3rd reading in the Lords
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Lord Campbell-SavoursLabour- Quote
- moved Amendment No. 1:
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Baroness ThorntonLabour- Quote
- My Lords, I very much appreciate the intention of my noble friend Lord Campbell-Savours in tabling Amendments Nos. 1 and 11. In many ways, I wish that he had tabled them earlier in our proceedings, but I will do my best to be positive and to satisfy him. We want to ensure that the views of staff in organisations that provide or commission health and social care are properly represented in the new regulator. We have discussed at length the importance of engaging and involving people who use services. I believe this is quite proper, given the concerns that the voice of the service user might otherwise not be heard. However, I would certainly not want to give the impression that the views of staff are not also important. We recognise the important contribution that staff in health and social care services make to the work of the Care Quality Commission. They are able to draw on their expert knowledge and experience and offer insight gained from working on the front line. Given that crucial insight and the importance of making sure that providers maintain proper working conditions, it has always been our intention for the Care Quality Commission to take account of the views of staff and their representative bodies. I am pleased to confirm on the public record that Clause 4(1)(a) already enables the commission to take into account those views as part of the regard it must have to views expressed by the public. I emphasise that this provision is sufficiently wide to include staff, and we would certainly expect the commission to engage with them as part of its overall responsibilities. I can also confirm that this provision would cover trade unions and professional organisations, as the commission must also have regard to views expressed on behalf of the public. I hope this clarifies the issues that my noble friend has raised. I would like to refer to several other provisions. Of particular relevance is our proposed registration requirement 17, which is about supporting workers to give people the care and treatment they need. The commission will need to engage with staff in assessing this and will be able to take action where this is not the case. We would also expect the commission, as CSCI currently does, to take into account the views of staff in gathering evidence to ensure that providers comply with all the registration requirements. Also, under Clause 24, the commission is required to consult on guidance as to compliance with requirements, and we would expect that to include providers and their staff. This is just one of a number of provisions in the Bill requiring consultation. I am sure that the commission will value staff input on many of these issues. I am sure that the noble Baroness, Lady Young, will carefully consider the views expressed today. The importance that we place on engaging widely with everyone with an interest is exactly why we introduced the new requirement for an advisory committee. When establishing that committee, the commission will want to draw on a range of expertise from different sides. We have always been clear that we want the advisory committee to include a range of people with expertise relating to health and social care services, including providers of services, representative bodies and other interested observers. I expect that this will include people with front-line experience of delivering services. I would be cautious, however, about naming a particular group in the Bill, which Amendment No. 11 seeks to do, as this goes against the concept of an independent regulator. I am confident that we can trust the commission to determine who is appropriate. If needs be—if the advisory committee were felt not to be providing the robust and representative sounding board we anticipate it should be—a power is provided for the Secretary of State to prescribe the sort of people that it must include. As part of the wider picture, I refer noble Lords to the report launched yesterday by the Minister, my noble friend Lord Darzi, much of which is about engaging with staff about the changes they want to see to the NHS and empowering them to provide the highest quality of care. I hope that I have been able to reassure my noble friend Lord Campbell-Savours that the Bill as drafted meets the intention behind both these amendments, and that the Government are serious about empowering staff to help shape their workplaces. I hope that he will withdraw his amendment.
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- Lord Campbell-SavoursLabour
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- My Lords, in the light of that very comprehensive response, which I am sure will be welcomed by members of trade unions, I beg leave to withdraw the amendment. Amendment, by leave, withdrawn.
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- Baroness ThorntonLabour
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- moved Amendment No. 2:
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Earl HoweConservative- Quote
- My Lords, I thank the Minister most warmly, in particular for Amendments Nos. 2 and 10 and for her welcome announcement about the future role of the Local Government Ombudsman in relation to complaints by those who fund their own care. I am sure it is extremely gratifying to Members of the House that the Government have been so responsive to the concerns raised during our debates.
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Lord Walton of DetchantCrossbench- Quote
- My Lords, I simply add to what the noble Earl has said in thanking the Minister and her noble friend Lord Darzi. They have both been assiduous in sending us letters of reassurance during the various stages of this Bill, which have been extremely helpful. I wish that to be formally recorded because these two amendments meet many of the concerns expressed in previous discussions on the Bill.
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Baroness Masham of IltonCrossbench- Quote
- My Lords, I, too, congratulate the noble Baroness on her splendid work in this Bill. She really has excelled with her communication. With health and social care, communication at all times is so important, and she has led the way.
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Baroness TongeNon-affiliated- Quote
- My Lords, I echo the remarks of other noble Lords. This has been a long Bill, but the amount of work that the Ministers have done and the way in which they have listened to us and taken on board our suggestions have been exemplary. In particular, I thank the Minister for the wonderful flow chart, which she sent me yesterday, on complaints. It is a masterclass in complexity—I have not yet learnt how to make a complaint but I shall master it.
