Oral Answers to Questions

Debate between Norman Lamb and Tony Baldry

Tuesday 15th July 2014 Commons Chamber

[Sir Tony Baldry (Banbury) (Con)]

6. What steps his Department is taking to support carers.

[The Minister of State, Department of Health (Norman Lamb)]

Under the Care Act 2014, rights for carers that are equal to those for whom they care will be enshrined in law for the first time. That includes support to meet their needs. My Department has also separately provided £400 million for the NHS to enable carers to take breaks from their caring responsibilities.

[Sir Tony Baldry]

As a condition of the better care fund, areas are being asked to choose local indicators, which will accompany national measures, to show progress towards the integration of health and social care. How many areas have chosen carer-reported quality of life as their local indicator, and how can more areas be encouraged to make carers a priority in their delivery of services through the better care fund?

[Norman Lamb]

My right hon. Friend is absolutely right to focus on the importance of better care fund plans, including the interests of carers. The planning guidance that was issued in December made it clear that the plans should include the well-being of carers. Updated guidance will be issued very soon, and will reinforce the central importance of carers’ being part of the plans. We do not yet have a final picture, but we are keen to ensure that all plans include the interests of carers.

Care Homes

Debate between Norman Lamb and Tony Baldry

Thursday 1st May 2014 Commons Chamber

[Norman Lamb]

I thank the hon. Lady for those questions. I completely agree that unacceptable practices, and abuse and neglect, must be stamped out. I hope she is pleased that the Government are taking action to ensure that we can prosecute care providers who have allowed unacceptable practices. When I came into my job and had to respond to the scandal at Winterbourne View, the question I asked officials was, “What has happened to the company? How has it been held to account?” I was told that the Care Quality Commission could not prosecute because it had to serve a notice first, and if the company complied with the notice, nothing could be done.

A flawed regulatory regime was established when the CQC came into being. We are changing that so that providers of care can be prosecuted if they fail to meet fundamental standards of care. [Interruption.] I am answering the question. That is precisely what we are doing. The hon. Lady mentioned the issue of corporate accountability and corporate neglect, and that is exactly what we are addressing: we are giving the CQC the power to prosecute when there is corporate neglect.

We are also going further by introducing a fit-and-proper-person test so that every director of every care company will have to demonstrate that they are a fit and proper person. That should already be the case, but this is the first time it has happened. We are also introducing proper standards of training for all staff.

On the care home concerned, I hope it will be helpful if I write to the hon. Lady setting out the whole sequence of events and the entire timeline of the steps taken by the CQC. I commit to doing that in the next few days so that she will have the full picture.

We have made sure that the CQC is independent—we have strengthened its independence. We are introducing a far more robust inspection regime and we are addressing a problem. When the CQC was introduced by the Labour Government, the design of the inspection system was for generalist inspectors who might inspect hospitals one week and care homes the next. We are introducing specialist inspections. When inspectors go into a care home, they will talk to relatives, residents and staff, to get a much fuller picture of what is going on. Care homes will then be rated on their standards of care, so everyone will know what their local provider’s standards are.

I hope the hon. Lady will feel that real, substantial steps are being taken to address unacceptable standards of care and to ensure that people are properly held to account when bad things happen.

[Sir Tony Baldry (Banbury) (Con)]

Everyone in the House will want to ensure that anyone in residential care is treated with the compassion we would expect if our own much-loved parents were in such care. In addition to supporting the CQC’s specialist inspections, does my hon. Friend not think that we may be reaching a point where health and wellbeing boards will need to consider setting up panels of trained, independent lay visitors to visit residential care homes in their own area—unheralded and unannounced—to check whether people are getting the care and compassion that is merited and that we would all want for anyone in a care home in our constituencies?

[Norman Lamb]

I thank my right hon. Friend for that question and I very much share his view. In my own county of Norfolk, a brilliant third sector organisation is doing precisely that. It is arranging for ordinary people to go into care homes, judge the sense of kindness of compassion there and give a much richer view than statutory agencies might be able to provide. I would also point to the role of Healthwatch England, which has been established through the health reforms. Those organisations have the power in every local area to go into care homes—they cannot be blocked from going into them or any other health or care setting—to make their own judgments on where things are going wrong. Through that much greater transparency and openness, we will not only expose poor care but drive up standards.

