House of Lords
Council Tax
Lord Woolmer of Leeds
To ask Her Majesty’s Government what assessment they have made of the impact on council tax arrears of the reduction in council tax benefit and the localisation of support for those in need.
The Parliamentary Under-Secretary of State, Department for Communities and Local Government (Baroness Hanham)
My Lords, the design of local schemes and the assessment of their impact is the responsibility of local authorities. It is for authorities to design local council tax support schemes that will minimise the possibility of anyone falling into arrears on their council tax. Localisation gives local authorities the freedom to choose how to manage the funding reduction and they are best placed to understand their local priorities and the needs of their vulnerable residents. This reform enables them to take these local factors into account when deciding on levels of support.
Lord Woolmer of Leeds
I thank the Minister for that reply. Does she recognise the additional costs being borne by local authorities in seeking to collect council taxes from some of the lowest income and poorest communities in their areas for the very first time? These costs include setting the support scheme, counselling and advising, seeking to collect and even, in extremis, taking people to court. Would the Minister be willing to review, with the local authorities, what those costs actually are in the coming months so that there is agreement on the costs being borne by them in seeking to introduce that policy in their communities?
Baroness Hanham
My Lords, local authorities were well aware of what the council tax support was going to be. They were also well aware that their schemes should take into account any additional costs which came about as a result of the council tax support scheme. As with everything else to do with local authorities, we will keep this under review but it would not qualify for any consideration under new burdens because council tax is always something that the council has had to deal with.
Lord Shipley
My Lords, does the Minister agree that one way of helping those on low incomes would be to increase the number of council tax bands at the top end, so that those who are wealthier pay more?
Baroness Hanham
My Lords, my department and the Government have made it clear that they have no intention of rebanding council tax.
Baroness Hollis of Heigham
My Lords, because the Government have cut the funding for council tax benefit for local authorities by 10%, local authorities are having to charge people on benefit who have never paid council tax before. As a result, chief executives are estimating that up to 75% of those new payers will not pay. As it costs £10 to collect £2.50 a week, we are going to create a culture of non-compliance just like there was with the poll tax. Will the Minister please think again? It is a very foolish policy indeed.
Baroness Hanham
My Lords, the matter is implemented now and the noble Baroness will be as aware as I am that the councils were all offered a transitional grant at the outset if they set a council tax support scheme which was not more than 8.5% from zero. A number of local authorities have done that. Nearly 200 took advantage of that transitional grant and if others had they would not be in the position which I think the noble Baroness is trying to describe.
Lord Brooke of Alverthorpe
My Lords, is the noble Baroness saying that the Government do not know whether or not council tax arrears have gone up? If she does know, will she tell the House, and if they have gone up, will she say what steps the Government will take to ensure that councils can get them down?
Baroness Hanham
My Lords, council tax arrears for 2012-13 have gone down. The new support scheme that started in April 2013 has barely had an opportunity to get off the ground but clearly this is something that will be kept under review. However, as I said, if local authorities had done what we gave them the opportunity to do and taken the grant, they would not have to ask people to pay council tax that they could not perhaps afford.
Baroness Gardner of Parkes
What is the position if you are in arrears but have a spare room? What is being done by councils to encourage such people to let their spare room? Our council is setting up a way for anyone to discover where those rooms are. I keep meeting people who are being put out of where they are and are dying to rent a room but cannot find any of these council people with a spare room which I would have thought would suit both parties to agree that they can occupy.
Baroness Hanham
My Lords, if the noble Baroness is referring to the extra rooms associated with the welfare reforms, I am sure there will be opportunities for local people who are affected by those to see whether they can take on a lodger as long as their subletting arrangements are sufficient for the local council.
Lord Beecham
My Lords, in light of the fact that 50% of councils have not taken up the transitional grant, will the Government apply the unallocated fund that they originally created to extend the transitional period to perhaps two years for those authorities which have taken up the offer? In that way, they could mitigate the problems that have been referred to by other noble Lords today.
Baroness Hanham
My Lords, it was made clear from the outset that the transitional grant would be for one year and one year only. Therefore, I do not anticipate that the question asked by the noble Lord will be answered in a way that he would like.
Lord Campbell-Savours
Is the Minister aware of the culture of non-compliance referred to by my noble friend Lady Hollis?
Baroness Hanham
My Lords, people are required to pay their council tax and I am sure that local authorities will make certain that they collect any arrears that are owed to them as necessary.
Baroness Farrington of Ribbleton
My Lords, would the Minister care to comment on the complaint from local authorities that the reductions are disproportionately heavy in areas such as the north of England and that it was therefore much harder for them to qualify for the transitional grant? Why do the Government keep favouring the south?
Baroness Hanham
My Lords, that is not evident. Of course, local authorities in the north sometimes have more to deal with than those in the south but I do not think that there is any evidence that there is an overweighting. Local authorities, irrespective of where they are in the country, were perfectly able to adjust their schemes for council tax support to take account of the transitional relief had they wished to do so.
Defence: Trident Review
(10 years, 10 months ago)
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Lord Lea of Crondall
To ask Her Majesty’s Government whether their review of Trident will include the issue of non-proliferation.
Lord Wallace of Saltaire
My Lords, the starting point for the review of alternatives to a like-for-like replacement of Trident was that the UK will continue to comply with its international obligations, in particular with the Nuclear Non-Proliferation Treaty.
Lord Lea of Crondall
My Lords, we know that the alternatives review will address the issue of options for replacing the Vanguard submarines. Will it also consider whether, relatively soon in a submarine’s lifetime, its missiles will need a new warhead? The Government plan to consider that question in the next Parliament, deferring the timetable for consideration in this Parliament given in the 2006 White Paper. Secondly, is it possible to develop a new warhead without testing it and therefore without rescinding our moratorium on testing and indeed contravening the provisions of the Comprehensive Nuclear Test-Ban Treaty? If it is not tested, how can we be assured that any new warhead would be effective?
Lord Wallace of Saltaire
My Lords, the British Government, under both the previous and the current Administrations, have been strong supporters of the Comprehensive Nuclear Test-Ban Treaty. We have developed sophisticated means of simulating the testing and checking of warheads. This is one area in which we are now co-operating with the French: on the sophisticated facilities available for examining current nuclear warheads and considering further developments in design.
Baroness Miller of Chilthorne Domer
My Lords, surely, whatever the outcome of the decision on Trident, it is important that this country continues to play its full role in diplomatic efforts towards non-proliferation and disarmament. Why did the UK ambassador not attend the UN open-ended working group intended to kick-start efforts in this area?
Lord Wallace of Saltaire
My Lords, the United Kingdom remains strongly committed to nuclear disarmament, and we are working in a range of different international contexts to achieve this. As noble Lords will know, the next Review Conference on the Nuclear Non-Proliferation Treaty will meet in 2015, and the preparatory committee met earlier this year.
Lord Browne of Ladyton
My Lords, the Minister will be aware of recent credible research which, using modern climate change models, found that even a regional war using nuclear weapons between emerging nuclear-armed states with relatively primitive weapons would quickly lead to significant global climate change, reduce temperatures, reduce growing seasons, have significant adverse agricultural effects and then quite devastating effects for all the world’s populations. Why, then, did the coalition Government not attend the Oslo conference on the humanitarian effects of nuclear weapons? Why did they boycott it? Do we have nothing to say to the rest of the world about these issues? Will we go to the follow-on conference in Mexico in 2014?
Lord Wallace of Saltaire
My Lords, I pay tribute to the noble Lord’s work within the context of the European Leadership Network and the Nuclear Threat Initiative, which is highly desirable, multilateral work involving the Russians and many others. It is exactly the sort of work that needs to be done and published to inform the debate on the future of nuclear weapons. Her Majesty’s Government decided, in the context of preparations for the Oslo conference, that we should be pursuing this, as far as possible, through the conference on nuclear disarmament; the priority was to unblock that conference. As for attendance at the follow-on conference in Mexico, British diplomats in Mexico met Mexican officials some weeks ago to discuss the question.
Lord Hylton
My Lords, is there not a contradiction between, on the one hand, the statements of successive British Governments about the weapons of mass destruction of others and the risk, therefore, of killing non-combatant civilians and, on the other hand, their own possession of nuclear missiles?
Lord Wallace of Saltaire
My Lords, I have no doubt that when the Trident alternatives review is published, it will stimulate a good deal of, I hope, informed and rational debate about the future of our nuclear weapons programme and of nuclear weapons as a whole. That was part of the intention of commissioning this review.
Lord West of Spithead
My Lords, unsurprisingly, the alternatives review that the Minister refers to seems to show that are no real alternatives to replacing the Vanguard class submarines if we wish to maintain our best-value and most capable deterrent. The only thing that will be looked at further is continuous sea deterrent and, even in that, the worst probability is that we will have to order two Vanguard replacements. With that in mind, will the Minister not agree that we should order those two replacements now, to remove the uncertainty hanging over many hundreds—indeed, over 1,000—skilled workers and their families about their future, and to save £300 million?
Lord Wallace of Saltaire
My Lords, I am not sure that major defence decisions should be driven either by the need to employ a large number of people to build aircraft carriers in Scotland or by the need to maintain employment in Barrow-in-Furness. There are larger issues at stake.
Lord Palmer of Childs Hill
My Lords, will my noble friend confirm that the purpose of that review, which is yet to be fully announced, is to reduce the number of nuclear weapons at sea and on land and that that is part of the non-proliferation effort that we are all engaged in? That is the purpose of the review, and I look forward to its outcome.
Lord Wallace of Saltaire
My Lords, of the declared nuclear states, Britain already has the fewest nuclear weapons. Under current plans we will further reduce the number of nuclear weapons deployed in recent years. We are therefore very much already at a minimum nuclear deterrent. The purpose of the Trident alternatives review, like the EU balance of competences review, which will also be published shortly, is to provide for an informed public debate. That is highly desirable on both major topics.
Lord Foulkes of Cumnock
My Lords, while the Minister and I will be campaigning side by side to keep Scotland within the United Kingdom, there is an outside chance that we might lose in that referendum. Why, therefore, is the Ministry of Defence not undertaking contingency plans to work out what will happen to the independent deterrent in that event?
Lord Wallace of Saltaire
My Lords, we shall be campaigning side by side. I hope that my son will have a vote in that election, since he may be about to move to Edinburgh. The question of whether Scots living outside Scotland should be allowed to vote is, as the noble Lord knows, a very active one. I would rather leave to another day hypothetical questions as to what would happen if Scotland were to become independent.
Sudan: War Crimes
(10 years, 10 months ago)
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Lord Alton of Liverpool
To ask Her Majesty’s Government what assessment they have made of the report by Amnesty International, We had no time to bury him: War crimes in Sudan’s Blue Nile State.
Lord Wallace of Saltaire
My Lords, we are deeply concerned about the suffering caused by the conflict in Blue Nile state. Accounts presented in Amnesty’s report underline our serious concern about the impact on civilians of the military tactics used. Our priority is a cessation of hostilities and full access to the area for life-saving humanitarian assistance. We continue to press both the Government of Sudan and the Sudan People’s Liberation Movement-North—the SPLM-N—to enter into talks to achieve this.
Lord Alton of Liverpool
My Lords, is the Minister aware that, in addition to this shocking report, new satellite imagery compiled by Amnesty International shows the sheer extent of the purging of the Nuba people from these areas of South Kordofan and Blue Nile, as well as the scorched-earth policies being pursued by the Sudanese military—unabated, uncondemned and unobstructed by the West? Can the Minister tell us when this situation was last raised in the United Nations Security Council and whether we support the extension of the current arms embargo on Darfur to the rest of Sudan? Rather than locking out refugees from camps such as Yida, why are we still not collecting first-hand accounts from witnesses that detail the genocide and war crimes against humanity which are carried out on a day-by-day basis?
Lord Wallace of Saltaire
My Lords, the noble Lord asked about six questions, and I am not sure that I can answer all of them. The UN is extremely heavily engaged both in Sudan and in South Sudan, with three UN missions and a number of other UN operations. We and other Governments make entirely clear to the Government of Sudan our horror at what is taking place. However, as the noble Lord knows, access to the areas of conflict is extremely difficult for diplomats at present.
Lord Chidgey
My Lords, more than 18 months ago, Matthew LeRiche found that civilians in the Blue Nile State were living in constant fear because of indiscriminate terror campaigns aimed at rendering the population unable to provide even the basics of daily life. Those perpetuating these crimes with impunity had the backing of President al-Bashir and six other ICC indictees. Does my noble friend agree that unless the ICC arrest warrants are implemented, there is little or no deterrence for the present crimes? Will the Government therefore press this case with the international community with absolute vigour to see a result?
Lord Wallace of Saltaire
The question of what is the international community for these purposes is very delicate. Arresting an active head of state in his own capital is not the easiest thing to do without going to war. We are deeply concerned about the current situation, but I should stress that the fighting which broke out in South Kordofan and Blue Nile two years ago was in fact sparked by the SPLM-N and it is the Government of Sudan who have responded in a particularly brutal and indiscriminate fashion.
Baroness Kinnock of Holyhead
My Lords, in an appalling repetition of history, the Government of Sudan have spent the last two years deploying the same brutality that they used in Darfur to crush the rebellions that have been mentioned in South Kordofan and Blue Nile. Does the Minister agree that the lessons of Darfur have not been learnt and that the United Nations Security Council is again failing to respond to the suffering of the Sudanese people, who are being bombarded by their own Governments?
