Care Bill [Lords]

Sarah Wollaston Excerpts

Monday 10th March 2014 Commons Chamber

[Barbara Keeley]

In introducing new clause 3, the right hon. Member for Sutton and Cheam (Paul Burstow) said how he felt that the NHS institutionally must change to identify and support carers. Of course I agree with that. My hon. Friend the Member for Leicester West (Liz Kendall) introduced new clauses 19, 20 and 21. She mentioned my private Member’s Bill, which I feel is having its last outing today in these new clauses; it proposed measures on the identification of carers. I want to touch on how long these issues have been around.

Eleven years ago, I completed a project on identifying and providing support for carers and co-wrote a report on that. The report made recommendations to Government, NHS bodies, GPs and their teams on how important it was to identify and support carers. That project mapped 36 primary care support initiatives for carers run by the Princess Royal Trust for Carers. We are talking about a long time ago. We felt that the role of carers, including their contribution to the work of the NHS, had generally been under-recognised and under-valued.

Through the 1990s, to the point where I wrote that report, we had carers assessments following the excellent Carers (Recognition and Services) Act 1995, introduced by Malcolm Wicks. That was strengthened by the Carers and Disabled Children Act 2000, which enhanced the carer’s right to an assessment. We even had in 1999 standard 6 of the national service framework for mental health, which said:

“all individuals who provide regular and substantive care for a person on the Care Programme Approach should have an assessment of their caring, physical and mental health needs, repeated on at least an annual basis”.

Even at that point, the Department of Health said that the implementation of the carers’ right to an assessment four years in was

“patchy. Assessments are not always carried out. Some carers are offered very sensitive practical and emotional support. But others receive very little, or no help”.

Fast-forward 15 years to the Care Bill, and carers are still in a similar situation. The identification of carers and referring them to sources of advice and support is still not happening on an adequate scale, and we have had all that legislation and good practice. Carers UK has told us that two thirds of carers that it surveyed said that, although their GP knew they had caring responsibilities, their GP did not give them any extra help. We have heard examples of what that can mean.

Carers week is in June, and we look forward to that. We know that in that week we meet carers at events. There is a common theme: they tell us repeatedly they are not getting advice and information to help them care. They can be carers of people with cancer, carers for people with terminal illness, carers of people with Parkinson’s or of people with dementia. Does the Minister want to start changing that for carers week this year? Does he want to go along to carers week events and have carers start to say to him, “I have been identified by my GP and my GP does recognise my caring role”? I hope he does, because I have heard so many people say how much it would have meant to them and what a difference it would have made to their caring if their GP had recognised it.

Even for conditions such as Parkinson’s, only one in 10 carers has been offered an assessment. These are people who are caring very often more than 50 hours a week, and, as a disease such as Parkinson’s progresses, up to 24 hours a day. They and the people caring for somebody who has had a stroke or who has dementia are the people who really need advice, support and breaks. These are the reasons we must support new clauses 3, 19, 20 and 21.

The Care Bill puts great emphasis on carers assessments rather than on the identification of carers, and I introduced a private Member’s Bill on that in September 2012. The clauses in that Bill, which we see again today, would have ensured that NHS bodies had procedures in place to identify carers and to promote their health and well-being and ensure they receive information and advice. I believe the key reason in identifying carers should be because we have a concern for their health, particularly those with the heaviest caring commitments. That is one in five of all carers, and that is more than 1 million people, which is just too many.

Those caring for more than 50 hours a week are twice as likely to suffer ill health, particularly those caring for a person with dementia or stroke. My right hon. Friend the Member for Salford and Eccles (Hazel Blears) has just talked to us meaningfully and movingly about the impact of that caring role on her family. We want early identification and support for those carers so they can maintain their health and manage and sustain their caring role. I agree with my right hon. Friend that they should be fast-tracked for appointments. As hopefully we move towards integration and, beyond that, whole-person care, local authorities cannot be expected to act alone to identify and support carers.

As has been touched on in this debate, we also have to face the fact that the number of people receiving social care services is shrinking. In Salford this year, because of budget cuts, 1,000 people are going to lose their eligibility for social care services and 400 people who would have become eligible for care will not become eligible. The unpaid carers in those families will be taking on that substantial burden, yet, sadly, the GPs and doctors around them will not identify them, will not help them, will not make sure they get advice and support.

This Care Bill is the place to make the change, and I say to the Minister let us not wait another 15 years to make the change and place such a requirement on health bodies—and schools, universities, colleges and further education colleges in the case of young and student carers. Let them just have policies in place to identify carers and to provide support for them.