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- Baroness ThorntonLabour
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- My Lords, I say to the noble Baroness that you have to be careful what you ask for sometimes. I thank noble Lords for their support. On Question, amendment agreed to. Clause 45 [Standards set by Secretary of State]:
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- Lord Campbell-SavoursLabour
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- moved Amendment No. 3:
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- Baroness Masham of IltonCrossbench
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- My Lords, I have a small rural riding centre in North Yorkshire and we are inspected twice a year. One of the inspections is done by a veterinary surgeon. It seems extraordinary to me that frail, vulnerable people in residential care should not be inspected more than my small riding centre.
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Lord RamsbothamCrossbench- Quote
- My Lords, I emphasise, as I did at earlier stages of the Bill, that inspection must not be confused with regulation and audit. To my mind, the tick-boxes of regulation and audit are wholly unsuitable and unsatisfactory for the type of inspection required of these care homes. I know that my noble friend Lady Young will be going into this in some detail and I hope that, when she does, she will consult other inspectorates involved in other activities in the public sector in addition to CSCI. She will have to balance the resource issue between the needs of the healthcare, mental health care and social care commissions, which will not be easy. I recognise all the points that have been raised. Having spoken to CSCI about this, I know that it has been concerned about the impact of resources on the time that it is able to spend on essential inspections. Cutting those short is almost as bad as not doing them at all, and I therefore entirely support the wording of this amendment. I hope that the Minister will recognise it as being desperately important when the new commission takes up its post.
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Baroness Young of Old SconeNon-affiliated- Quote
- My Lords, because I am conscious of the Addison rules, I have had rather a self-denying ordinance on this Bill, but I have to say something on this amendment. I cannot speak on behalf of CSCI, which is a statutory body led by its own board, and I do not want to comment particularly on the issues that the noble Lord, Lord Campbell-Savours, has raised about CSCI itself. I simply want to reflect on the issue from my background in regulation and from the five weeks’ experience I have had of looking at the future role of the Care Quality Commission. My view is that regulation is a wide, embracing and generic process. It is about drawing information from a whole variety of sources to allow a regulator to take a view about the performance of an individual institution and about its managers. It needs to draw from inspection as one source of evidence, but also from a whole variety of others—including the views and verdicts of carers, families and, indeed, staff. My experience in the regulatory field is of one who shies very much away from minimum inspection frequencies because, over time, services and circumstances change and that mix of information, from a whole variety of sources, needs to be adjusted. The problem with minimum inspection frequencies as a statutory requirement is that they are, as your Lordships know well, quite difficult to change once in a statutory process, even if in statutory guidance. As a result, they are incredibly inflexible. In my previous regulatory roles, I have experienced circumstances where everyone knew that as a result of minimum inspection frequencies we were having to do things that were, frankly, crazy and a poor use of public resource. Yet we had no means of getting the appropriate regulatory change made to allow more flexibility. I really would not like to see the CQC in that position. The noble Lord, Lord Campbell-Savours, aptly raised a recent report from the Commission for Social Care Inspection indicating that one of the best determinants of quality for a particular group of patients was, indeed, observation. Rather than a minimum inspection frequency, understanding how staff were relating to patients—and how that institution encouraged that degree of inter-relationship—was probably one of the best determinants of quality in that setting, which was the care for people with dementia. It would really be unfortunate, then, if the Care Quality Commission had an absolute requirement on minimum inspection frequencies and none on any of the other sources of information or regulatory models that it might feel best able to deploy, over the next few years, to produce the best outcome for users, patients, carers and their families. As one word of support for the current Commission for Social Care Inspection, I do not believe that it operates a desk-based exercise supplemented by self-assessment. It is working hard to develop models that are genuinely risk-based and proportionate, taking the best research evidence it can for the most effective set of information to find out about an institution and the care settings of individuals. I believe that we should be giving the CQC that sort of encouragement for the future, rather than setting minimum inspection standards.
