toxicity that can accompany such issues.

My noble friend Lord Balfe and the noble Lord, Lord Sawyer, suggested that collective bargaining was the way forward. Perhaps that was a reminder of the past involvement of my noble friend Lord Balfe in unions and the Labour Party. However, I am not convinced that that is the right way forward. I do not think that it matters whether a provider is in the private sector, the public sector or the voluntary sector. As Tony Blair once said, what matters is what works. It is quality that counts and that is why we need to have the staff and the training to make sure that happens.

The noble Lord, Lord Cashman, talked about discrimination in medical care. That is, of course, absolutely wrong when it is done for unjustified reasons. There can be reasons why decisions are made not to operate on older people but those must always be clinical decisions based on clinical judgments and not because of any kind of prejudice. It is important to emphasise that there are routes such as HealthWatch and the health ombudsman through which people can report instances of discrimination.

At the heart of the proposals of the noble Lord, Lord Foulkes, is the idea of a charter of older people’s rights, which was endorsed by the noble Baroness, Lady Massey. It is quite right, of course, that there is such a charter for children, and, indeed, a Children’s Commissioner has come from that. I hate to disappoint them, but that is not currently part of our plans. However, we will continue to watch the UN’s work in this area, as was highlighted by the noble Lord, Lord Rea, with interest.

The noble Baroness, Lady Massey, also asked about the difference between hospice and care home funding. They are funded very differently. The periods of time that one would expect to spend in one versus the other is also different. However, I shall certainly write to her with more detail of how those could be aligned.

The noble Baroness, Lady Cavendish, asked about merging the health and care professions. That was an incredibly wise point. There are huge benefits from integration, not least because care is increasingly delivered in an integrated way, because of the complexities involved and because of the progression that integration offers. One of the criticisms of social care as a profession concerns the glass ceilings that exist within it; the opportunities for seniority are not there, whereas integration with the medical professions would provide that.

The noble Lord, Lord Jordan, asked about preventive action. I completely agree with him on that. He will be pleased to know that there are big increases in capital spending on the disabled facilities grants, which is going up year on year precisely to combat some of the very avoidable issues of the usability and safety of homes, for example, to provide the kind of preventive action that he is looking for and that ought to reduce the instances to which he referred.

The noble Baroness, Lady Thornton, asked about raising the pension age. The Government have taken action to limit the maximum change to the state pension age to 18 months, building on the 1995 Act at a cost of, I believe, over £1 billion, so the Government are taking, and have taken, action to address that issue.

In conclusion, I again thank the noble Lord for producing his report and instigating this debate. I thank all noble Lords for their wise and thoughtful contributions.

I would like to end where I started. The way we care for older people reflects our values as a society. As a country, we have a fantastic record of supporting and cherishing older people, but the challenge of making sure they can live their lives with independence and dignity is getting harder. We can meet this challenge only by working together, with imagination and compassion, to tackle the difficult decisions and choices that are needed, not least in the reform of social care services and funding. Noble Lords have a huge amount to contribute to this process and—as others have pointed out—because of the mean age quite a keen personal interest in it too. I look forward to working with noble Lords in that endeavour.