[Dr Sarah Wollaston (Totnes) (Con)]

I would like to speak briefly to new clauses 1, 26 and 9. I hope new clause 1 on the adult safeguarding access orders would rarely ever be necessary because, as the Minister knows, the vast majority of carers are out there day in, day out, night after night providing dedicated care, often at the expense of their own health. There is a tiny minority of people, however—and I am afraid I have met some of them—who are coercive, controlling and manipulative, particularly if there is money at stake. At the moment there is no right of entry even if other relatives or neighbours and friends have raised concerns, and even if clinicians have concerns. Of course in most cases a negotiation can take place and access can be gained, but very often that access is only with a rather controlling person in the room as well, and it can be very difficult to make a full assessment of capacity under those circumstances, as I am sure the Minister is aware. There are people who are at risk. We know that 29 local authorities have identified that there have been vulnerable adults for whom they have been unable to gain access.

New clause 1 is about stating that there needs to be a final backstop in circumstances where it is clear that the safeguarding of a vulnerable adult at risk is paramount. I know there are those who say we already have right of access under the Police and Criminal Evidence Act 1984, but unfortunately the bar is set too high and there is uncertainty about the ability to gain access. New clause 1 sets out very clearly the thresholds, and also the safeguards, because this is not about riding roughshod over individuals who do not wish to have a social worker entering their home. Instead it is about setting out the rights of an individual who may be under the control of a coercive third party. We need to have greater clarity and I hope the Minister will consider this new clause. Having a final backstop works well in Scotland; it is very rarely used but we need to have it in place as a final resort.

--- Later in debate ---

[Mr David Burrowes (Enfield, Southgate) (Con)]

I, too, have had experience of being in a police station, as a duty solicitor in my case, and therefore have seen for myself that the very last place these most vulnerable of people should be is a police station. Given that the Government have made commitments—indeed, financial commitments—on a diversion service, to ensure that the principle of diverting these vulnerable people is recognised, surely the next step is to support the principle of my hon. Friend’s new clause?

[Dr Wollaston]

I thank my hon. Friend for those comments and I welcome the mental health crisis care concordat, and what is being done to emphasise that prevention is by far the best way forward, but even with those prevention measures in place I think we would all accept there will still be circumstances where people will reach crisis, and unfortunately a police station is absolutely the last place anyone, let alone a child, would wish to be in crisis. In Devon and Cornwall alone, 27 children last year were taken to police cells for long periods of time. On three occasions those children were as young as 12 and 13. That is simply unacceptable. One of the reasons it is likely to continue is that there is no penalty currently for the NHS in continuing to use such facilities. It does not have to pick up any of the financial tab. That is putting enormous pressure on our police forces. They do not wish this to happen, of course. If we cannot at least have this sunset clause, which I think is eminently sensible, I hope the Minister will consider making sure that the NHS has to pay to use the police cells, and that there is a significant financial penalty, because that would be a driver. That would make it financially much more sensible for the NHS to put in place measures for these vulnerable people—who often have been found by the police at the point where they are about to take their own lives. It cannot be acceptable for this situation to continue.

Moreover, the variation in such use of police cells is extraordinary. There are some areas where that is not used at all and others where it is very heavily relied on. I hope the Minister will say in his response that he is prepared to consider a sunset clause, or at least a financial penalty, so we see drivers in place and we continue to move away from such a practice. However, I absolutely recognise the point made by my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) that prevention is far better, and I know all areas are working towards that and that the Minister fully supports it.

New clause 9 is an extraordinary measure that is widely welcomed because of the principles to which the right hon. Member for Salford and Eccles (Hazel Blears) referred about well-being and prevention. These are at the heart of the Bill and everybody welcomes them. However, I think the Minister recognises that there could be unintended consequences if we were to introduce many new statutory obligations without their being funded fully. As he will know, we have two tests—a needs test and a means test—for people to pass in accessing social care, and 88% of needs tests are now set at a substantial level, which has been quite a considerable change. There is also the means test, which stands at £23,250. On many occasions as a GP, I remember coming across the absolute shock encountered by people when they realised that they would get no help whatever.

The change under the Bill will be extraordinarily welcome, although we should be under no doubt about the burdens that it will place on local authorities, in particular in my area. Devon has the third oldest demographic in the country, but funding of local authorities for health care does not have sufficient emphasis on the age structure of the population. There will be great impact on Torbay and on other areas in Devon, such as my constituency.

New clause 9 is a sensible measure about how we plan for the future and make an appraisal of whether we are fulfilling the important provisions in the Bill, ensuring that we have sufficient resources directed towards prevention and well-being. I hope that the Minister will see the new clause as helpful and as one that will assist us in planning for the future.