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Baroness Howarth of BrecklandCrossbench- Quote
- My Lords, I was going to have a self-denying ordinance and not speak at this point, mainly because I did not want to get into a difficult debate with the noble Lord, Lord Campbell-Savours, for whom I have the utmost respect. I believe that his heart is solidly behind ensuring the protection of vulnerable people, but I feel that I need to support the noble Baroness, Lady Young, in her endeavour not to find herself with a set of minimum standards that will make regulation very difficult. I just want to mention one group of people who have not been mentioned at all in this debate but who were mentioned a great deal by Members on the Benches opposite in a discussion on the previous Bill: the providers of those services, who have to deal with regulation. I spend quite a lot of time with providers and I am a provider myself; I declare an interest as the chair of Livability. I am immensely grateful that inspectors come in and do in-depth, all-round inspections, where they come to observe. There are some tick boxes—I may have a bit of a difference of opinion about terminology with my noble friend Lord Ramsbotham—but, all in all, the approach is very rounded. I do not doubt for a minute that not every inspection is perfect. Having worked in so many large organisations, I know how difficult it is. However, I also know that service providers who feel that they have worked immensely hard to get their service to a high level of provision find it difficult to be faced with the fact that here we are considering streamlining regulation on the benefits to the vulnerable elderly so that they get more attention. One criticism made in the BBC report was that an inspector said that they did not want a poor report because it meant more work. Indeed it does mean more work, because if you get a poor report, you get the inspectors back quite a lot until you improve. One of the positive things about CSCI is that, unless the service is dangerous, in which case it is closed immediately, the organisation works hard with the provider to bring services up to the appropriate level, because the alternative—closure—is disastrous for the vulnerable elderly. Anyone with a medical background will tell you that if you move the frail elderly or vulnerable severely disabled people, the likelihood of their death is increased. I have been faced with that option myself in the past. In thinking this through and thinking how we move forward, we should recognise that all of us—I am absolutely with my noble friend Lord Ramsbotham in this—want CSCI to have enough resources to carry out the inspections that it believes are needed, but not to be so stuck in a framework that it cannot manage that flexibly. We do not want really good providers being punished by what they may feel is overregulation because of those who do not provide the best service. I apologise for making my small intervention, despite having said that I would not speak.
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- Baroness ThorntonLabour
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- My Lords, as I hope I made clear when we discussed my noble friend’s amendment on Report, there is no intention to reduce the total amount of inspection activity or to reduce the new commission’s ability to act where care providers are failing to meet the safety and quality of care that users are entitled to expect. On Report, we heard the views of several noble Lords who, while emphasising the importance of visiting and dealing with poor services, recognise the value of focusing resources on those services rather than on those that are doing well, as explained by the noble Baroness, Lady Howarth, who should never apologise for her interventions. That is why we are emphasising the benefits of unplanned rather than routine inspection and of intelligent and proportionate regulation, as explained very well by the noble Baroness, Lady Young of Old Scone, who, from her great experience, put the case for how robust regulation might take place. I wrote to my noble friend yesterday following up on our previous debate, including responses from the Commission for Social Care Inspection to the points that he raised. Again, I cannot emphasise enough the importance that we place on keeping providers on their toes. However, as I hope I made clear before, although it will not be necessary in most circumstances, Clause 61 already gives the Secretary of State the power to set the frequency of inspection in regulations, should that be required in particular circumstances. I feel like the referee who cannot take much action, in this case between the BBC, CSCI and the concerns expressed by my noble friend. However, if I can help in any way to clarify and reassure him about what has happened, I will be happy to do so. On the point about CSCI getting worse, we have no evidence to suggest that its performance is changing for the worse or that standards are slipping, but I understand my noble friend’s concerns and I undertake to follow this up further. I hope that my noble friend will appreciate that we are committed to establishing a proportionate regulator that focuses its attention where it is needed most to get the greatest safety and quality benefits for patients and service users. While drawing on the best experience of the current commissions, we intend to leave those vital inspection decisions to the discretion of the commission, as the noble Baroness, Lady Young, indicated. It will be the commission’s job to set specific frequencies if they are required, so I hope that my noble friend will feel able to withdraw his amendment.
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- Lord Campbell-SavoursLabour
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- My Lords, I have listened carefully to what my noble friend has said and to the comments of other noble Lords. The noble Lord, Lord Ramsbotham, said that there was a need to draw a clear distinction between regulation, audit and inspection and the approach of ticking boxes. I hope that the successor organisation has that clearly in mind when it sets out to undertake its task. The noble Baroness, Lady Young, has sought to reassure me. I wish her good luck in the task that she is to undertake. However, “risk-based and proportionate” inspection frightens me, because I know, as will other Members of the House, what that means. It means that some will get through that should be sorted out, but they will not be sorted out because they will slip through under that regime. However, if we are to proceed by introducing and using the reserve power to which my noble friend referred, then so be it. The noble Baroness, Lady Howarth, referred to flexibility in inspection in her support for the noble Baroness, Lady Young. I understand perfectly where she is coming from, because she has made a number of contributions to which I have listened closely during the various proceedings on the Bill. Finally, the Minister said that she undertakes to follow this up further. We could read a lot into that. I certainly want to do so, as long as following this up further is based on taking evidence not only from but through CSCI. If the information that my noble friend seeks comes from the senior management of CSCI, it will only reiterate the case that CSCI has made repeatedly in recent months that almost everything is all right. I do not accept that. If she means that she will seek evidence from a wider cohort of people—one that does not necessarily include the group that I have just referred to—I wish her the best of luck and I think that we will find where the truth lies. I hope that at some stage in the future I can table a Question to which she can give us far more up-to-date information than the information that is currently available. On that basis, I beg leave to withdraw the amendment. Amendment, by leave, withdrawn.