Carers

Debate between Norman Lamb and Tony Baldry

Thursday 20th June 2013 Commons Chamber

[Sir Tony Baldry]

One of the non-executive members of the IPSA board will shortly be work-shadowing me for a day, so I will certainly raise that valid point with her. I will give her lunch, out of my own taxed income, along with other colleagues who might want to talk with her, and the hon. Lady would be very welcome. I think that the board’s non-executive members have to take some responsibility for the way IPSA functions.

[Norman Lamb]

Does my hon. Friend agree that it is not simply about employers having a duty to look after employees who have caring responsibilities; it is also about enlightened self-interest? It is an enormous own goal when so many employers lose really good and experienced employees, who could otherwise contribute so much to a business, because they have caring responsibilities. It is in their interests to keep those employees.

[Sir Tony Baldry]

I entirely agree and hope that all employers see the enlightened self-interest in looking after carers. I think that there is a general recognition that everyone in the system has to start thinking about carers, particularly those who are caught in the sandwich generation and have to look after children and older relatives.

The two colleagues who have spoken in the debate have already set out the broad context of the research done in carers week: about three quarters of carers felt unprepared for their caring role; four in 10 had reduced their working hours because of caring; nearly a third had missed out on the chance of promotion; almost half had used savings to pay basic bills, such as those for heating and food; and more than a quarter had taken out a loan or fallen into debt as a result of caring.

I am conscious that many colleagues wish to speak. I will use the time remaining to highlight some specific concerns raised by Carers Oxfordshire. In anticipation of today’s debate, I asked Carers Oxfordshire about the concerns of local people. Unsurprisingly, there was a huge response from carers. I think that there is a feeling among many carers that one of the most important things is having their voice heard. The sorts of points raised were as follows:

“Carers would like to hear greater clarification about the implementation of the Care and Support Bill along the following lines: ‘Carers are very pleased to see the rights of all carers to have an assessment so clearly defined in law. The concern is that the regulations are written in the spirit of the legislation i.e. of widening the access to help and support for carers. The national eligibility framework needs to reflect this and ensure that the threshold of eligible needs is not set too high. The risk is that local authorities will use the framework to restrict “eligible needs” on the basis of limited resources, which could mean many carers will not be any better off in terms of the help and support they receive. We must ensure there is not a postcode lottery in the way the framework is operated by local authorities.’”

On respite for carers, respondents commented that it is

“too expensive and too hard to get currently as care homes often don’t ‘allow’ bookings to be made well enough in advance to allow carers to book holidays. There is very little financial help for ‘stay at home’ carers. What about care vouchers similar to child care vouchers being issued, or tax relief on care costs?”

With regard to GPs, the identification of carers is a really important issue. There

“needs to be more emphasis from GPs and a greater recognition of carers’ contribution and value, including their health and wellbeing.”

Another point was this:

“Poor quality of care provided by care agencies is a huge concern. Quality, reliability and accountability are ongoing concerns for carers.”

On carers in employment, concerns were expressed about the financial cost of care and the impact on those who have to give up work or reduce their working hours.

The respondents make an interesting point:

“Military carers and their family can suffer a significant disadvantage, to include homelessness due to ‘entitlement’ issues around properties when they take on caring responsibilities. Lack of recognition from the military.”

They continue:

“Carers want to see social care and nursing care fully combined as one discipline. As far as they are concerned they are one and the same thing. During one carer’s experience in the weeks prior to her mother’s hospital admission she had had three different teams visiting her throughout the day. They spent more time completing forms and leaving files than anything else. It was tiring and draining for her to have so many different people coming and going. Full integration of the two disciplines is key for continuity, to prevent duplication of effort and reduce needless bureaucracy.”

Finally, they state:

“Look at simplification of forms for applying for carers allowance and attendance allowance.”

It is really good news that the Care Bill will consolidate and simplify decades of social care legislation in England. We must not lose sight of the fact that it will include significant and welcome new rights for carers to improve access to carers assessments and new duties on local councils to provide care services. I share the concerns of the hon. Member for Worsley and Eccles South (Barbara Keeley) about young carers, but I am confident that those on the Treasury Bench have taken on those concerns and will table amendments to the Bill in the Lords to cover them.