Lord Wallace of Saltaire
My Lords, we have to be careful not to assume that the United Nations can do too much. The UN has been actively engaged in this extremely complex series of wars. Let us be quite clear: there are not just two sides on this, as the noble Baroness herself well knows. There is conflict within South Sudan; there is conflict within Sudan itself; there is conflict between groups which are claimed to be supported from across the border. It is now 10 years since the Darfur conflict started. Things are a little better than they were. I speak with some direct experience, having a close friend who has worked both in Darfur and in Abyei in the past three years. Sadly, there are limits to what the international community can achieve, but I assure the noble Baroness that the British Government and others are working extremely hard and providing as much humanitarian assistance as they can in this dreadful situation.
Baroness Cox
My Lords, is the Minister aware that I visited South Kordofan and Blue Nile states earlier this year and witnessed at first hand the constant aerial bombardment of civilians, which deliberately targeted schools and clinics, forcing civilians to hide in caves with deadly snakes and in banks carved out from rivers, and preventing them harvesting crops, with many dying of starvation? Does the noble Lord agree that this aerial bombardment of civilians is being undertaken only by the Government of Khartoum and that, therefore, there is no moral equivalence between the policies of Sudan and South Sudan? What are Her Majesty’s Government doing to call the Government of Khartoum to account for this aerial bombardment, which has been carried out so far with complete impunity?
Lord Wallace of Saltaire
My Lords, we are not the only external actor influencing Sudan. We have to work with the Chinese, who are major actors in terms of external influence on Sudan, the Arab League countries and others. As the noble Baroness will know, there is a tripartite body consisting of the United Nations, the African Union and the Arab League which is attempting to mediate on what is happening in Blue Nile and South Kordofan. I do not in any sense underestimate the horrors of what is happening there.
I am very grateful to the noble Baroness for sending me some material on what she witnessed in her recent visit. It is the most appalling—I emphasise—series of interconnected conflicts from Darfur all the way across to Jonglei and Blue Nile. Part of the problem is that Governments in both South Sudan and Sudan are weak and do not control the whole of their territories.
Lord Triesman
My Lords, the Minister made the point that President al-Bashir would be hard to capture in his own capital. That is of course entirely true, but he must be one of the most widely travelled Presidents of almost any country in Africa. He is at meetings and conferences throughout Africa, throughout the Middle East and occasionally completely out of the hemisphere. What influence are we trying to bring to bear on those other countries that he routinely visits and which do not necessarily have an adverse view of bringing a war criminal to justice?
Lord Wallace of Saltaire
My Lords, the noble Lord will be well aware from his own experience as a Minister how complex these issues are. It is not just a question of Sudan and the ICC. There are delicate questions of Kenya and the ICC at the moment as well. Her Majesty’s Government do of course make representations to other Governments whose territories ICC-designated people visit. Unfortunately, Britain does not command as much influence as we might like in a number of countries in the third world.
Lord Hussain
My Lords, I have had the opportunity of visiting South Sudan and Sudan in the past year or so. Does the Minister agree that, according to the comprehensive peace agreement, the Government of Sudan were required to withdraw all their military forces from South Sudan, which they have done, and that the SPLA was required to withdraw its military people and armed forces from north Sudan but has so far failed to comply?
Lord Wallace of Saltaire
My Lords, the border drawn between Sudan and South Sudan has not been entirely settled. Questions remain about who belongs where, because a number of tribes are pastoral and move across the border. Many issues are not entirely clear or settled. That is very much a problem that we face after the prolonged civil war from which the two countries emerged.
Bank of England: Monetary Policy Committee
(10 years, 10 months ago)
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Lord Barnett
To ask Her Majesty’s Government what is the Chancellor of the Exchequer’s assessment of the latest statement by the Monetary Policy Committee of the Bank of England.
Lord Newby
My Lords, the Bank of England Act 1998 gives powers of operational responsibility for monetary policy to the independent Monetary Policy Committee of the Bank of England. The updated MPC remit set at Budget 2013 by the Chancellor requests the MPC to provide an assessment of the merits of using intermediate thresholds in monetary policy in its August 2013 inflation report, which will be published on 7 August.
Lord Barnett
My Lords, in the House last week, in answer to me, the Minister quoted the Prime Minister as saying at the G8 that the UK Government were “supporting … [an] active monetary policy”. How can he say that when it is not their responsibility? Is it because the new governor is virtually unsackable at the moment? Or is it that the Government are simply not interested at all in monetary policy? The new governor took his first meeting, to which the Minister referred. During the meeting, unusually for a governor, he gave some guidance and said that interest rates would be low for a long time, and could even go a little lower. In those circumstances, the pound dropped substantially. Some people are very happy with that. Is the Chancellor?
Lord Newby
My Lords, on the first point, the Government updated the remit of the Monetary Policy Committee at Budget 2013 to give it greater powers to clarify the trade-offs that are involved in setting monetary policy to meet a forward-looking inflation target. That is what the governor and the Monetary Policy Committee will do over the coming months. On exchange rate policy, as the noble Lord knows, the previous Government did not have a policy for an exchange rate, and this Government do not have one, either.
Lord Lamont of Lerwick
My Lords, perhaps the Minister will comment on one aspect of the asset purchase scheme—quantitative easing—about which there has been some argument. When the original document setting up the asset purchase scheme was signed, and it was made consistent with the Bank of England Act 1998, was it set down that increases in the scale of the asset purchase scheme required the agreement of the Government, and that while day-to-day monetary policy may be the responsibility of the Bank of England, an increase in the scale of quantitative easing would require endorsement by the Government? Is that correct?
Lord Newby
My Lords, my understanding is that it is for the MPC to decide on the scale of quantitative easing. As my noble friend will know, there is a Treasury representative at all meetings of the MPC. That representative is allowed to speak but does not have a vote.
Lord Sharkey
My Lords, last week the New Economics Foundation suggested a new approach to quantitative easing. It suggested channelling investment directly into housing infrastructure and SME lending. Does the Minister agree with that suggestion?
Lord Newby
My Lords, the Government are looking at a number of ways of increasing investment in all those areas of infrastructure. We set out in the spending review our plans for doing that in 2015-16 and subsequently. Plans or programmes already in place, such as the finance for lending scheme, are already having a significant impact on new housing construction.
Lord Davies of Oldham
My Lords, would not a word of caution be apposite at this time? Is not the American experience—where it has been difficult for the Federal Reserve to press on the monetary brake without destabilising the markets, as we have seen—a lesson that we need to learn for the British economy, particularly if there is any pick-up at all and the possibility of rising inflation?
Lord Newby
My Lords, the American experience demonstrates how tricky it is for central banks to give forward-looking guidance without it having an effect on the market. However, as the MPC said at its meeting just last week, it viewed the implied rise in the expected future bank rate as not warranted by recent developments in the domestic economy. It is trying to be cautious and reduce any potential volatility.
Lord Vinson
My Lords, the world’s biggest gilt brokers, PIMCO, wrote about four weeks ago, as reported in the Financial Times, that the new Governor of the Bank of England would have only one shot in his locker, and that is to let the pound depreciate. Is it such a bad thing if, after 30 years, a trading nation begins to consider the rate at which it trades with the rest of the world? Is not our failure to look at the rate of our exchange in the past one of the reasons why we have such a high imbalance of trade?
Lord Newby
My Lords, the pound has fallen in value against other international currencies by about 20% in recent years and that has not automatically had a vast impact on the balance of payments. There are considerable signs of optimism about that. For example, exports in goods to the EU increased by almost 7% last month. However, I think that recent experience has shown that devaluation on its own does not cut the mustard—we also need to have a whole raft of supply-side measures in place. That is why things ranging from the additional resources to UKTI, at one end, to bringing more money into science and apprenticeships, at the other, are necessary if we are to have a significant improvement in the balance of payments.
Local Audit and Accountability Bill [HL]
Baroness Hanham
That the amendments for the Report stage be marshalled and considered in the following order:
Clause 1, Schedule 1, Clause 2, Schedule 2, Clauses 3 to 7, Schedule 3, Clauses 8 and 9, Schedule 4, Clauses 10 to 17, Schedule 5, Clause 18, Schedule 6, Clauses 19 to 23, Schedule 7, Clauses 24 to 28, Schedule 8, Clauses 29 to 32, Schedule 9, Clause 33, Schedule 10, Clauses 34 and 35, Schedule 11, Clauses 36 to 42, Schedule 12, Clauses 43 and 44, Schedule 13, Clauses 45 to 47.
Offender Rehabilitation Bill [HL]
(10 years, 10 months ago)
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15:49 - Division on Amendment 2 - Ayes: 186 / Noes: 205 - Amendment 2 disagreed.
Lord McNally
“Arrangements for supervision and rehabilitation: female offenders
In section 3 of the Offender Management Act 2007 (power to make arrangements for the provision of probation services), after subsection (6) insert—“(6A) The Secretary of State must ensure that arrangements under subsection (2) or (5) for the supervision or rehabilitation of persons convicted of offences—
(a) state that the Secretary of State has, in making the arrangements, complied with the duty under section 149 of the Equality Act 2010 (public sector equality duty) as it relates to female offenders, and(b) identify anything in the arrangements that is intended to meet the particular needs of female offenders.””
The Minister of State, Ministry of Justice (Lord McNally)
My Lords, I am pleased to move Amendment 1 which seeks to recognise the needs of female offenders and put them firmly in the Bill. It requires the Secretary of State to ensure that arrangements for the supervision and rehabilitation of offenders state that, in making those arrangements, he has complied with the public sector duty under Section 149 of the Equality Act 2010 as it relates to female offenders. The arrangements must also identify any provision that is intended to meet the particular needs of female offenders. It applies both to the contract with private providers and services provided by the public sector probation service.
I pay tribute to those noble Lords who have argued for such statutory safeguards for female offenders. I am particularly grateful to the noble and learned Lord, Lord Woolf, for his earlier amendments and for his constructive discussions with me about this amendment. I am delighted that he has agreed to put his name to the amendment today. I likewise thank my noble friend Lord Marks and the noble Lord, Lord Beecham, for adding their names.
The amendment inserts a new subsection in Section 3 of the Offender Management Act 2007, which relates to making arrangements for the provision of probation services. Under the first part of the amendment, arrangements for the provision of supervision or rehabilitation services must state that the Secretary of State has complied with the public sector equality duty at Section 149 of the Equality Act 2010. This means that the Secretary of State must consider evidence on the particular needs of female offenders where they differ from those of men, and consider whether any adjustments or special provision for female offenders is necessary to address these needs. Where a particular need is identified, this will be reflected in the contractual or other arrangements, which will include outputs specific to female offenders.
In order to win contracts, service providers will be required to demonstrate that they understand and will respond to the particular needs of female offenders where these differ from those of men. This will include, for example, taking account of women’s family and caring responsibilities. We will be looking for providers to come up with innovative ways to deliver gender-specific services that are responsive to local needs, and we will expect them to make links with partner agencies to provide a holistic service at a local level.
As I have mentioned to the House on previous occasions, service providers will be supported by guidance on working with female offenders and the sorts of provision that are known to be effective, which is being prepared in collaboration with members of the new advisory board on female offenders. Once bids have been through a robust evaluation process to ensure that potential providers are offering innovative and effective services to female offenders, the second part of the amendment requires contracts and other arrangements to identify anything in the arrangement that is intended to meet the particular needs of female offenders. Noble Lords will also be pleased to hear that, in the spirit of transparency, details of contracts and service level agreements will be published. This will mean that people can see what provision is being made to meet the needs of female offenders and hold us to account. Contract managers within the Ministry of Justice will also monitor service delivery to ensure that key outputs for female offenders are being delivered.
I hope that noble Lords will welcome and support Amendment 1, which I firmly believe will provide the recognition and safeguards for female offenders that the House has been seeking. I beg to move.
Lord Woolf
My Lords, I should remind the House, particularly in view of the generous way in which the Minister introduced the amendment, and his references to myself, that I am the chairman of the Prison Reform Trust, and received considerable help in putting forward the matter from that trust in that capacity.
This is a considerable step forward in the way in which we treat criminal offenders who are female. It has been well recognised that their needs are different, and it is certainly time that those who are responsible for meeting those needs should have responsibility clearly set out in statute. I am particularly grateful that the Minister and his advisers found ways in which that could be done in the shape of this Bill. The amendment is not as clear as I would have liked but it has to be recognised that what we are achieving is being done by using three pieces of legislation, which is not the ideal way to legislate, but it achieves a purpose. I am very conscious that we are told that we must not look a gift horse in the mouth when it is offered, but I have to confess that this gift horse, if that is an appropriate description, was examined most carefully.
I am particularly grateful for the way in which the Minister introduced this amendment. He stressed the importance of clarity and transparency with regard to various connected matters, so that it achieves the purpose he identified. During debates at the earlier stages of the Bill, the Minister indicated that there would be an annual statement of progress so we can all see that it is moving forward as we would hope. Does he not agree that this is one matter that can be dealt with that way?
It is possible that, when three pieces of legislation are involved—as in this case—the time will come when they are initially disconnected. If this does occur, I believe—and I am sure the Minister will confirm this—that the department will ensure that no prejudice is caused to female offenders as a result of any gap in time. I repeat my gratitude for this amendment and would strongly recommend it to the House.