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Baroness Gardner of ParkesConservative- Quote
- moved Amendment No. 4:
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- Earl HoweConservative
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- My Lords, I support my noble friend, who has argued her case extremely persuasively throughout the passage of the Bill. I was persuaded on the first occasion that she spoke to it and I am equally persuaded now. It would be helpful to hear from the Minister that she accepts the argument put forward by my noble friend and that she will use her best endeavours to encourage the regulatory bodies to take up this idea, look with favour on it and, where possible, apply for the necessary Section 60 order, which I understand is the process that would be needed for those bodies which do not have a scheme of this kind.
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- Lord Walton of DetchantCrossbench
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- My Lords, I warmly support the principles underlying the amendment so ably proposed by the noble Baroness. But this is a complicated issue which raises all kinds of problems. I was very surprised on Report to learn from her that the General Dental Council was not allowing retired dentists to remain on the register. Whereas for many years retired doctors have been entitled to remain on the register, the concern that I expressed on Report was because a legal opinion recently taken by the General Medical Council now suggests that retired doctors wishing to remain on the register must pay the annual retention fee from which they have been exempt since the age of 65. It is 21 years since I had to pay a much reduced registration fee for the General Medical Council. Another problem is that next year the General Medical Council proposes to introduce a programme of revalidation which may, if the doctor succeeds in having his or her practice revalidated, lead to the establishment of a licence to practise which will be distinct from registration. It is a complicated issue which might make it difficult for an amendment of this nature to be enshrined in primary legislation. The idea suggested by the noble Baroness that the issues involved might well be dealt with by secondary legislation has many attractions. As the noble Baroness, Lady Gardner, said, doctors take pride in remaining on the register and dislike the thought, even in retirement, that they will no longer be registered medical practitioners. Legally, a doctor who is qualified and who has never been erased from the register for disciplinary or other reasons would be entitled in an emergency to give medical support even if they were no longer registered, but many doctors would feel embarrassed and reluctant to do so without being on the register because of the potential fear of medical/legal complications. It is crucial that a mechanism be introduced whereby retired doctors can remain on the register. I should like to see the same for dentists and the other healthcare professionals listed in the amendment. In principle, I warmly support the amendment, but I foresee difficulties in having it enshrined in primary legislation.
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- Baroness TongeNon-affiliated
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- My Lords, I do not wish to try the patience of the House but I should like to make one additional point. Would it not be in all our interests for all the professions mentioned to have a list of retired members and for it to be nationally held? In a national emergency it might be extremely useful to know where all the retired physiotherapists or pharmacists are. It is a sad thing if a group of professional people from all of these specialties are just discharged when they retire, as if they are of no more use to society. We clearly know that they are. I hope that there is some device whereby the royal colleges—or whatever—can make sure that these people remain on the register.
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- Baroness Howarth of BrecklandCrossbench
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- My Lords, the noble Baroness made her arguments immensely persuasively yet again. I hope that the Minister can look at the issue, though I take the point made by my noble friend on primary legislation. I mentioned social workers when this issue was previously raised. Social workers do not have a right to appear on any of these lists because they are not defined as health professionals. Therefore, I hope that social workers will be considered too. Social workers can be members of the British Association of Social Workers, as I am, but their registration is completely separate. I am not registered at this moment—I do not get on and do the forms, not because I have not done the practice days. That is a separate issue. If the Minister is looking at the list of health professionals, it might be worth a glance at the other people in social care who seem to be missing.
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Lord ColwynConservative- Quote
- My Lords, having practised for 40 years myself, I continue my indemnity insurance because the Medical Protection Society will continue to indemnify you after you are retired as long as you are on the register.
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Lord ReaLabour- Quote
- My Lords, as a retired member of one of the professions mentioned in the amendment, I support the feeling behind it. I hope that my noble friend will be able to come up with some formula that accepts the principles if not the wording.
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Baroness GoldingLabour- Quote
- My Lords, not to be left out, as a retired radiographer I was amazed when, less than two years ago, I was contacted to find out if I would like to train for a proper job and take up my former profession.