We are making good progress. The direction of travel is a good one, but we have to recognise that a huge amount of distance still has to be covered if we are to be proper advocates and protectors of the millions of carers in the UK who selflessly give themselves to look after a loved one.

Oral Answers to Questions

Debate between Norman Lamb and Tony Baldry

Tuesday 16th April 2013 Commons Chamber

[Norman Lamb]

I seem to be ready to agree to several meetings and I will certainly add that one to my list. I will be delighted to meet my hon. Friend—and I should also pay tribute to him for the work he is doing in this area.

[Sir Tony Baldry (Banbury) (Con)]

13. What steps he is taking to make the services of hospices more available to NHS patients.

[The Minister of State, Department of Health (Norman Lamb)]

We are supporting NHS England to develop a fairer and more transparent funding system for hospices, to be in place by 2015. We have made £60 million in capital available to hospices to improve their physical environments, and will continue to provide over £10 million in central funding for children’s hospices.

[Sir Tony Baldry]

Will my hon. Friend confirm that the new NHS commissioning arrangements should increase the opportunities for hospices in the voluntary sector, such as the excellent Katharine House hospice in my constituency, to provide palliative care and terminal care for NHS patients?

[Norman Lamb]

I pay tribute to the hospice movement, including Katharine House in my hon. Friend’s constituency. It is crazy that we are spending a lot of public money on caring for people at the end of life in places where they do not want to be. Most people do not want to end their life in hospital, yet about 50% of people still die in hospital. We are looking to create a new funding regime where money will follow the patient, to ensure people’s choice is respected so they can die where they want to, and so that hospices have fair funding.

Winterbourne View

Debate between Norman Lamb and Tony Baldry

Monday 10th December 2012 Commons Chamber

[Norman Lamb]

I thank the hon. Gentleman for that question and completely agree that we have to address the issue of skills. It is worth pointing out that there are some fantastic providers in the voluntary sector, and in the private sector as well. We should applaud that and recognise that there are many well trained people on low wages providing a fantastic quality of care, but there are also places where that is not the case. That needs to be addressed.

I absolutely agree with the hon. Gentleman that we should look closely at the voluntary or not-for-profit sector. I had a meeting recently with the head of Shared Lives, an organisation that places people with learning disabilities into people’s homes. Surprise, surprise—when people are treated with dignity and treated as human beings, their behaviour improves and sometimes all the complex problems subside. There is an awful lot we can do. In the new year I will bring together the providers of the best care available so that we can learn the lessons from them.

[Sir Tony Baldry (Banbury) (Con)]

As patients had come from different parts of the country to Winterbourne, there was a sense that they had got lost in that locality. Whatever happens, it is a tragedy that it took a television programme to discover all this. We are now going to have health and wellbeing boards and HealthWatch. Can my hon. Friend tell the House how, between them, they can ensure that they inspect and have a grip to ensure that something like this never happens in my county of Oxfordshire? It has never happened there because the structures of local government and health and social services are constantly monitoring and inspecting whatever is happening in our areas, irrespective of whether they are delivering health or social care.

[Norman Lamb]

I thank my hon. Friend for his question. He is absolutely right. The new structure provides far greater local accountability than we have ever had. One of my great criticisms of the old primary care trusts is that they are, in effect, completely unaccountable to their local communities. Health and wellbeing boards scrutinising what clinical commissioning groups and the local authority are doing can be very powerful. He also mentioned HealthWatch. Like its predecessor organisations, the local involvement networks or LINks, it will have the power to go into all care and health settings and inspect what is going on, often behind closed doors. We encourage HealthWatch to use those powers to shine a light on what is happening in some of those places.

Oral Answers to Questions

Debate between Norman Lamb and Tony Baldry

Tuesday 27th November 2012 Commons Chamber

[Sir Tony Baldry (Banbury) (Con)]

T2. The new mandate for the NHS includes a very welcome objective for it to be a world leader in end-of-life care. Can we have an indicator in the commissioning outcomes framework on deaths in preferred places of care to ensure that new commissioning groups prioritise better end-of-life care, and to ensure that those who want to die peacefully at home have the best opportunity to do so?