Lord Marks of Henley-on-Thames
My Lords, in supporting this amendment, I would associate these Benches with everything that the noble and learned Lord, Lord Woolf, has said in welcoming it and in thanking the Government and congratulating them on the way in which they have considered and recognised the particular needs of women in the system. In Committee, we moved certain amendments which would have required the recognition of those needs at various points in the system and we are content that this all-embracing amendment meets them.
I would also associate myself with what the Minister said in tribute to the noble and learned Lord, Lord Woolf, who has campaigned so hard for recognition of the needs of women in this area. As a spokesman on these matters for one of the coalition parties, it gives me particular pleasure to note that we have made a great deal of progress on two of the significant issues for which he has campaigned—restorative justice and women offenders.
I particularly welcome the commitment in this amendment to transparency because, as has been pointed out during the passage of this Bill, we are entering a new era for the probation services. The ability to monitor what is being done after this legislation is passed is of considerable importance.
Lord Beecham
My Lords, I join the Minister and the noble Lord, Lord Marks, in congratulating the noble and learned Lord, Lord Woolf, and thanking him for bringing this matter to the fore in the debates on the Bill. I am happy to break the habits of a brief parliamentary lifetime and congratulate the Minister on his constructive response. I hope he finds this habit catching, in which case I promise to reciprocate.
Like other noble Lords, I have received a briefing from the Prison Reform Trust. While welcoming the amendment, there are a couple of matters on which they seek some assurance—and I would echo their request. First, that the Government should require the contractors to specify—within the contract specifications —what particular services would be provided for women, and that the tender criteria, in turn, as part of the contract, would give sufficient weighting to that element. I imagine that should not present any difficulties but it would be good if the Minister could confirm it. Equally, the commissioning bodies will be given guidance along those lines.
Perhaps I may raise a point related to women prisoners that is not specifically covered by this amendment but which has been referred to in the course of our debates—that is, resettlement prisons. It is a welcome concept and certainly should help to reduce reoffending by ensuring that women serve their prison sentences, or at least the latter part of the sentence, closer to where they are likely to return on release. I raised a question in earlier debates about the specific position of women in this respect because, as I understand it, there are only 13 women’s prisons in the country and they are not necessarily geographically distributed in such a way as to facilitate the Government’s intentions. I am not asking the Minister to confirm specifically today, but it would be good to know that that is being considered and that it is an objective which it is hoped the Government will seek to achieve. It would largely complete the work raised by the concerns now embodied in the amendment, which these Benches certainly fully support.
Lord Ramsbotham
My Lords, I support the amendment and I am extremely glad to see that it has been introduced by the Government. For many years people have been hoping that there would be an improvement, and therefore it is to be warmly welcomed. The amendment refers to arrangements for supervision. I would like to raise one point in connection with that because the supervision, of course, involves the probation service.
As noble Lords will know, each of the 35 trusts has a volunteer probation board which is the employer of all the probation staff working in a trust. Apparently, there is an expectation that board members do not criticise the wishes of the Government because although they are volunteers, they are not civil servants. They have been reminded by the head of Transforming Rehabilitation that they should have regard to the constraints imposed on civil servants. I have had representations from board members about the vote which was passed in this House on Report about the requirement for the Secretary of State to allow us to discuss changes to be made to the probation service. Apparently, the board says that planning is going ahead on the timetable which I outlined on Report regardless of the vote in this House. Probation staff around the country are, as he described it, lost for words because it was expected that at the very least the Government would respect the vote of this House and reconsider their proposals, or at least appear to do so. As it seems that that is not happening, and this amendment is all about the supervision of women offenders, I should be grateful if the Minister could tell the House exactly what is happening following the vote on Report.
The Minister of State, Ministry of Justice (Lord McNally)
My Lords, perhaps I may deal with that matter first. The Bill is now in this House. It will then go to the other place, which will also have views about an amendment which the noble Lord was told at the time was defective and which remains defective. I do not think I can go any further than that. We will see what the other House thinks about the amendment and in due course it will come back to this House to be dealt with.
I thank the noble Lord, Lord Beecham, for his kind remarks. He will find that that gives him a warm glow and so I recommend that he continues to make a habit of it. As my noble friend Lord Marks has said, the noble and learned Lord, Lord Woolf, has a good strike record on these Bills and I very much enjoy working with him and benefiting from his wisdom. On the question of the report on progress in dealing with women in the criminal justice system, we will be reporting to Parliament and we will be able to see the progress not only of these measures, but of others that we are taking.
With regard to the prison estate, the noble Lord, Lord Beecham, has drawn attention to an issue that we are currently looking at. We have a number of thoughts on this matter and a study is being undertaken of the prison estate. We will come forward with specific ideas about how released prisoners and the specific issue of women offenders will be dealt with.
On contracts, the contract specifications will set out the services that contracts are obliged to provide. The contract will contain specific outputs designed to meet the needs of female offenders. In order to comply with this new duty, the contract will state that the Secretary of State has,
“complied with the duty under section 149 of the Equality Act”,
and will also draw attention to the specific outputs. As my noble friend Lord Marks pointed out, we will publish these contracts and they will be brought forward with all possible transparency. I hope that this will give confidence and that the House will adopt the amendment.
Lord Beecham
“Provision for veterans’ treatment courts
(1) Within one year of the passing of this Act, the Secretary of State shall report to both Houses of Parliament on the case for establishing veterans’ treatment courts for dealing with ex-service personnel convicted of offences for which non-custodial sentences could be imposed by the trial court (“relevant ex-service personnel”).
(2) The report under subsection (1) shall cover but not be limited to the following—
(a) the statutory basis of veterans’ treatment courts;(b) the composition and functions of veterans’ treatment courts; (c) whether veterans’ treatment courts would be of most effect in diverting, where possible, ex-service personnel from the criminal courts or in overseeing the rehabilitation of ex-service personnel offenders sentenced by the criminal courts;(d) an estimate of the impact of veterans’ treatment courts on the rehabilitation of, and in reducing re-offending by, relevant ex-service personnel;(e) an analysis of relevant international comparators; and(f) an account of consultation which shall be undertaken with all relevant parties including magistrates.(3) Within six months of the laying of the report under subsection (1), the Secretary of State may by statutory instrument make provision for one or more pilot schemes for veterans’ treatment courts, to extend for two years.
(4) A pilot scheme under subsection (3) shall, within six months of its conclusion, be independently evaluated, and a report of that evaluation laid before Parliament.
(5) Within six months of the laying of the report under subsection (4), the Secretary of State may by statutory instrument make provision for a permanent scheme for veterans’ treatment courts.
(6) A statutory instrument made under subsection (3) or (5) shall be laid before, and be subject to approval by resolution of, both Houses of Parliament.”
Lord Beecham
My Lords, this is the fourth iteration of the concept I floated at Second Reading and which we have debated in Committee and on Report. I can claim no credit for the idea. It was conceived in the United States in 2008 where it has been applied with remarkable success in terms of the reduction in reoffending by ex-service men and women and in promoting their welfare, with courts now established in every state. It is now seen as embedded in the justice system and is an integral part of what we in this country call the military covenant, under which we recognise the special responsibility we have as a society for those who have served their country, often in difficult and dangerous circumstances.
The veterans’ treatment courts do not adjudicate on guilt or innocence. Nor do they deal with those who are convicted of, or plead guilty to, crimes for which only a custodial sentence would be appropriate. Their purpose is to promote the rehabilitation and prevent the reoffending of men and women who often find it hard to readjust to civilian life, which is so different from the collective existence—perhaps better described as the regimented existence—that, of necessity, military service often involves. Some will have suffered, and may continue to suffer, combat stress or post-traumatic stress disorders and a number will fall foul of the law, with crimes of a violent or sexual nature being particularly common.
The courts in America are presided over by the relevant judge. A veteran mentor is assigned to each offender, who has to attend monthly court sessions and is helped in a variety of ways to adjust to life in the wider community, receiving practical, psychological and, where necessary, clinical support. Failure to co-operate with the treatment court leads to a return to the sentencing court and the risk of a prison sentence.
It must be said that there is no certainty about the numbers that might be involved in this country were we to adopt the system, even for those serving prison sentences. The MoD estimates that some 3.5% of prisoners at any one time are ex-service personnel. However, other estimates rise as high as double figures. A survey by Mr Colin Back of the Regular Forces Employment Association, who has worked extensively with this group and who attended a recent helpful meeting with the Prisons Minister, Mr Damian Green, has produced an estimate of those claiming and proven to have served in the Armed Forces to be an average of 6% of the inmates in a wide range of establishments, with a lowest figure of 3% and a highest figure of 11%. It is likely, however, that these figures are understated because some of those in prison do not wish to disclose their status to other prisoners or to those who, like Mr Back, are inquiring as to their position, because of concerns about how other prisoners will react or fear of loss of pensions and the like.
Be that as it may, it is clear that the number of ex-service men and women who come before the courts will substantially exceed the number who end up in prison. Even 3.5% of those who receive non-custodial sentences such as probation or community sentences will amount to several times the lowest estimate of those in custody, which is around 2,500. I do not find the number quoted by the Minister on Report for this group of non-custodial offenders of some 5,800 to be particularly credible, except perhaps as an annual figure. Therefore, over time the offending group will be quite substantial and the cumulative total must be considerably higher. We must remember that the figures are but a snapshot at any one time so the total who will have been in the system over time, whether in prison or—particularly relevant here—on non-custodial sentences, will be correspondingly greater. Moreover, at current reoffending rates, the figure would be further inflated. Obviously, addressing the general reoffending rate is the whole point of this Bill. Finally, those who have served in Bosnia, Iraq and Afghanistan are due to return and 20,000 will leave the forces, so the potential for an upward spike in numbers is all too apparent.
Lord Ramsbotham
My Lords, I support this amendment, to which I have added my name. We have spoken about this issue many times before. Several advantages come with this amendment in the context of the Armed Forces covenant, for which the Government are very much to be commended, not least because it requires an annual report to both Houses of Parliament by the Secretary of State.
What has been most encouraging since the announcement of the covenant is the number of local covenants that have been commissioned around the country. There is a huge support network for a particular focus on the multifarious needs of the Armed Forces. Mention has already been made by the noble Lord, Lord Beecham, of the large voluntary sector which supports the military and their families. Those organisations are very capable of carrying out many of the functions that are needed. In addition to that, a growing support network is being developed for those suffering from mental health problems—the Minister has mentioned post-traumatic stress disorder and other kinds of fatigue—not least a number of official recovery centres based around the country which are linked into the military command structure. This is a diversion scheme, very much on the lines of the scheme developed by the noble Lord, Lord Bradley, which the Government have supported. It is poised to go, supporting an element of the community to which the Government have said that they wish to pay particular attention.
I was present at the very encouraging meeting with the Minister, Damian Green, and was glad that he took all these points on board. Therefore, I hope that the Minister will be able to respond positively to the amendment and give the House an indication of the sort of timing that we might expect in terms of a government response.
Lord Lloyd of Berwick
Before the noble Lord sits down, perhaps I may ask him one question for my elucidation. I am interested in the use of the word “treatment” in connection with the word “courts”. Is it the intention that these courts should be available only to those who are shown to be suffering from either post-traumatic stress disorder or, let us say, Gulf War syndrome, or are they to be open to all, whether or not they need “treatment” in that sense?
Lord Ramsbotham
I think that I should defer to the noble Lord, Lord Beecham, who is responsible for the wording of the amendment.
Lord Lloyd of Berwick
I am very sorry. I had hoped to ask the question of the noble Lord, Lord Beecham, before he sat down, but it was by then too late. Somebody, I hope, will give me the answer.
Lord West of Spithead
My Lords, I support the amendment, to which I have added my name. The amendment is the least that we can do for the men and women who have put their lives on the line for our nation’s security.
Viscount Slim
My Lords, the Minister will be aware through conversations and debate in the Chamber that I strongly support this amendment. I know that he has been working on a plan along the lines that we asked for. Here it is. It is a good one; it should be trialled. Like the noble Lord, I hope that the Minister will see the sense in it and give his blessing to it. If not, I hope that the House will take the necessary steps.
Lord Hylton
My Lords, my noble friend Lord Ramsbotham referred to existing support systems for ex-servicemen. I imagine that he has in mind the British Legion, Help for Heroes and other voluntary organisations, together with local authorities. However, the sad fact remains that a significant number of ex-servicemen find themselves homeless and sleeping rough, many of them in London. Could this factor also be borne in mind in whatever preventive work is done?
Lord Ahmad of Wimbledon
My Lords, I thank all noble Lords who have participated in this debate. The noble Lord, Lord Beecham, has once again returned to the very important issue of providing support for ex-service personnel impacted in this way who find themselves involved with the criminal justice system.
However, we should not lose sight of the fact that the vast majority of men and women who serve in our Armed Forces go on to lead successful, law-abiding lives. Ex-service personnel are an important asset to the economy of this country and any employer should welcome the skills that they bring to any job. I also pay tribute to all the brave men and women who serve in our Armed Forces and continue to do so with great distinction and honour. We pray for them, particularly those who find themselves on the front line as we speak today.
The noble Lord, Lord Beecham, has already mentioned the meeting he had with my right honourable friend Damian Green, the Minister who sits appropriately in both the Home Office and the Ministry of Justice and who is ideally placed to consider the issue of ex-service personnel who find themselves in the criminal justice system. That meeting was attended by not only the noble Lord, Lord Beecham—as he has acknowledged—the noble Lord, Lord Ramsbotham, David Anderson, the MP for Blaydon, and my honourable friend Oliver Colville, the MP for Plymouth Sutton and Devonport, were also present. Therefore, it is fair to say that there is support for looking at this important issue both here and in the other place, throughout the country and across the political spectrum.