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- Baroness ThorntonLabour
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- My Lords, the noble Baroness, Lady Gardner, has raised this issue in relation to dentists both in Committee and on Report. As I said in my response to those amendments, she knows that I am sympathetic to her view. As a result of the debate we had on Report, the noble Baroness has widened the scope of her original amendment to provide that the Secretary of State must make regulations giving powers to a health care regulator to establish a non-practising register with a reduced fee if the regulator requests it. It does not include any provision for social care regulators—the noble Baroness, Lady Howarth, is quite right on that. This amendment is an enabling provision. As I have said previously, we already have such a power to amend the law in Section 60 of the Health Act 1999. As the noble Baroness and my noble friend have asked, I shall put it clearly on the record again that we already have the powers to do everything the noble Baroness is asking for. We do not need another power to do this. Adding this amendment to the Bill would be duplicating what already exists. The noble Baroness knows this but is mounting a justified and effective campaign. As noble Lords know, Section 60 orders enable changes to be made to both primary and secondary legislation. Since 1999, these orders have become the usual means by which legislation relating to healthcare professions is made and amended. Indeed, your Lordships’ House has agreed 11 Section 60 orders since 1999. In other words, I do not understand the reservations that were expressed in the letter to the noble Baroness by the General Dental Council. Importantly, Section 60 orders provide safeguards, such as requiring consultation with the professions and the public and affirmative approval by Parliament, which the amendment does not contain. Given that we already have the power to change the way regulators deal with retired members of the professions, the debate we need to have now is not whether we need another enabling power but whether we need to use the existing powers to change the system. I understand that non-practising and retired dentists may want to keep in touch with their profession, especially—as with the two noble dentists here today—when it has been a fundamental part of their identity. There is a strong argument that those who consider themselves no longer in practice but who teach, lecture, write health-related articles or are on boards of governors or boards of companies where professional advice is required should be registered with the regulator. That model has been adopted by the Royal Pharmaceutical Society of Great Britain. All those issues are being considered at the moment by two of the working groups that have been set up to help implement the White Paper, Trust, Assurance and Safety. Those groups include external experts such as the regulators themselves, professional representative groups such as the BMA, and patient and consumer organisations such as Which?. We are looking at the issues raised by revalidation and the new process by which all health professionals will have regularly to show that their professional skills are up to date. The way the registers are kept by the regulators may have to change as a result. A large part of that will consist of looking at the implications of revalidation for people who may no longer treat patients but have an active professional role or are retired. The noble Baroness, Lady Gardner, may also be assured to know that your Lordships’ House will be debating a Section 60 order to enable quick re-registration of appropriately qualified professionals in the event of a emergency—for example, of retired doctors. I will be taking that order through the House on Thursday. I am happy to use my best endeavours to help the noble Baroness take forward this cause, and I have been discussing it with officials. Given the breadth of her amendment, it is legitimate that we now raise the whole issue with all the regulators. I will be happy to do so with her support, which I know she will give me. I hope that my response has indicated that we take the issue seriously and that the noble Baroness will be sufficiently encouraged to withdraw her amendment.
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- Baroness Gardner of ParkesConservative
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- My Lords, I thank the Minister for that reply, which was very positive. These professions should look on that reply as being suitable encouragement to feel that we are not going to be overlooked. It may be too late for me in dentistry—I am not worried about that—but it is a much bigger issue than that, something that has become apparent in these debates. Revalidation is going to mean a dramatic change for all healthcare professionals. Whatever dividing lines there have been in the past, there will be much greater ones after revalidation comes in. There is a place for professionals to continue to be listed, and it may be desirable to have entirely separate lists for the validated ones and those who do not wish to continue practising. In fact, it is in the public interest to have them as entirely separate lists, which in the past has not been the case; doctors are still in their ordinary basic list. After revalidation, it will be better to have separate lists. The Minister has said that she will do her best to see that all the regulators looking into this and all the consultations about the White Paper will fully consider all these points. I speak as a dentist, but also to a certain extent as one of the many healthcare professionals. We should be satisfied with what the Minister has said, because she has been very positive about this matter. Her response should be acknowledged by everyone as being very helpful and something that we can bring forward when those consultations and determinations are made. For that reason I thank her for all that she has done. Indeed, the whole House has been very patient as I have gone through this issue time after time. I beg leave to withdraw the amendment. Amendment, by leave, withdrawn.
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- Baroness ThorntonLabour
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- moved Amendment No. 5:
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- Earl HoweConservative
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- My Lords, it would be wrong to let this amendment pass without expressing my thanks to the Minister for bringing it forward. It will provide pharmacists and the Royal Pharmaceutical Society, which has been assiduous in promoting this issue, with the added confidence and reassurance that they were seeking. I am most grateful. On Question, amendment agreed to.