[The Minister of State, Department of Health (Norman Lamb)]

I thank my hon. Friend for that question. The NHS outcomes framework includes an indicator on the quality of end-of-life care as it is experienced by patients and carers, which is based on the VOICES survey of bereaved relatives. The proposals for reform to the NHS constitution include a right for patients and families to be involved fully in discussions, including at the end of life.

Social Care (Local Sufficiency) and Identification of Carers Bill

Debate between Norman Lamb and Tony Baldry

Friday 7th September 2012 Commons Chamber

[Sir Tony Baldry (Banbury) (Con)]

The Government published their White Paper, “Caring for our future: reforming care and support”, just before the summer recess, and I think we would all agree with its statement:

“Carers make a vital contribution to promoting the wellbeing and independence of the people they care for…The support provided by millions of carers is testament to the strength of our society and our communities. However, we also recognise that caring brings challenges. Providing better support to carers is therefore crucial to ensure that they can maintain their own health and wellbeing, care effectively and have a life of their own alongside caring.”

Earlier this year, various all-party groups, including the all-party group on social care, which is chaired by the hon. Member for Worsley and Eccles South (Barbara Keeley), who has so ably introduced this Bill, and the all-party group for carers, which I co-chair, met to consider the measures needed to do exactly what the Government say they want to do in their White Paper, namely provide better support for carers, so that they can

“care effectively and have a life of their own alongside caring.”

The hon. Lady was fortunate enough to come reasonably high in the ballot for private Members’ Bills and, with the help of a number of carer organisations, such as Carers UK, drafted a Bill that addresses the challenge of how we can give effective support to carers.

The Government then published their much-awaited White Paper on social care, which was widely welcomed. I am delighted to say that, for the first time, it makes substantial commitments to carers, which I will come to in a moment. Unfortunately, but perhaps understandably, most of the press commentary on the White Paper centred on what the cost of residential social care would be. The new policy and the contribution to the support of carers were not necessarily highlighted sufficiently, but they are included in the White Paper.

The hon. Lady and those involved in promoting the Bill examined the measures in the White Paper and considered what other measures would be of further benefit to carers. A number of the Bill’s provisions are, therefore, not included in the White Paper, but I acknowledge that there is some overlap. For example, clause 1, which would introduce a duty to ensure sufficient social care support, is probably covered by the provisions in the draft Care and Support Bill.

I am anxious to find a way forward whereby we do not wake up tomorrow morning to headlines stating that the Government have killed off a Bill that would give more support to carers. We need to find a grown-up way to do this. My hon. Friends the Members for Shipley (Philip Davies) and for Bury North (Mr Nuttall) are present, and I suspect that these sextons on duty—these pallbearers of private Members’ Bills—will make lengthy contributions that may well not enhance the nation’s understanding of the problems faced by carers.

Before we make any further progress, I therefore want to make a request to the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), who I am delighted to see taking responsibility for this issue at the Dispatch Box for the first time. The White Paper contains a welcome chunk of policy on carers, but people involved with carers feel that some areas could be further enhanced. All I want my hon. Friend to do is give a clear undertaking that, between now and the eventual Second Reading and debate of the Government’s Bill on social care, he would be willing to have meetings with the relevant all-party groups to discuss how provisions relating to carers could be further enhanced.

I fully accept—the interventions on the hon. Member for Worsley and Eccles South demonstrated this—that there are tensions in relation to how one balances duties on various organisations and partners in ways that are reasonable to their costs, and to some of the changing patterns resulting from the fact that local governments are now seen more as enablers than deliverers. I want my hon. Friend to give an undertaking that he would be willing to have discussions with those of us who are concerned about carers policy, to try to ensure that, when the Government’s Bill on social care is presented to the House, those parts relating to carers are as robust and as resilient as possible.

I hope that my hon. Friend is willing to give that undertaking. Given that he has only taken up his brief this week and has probably yet to read the briefing for incoming Ministers in his red box, I would fully understand it if he felt unable to respond in detail today and say, “Well, I can accept those bits of the Bill, but not those bits.” That would be difficult. It would be disappointing, however, if there were any scintilla of a suggestion that the Government want to “kill off” this Bill because they do not want it to pass. I hope that my hon. Friend will see this as an opportunity to have a constructive debate on policy on carers and their needs, and trumpet his willingness to engage with us to make sure that those parts of the Government’s new Bill relating to carers are as good as possible.