Also at that meeting were a number of representatives of veterans’ groups, such as Tony Wright of Forward Assist. I know that my right honourable friend Damian Green particularly welcomed their input and the information that they supplied about the experiences of ex-service personnel. One of the key things that emerged from that meeting is that the focus is not necessarily on ex-service personnel who are in prison. It is of course important that we continue to develop services for those who are in custody, such as the veterans in custody support officers, and expand the specific guidance that is produced in collaboration with interested government departments and the important voluntary sector.
As I said in Committee, it will be important to have tailored supervision for ex-service personnel on release, including, for example, mentoring from those with service backgrounds—a subject that we have talked about previously. So while we continue to work with ex-service personnel in custody, we also need to focus on those who receive non-custodial sentences or those who can be diverted from the criminal courts altogether. We believe that there are a number of ways to address offending by veterans at that level. For example, we could look at the programmes that are available as part of conditional cautions, which are administered by the police.
The noble Lord, Lord Beecham, also mentioned the US experiences. That is something that the Government are also looking at. For those receiving community orders or suspended sentence orders, there are powers available to the courts to review sentences, essentially to monitor progress of that particular order. We suspect that these approaches might benefit some ex-service personnel. However, we need to know more about the problem of offending at this level in order to decide what the best solution is.
One of the most striking things raised by veterans’ groups is the lack of detailed information about the scope and nature of offending by ex-service personnel. That point was well made by the noble Lord, Lord Beecham. Even in prisons there are significant differences in the estimates, ranging from 3% of the population to 11%. For those involved in less serious offending, the information is even less clear. That is why we want to work with the veterans’ groups to try to establish a better understanding of the nature and extent of offending. If we have that information, we believe we can focus better on a response.
The Government are already taking forward work to look at the data that are available. I am also happy to make a commitment that the Government will produce an assessment of the issues identified, as raised in this amendment, including a veterans’ court and other mechanisms to provide support. We will share that assessment with noble Lords. I am also confident that we will be looking to complete this particular assessment and share the findings with noble Lords within the coming year.
Likewise, I reassure noble Lords that we will continue to consult relevant groups. We want to discuss the issue with other key government departments, such as the Ministry of Defence, as well as the Department of Health and the Department for Work and Pensions. We will also need to talk to the judiciary about its experience of dealing with ex-service personnel.
Lord Beecham
My Lords, I am grateful to the noble Lords who have participated in this short but important debate. The noble and learned Lord, Lord Lloyd, asked about the term “treatment”. It is not designed to refer to clinical treatment. It is a phrase used in the American system, and treatment can take a variety of forms, including advice and support of all kinds. As I said, it does not necessarily have a medical or clinical connotation.
The noble Lord, Lord Hylton, referred to homelessness as a particular problem, and that of course is true. Indeed, it is the function of the mentor and others in American veterans’ courts to assist precisely with that kind of problem. To a certain extent and as the noble Lord, Lord Ramsbotham, pointed out, it is something that is now increasingly carried on across a number of local authorities, especially those in my home region of the north-east.
Nothing in what the Minister said is excluded from the range of the amendment. The amendment is not at all incompatible with what he said. It sets out a process and one would hope to end up with the option of a system clearly rooted in the experience abroad. It would also have to be tested here, as we are suggesting.
I welcome the warmer response given by the Minister today compared with that given previously. I understand that parts of the Government are addicted to something called the “nudge theory”, in which people can be encouraged by a nudging process to change their ways. I think that it would be appropriate to seek to nudge the Government in the right direction by having a clear expression of opinion on the amendment. Accordingly, I wish to test the opinion of the House. I hope that we can give a clear message that we want the Government to build on their growing warmth and accept the principles set out in the amendment. One hopes that they will move in due course, on the basis of piloting, to making a systemic change in the way that we deal with offenders.
Care Bill [HL]
(10 years, 10 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
“( ) the importance of identifying housing options required to exercise that duty”
Lord Best
My Lords, we come now to a group of amendments, five of which are in my name and the names of my noble friends Lady Wilkins and Lady Tyler. These five amendments have the same underlying purpose—namely to give greater prominence to the crucial role that housing can play in preventing and reducing the need for health and social care services. The amendments have been prepared by the Care and Support Alliance, which is composed of more than 70 organisations that support and represent older and disabled people. I am particularly grateful to the National Housing Federation, which has helped bring these amendments together and given excellent briefings to interested Members of your Lordships’ House.
The Bill has been welcomed by those organisations, and they note with approval that the definition of “well-being” in Clause 1 covers “suitability of living accommodation”. Also, in relation to the duty on local authorities to meet needs for care and support, Clause 8 includes reference to such assistance being provided “at home”. However, these passing references to the place where many elderly and disabled people spend almost all their time do not do justice to the significance of housing to enabling people to live independently.
The Bill takes highly significant steps to integrating health and social care services, but downplaying the housing element—the third leg of the stool—will undermine the legislation’s good intentions. The Age UK report, Stop Falling: Start Saving Lives and Money, notes that falls cost the NHS around £4.6 million every day and that around half of the people over the age of 80 suffer a fall each year. It makes clear that it is accidents in the home, or on the icy step outside, that so often lead to hospitalisation. Cold and damp premises are equally likely to be the cause of a deterioration in health. Once in hospital, if the home to which the patient should return is totally unsatisfactory, their discharge will be delayed and/or there will be a swift readmission to hospital when the home fails them. Informal family carers cannot cope with someone’s care needs if they are battling with the inadequacies of a home that has unmanageable stairs or cannot accommodate a wheelchair.
The case has been made for the financial benefits of getting the housing service right. The National Housing Federation’s new report, Providing an Alternative Pathway, for example, shows that housing for someone with dementia in a self-contained flat in an extra-care scheme provided by a housing association can cut the cost of their care by up to 50%, allowing them to live more independently with care and support on-site, rather than in a costly residential care home. Currently, the UK is spending £9.43 billion on housing those with dementia in care homes, so housing alternatives can have a huge impact on health budgets.
Often the ideal housing solution for so many of us as we grow older is a move to a more manageable home with very low heating bills, no stairs or steps, but with high standards, space, light and ventilation. As a wonderful bonus, when an older person downsizes, a much needed family home, probably with a garden, comes on to the market for the next generation. I declare my interest as chair of Hanover Housing Association, which endeavours to build accommodation of this kind, which is in turn likely to be the best place for care and support services to be delivered. The housing provider can supply the back-up, not only through emergency call systems—now much enhanced by new technology—but in personal terms in acting as helper and ally in securing care services. Age-friendly housing developments for older people also protect against loneliness and isolation for the resident through ensuring a sociable, companionable environment.
However, the great majority of people will stay put in their family home. A joined-up care and housing service can make this possible. Sometimes very minor adaptations are all that are needed to extend people’s independence and autonomy. Handrails that are discreetly and strategically placed can prevent falls in the home. Long-armed “D” taps for people with arthritic hands can reduce the occupier’s need for costly help. Introduction to a “handy person” service can get these things fixed. Arrangements to pay for a defunct central heating boiler to be revived can end the misery of choosing between being freezing cold and spending a fortune on an electric bar heater which may well be unsafe. This investment in the home can keep people well.
Home improvement agencies, often called “care and repair” services, can organise access to disabled facilities grants for items like stair lifts or the installation of walk-in showers, making life so much easier for family carers as well as for the person themselves. It is good to note, in the spending review, the transfer of resources from the Department of Health to fund a planned 20% increase in the budgets of disabled facilities grants.
All these measures that prevent the need for more costly care services achieve very rapid payback as well as transforming people’s lives. If a patient cannot be discharged from hospital for a couple of weeks because their home cannot take them back, the NHS will incur costs of well over £5,000—money that could have been so much better spent fixing the home and preventing a series of unnecessary and unwanted hospital stays. Avoiding a move into residential care for a couple of years will save tens of thousands of pounds.
Each of these amendments covers a different clause in the Bill and inserts a housing dimension to the very welcome measures already therein. First, Amendment 80 addresses Clause 2, which focuses on preventing or delaying a person’s need for care. It seeks recognition that housing is a crucial part of a preventive care service.
Secondly, Amendment 81 is particularly significant. It adds housing to Clause 3, covering promotion of integration of care and support with health services. It is interesting to note, in this context, that in Scotland this holistic view of integration is now taken. The relevant Scottish guidance says:
“It will be important that, in bringing … health and social care closer together, partners ensure that housing services (including those provided by housing associations and the third sector, as well as by local authorities) are fully included in the integrated approach to service planning and provision, and that health and social care planning and local housing strategies are mutually supportive”.
So says the Scottish guidance. Sadly, our Health and Social Care Act 2012 does not explicitly reference housing, and a framework for engagement was neglected in that Act’s guidance. This has led to a very patchy involvement with housing by the new health and well-being boards. Some are examplars of engagement with housing providers in a three-way partnership, while others seem blind to the significance of this element in the equation.
Thirdly, Amendment 86 covers Clause 4 and relates to information and advice. Again, this is a very important amendment. The Joint Committee that looked at the Bill strongly recommended that local authorities provide information and advice on the housing options available in their area. However, although the Government have incorporated the need for independent financial advice, the recommendation from the committee to include housing has not been taken up. This amendment, by including housing options in the Bill, should ensure that local authorities provide the requisite information on specialist and adapted housing in their area, on ways for people to get their home adapted, and on the ways in which people can cover the costs of home improvements.
Fourthly, Amendment 87 seeks to improve Clause 5, which is concerned with the diversity and quality of local services. It extends the definition of care and support services to ensure that local authorities include specialist housing, accessible housing and housing-related support in their mix of services.
Finally, Amendment 88 addresses Clause 9, which relates to the assessment of an adult’s needs for care and support. It is intended to make sure that local authorities pick up on whether adaptations to a home are needed or whether a move to more specialist housing would be best. Assessing the housing requirements of the individual is a vital part of the process of seeing what is best for that person and how their lives can be improved. The amendment seeks to make sure that this ingredient in the process is covered as a matter of course.
I hope that the Minister will feel able to take on board the kind of changes to the Bill which these amendments advocate. The report last year from the All-Party Parliamentary Group on Housing and Care for Older People, Living Well at Home, spelt out the case for the three-way integration of health, social care and housing. The White Paper published prior to the Bill promoted the theme of including housing more centrally in the future of social care. The House of Lords Select Committee report, Ready for Ageing?, highlights the housing requirements of older people. The pre-legislative scrutiny committee, so ably chaired by Paul Burstow MP, took this forward with strong recommendations for a higher profile in this Bill for the housing dimension. The 70 organisations in the Care and Support Alliance, which have a real understanding of the needs of older and disabled people, believe passionately that these changes would greatly improve the Bill. I beg to move.
Baroness Wilkins
My Lords, I strongly support the amendments which have been so expertly described by the noble Lord, Lord Best, and to which I have added my name, as well as Amendment 87ZC in the name of my noble friend Lord Hunt of Kings Heath.
This is an important group of amendments. In combination, they will help to ensure that housing is at the forefront of decision-makers’ minds when providing for an individual’s care and support needs. The person will be supported in a way which makes them the least dependent on health and social services only if housing solutions are properly taken into account. However, that element is all too often ignored, and dependency is ensured.
I well remember a dispirited social worker who described the effects of a two-year delay in providing an arthritic lady with lever taps. In the mean time, she had to have considerable support to wash and cook and objected strongly when that support was taken away because she was now able to turn on the taps. However, it helped to convince the council to clear their backlog of occupational therapy cases.
It is so often the case that the housing element ensures that a person can maintain their greatest independence and be enabled to live their life to the fullest extent they can. Housing solutions have to focus on the individual—ensuring that the person is at the centre of the services and not the system. There are numerous examples of how, when housing, health and social service professionals work well together, people are able to regain a control over their lives which can all too easily be lost when social or health care are seen as the only options.
Lord Rix
My Lords, having heard the words about Mencap spoken by the noble Baroness, Lady Wilkins, I, as president, must of course support this amendment. I say “must”, but I am surprised that these amendments have to be tabled at all. I would have thought that any Bill dealing with care must deal absolutely explicitly with housing. After all, noble Lords will remember when the long-stay, sub-normality hospitals were closed in the late 1970s, the 1980s and the early 1990s, the very thing that was required was housing. Mencap did provide the housing in those days, as best it could, with the Mencap Homes Foundation. It has progressed now to Golden Lane Housing, which allows people with a learning disability actually to own their own housing with the appropriate support. These provisions are necessary, and I am amazed that these amendments were necessary in the first place.
Baroness Jolly
My Lords, I support this suite of amendments—this flight of amendments—on housing. As noble Lords have eloquently said, housing is the third side of the care triangle. Those of us who sat on the scrutiny committee were absolutely clear on that. We thought that it had been extended to our report, but clearly it has not been reflected totally in the Bill. There was mention of it in Clause 1, the well- being clause, in Clause 6 on co-operation, and also in Clause 8 on how to meet needs. The noble Lord, Lord Best, has filled in the gaps, with Clause 2 on prevention, Clause 3 on integration, Clause 4 on the provision of information and advice, Clause 5 on market shaping and Clause 9 on the assessment of needs. In each of these elements of the Bill, housing is imperative. The anxiety that many of us share is that if housing is not in these clauses, it will not be dealt with when an individual is assessed, or when there are issues around integration.