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Baroness Campbell of SurbitonCrossbench- Quote
- moved Amendment No. 6:
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Baroness WilkinsLabour- Quote
- My Lords, I strongly support this amendment, to which I have put my name, and which has been so persuasively presented by the noble Baroness, Lady Campbell of Surbiton. What an indictment of a local authority—and of its association, the LGA—to argue that it is justified in refusing to accept another authority’s judgment of a disabled person’s assessed needs. Disabled and older people do not move on a whim. It takes an enormous amount of organisation and effort. As we have heard, some people have no option but to move and throw themselves on the mercy of another authority. Is that authority then likely to decide in the end that the person has vastly different needs? What justification is there for the months of misery, cost and wastage that can currently take place while needs are being reassessed? As a Labour Peer I am proud of my Government’s commitment to independent living and the goal of equal lives for disabled people. So many policies have been put in place to improve our social and economic well-being. We have rightly invested thousands of pounds in schemes to help disabled people out of poverty, off benefit and into employment. Yet what greater disincentive can there be to prevent someone seeking employment which is just over the boundary of their authority than forcing them to take this gamble with their care needs? The Minister is expected to say that this problem of portability will be dealt with in the forthcoming Green Paper on adult social care. I welcome that Green Paper, but it will be many years before that policy becomes everyday practice. In the mean time, let us give disabled and older people with support needs the freedom that they desperately need: the freedom to move to be closer to their family and friends; the freedom to get the education they need; and the freedom to apply for the job of their choosing wherever that may be. I urge noble Lords to support this amendment.
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- Earl HoweConservative
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- My Lords, the Minister will know how vitally important this issue is for disabled people; it is an issue of literally life-changing importance. For our society to allow disabled people to feel trapped in a local authority area, and to find themselves unable to take up employment opportunities elsewhere or to be near family, is simply unacceptable. It is equally unacceptable to subject disabled people who move to another area to the insecurity, worry and bureaucracy that almost inevitably ensues. I know that the Minister is sympathetic to the arguments that the noble Baroness, Lady Campbell, has so ably put forward. However, I am aware that she is unlikely to be able to accept the amendment as it stands. What we need from her is a commitment that this problem will be sorted. I am not sure that a rather loose promise to place a set of proposals in a Green Paper is quite enough to allay the fears and worries of the disabled community. We need an undertaking that the Government will take this issue away and deal with it appropriately. If there is to be a proposal in a Green Paper, that part of the Green Paper should have very distinct white edges to it. I hope the Minister will be able to give us the reassurance that we seek.
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Baroness Finlay of LlandaffCrossbench- Quote
- My Lords, this amendment goes to the heart of the rights of those needing a care package to live independently. The question before us is one of principle. If people cannot move to be economically active or to be nearer relatives and other support, they are locked into dependency on the state, deteriorating health through demoralisation and thus increased social and health costs. The provision makes economic sense as well as being fundamental to equality of the right to work and the right to family life. I fear the Minister will say that the issue will be addressed in a Green Paper and that that will solve the problem. It will not. We need to know exactly when the matter will be sorted out, which needs to be in the lifetime of this Parliament. The provision must address people of all ages, including children, and must be delivered through the legislation set out in the amendment. You cannot ask those with a disability and their families to settle for anything less or to wait any longer.
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- Baroness TongeNon-affiliated
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- My Lords, I am somewhat horrified that this amendment has been brought before the House at such a late stage. It should have been discussed weeks ago because this matter is of such tremendous importance to the individuals concerned. It is a huge issue. All of us have only one life and if we are disabled we need enormous support to try to make it as normal as possible. Social services departments up and down the country have varying provision for the disabled and the elderly. This is another example of our postcode lotteries. Where you live depends on all sorts of circumstances, but local authorities’ provision differs. As a former chair of social services in the London borough of Richmond, I know that if someone with a huge need, which can incur costs of hundreds of thousands of pounds a year, moves into an authority’s area, it can be very difficult financially to match the provision that that person received previously. This is a very serious issue, and with the best will in the world a social services department might want to match that provision but be unable to do so because it has a very small budget. Some local authorities will have a very low budget for social services due to their demography. The London borough of Richmond, where I was chair of social services, had a big budget because at that time we had the second highest proportion of people over the age of 85 after Worthing. We wore that badge with pride. However, provision can vary among authorities. Although I appreciate the need to sort this out, and clearly people’s needs have to be met if they move to a different area, we must also understand local authorities’ problems in seeking to make that provision. I hope that the Minister will tell us that there is something in the pipeline, such as another discussion, a secondary regulation or a device whereby this matter can be addressed, thoroughly discussed and sorted out because it is a human rights issue for disabled and elderly people.
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Lord Ashley of StokeLabour- Quote
- My Lords, I congratulate the noble Baroness, Lady Campbell, and her colleagues on tabling this amendment and presenting it so coherently and persuasively. The need for it is paramount. It is the most important amendment for disabled people that the Government can address. Labour Peers lean over backwards to make things easy for the Government because we support them, but on this occasion we feel a bit perplexed because they do not seem to accept the powerful case for this specific provision. We have had delay so often in this area. I have been involved in politics for 40 years and there has always been an excuse why Governments cannot do this or that. Although this Government have a marvellous record on disability and other things, they have failed to rise to the occasion on this matter. We have heard Labour and Conservative Peers put their cases. What are we waiting for? All sides—Labour, Liberal and Conservative—support the amendment.