[John McDonnell (Hayes and Harlington) (Lab)]

I will speak to the amendments in my name. I share the view of the right hon. Member for Banbury (Sir Tony Baldry) that we should not have nodded the programme motion through blithely. Many of my constituents have contacted me about the Bill, because care in my area is on the edge of crisis, with the new threshold rolling it back for many people. That is why I support new clause 11; people need their human rights to be ensured in the Bill. New clause 2 is important, because we have a Children’s Commissioner and we need a commissioner for the elderly and other care services, so that there is someone to speak out for people. I support new clauses 7 and 9, because I agree that introducing legislation without funding is meaningless. We place local authorities in an impossible position, as they struggle to provide the services.

With regard to the work force, we need to ensure pay and adequate training, so that we fully professionalise the work force. In my area, we have a high turnover of care workers, which leads to distressing results. In one case, an elderly lady was burgled and on the next day a new carer came in, but she thought that she was being burgled all over again, because she did not recognise the person. That is the instability in the industry at the moment. That is why I support new clauses 17 and 18.

On the amendments in my name, new clause 31 is generated by one of my constituents called Jonathan Kay, who asked me to get the matter dealt with in the Bill. For many years, Jonathan has been funded by the local authority to employ a personal assistant to enable him to carry out his day-to-day tasks—he is a disabled person—but he has experienced serious problems with personal assistants in the past, even suffering abuse on more than one occasion. When employing personal assistants, Jonathan has found assessing the suitability of candidates extremely difficult, and he has not been able to obtain reliable recommendations from any public body, despite using public funds to employ them.

Part 3 of the Bill provides that the training and education —but no qualifications—of carers will be undertaken by Health Education England. The purpose of my new clause is for Health Education England to allow scope for the local education and training boards to do such work and to compile, publish and maintain a register of all persons who provide regulated social care for individuals under arrangements made by or paid for by a public authority. That would allow people such as Jonathan to access a list of trained professionals whom they can employ with confidence, we hope, in future.

With amendment 26, I am simply seeking to install into the Bill a provision on the right to live independently, as recommended by the Joint Committee on Human Rights, but dismissed by the Government. The Government might well have been concerned about the legal actions that were taking place with regard to the independent living fund, but the Committee’s report made its disappointment very clear that the Government had not taken the opportunity of the Bill to be explicit about their support for the convention on the rights of people with disabilities and article 19—“Living independently and being included in the community”—being a human right. It should therefore be included in the Bill. The Government have given assurances that the general direction of the Bill might achieve the same ends, but that is not good enough in that it does not enforce the rights in law.

My amendment 21 covers the same ground as new clause 15, so I will not dwell on it in any depth, but I will give an example. Whether with our parents or in our community, we all know about the uncertainty of charges for residential care. They cause real concern and anxiety among families. Yes, the ability of local authorities to negotiate rates influences the overall market, but that is why there is a need for some form of indicative price. A care funding calculator is used to set the care of people with learning difficulties, and that model has worked and saved public funds. We should at least be considering in the Bill that sort of process for care overall.

My proposals in amendment 20 would

“require the local authority, when carrying out the assessment, to capture an individual’s main and other disabling conditions”.

A whole group of organisations, including the Parkinson’s Disease Society, Sue Ryder, the Motor Neurone Disease Association, the Multiple Sclerosis Society, the Epilepsy Society, the Neurological Alliance and the Alzheimer’s Society, have all campaigned for this simple change in the assessment process, which merely requires local authorities to collect and record information about an individual’s main and other disabling conditions when they are conducting their social care assessments and arranging care packages. Why is that important? It is important for local authorities to be aware of the different conditions in their community, so that they can plan long-term services, but it is also important for us to be aware of the information nationally, so that care services and our investment can be planned in the long term. Taking that into account seems to be a minor amendment.

Amendment 22, which I also tabled, was proposed by the Royal National Institute of Blind People and lobbied for by a number of my constituents. In clause 76, the duty is placed on the local authority to establish

“a register of sight-impaired and severely sight-impaired adults who are ordinarily resident in its area.”

The existing provision relates only to adults and does not include children. My amendment simply ensures that the local authority is required to collect information on both adults and children. The reason for this is that, under the Children Act 1989, there is a requirement on local authorities to collect information with regard to blind and partially sighted children, but 20% of local authorities admitted failing to meet that legal requirement. Furthermore, 20% of local authorities have no register; three councils include just 1% of disabled children known to the authority on the registers; one in four authorities have whole registers with fewer than 2% of disabled children known to the council; and almost six in 10 councils include 10% or fewer of the disabled children. The RNIB therefore emphasises that in clause 76 we should place on local authorities a duty, when collecting information, to include children ordinarily resident in their area. Again it is the same mechanism; it is about the planning of services to ensure that they are properly invested in over the long term.

Overall, I welcome the Bill, but I fear that it will disappoint many as a result of the failure to address some of the considerable issues with regard to funding, rewards to the work force and professional training, and the appropriateness of the cap on costs.