In the Select Committee, the most compelling witnesses were from the housing sector. They understood the impact that appropriate housing, and any adaptations to houses, would have on the lives of the people living there—on the health and well-being of the individual. The amendments in this group put housing where it should be. It is core to assessment and core to integration of care. It is a preventive measure, and it is also core to the provision of information. There is no point in having a conversation as a result of your assessment and as part of the information process if you are not aware of what your housing needs are, because without housing, the conversation makes no sense.
Local authorities need clear direction from the Government. The noble Lord, Lord Best, articulated this clearly when he introduced his amendments. Some health and well-being boards have got it and some have not. Those that have not should have it spelled out, so the amendments in this group are absolutely appropriate. I hope that my noble friend, when he sums up, will reassure the House in this regard.
Baroness Emerton
My Lords, I support the amendments of the noble Lord, Lord Best. I also support what my noble friend Lord Rix said about closing the large institutions and providing the necessary housing. The reason the necessary housing could be found, either through charities or local authorities, was that it was clearly spelled out in government policy. I therefore strongly support the need for this provision to be in the Bill. Without that background, I would have found the job of closing two large institutions extremely difficult, because there was resistance from local authorities and local communities to providing suitable accommodation. However, as it was government policy, we were able to persuade and influence the local authorities to do it. Therefore, I support the amendments in this group.
Lord Campbell-Savours
My Lords, I will speak primarily to Amendment 88, in the wider context of Clause 9, and put an idea to the Minister that dawned on me during conversations with local authorities that are faced with problems in this area. Clause 9 deals with the assessment of an adult’s needs for care and support. It states:
“Where it appears to a local authority that an adult may have needs for care and support, the authority must,”
carry out an assessment. The clause goes on to list what the assessment must include. Amendment 88 would add,
“housing options to contribute to the achievement of those outcomes”.
What struck me as an outsider looking into these matters is that, irrespective of the changes to which the noble Lord, Lord Rix, referred, problems still arise where elderly people—perhaps in their 80s, 90s or whatever—have to transfer out of their homes, which they may well own, or from hospital into some kind of care environment, perhaps a nursing home. I wonder whether it would be possible for that process to be made more seamless in circumstances where a local authority took on the responsibility of marketing—I shall come on to what I mean by “marketing”—the home for sale, clearing the home and making all the arrangements for the transfer of that resident, be it from their home or from hospital, into a care environment.
It may be that a local authority could offer a package. At the moment, that package, in part, is offered by some of the charities. I have spoken to charities, such as Age Concern, which carry out various components in this process of transfer but I wonder whether money could be raised by local authorities through taking a proportion of the commission on the sale of properties by estate agents. In other words, a local authority would advertise within its area and estate agents could tender for the right to handle the properties for which the local authority took responsibility in this process of seamlessly transferring people from their homes to a caring environment.
As estate agents would not necessarily know whether they would get that business if it was organised in the wider market, if they knew they were going to get all the business provided by the local authority—in other words, that they would be the estate agent responsible for carrying out the process of transfer in a particular district—they might be prepared to share their commissions with the local authority because they had access to business which they might not otherwise have had. It would provide a revenue stream.
As we introduce amendment after amendment to the Bill, I keep thinking, “Where is the money coming from?”. It has to come from somewhere. It is all right Parliament passing legislation placing all these new responsibilities on authorities but, at the end of the day, the local authority has to find a way of raising the revenue. If local authorities could somehow attach themselves to the revenue from the sale of houses, it might well provide an income stream—and what better way to do so than to provide a package for the seamless transfer of the elderly into a more caring environment? I put it simply as a proposition that the Minister might wish to consider over time.
Lord Martin of Springburn
My Lords, everyone supports these amendments. I do not wish to detain the House but I would like to add my voice to that support.
When I became a councillor in 1973, it was my duty to concern myself with the housing problems of constituents who lived in my ward. After seven years, when I became a Member of Parliament, I thought the housing problems would go to the councillor who took my place. That was not the case. Right up to my last week of being a Member of Parliament, I was still receiving housing complaints and problems. I recall in another life, when I was a member of the Labour Party, some of my friends saying, “Education, education, education”—that was the motto—but I said there should be something else: “Housing, housing, housing”.
If people do not live in decent homes, they will not be able to do anything. If dampness is coming down the walls, the brightest child will never be able to study properly and get the best out of his or her education. So I say to the Minister that sometimes it is the simple things that matter in housing, not the expensive things that the noble Lord, Lord Campbell-Savours, has referred to.
I have mentioned dampness. There used to be a great deal of dampness in some of the houses in my area of Glasgow. A scheme was introduced—all credit to the Government, as it was not just the local authority —to bring in central heating. What a difference it made to the health of the young and old who lived in those houses. They could get up in the morning to a warm house and go to bed in the evening in a warm house. It meant that bronchitis, emphysema and all the other problems were greatly reduced.
Baroness Howarth of Breckland
I want to bring us back briefly to the amendments that we were discussing. Broadly, housing obviously has a tremendous impact on people’s lives, but we are talking about inserting the word “housing” in a number of clauses that will enable co-ordination between health, social care and housing.
Many local authorities and well-being boards, as the noble Baroness, Lady Jolly, mentioned, already have it—that is, if you achieve this co-ordination, you will make savings and produce better outcomes for the individuals being helped. Having it on the face of the Bill will ensure that the leadership of all these authorities has to pay attention to it, and I think that is important. At the moment we have a postcode lottery. If you are fortunate enough to live in an authority that has got it together, your adaptations will arrive; you will have all your other housing issues sorted out, along with your care package, and, if you are an old person in hospital, you will be out in a very short time. If you are a person with a disability, as that disability increases, or if you have a sudden disability, your adaptations will appear because there will be that co-ordination.
In many local authorities, however, the housing department can opt out and not play its part, which causes huge delays—I speak as someone who works in a number of charities and with people with disabilities. I want to support the amendment’s inclusion in the Bill so that the leaderships of authorities have to take it to heart and so that we do not have a postcode lottery and this is all part of strategic planning for the authority.
Baroness Wheeler
My Lords, the Joint Committee on the Bill acknowledged that it had been widely welcomed, but asserted that this did not mean that it could not be improved—there are gaps and risks and unintended consequences. The failure of the Bill adequately to underline the importance of housing not just to well-being but to integrated care, to prevention and to being included in the provision of advice and information on quality of care and assessment is what these amendments seek to address. The interplay between housing and well-being—the standard of someone’s living circumstances and their health condition, the appropriateness of their house or flat and the likelihood of their being able to remain in it and care for themselves—is long established. However, as noble Lords have shown, it is overlooked in key clauses of the Bill.
Our Amendment 87ZC takes forward the vision of specialist houses fully integrated into the health and social care system which was so comprehensively set out by stakeholders from across the housing sector in their evidence to the Select Committee. The quality of that evidence was commented on by the noble Baroness, Lady Jolly. There are numerous examples of inspiring best practice where housing is an integral part of care and support and service delivery. The Bill needs to provide the momentum for good practice to become embedded across all local authorities and health providers.
The evidence to the Select Committee from organisations across the housing sector cites inspiring examples of where housing, health and social care provision and support join up to provide integrated person-centred care. However, alongside this, there is huge frustration that progress across the country has been so slow and patchy. This is especially so when what stakeholders refer to as low-level interventions, which really make a difference, are often the services earliest to be cut back and dispensed with. The Anchor Trust, for example, described the determination to keep its service-level manager on site at one of its sheltered housing schemes because it made all the difference. The noble Lord, Lord Martin, made this point, too. Anchor said that, in its view, once the manager left, the next steps for elderly and frail people were usually into residential care. This was one of the many examples given of the consequences of not having housing-related support regarded as a key social determinant of health. I look forward to the Minister’s explanation as to why the Government have not ensured that this is fully reflected in the Bill.
Earlier, we heard the case from the noble Lord, Lord Best, and my noble friend Lady Wilkins for Amendment 81, supported forcefully by the noble Lord, Lord Rix, on the importance of including the promotion of housing provision in the duties of local authorities under Clause 3 to provide integrated services, and of ensuring that there are similar duties placed on the health service. Our amendment to Clause 6 complements this by reinforcing integrated joined-up working with registered housing providers, including housing associations and registered social landlords, and recognising these as key, relevant partners under the Bill.
The need to recognise housing as a preventive service cannot be overestimated or overemphasised. Schemes such as Midland Heart’s reablement service for the elderly or frail combine social care and housing association support to enable people to be discharged from hospital back to their homes quickly and help independence to be regained. They delay or prevent the need for more intensive care, reduce the likelihood of repeated hospital stays and can prevent avoidable accidents. Commissioners need to be encouraged to consider specialist housing, home-from-hospital services, housekeeping-related support and adaptations when designing preventive services. Housing is a crucial preventive service and Amendment 80 is important for ensuring that this is recognised in the Bill.
Amendment 88 is also important for ensuring that needs assessments include an assessment of housing options, as is Amendment 86, which underlines the importance of ensuring that local authorities provide information and advice for adults and carers on available housing options and the choice of providers available in the authority’s area. While in Amendment 87 we fully recognise the need for more specialist housing to be built to meet the needs of care and support, we would be cautious at the present time of putting this extra burden on local government when it does not have the resources or the means to deliver. It is the responsibility of national government to provide the £10 billion extra investment in infrastructure that the International Monetary Fund has called for to get the economy moving and make shovel-ready projects such as housing happen.
I am grateful to the National Housing Federation for its excellent briefing, and I refer to an example of integrated care and support it gives that was provided by one of its members, the housing association Look Ahead, for a psychiatric patient. It shows what can be achieved. Following a six-month stay in hospital, it had initially been intended that he should move to a residential care placement, but instead he was referred to Look Ahead’s rehabilitation service. The support that he received helped him with basic life skills, diet management and managing his condition. After 18 months, he had successfully moved to his own flat, had been able to reduce his psychiatric medication and had started a nursing diploma. This service, taking him from hospital to independence in his own flat in 18 months, was provided by successful joint working between the housing association, the local authority and the NHS trust, with an estimated saving of nearly £250,000 across the three services.
We heard, too, at our latest stakeholder group meeting yesterday about a successful jointly procured and delivered reablement centre in Liverpool that is funded by the local authority and the clinical commissioning group in respect of hospital discharge. The scheme provides two to three weeks of intensive occupational therapy and other key services, which doubled from 40% to 80% the percentage of patients who did not require a continuing care package after this initial support. However, we understand that in some parts of the country CCGs are expressing reluctance to enter into joint funding schemes with local authorities in case the health funding element is leaked into other council services, given their budget situations—literally, I suppose, into filling potholes or such like. Can the Minister tell us what steps are being taken to reassure CCGs about this potential barrier to providing integrated services?
As part of its oral evidence, Jake Eliot from the NHF said:
“Too often, the integration that occurs happens because service users, carers, providers and commissioners are working skilfully in spite of the system rather than because of it”.
This is something that the Bill can change effectively. I hope that the Minister takes these words to heart and accepts the amendment. It would ensure that the Bill recognises the importance of housing. It is important not just for well-being but for prevention, for the provision of advice and information in the assessment process and for ensuring that the overall quality of care is fully recognised.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, in tabling these amendments, the noble Lord, Lord Best, brings to the attention of the Committee the important role that housing plays in both care and support, and as a determinant of well-being. I have listened with care to the powerful contributions in support of them. Having done so, I begin with an observation that I hope is incontrovertible, which is that simply having a roof over your head will have a profound impact on your well-being. Having access to suitable housing for those with care and support needs plays a vital role in promoting not only their well-being, but their independence. The noble Lord, Lord Best, brought this point home very well. Properly taking into account the suitability of someone’s living accommodation could, for example, help to prevent a frail older person from falling and thus suffering the pain and trauma of broken bones and an unnecessary stay in hospital, the need for a greater level of care and support following discharge, and the costs of this to the public purse. It is vital that the system actively works to promote independence rather than waiting for people to reach a crisis point.
To reflect the importance of housing as a determinant of well-being, we have explicitly included the “suitability of living accommodation” in Clause 1(2), which sets out a list of things to which well-being relates and that the local authority is required to promote in performing its care and support functions. Furthermore,
“accommodation in a care home or in premises of some other type”,
is set out in the high-level list of examples of how to meet needs in Clause 8. Together, this means that the Bill ensures that housing is an integral part of care and support, where it is not general housing as excluded by Clause 23.
Lord Best
My Lords, I am deeply grateful to all those who have participated in this debate, particularly the noble Baroness, Lady Wilkins, for coming in so supportively and giving us those really practical examples. It is astonishing that, in the case she mentioned, £50,000 a year was being saved, giving a much better life to Bruce, the tetraplegic she talked about. Big money is being saved in improving people’s lives, absolutely underlining the essence of what we are trying to do here. I am grateful to the noble Lord, Lord Rix, for bringing in the Mencap dimension so fully and reminding us of those old mental institutions, which the noble Baroness, Lady Emerton, was so instrumental in closing, and how housing was seen as the link that really mattered.
I am grateful to the noble Baroness, Lady Jolly, for pointing out how important the Joint Committee thought this to be. I know that members of that committee have not been happy that housing has not appeared in the Bill in the way that they had hoped when they produced their report.