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Baroness GreengrossCrossbench- Quote
- My Lords, I strongly support the amendment. I am delighted that my noble friend Lady Campbell was well enough to return and put the amendment so movingly. I am a commissioner on the Equality and Human Rights Commission and vice-president of the Local Government Association, which is worried about extra costs and burdens. I honestly feel that if this amendment is seen to be necessary, the Government’s role is to encourage local authorities to take it seriously and ensure that local authorities are given sufficient resources. It is important that we enable older people and disabled people who live in this country to feel that the system is fair to them. It cannot be fair if you are caught just because you want to move from one locality to another. Everything that is said about different levels of care and service provision in different parts of the country militates against that feeling of fairness. That is quite wrong. It would cost very little in real terms and would enable disabled and older people who need services, educational opportunities and a proper family life to move without feeling that they would be terribly disadvantaged by doing so.
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- Baroness Masham of IltonCrossbench
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- First, I say to the noble Baroness, Lady Tonge, that this subject was discussed at Second Reading and an amendment was discussed in Committee. The amendment would stop a disabled person being in limbo while a new local authority assessed them yet again. This can take months, if not years. Would the Minister tell us how much it costs to do an assessment, or do they differ between local authorities? This amendment might, in the long term, save rather than cost money.
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- Baroness Howarth of BrecklandCrossbench
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- My Lords, the noble Baroness, Lady Campbell of Surbiton, has put her case most cogently. I am only sorry that she was not here at Second Reading. I feel that this is more of a Second Reading than a Report debate. Therefore, I beg leave to say a few more words than I would normally say at Report. That does not mean that I will speak at length; I seldom do. I simply want to make a few points. A little while ago, we had a debate on the Floor of the House about disabled people’s needs which should have been led by the noble Lord, Lord Ashley. On that occasion, none of my friends with disabilities was able to be present. All of them were suffering from the difficulties that occur when you have respiratory problems caused by a disability. That was why the noble Baroness, Lady Campbell, was not able to put her amendment at that time and why it is important that we hear all the arguments today. In that debate I mentioned a campaign that I am involved with, Freedom to Live, run by Liveability, which has identified a wide range of difficulties that disabled people face simply because our systems do not allow them to move, not only geographically but between bureaucracies. If this amendment were pressed, however, I could not go through the Division Lobby with my good friend, and I will tell noble Lords why. This is the broader point. As the Local Government Association—of which I, too, am a vice-president—has pointed out, funding for these services has already outstripped supply. Its worries are about the implications for existing services. That seems an extremely serious position for the nation to be in. It is particularly serious as I have also read documents in which residential services are being encouraged to provide quality care while faced with a framework that pays the minimum wage to people who will not only care for some of the most vulnerable in our society, but give them the opportunities that we have. That is the perceptual difficulty, which I hope the noble Baroness, Lady Campbell, and our other campaigning friends who have campaigned extremely actively, have made us understand. Being in a wheelchair and being disabled does not mean you are disabled in terms of what you can contribute to society overall. Despite that, I find it difficult to support this amendment because of the extraordinary complexity of the services that we need to look at. The noble Lord, Lord Low, and I did not table yet another amendment about the transfer of funding for residential care between one authority and another, but that is another aspect that needs to be looked at. I have a sheaf of papers from Ministers in replies to queries that I have raised about the problem of people moving from residential care into housing, from housing into supported housing and, possibly, back into residential care. It is impossible, if your disability improves or gets worse, to move between services. Never mind that; what about the benefits system? When you transfer from one place to another, benefits become even more complex. One area that has been hit on is assessment. People who move between one place and another have to undergo constant reassessment. The amount of person power that it takes to decide, for the third or fourth time, what the individual actually needs, is something that the Minister in the other place, at a meeting I was at recently, has undertaken to look at. I will ask the Minister, when we look forward to the Green Paper—as the noble Earl, Lord Howe, said, these issues can be looked at even sooner—for an assurance that someone will grasp the complexity of this issue. That person should be prepared to look at the detail, not put it into the “too difficult” box—difficult as it is—and come up with some real plans, so that people such as my noble friend Lady Campbell and many others I know like her have the opportunity to live their life where they want to live it and how they want to live it without the inhibitions that we currently place on them simply by our own processes.