[The Minister of State, Department of Health (Norman Lamb)]

I am grateful to my hon. Friend for his comments, and I am happy to give, straight away, the undertaking that he seeks. I will engage fully with the hon. Member for Worsley and Eccles South (Barbara Keeley), who is the Bill’s promoter, and with the relevant all-party groups. It is important that we get this right and that we do not let down those people with caring responsibilities. I am very happy to give a firm commitment to engage fully between now and when the Government’s Bill is presented to this place.

[Sir Tony Baldry]

I am grateful to my hon. Friend for that undertaking. I would understand if the Government did not want the Bill under discussion to progress, but that must be balanced against his undertaking.

--- Later in debate ---

[Sir Tony Baldry]

Before I give way to the right hon. Lady, I want to say that I hope that the Government’s Bill will codify all the existing legislation relating to carers. Over the years, a whole number of private Members’ Bills, one of which was introduced by the hon. Member for Aberavon (Dr Francis), have enhanced the role of carers. It is confusing and difficult for people to find their way around different bits of legislation, so it would be good if all of the legislation relating to carers were collected in one piece of legislation.

[Norman Lamb]

I am grateful to my hon. Friend for allowing me to intervene again.

It is the Government’s ambition to codify all the provisions relating to carers and care and support in one Act of Parliament. A big problem, as he rightly identifies, is that the law has developed in a haphazard way. Getting it all into one Act of Parliament, written in plain English, would be of real benefit to carers and others in the sector.

[Sir Tony Baldry]

I am genuinely delighted to hear my hon. Friend say that. It is really good news. If we continue on that basis, we will make substantial progress.

--- Later in debate ---

[Norman Lamb]

I am grateful to my hon. Friend for raising that point. Yes, absolutely, there is and I will come back to that. One concern I have is the focus in the Bill on social care, whereas the thrust of Government policy is the importance of integrated care. My hon. Friend and the shadow Minister referred to Torbay. I am passionate about that approach. We can do an awful lot more. The whole approach should be to integrate health and social care in our planning and our execution, rather than, as the Bills risks, silo-ing social care and assessments of social care and carers’ needs separately.

The shadow Minister commented on budgets. I absolutely understand that budgets are tight and that local authorities are in difficult times, but the new budget survey from the Association of Directors of Adult Social Services shows not huge cuts but that councils have risen rather impressively to the challenge and identified savings of £1.89 billion since 2010-11 by using resources more efficiently. Surveys show that councils’ spending on adult social care is due to fall by only £200 million or so. If the money can be used much more effectively, we can ensure that services are protected.

One thing I am interested in pursuing in my new role is how well we commission care. There is disturbing evidence of a race to the bottom, with care being commissioned on the basis of an hourly rate and the cheapest getting the contract. We need to do everything we can to ensure that commissioning provides incentives to improve health and well-being, prolong independence and improve mobility, thereby saving money and improving care, which is what we need to achieve. There is probably a widespread view that we do not commission care nearly effectively enough. There must be a substantial improvement in our expenditure on social care.

We agree with much of the intention of the Bill, but for a number of reasons we cannot support it. First, it would perpetuate the fragmentation of carers legislation, which we are seeking to end. My hon. Friend the Member for Bury North made the point that the Law Commission argued for a single statute. It seems irrational, at the very moment that the whole sector is celebrating the fact that we are seeking to bring everything together, to have a separate Bill introducing new duties. The debate about getting the framework right—putting everything together in one clear framework, written in plain English—needs to be part of the Government’s Bill.

[Sir Tony Baldry]

I urge my hon. Friend to be as conciliatory as possible. In fairness, when the hon. Member for Worsley and Eccles South (Barbara Keeley) started with her Bill, the Government had not published their social care White Paper, so she had no idea what it would contain. The important thing is to focus not on the Bill’s potential failings but on a process that enables us to look at its ideas and concepts and decide which will fit into the social care Bill that my hon. Friend will bring forward for Second Reading in due course.

[Norman Lamb]

I completely agree with my hon. Friend.