The noble Lord, Lord Campbell-Savours, recognised that we have to find the money from somewhere. Sharing estate agents’ fees is a clever idea. The more likely one, I guess, is the transfer of resources from the NHS, because it is there that the savings are found and the two tie together so well.
The noble Lord, Lord Martin, emphasised the role of housing. He touched on central heating making such a difference to people’s homes, preventing bronchitis and emphysema and so on. When I visited the Care & Repair scheme in Leeds recently, staff told me that one of the most frequent causes of people having to go into hospital and of their homes being found totally inadequate was the fact that a central heating system that was 15 or 20 years old had fallen apart, and they did not have the wherewithal or the knowledge to replace it with a new boiler because that would involve a few thousand pounds. That one adaptation to the home alone would have made a huge difference to their health and well-being.
I am grateful to the noble Baroness, Lady Howarth, for emphasising that putting things in the Bill attracts the attention of the leadership of local authorities to their priority and importance. I am grateful also to the noble Baroness, Lady Wheeler, who emphasised what the Joint Committee on the Bill had said and how, since the previous legislation had gone through, we had seen very patchy take-up, with health and well-being boards and the rest, in recognising across the piece that housing is so important.
The Minister hoped that I would be comforted by the very full exposition that he gave of how there is the implication in so many places in the Bill that housing should be taken on board. I am sure that it is the intent of government that housing should be there; it is just a shame that it is so well hidden from so many of us. Although using the spending review’s £3.8 billion as a ring-fenced sum will require people to be more joined-up, including in relation to disabled facilities grants, and although the legal basis is no doubt in the Bill, it would be helpful if that was more overt and the Bill could make it a little clearer. We may want to return to this matter when we have heard about the compact that the Department of Health is working on, which would be very important if it emphasised housing in a fundamental way. For the moment, I beg leave to withdraw the amendment.
Baroness Wheeler
“( ) In exercising its duties under this section, a local authority must have regard to the relevant joint strategic needs assessments and joint health and wellbeing strategies required under sections 116 and 116A of the Local Government and Public Involvement in Health Act 2007.”
Baroness Wheeler
My Lords, the amendment is supported by my noble friends Lord Hunt and Lord Beecham. I shall speak also to our Amendments 81C and 87ZZA, as well as to other amendments in the group.
As my noble friend Lady Pitkeathley showed last week, we on these Benches will never tire of banging the drum for the importance of integration of health and social care—and housing—from the point of view of patients, service users and their carers. Our amendments would include in Clauses 3 and 6 specific reference to the body that stands the best chance locally of making this happen: the health and well-being board. These clauses deal with integration and the duty of local authorities to co-operate with relevant partners. We also stress in respect of these clauses, and Clause 2 under our amendment in an earlier grouping, the importance of the Bill emphasising a joint responsibility for co-operation and collaboration between local authorities and relevant partners, such as NHS bodies in their area.
Baroness Greengross
My Lords, I rise to speak to my Amendments 87ZA and 104A. I thank the noble Baroness, Lady Wheeler, for what she said and I heartily agree with her.
We read far too often about frail older people blocking beds in hospital wards and, apparently unintentionally, making the health service very difficult to function properly. However, they are there due to inadequate planning. These two amendments are intended to try to ensure that the discharge process is started when somebody goes into hospital—that is, right at the beginning of their stay in hospital.
We all have experience of very poor practice. My personal experience is of a 94 year-old who was admitted to a London hospital as an emergency and therefore arrived in pyjamas and with bare feet. He was returned home in pyjamas and with bare feet in the late evening in winter. He had to cross a grassy patch, go into his block of flats and up a flight of stairs in that condition in order to reach his home. There was no planned process to look after him. That sort of thing is totally unacceptable. The aim of this Bill is to stop that sort of practice and to make sure that it does not happen in the future. I think that all your Lordships feel the same about this: we have to get it right. As I said, I feel that the discharge plan should be initiated when someone is admitted to hospital and it should be used as the template for the discharge, when it occurs.
I declare an interest as chairing the All-Party Parliamentary Group on Dementia. We know from one of the inquiries that we have carried out that most frail older people who go into hospital have comorbidity—that is, they have more than one condition. If they have gone into hospital for a fractured femur to be fixed or for some other physical condition to be dealt with, they will stay in hospital for much longer if they also have, for example, dementia. They stay in hospital longer partly for the same reason: that no plan has emerged to look after them when they come out. It is very bad for them to be in hospital and it is bad for all the other patients as well, for obvious reasons. We need to ensure that the local authority and relevant partners know about the special conditions of a patient to get the planning right. We need to ensure that special care and support needs are taken into account long before they leave hospital. That is the reason for those two amendments, which I very much hope that the noble Earl will accept as part of good practice.
Lord Rix
My Lords, I wish to speak to Amendment 87ZB, so wholeheartedly supported by the noble Baroness, Lady Wheeler. It would add providers of relevant services to the list of relevant partners of the local authority. The amendment lays the foundation for a number of amendments which I have tabled in the safeguarding section of the Bill, which will be taken later. There has been widespread concern that the mechanisms and procedures in place to safeguard adults at risk of abuse or neglect are totally inadequate.
Time after time, we have witnessed how processes have failed or safeguarding has not been taken seriously, which has led to serious consequences for people with a learning disability. For example, there is the death of Francesca Hardwick and her mother Fiona Pilkington, the murder of Steven Hoskin, and more recently, the abuse scandal at Winterbourne View. There have been a number of prominent cases where the provider has failed to co-operate in providing information on adults at risk or where cases have occurred such as that reported in the aftermath of Winterbourne, where the provider declined to share information for the serious case review and there was no requirement on it to do so.
The amendment is therefore intended to add providers as relevant partners, so that they are in the frame for further amendments to the safeguarding part of the Bill in Clauses 41 to 46. When we talk about providers, I am referring to those who are providing a service which has been commissioned from a person's care plan, such as care and support or education services. Although I appreciate that regulations will set out other relevant partners, we feel that providers should be named explicitly in the Bill. This will emphasise the importance of the provider of services being subject to the duty to co-operate and will bolster the safeguarding process accordingly. I look forward to hearing the Minister’s thoughts on the matter.
Lord Sutherland of Houndwood
My Lords, I give particular support to the amendment proposed by the noble Baroness, Lady Greengross, for two reasons. First, we all know from a passing acquaintance with hospitals either in our own or relatives’ cases that they are large and complex organisations. Unless a proper assessment is made early on after someone’s entry to hospital needing care, the entry will not be recorded. If it is not recorded, you can be sure that those responsible for the discharge of the individual will not have been present when the assessment was made.
The complexity of the system is such that that is how it is—would that it were better and, doubtless, it can be better, but the reality is that unless a proper assessment is made and recorded, those discharging someone from hospital will not be able to specify adequate provision. In education, we all talk about added value. That concept has a place in hospitals. What will be the added value that will allow a proper discharge and will, in that process of discharge, ensure that the patient in question will not return early to hospital? That is the second reason for supporting the amendment of the noble Baroness, Lady Greengross. The research that I have seen indicates that where inadequate care is provided—that includes care plans not made at the point of discharge—the individual is many times more likely to find themselves back in hospital within the month. It so happens that I have seen research related to intensive care units, where you might expect that to be even more prevalent, but it applies across the board. To be sure that the care is right is to be sure that the care plan is right. My argument in supporting these amendments is that that has to include an assessment at the beginning. It helps, too, when a patient is moved to another more specialised hospital. That happens quite often as the investigations take place, so there is a great need for this.
Baroness Barker
My Lords, I wish to speak to Amendment 82A, which is in my name in this group, and to support the amendments in the name of the noble Baroness, Lady Greengross. For well over a decade, we have had evidence that the recovery rates for people being discharged from hospital during the week, through to people being discharged on Friday, vary enormously. There has been evidence in abundance for the past decade that the failure to integrate care plans for people leaving hospital with community services leads to their readmission into hospital as an emergency—and in some cases, to their death. All the factors that contribute to that should not be news to anyone who has ever read about delayed discharge.
At the heart of our failure to really look after older people who go in and out of hospital is not just the failure to carry out assessments at the proper time but the failure to share that information with all the relevant people along a care pathway. It has been interesting, particularly over the past year, to begin seeing something of a change taking place both in health and social care. One of the driving factors behind that are the shared outcomes frameworks to which health, adult social care and mental health now have to work. The fact that we have the five overarching domains and that each of them is working to performance indicators below them is beginning to have a real influence, not just on high-level strategic planning but on front-line work.
We have always known that there have been excellent examples of integrated care. Where care works well, it works fantastically well and where it does not, it is just a disaster. The trouble is that we can never really pinpoint and identify where that will happen, other than that the systems that work well are always those which have the patients at their heart, involved in the planning process as well as being recipients of care.
My Amendment 82A is prompted, as I think noble Lords will know from last week, by the Christian Scientists—the people who, as part of their belief system, wish it to be known that their care should not involve medical treatment because that is incompatible with their beliefs. Beyond that small group of people, whose beliefs I do not share, it is important to register in all this that when we are building systems that assess the needs of older people there has to be within them a point at which older people can dissent, particularly if quite forceful medical decisions are being made about their care. Sometimes we get incredibly enthusiastic in our support of doctors and manage to let that take things over completely.
The noble Baroness, Lady Greengross, has highlighted the key points that we need to focus on because, at the end of the day, integration depends entirely on all the different care providers in the pathway working to common information. If we cannot start now to develop those systems, we will not achieve what has proved for so long to be that elusive solution to integrated care.
Baroness Wall of New Barnet
My Lords, I also support all these amendments, particularly in relation to the previous discussion of getting older people out of beds that they are blocking, as I think the noble Baroness, Lady Greengross, put it. That is perhaps an inappropriate word but, in reality, those are the facts. The care plan that everybody has talked about is important, and hugely effective when it works. I have to admit that in my own hospital—I declare my interest as chair of Barnet and Chase Farm Hospitals Trust—it does not always work. Very often, the breakdown with the local authority can come from the start of the agreement on a care plan—what will happen to the individual, how many X-rays they will have, where they will go at the end and so on.
One of the good things in the new system—there are several—is the CCGs. The relationship between clinical commissioning groups and local authorities is proving, in the very short time that it has been working in my area, effective. The more pressure on commissioners in terms of getting hospitals running better, the more interest they have in making sure that local authorities are doing their bit as well. That partnership, in my view and my experience of the past months, has been working much better, which, for us, is a very good thing.
Baroness Gale
My Lords, I will speak to Amendments 92ZZEA and 92ZZEB. Clause 22 is titled:
“Exception for provision of health services”.
Subsection (1) is crucial, as it sets out the legal test for when NHS continuing care or registered nursing care should be provided and when the means-tested social care system may lawfully provide for nursing care.
Recently, I have been listening to people give evidence to the APPG on Parkinson’s, which I chair and which has been conducting an inquiry into NHS continuing care. Listening to the witnesses, it has become very clear that there are often lots of problems with the health service and social care services arguing over funding. People are having difficulty accessing continuing care under the NHS and have to get over lots of barriers. It is quite heartbreaking to hear the problems that people are having.
The wording of Clause 22 still carries a potential risk for those who self-fund their care. There are various provisions in the clause that allow local authorities to arrange for health services that should be provided by the NHS. Once councils start delivering healthcare, when they traditionally used to deliver means-tested and chargeable social care, there is a risk that someone—somewhere in the system—will mistakenly conclude that the council can charge for those services. There is a need to ensure that self-funders are not exposed if they are found to be eligible for NHS continuing care, or registered nursing care, and the package of delivery is with the local authority. These matters were raised by the Joint Committee scrutinising this Bill but have not yet been addressed.
In legal terms, local authorities are prohibited from providing anything authorised or required to be provided under the NHS Acts. This means that social services cannot provide care home accommodation if a power or a duty to provide the accommodation exists under any of the NHS Acts. Clause 22 has narrowed this down to just “required”, for example by omitting the “power” or authorisation provision. That leaves local authorities able to provide accommodation that the NHS has a power to provide. I believe that disputes and confusion have occurred between councils and the NHS over continuing care, and this seems to be a recipe for more. The Bill should be amended to prohibit local authorities providing a service or facility that is authorised or required to be provided under the NHS Act 2006.
My amendment would mean that local authorities would be prohibited from providing health services that are authorised or required to be provided under NHS Acts. My aim is to make it clear who can deliver what, so as to avoid self-funders being at risk, however small that risk might be, of having to pay for care that they should be getting free.
Clause 22(4)(a) also states that a local authority may, despite the prohibitions, arrange for care home accommodation with nursing care if it has consent to do so from the clinical commissioning group. This may also put self-funders at risk of being charged for services that should be free.
These amendments would introduce an explicit clause that sets out that, where a local authority provides services on behalf of a clinical commissioning group, the authority may not recover the cost from the individual whose needs are being met. I trust I have set out clearly why these amendments are needed and I hope that the Minister will agree with me.
Earl Howe
My Lords, it is vital that care and support, health and other services are joined up, as this offers the potential to make measurable improvements in individuals’ outcomes and experiences of care and support. Clause 3 places a duty on local authorities to carry out their care and support functions with the aim of integrating services with those provided by the NHS or other health-related services such as housing. Amendment 81C, tabled by the noble Baroness, Lady Wheeler, raises the issue of co-operation duties on the NHS; I have no issue with that sentiment. Clause 3 is intended to reflect the similar integration duties placed on NHS England by Section 13N, and on clinical commissioning groups by Section 14Z1 of the National Health Service Act 2006, in the context of this Bill.