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- Baroness ThorntonLabour
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- My Lords, we debated a similar amendment in Grand Committee. I said at that time that I have every sympathy with its intention, as the noble Baroness knows. I fully understand the reason for returning to this issue again today. I join other noble Lords in welcoming back the noble Baroness in good health to the Chamber. I commend her for the eloquence with which she and my noble friend Lady Wilkins spoke to the amendment. Noble Lords will be aware that, throughout the passage of the Bill, the Minister and I have sought on every occasion to listen to the experience and expertise in the various areas covered by the Bill. Together—that is, noble Lords and the Government—we have created a much improved Bill to send back to the other place. In the parts where it has not been possible or practical, for various reasons, to include provisions in the Bill, we have sought to engage in constructive discussion and provide reassurance and explanation. While it is with deep regret that I cannot support this amendment, as it is currently drafted—because it seeks to place a wholly new and rather fundamental provision in the Bill—I seek, in the spirit that has applied to the rest of the Bill, to discuss how we can take this issue further. I have spoken to the Minister responsible for this area of policy and I am able to give noble Lords more positive information about continuity of care than I could in Grand Committee. I hope to convince noble Lords that the Government are determined to resolve the issue. A Green Paper with white edges, as was mentioned by the noble Earl, is the right way to express that. First, I make it clear that the issue that lies beneath this amendment—whether care and support services should be the same no matter where a person lives, as opposed to local authorities being able to respond to local needs and provide different kinds of services—is a strong theme of the engagement activity that the Government are currently leading, in preparation for a Green Paper on the future system of care and support in this country. When looking at national standards versus local flexibility, the issue of transitional arrangements is fundamental. The Government accept that there are great challenges within the care system and have signalled their intention for radical reform with the announcement of the Green Paper. They have, for the first time, launched a public engagement process which specifically asks people whether care and support in the future should be based on the principle of devolved control and local flexibility, or on a more national basis where a person will be entitled to the same support no matter where they live. That is at the heart of this issue. This question is explicit in our published discussion document, is on our website and is part of our current programme of engagement events. I can also confirm that the issue of portability, which the amendment raises, is being addressed as part of the debate on the Green Paper. This is a fundamental component of the system that can be addressed only as part of a full review because of its implications for local and national accountability, democracy and control of budgets. The Green Paper will set out options for the future funding of care and support. I can confirm for the first time—I am happy to do so on the record—that these options will address the wider issue of local flexibility versus national standards, and the difficult problems that this presents to service users, as set out in the amendment. We will then hold a formal consultation on these options and decide, in the light of the responses, what the care and support system of the future will look like. I undertake to ensure that we pursue that with rigour and speed. Among other things, the Green Paper will be informed by the review of the eligibility criteria for fair access to care services that the Commission for Social Care Inspection is conducting for us. In January 2008, my honourable friend Ivan Lewis asked the commission, in the context of the Government’s vision for adult social care, Putting People First, to undertake a review of the eligibility criteria, their application by local authorities with social services responsibilities and their impact on people. This followed a report from the commission that highlighted major inconsistencies in the way eligibility criteria were applied in different local authorities. The commission has been asked to submit its review by 15 September. After Ministers have received it, we expect the commission to make the review public. We cannot say at this stage what the commission will recommend, but the aim is clear: to achieve greater consistency in eligibility criteria across local authorities. This is another activity related to the wider issue raised by the amendment, and further evidence of the Government’s willingness to tackle the issue as part of a coherent review of the whole system of eligibility for social care services.
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- Baroness Campbell of SurbitonCrossbench
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- My Lords, first, I thank all noble Lords who supported this amendment; they have been tremendous. I would mention them all by name, but I might run out of puff and I will save that for the Minister, whom I thank for her reply and her sincere endeavours to be helpful. I know that she is personally supportive of equality of opportunity for older and disabled people, and has great sympathy for this amendment. It is a tough judgment call. On the one hand, my heart is heavy. I have heard how complicated this is and how we have to talk about it more and get to grips with it; yet I have been doing this for eight or nine years and feel that I have gone over the arguments ad nauseam. Therefore, it is difficult for me to see light at the end of the tunnel. However, today I feel that we have made some progress, even perhaps within the past hour. A combination of three announcements, some enthusiasm and clarity about going forward in a positive way and, frankly, sorting this matter out makes me feel that the journey could go in the right direction. Naturally, I and others will follow this issue forensically as it progresses. However, I feel that we have a plan and that I may not now need to take the action that I thought I would take only a few hours ago. I feel that I will probably now be free to accept that job of a lifetime in Newcastle next year and that my care package will go with me because we will have sorted it all out. With the Minister’s commitment, I beg leave to withdraw the amendment. Amendment, by leave, withdrawn. Clause 170 [The appropriate authority by whom commencement order is made]:
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- Baroness ThorntonLabour
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- moved Amendments Nos. 7 to 9:
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- Baroness ThorntonLabour
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- moved Amendment No. 10:
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- Baroness ThorntonLabour
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- moved Amendment No. 12:
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- Baroness ThorntonLabour
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- moved Amendments Nos. 13 and 14:
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- Baroness ThorntonLabour
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- My Lords, I beg to move that this Bill do now pass. Moved accordingly, and, on Question, Bill passed, and returned to the Commons with amendments.
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