Clause 6 imposes a general duty to co-operate between the local authority and other relevant authorities that have functions relevant to care and support. Clause 7 supplements this by creating a specific duty to co-operate in individual cases.
Clause 22 sets out the limits on what a local authority may provide by way of healthcare and so, in effect, sets the boundary between the responsibilities of local authorities for the provision of care and support, and those of the health service for the provision of healthcare. Our intention is to replicate the effect of the current prohibitions on what a local authority may provide by way of healthcare, which are imposed under Sections 21 and 29 of the National Assistance Act 1948 and Section 49 of the Health and Social Care Act 2001. This is a matter eloquently raised by the noble Baroness, Lady Gale, in tabling Amendments 92ZZEA and 92ZZEB.
The word “authorised” in Section 21 of the 1948 Act has resulted in much confusion and case law. The intention behind Clause 22 is therefore to simplify the language and to make the boundary clearer without moving it. Make no mistake: where nursing care is being funded by the health service, it will continue to be unlawful for a local authority to recover the cost of this from the individual. It is the relevant clinical commissioning group that would be responsible for this cost.
On Amendment 82A, I wholeheartedly agree with my noble friend Lady Barker that no one should be given medical treatment or be medically assessed against their wishes where they have capacity to make such a decision. I hope that my noble friend will be reassured that the existing legal position and clinical practice is clear on that point.
Amendments 87ZZA and 81B were, again, spoken to by the noble Baroness, Lady Wheeler. The prominence of health and wellbeing boards will be strengthened through their role in signing off the joint plans that are required as part of the £3.8 billion pooled fund between local authorities and the NHS to support joined-up and integrated working. The need for local commissioners to engage with their health and wellbeing boards is made clear through their composition, which includes the director of adult social services, the director of children’s services, the director of public health and a representative of each relevant clinical commissioning group. The duty to co-operate already applies to these health and wellbeing board members.
Baroness Wheeler
My Lords, I thank the Minister for his comprehensive response. We need to reflect very carefully on the issue raised by my noble friend Lady Gale in respect of NHS continuing care and the social care boundary and its impact on self-funders. I will discuss with her whether we need to return to this issue on Report. She is right to mention the Joint Committee, which is particularly concerned. We need to be absolutely reassured that the Bill takes these issues forward.
I will study the Minister’s comments on health and well-being boards. He more or less agreed with me but did not want reference to them in the Bill. However, he accepted my Amendment 81C—which is a first for me—so I am grateful for that. With those comments I thank noble Lords for a very important debate, particularly on hospital discharge, and I beg leave to withdraw my amendment.
Baroness Meacher
Baroness Meacher
My Lords, Amendment 82B has the effect of requiring local authorities not only to provide information about the system of care and support, how to access it and so forth, but also to take action to facilitate access to that information; that is, to try to make sure that people know it is available. My remarks also apply to Amendment 86C, to which I have added my name, which requires that the local authority must produce or arrange for the production of packs of information relevant to the needs of individuals with specific medical conditions and ensure that these packs are provided to individuals following the diagnosis of a specific condition—not waiting until much later on, when they probably need social care or other intervention.
First, I apologise to the Minister and to your Lordships that I was unable to be here for earlier sittings of the Committee. I have been out of the country a lot on other Lords’ business and just have not been able to participate. I also must thank the Alzheimer’s Society for its help with these amendments.
I join other noble Lords who have welcomed the Bill, which has an emphasis on the provision of care and support for people who need it. I was impressed by the quote at the top of the Department of Health Factsheet No. 1, which states:
“Information, information, information; without it, how can people be truly at the heart of decisions? Information should be available to all regardless of how their care is paid for. There are some things that should be universal; information is one”.
That is from a Department of Health document; perhaps other noble Lords have quoted it before me, in which case I apologise. The point is that if people are unaware that information and advice are available, they are unlikely to look for them. We can assume that if these amendments are not accepted by the Government, there will be considerable underuse of information services and, of course, that the people who will lose out will, as always, be the most vulnerable—those who most need that information.
The Alzheimer’s Society tells me that it frequently hears of the difficulties people face when struggling through the complexities of the health and social care system for the very first time. Too often, people with dementia and their carers report that they did not have access to the information and advice they needed because they simply did not know it was available. We all know that feeling: if only we had known that it was available, we would have looked for it, whatever it was. Sadly, people often come across services by chance and far too late.
If a person in the early stages of Alzheimer’s is aware of a memory clinic, for example, which can either provide help itself or refer the client on to organisations such as the Alzheimer’s Society well before they need social care, the client can make adjustments to help them continue living as normally as possible and for as long as possible in their own homes. These are simple things like putting a note on the front door that says, “Are your keys in your pocket?”, and suchlike. With guidance, carers can gradually increase the home adjustments as they notice the need for them and thus defer the need for the involvement of social services and ultimately residential care.
Noble Lords will know the point that I am coming to. We all know that resources are incredibly tight. The point is that timely information and making people aware that it exists is very cost-effective. If you manage to keep people in their homes much longer, and if you manage to help them avoid social services intervention, all this will save taxpayers’ money. We can expect that a small spend on a proactive approach to information provision will save the taxpayers a great deal of money over time. I beg to move.
Baroness Greengross
My Lords, I support Amendment 82B in the name of the noble Baroness, Lady Meacher, to which my name is also listed. At the same time I speak to Amendments 83, 83A, 84, and 85. I think that Amendment 86C is in the next grouping; I hope that I am right.
On Amendment 82B, we know that many people, as well as their carers, say that they did not have access to the necessary information and advice—and that they did not even know that it was available. They have had to seek out the information themselves. We are talking about people who are vulnerable and often at crisis point. It is the worst time for either frail people or their carers to have to find out where to go and how to find the advice they need. I would add that, in my long time working in this field with older people, I once had a telephone call from a Minister in the department whose mother needed care and who was asking me to help because this Minister had no idea where to go to get the information and advice. It is not just people who do not know their way round the right office—it is all of us at certain times. We just do not have the knowledge of where to go.
If we require local authorities to adopt a proactive approach to information provision, perhaps it will ensure not only that people have the right information at the right time but that the information is in a format that is accessible. This will help people to get the right care and support in place and give them the confidence they need in very difficult situations.
On Amendments 83, 83A, 84 and 85, I was very pleased to see that, in Clause 4, the Government have incorporated a key element of the Joint Committee’s report into the Bill, namely that it is part of a local authority’s duty to establish and maintain the service for providing people in its area with information and advice. We must make sure that advice relating to care and support includes information about access to regulated independent financial advice.
The Bill will also oblige local authorities to offer deferred payment agreements which will involve local authorities in taking an interest-bearing charge on the property of an individual against the cost of care fees which, as we know, will be repaid after the individual’s death. As has been said, however, individuals offered these products may be highly vulnerable. They expect the same authority to assess fairly both their eligibility for care and their ability to fund it, as well as providing appropriate advice and information about a financial product which the local authority itself is offering to pay for that care.
In a way this is in competition to FCA-regulated financial products, so, obviously, there is a potential conflict of interest here. This conflict is exacerbated if the care for which the loan is made is directly provided by the local authority and if the level of charges and interest are also determined by the local authority. It is therefore very important that people are directed towards regulated financial advice as part of the decision-making process. This amendment seeks to do that through regulated, accredited financial advisers such as the people who are members of SOLLA, the Society of Later Life Advisers. Only in that way can the development of safe and secure financial products be facilitated.
Baroness Browning
My Lords, I will speak to two amendments standing in my name in this grouping. The first is Amendment 86H, to which the noble Baroness, Lady Pitkeathley, has put her name. This deals specifically with proportionality and early identification in providing information and advice.
In its report on adult social care, the Law Commission argued that it was essential that the issue of proportionality be addressed in the regulations setting out the assessment process. The Law Commission stated that where a person has complex or multiple needs, a proportionate assessment would require an in-depth and comprehensive exploration of those needs—something which we have already heard about this afternoon. Defining complex needs can be difficult, with the full extent of needs not always immediately identifiable. For instance, older people in particular do not always present their needs accurately on first or subsequent contacts.
Deploying qualified social work staff across all areas of service provision, including the information and advice stage, would help—as this amendment seeks to do—to ensure that the potential for complexity is recognised early on and the individual receives signposting to non-statutory services and/or initial statutory sector support proportionate to their needs.
Looking round the Chamber, I see several people who I meet on a weekly basis as we are currently carrying out post-legislative scrutiny of the Mental Capacity Act. The assessments of capacity across a range of people—not just the elderly, who are very important, but even much younger people—are extremely important. It is extremely important that there are qualified social workers who are involved in this exercise.
To have the social worker available at the pre-assessment stage, as part of an information and advice team, would allow unqualified staff the benefit of accessible professional support. I am aware that the College of Social Work supports this measure and the duty on local authorities to ensure that in providing advice and information, qualified staff are deployed in sufficient numbers to ensure that all aspects of need are taken into account. This would ensure that people are put in touch with the most appropriate services for them from the earliest opportunity.
I am aware of the letter that my noble friend sent to the noble Lord, Lord Hunt, dated 27 June, in which he covered in the first paragraph the query by the noble Lord, Lord Warner, about ensuring that there are sufficient skilled workers. When he responds, would he cover this question of sufficient qualified social workers? His reply to the noble Lord dealt mainly with staff employed in the health service as opposed to social services. We have heard a lot in these debates about the need for multidisciplinary teams in decision-making, so I would be grateful if he would address the question of the number of skilled social workers who might be deployed, particularly at the initial information and advice stage when early assessments are carried out.
My second amendment in this group is also in the name of my noble friend Lady Barker. It addresses the question of independent advocacy and proposes a new clause. Of course, I am aware of the role of, and the statutory requirement for, IMCAs in the Mental Capacity Act. I will not pre-empt the findings of the post-legislative scrutiny committee on the Act, but I will explain why I felt it necessary to propose a new clause in the area of independent advocacy. I refer the Committee to my interest in the register, and in particular my ongoing interest in autism, mental illness and people with learning disabilities.
The right to advocacy is essential to enable the people who find it hardest to communicate to exercise their rights, represent their interests and obtain the services they need. Clearly, if somebody is deemed not to have capacity, there is already statutory provision for an IMCA to assist them with decision-making. However, it is also vital that those who experience substantial difficulty in understanding, retaining, using or weighing information relevant to an assessment, and then expressing and communicating their views, should also have access to an advocate. I referred just now to autism. People on the autistic spectrum might be deemed to have capacity but their disability might mean that they would have difficulty on their own, without the help of an advocate to explain and help them work through the decision-making process. That group is not adequately covered by the provisions of the Mental Capacity Act.
Advocacy is separate from information and advice. It provides support to some of those who are most vulnerable and most in need of services, including those with autism. There was a recent commission on autism and ageing chaired by the noble Baroness, Lady Greengross. Both she and I have had to forfeit the presentation of that report to be here in the Chamber. The report found that the families of people with autism frequently act as their advocates. Ninety-six per cent of parents with a son or daughter with autism recently told a National Autistic Society survey that they were concerned about what would happen when they passed away or were unable to support their children. This fear is common to parents of people with many different lifelong disabilities, not just autism. Families frequently say how worried they are about what will happen when they can no longer perform an advocacy role, and that independent advocates must therefore be available.
If the Bill is to help ensure people access the support they need—including people who are currently missing out—advocacy will play a vital role. I ask my noble friend to consider this large group of people who are not covered by existing statutory provision, for whom the new clause would provide a safety net to enable their services and package of care to go forward, thereby ensuring that they have equal opportunity to access the services that we are discussing in relation to the Bill.
Lord Lipsey
My Lords, perhaps I may remind the Committee that I am the honorary president of the Society of Later Life Advisers. SOLLA accredits the gold-standard financial advisers who will be so important to the working of the Bill.
My six amendments in this group are Amendments 83B, 83C, 86B, 86D, 86F and 86G. Before I turn to them, I will say a few words more generally about advice and the Bill. If the Bill is to do the job we all hope and expect it will do, information and advice should be not just an add-on but a central requirement, without which the Government’s plans, however well meaning, will collapse, and old people and their families will end up frustrated and angry. This is for several reasons. First, there is a widespread reluctance among old people and their families to face up to the problems of care in old age: how to get it, whether to be cared for at home or in a home, and how to pay for it. It is marvellous that people are living ever longer, but that does not mean that the very last years of their life are easy. Not surprisingly, people do not like to contemplate the years before their demise until they feel they absolutely have to.
Secondly, there is an extraordinary ignorance among older people and their families about social care. More than one person in two still thinks that the state will pay in full for the care that they will require. Thirdly—it is early days, I know—there is even less understanding of Andrew Dilnot’s solution. For example, many people—I have even come across a few in this House—think that once you have spent £72,000 on care, you will be looked after for free. This is not so. You will have to fund hotel costs of £12,000 a year. More importantly, you will have to fund the excess care costs over what a local authority would pay to look after you. That could cost a further £25,000 a year. If my arithmetic still works, that means many people will have to pay £37,000 a year after the cap has been reached, so they should plan for that.
Different people in different situations need different advice. Somebody whose care costs are paid in full needs different advice from somebody on the means test. Whatever their circumstances, very few people are capable of navigating these waters without a trusted pilot or pilots. Local authorities are experienced in conducting assessments of people and in helping them. The noble Baroness, Lady Greengross, made this point well. They have interests that may be different from, or even conflict with, those of the people they are advising. For example, under the existing deferred payment scheme you do not have to sell your house but can take out an interest-free loan. It is evident from the figures that many local authorities try like mad to persuade people not to go down that road because it costs the authority a lot of money if they do. Even if it would be beneficial to the individual, they steer them away. It is human nature. That is why it is vital that when advice is needed on this kind of subject, it should be independent of the local authority.
Baroness Browning
I agree with what the noble Lord said. Something that is rarely mentioned but is often a solution for many elderly people when they go into care is not that their house is sold but that it is rented out. That can be a very viable, practical and suitable solution. Local authorities never mention that, and nor do they have the means to provide such a service.
Lord Lipsey
I quite agree with the noble Baroness. That is exactly why independent financial advisers can be so helpful. Often, the rent on the house will pay for the whole of care, and still leave the home to be handed on to the children if that is what the old person wishes.
All this underlines the fact that it is crucial that the advice comes from people who are qualified to give it—not necessarily local authority social workers, CAB advisers, regulated independent financial advisers and so on. Nor is it any good the local authority just handing out a list of people and saying, “You can go and see them and ask their advice”. For one thing, frequently there are issues of mental capacity, and the stress on an old person at this time is likely to be severe, particularly if they are thinking of going into a care home. For another, there is the general reluctance problem, and people are also often frightened by the cost of the independent financial advice that they may be seeking.
Some local authorities in these circumstances are performing heroically. I recently opened a centre in West Sussex which combines the resources of voluntary organisations, the local authority and independent financial advisers to offer a comprehensive service. It has recently relaunched its service and a local radio station, Spirit FM 96.6, has featured it in its drive time programme every weekday, which is tremendous. Incidentally, in doing this, the local authority is not acting wholly selflessly. Many people in West Sussex who have moved out of London to retire have quite a bit of resources but do not have infinite resources. If they are not well advised on how to use their resources they will run out of money and fall back on the council and its means-tested benefits to pay for their care. However, if they are properly supported, learn to use their money well and are advised of the products that are available to help them, they will not fall back on the local authority. So this, again, is a case where appropriate advice, properly structured, can save public money, not cost it.
Lord Sharkey
My Lords, I support the amendments in this group in the name of the noble Baroness, Lady Greengross, and I shall speak to my Amendment 86E. The noble Baroness has already spoken eloquently to her amendments and I simply wish to say that not only are they compelling but it is critically important that they become part of this Bill.
The decisions that most people make under the terms of the Bill will be some of the most important that they will ever make and it is obviously critical that people are able to make them on the basis of proper and impartial information. Many of these decisions will involve taking a view about the merits of various financial products. Many people—perhaps the overwhelming majority—will have had no experience of doing this.
There will inevitably be a high degree of uncertainty about how to choose and about the detailed implications of those choices. People will need guidance in deciding which, probably complicated, financial product to buy. This is no less true for these products than for any complex financial product, with the added emphasis that a wrong or inappropriate choice could have pretty unattractive consequences. That is why I strongly support the proposal to introduce regulated financial advice into the process, as the amendments of the noble Baroness, Lady Greengross, seek to do. Only with this kind of advice can people have some comfort that they are making the correct choices in a complex and difficult area.
My amendment in this group, Amendment 86E, also deals with the information and advice that a local authority must provide. As the Bill stands, Clause 4(3) simply says:
“In providing information and advice under this section, a local authority must in particular seek to ensure that what it provides is sufficient to enable adults”,
and so on. There are two problems here. The first is the phrase “seek to ensure” and the second is the unqualified notion of “sufficient”.
I raised the issue of sufficiency at Second Reading, when I said that there appeared to be no test for it. There is no provision in the Bill for local authorities to have a mechanism for measuring and reporting the success of their efforts in providing information or on the success of that information in achieving its objectives. My amendment is intended to address those concerns. In particular, it would remove the phrase “seek to”, so that instead of local authorities having to seek to ensure that the information they provide is sufficient, they simply must ensure that it is sufficient. The phrase “seek to” seems to me to weaken the obligation placed on local authorities quite unnecessarily. It is quite possible that any local authority could demonstrate that it was seeking to do something without actually doing very much at all. Arguably, for example, the slow and gradual implementation of a plan to provide information would fulfil the local authority’s obligation.
I am sure that that is not what the Government had in mind or what local authorities would really want to do. In that case, I see no merit in having local authorities’ obligations significantly weakened by the use of the phrase “seek to”. My amendment would remove this phrase and give the local authorities a clear, simple, plain-English duty to ensure that the specified information is sufficient for the purposes set out in the Bill. If it is possible to have a measure of sufficiency, as I believe it is, it is surely possible to ensure sufficiency rather than just seeking to ensure it. Again, in plain English—or in fairly plain English—the situation is this: we want local authorities to make the information that they must provide by virtue of subsections (1) and (2) of Clause 4 sufficient for the purposes set out in Clause 4(3)(a) and (b). We want them actually to do this, not just seek to do it.
That brings me to the notion of what “sufficient” may mean and what tests might apply. My amendment would qualify “sufficient” by inserting the word “demonstrably” before it. I can probably guess what my noble friend the Minister will say about the use of the word “demonstrably”. He will probably ask, “Demonstrable to whom?” and, “Demonstrable according to what criteria?”. The phrase “demonstrably sufficient” has a clear meaning in the context of Clause 4(3)(a) and (b). It means simply that local authorities will have to be able to show evidence that the information they provide actually does enable adults to identify matters that are or might be relevant to their personal financial position that could be affected by the system provided for in Part 1. It also means that local authorities will have to be able to show that the information they provide does enable adults to make plans for meeting needs for care and support that might arise.
Commercial organisations routinely apply this kind of test to the information they put out. It is not difficult, time-consuming or expensive to do. Doing it would have the merit of providing a real test of the meaning of sufficiency and a mechanism for reporting success in delivering it. I believe that this is what the Government and local authorities want. Using the phrase “demonstrably sufficient” provides for that.
Baroness Pitkeathley
My Lords, I support almost all the amendments in this group because I acknowledge their importance, particularly from the point of view of the Joint Committee, which similarly placed a great deal of store on the provision of information and advice. Indeed, it suggested that there should at the very least be a national campaign to promote the new arrangements to those who might use them.
I rise to speak briefly to Amendment 86H, to which I have put my name, along with the noble Baroness, Lady Browning. Social workers on the whole do not get a good press. They are heard of only when things go wrong. Most of the time the vast amounts of quiet, patient work that is carried out by social workers in local authorities, the NHS and the voluntary sector is ignored. We should give their skills and the vital contribution that they make to help people find their way around complex systems more recognition. The noble Baroness made it clear that she is suggesting that a social worker needs to be involved not in all cases, but just when present and foreseeable needs are classed as complex. In those cases we must take into account that people’s ability to take in information is tremendously variable, depending on their situation and state of mind at the time. I have lost count of the number of conversations I have had with service users and carers who are totally bemused by the information they are given or the access that they have even when they manage to get hold of some information.
I will never forget the carer who gave me a wonderful illustration some years ago. She said, “I feel as though somewhere out there is a great mushroom of information. If I could just find my way up the stem, I’d find out where all this information is, and it would help me. But I don’t even know where the stem begins, and nobody seems to be able to help me”. Information in its raw state is often very difficult to interpret. It is the skill of the social worker in assessing what information is needed, when and in what form it is needed in complex cases, and signposting the information and advice that is required in every case. Those particularly complex cases need social worker involvement. Such cases are not being met and will be even less well met in the future with the new system and range of information that will be available.
Baroness Gale
My Lords, I rise to speak to Amendments 83ZA and 86A, tabled in my name. For individuals entering the world of care and support for the first time, it can be a confusing, complex and protracted process. The introduction of information and advice services for those individuals will be very welcome.
I mentioned earlier that I chair the APPG on Parkinson’s and that we are currently conducting an inquiry into NHS continuing care. Continuing care is a package of care that is arranged and funded by the NHS and is free of charge to the person receiving it. The decision for eligibility rests not on a person’s condition but on whether the need for care is primarily due to health needs. While there are just over 57,000 people in receipt of NHS continuing care in England, it is unknown how many people may actually be eligible in law and have not even applied for it, or who have failed in their attempts to be assessed properly for it. As part of the inquiry into NHS continuing care, I have been hearing from people about their real problems in accessing NHS continuing care. We found during our inquiry that people with Parkinson’s and other long-term conditions are not given information about NHS continuing care. The impression that I have been given is that, because it will cost the NHS considerably, people are not encouraged to apply for it. This leaves people with no option but to go to the means-tested social care system to have their health needs met. That situation is entirely unacceptable.
As Clause 4 introduces a duty on local authorities to establish and maintain an information and advice service, it is important that all the appropriate information and advice are provided. With the further integration of health and social care, it is essential that individuals are in full possession of the facts about all aspects of the support to which they are entitled. While the list currently provides some crucial aspects for people receiving care and support, I believe that NHS continuing care is a glaring omission. We hear of the two services arguing the differences between what is a health need, which is free at the point of use, and what is a social need, which is currently charged to the individual. This can often lead to the individual either being forced unnecessarily to pay for their own care while the debate goes on or being left trapped in their hospital bed. Although NHS continuing care is part of the health system, it must be included in the list provided by the local authorities as set out in Clause 4. People who may be eligible for NHS continuing care are also likely to have such needs that they could be in receipt of support provided by their local authority. If their needs change so as to render them eligible for NHS continuing care, there should be a seamless transition to that system that does not affect the standard of support they receive.
A strong information and advice service must include information about an assessment for health provision, so that individuals can go to this service confident that they will find out everything they need about care and support. The Care Bill offers an unprecedented opportunity to address these defects within the NHS continuing care system. Including it in the list of matters about which people should be given information and advice would promote awareness of its existence and prompt councils to refer people for assessment where they appear to be eligible for NHS continuing care. I trust that the Minister will take note of the points that I have made and that he will be able to accept these amendments.
Baroness Barker
My Lords, I declare an interest in that I work with a number of charities involved in the provision of information and advice about health and social care.
When I read this policy, it seemed to me that it reflected the practice of giving information and advice as it has been done for the past 20 years. I am not sure that that model of information and advice-giving is sustainable. It has depended largely on local bodies, many of which are in the voluntary sector and extremely professional in their services, but which provide a lot of generic, low-level advice. I do not think that that is sustainable—I was going to say in the longer term but, given the way that local authority budgets are going to have to decrease by a third by 2015, I do not think that this is sustainable in the short term either.
In future, there will increasingly be a move towards providing information digitally. New organisations and new social enterprises, such as IncomeMAX, are already heading down that path, and a number of local authorities are increasingly turning much of their provision over to that way of doing things. That is fine for people who are very well informed and who can access information in that format. What I cannot see is a sustainable funding model for the sort of high-level, complex financial advice that the noble Lord, Lord Lipsey, was talking about. This is necessary when people need to be enabled to go through the process of making decisions about, let us face it, the biggest asset that they have, which is their home. We are talking about something on an altogether different level.
We should also note that the system that we have had until now in terms of the provision of advice about social care was predicated on there being different eligibility criteria throughout the country. That is not going to be the case in future.
Like many noble Lords, over the past three or four years since Andrew Dilnot first appeared on our horizons, I have attended many seminars and lectures where people have tried to work their way around this problem. Two things strike me as being important. First, we cannot lay all the obligations on local authorities alone. At least in part, the NHS has to realise that it has to fund information and advice as part of the overall health and well-being package. I freely admit that I have yet to come across people in the NHS who truly understand the basic importance to health of information and advice. One of the first things that the department and the Government could do is to work on how we explain to commissioners in the health service why the outputs of information and advice services are important to them.
Secondly, we already know—the noble Baroness, Lady Greengross, and I know very well—that if you ask a group of older people who have assets what is the number one thing that they want, they say that they want independent financial advice. They do not believe that the people who sell them products are independent. They are right not to do so. That is a problem for the providers of those products. The only way of getting around this that might work is if, in future, some of those products have an element of money within them that is somehow passed into a pooled fund of money that comes from the private and statutory sectors and which can be put towards the provision of independent advice. That is not a worked-out idea, but it contains within it something of the ideas that the noble Baroness, Lady Greengross, mentioned, which are the key points in all of this. She is right that there is a need for regulated advice. I am not quite sure at which point a person needs that. Is that regulated advice something that they need before they come to a decision about which financial product to choose? The law that governs the regulations that exist at the moment usually comes into play when somebody decides to buy a particular product, so there is a real problem about when people have access to the right type of advice. The noble Baroness is on absolutely the right track. Somehow, in all of this, we need to arrive at a point at which resources are spent by people with the right knowledge and the right degree of independence to enable them to come to the right decisions.
Lord Touhig
My Lords, I rise to support Amendment 88G in the name of the noble Baronesses, Lady Browning and Lady Barker, and myself. It introduces a new clause which would ensure that there is a duty to provide independent advocacy.
The right to advocacy is essential to enable people who find it hardest to communicate to exercise their rights; who find it difficult sometimes to represent their interests, and therefore obtain the services that they need. I spent just over 15 years serving in the other place and, throughout that time, I remember many people coming to my surgery who wanted advice and help. In many instances, they also wanted an advocate—someone who would put their case strongly and make sure that their voice was heard.
Reference has already been made to the Autism and Ageing Commission whose report was published today. It was chaired by the noble Baroness, Lady Greengross. I sat on that commission and it brought home to me again the importance of advocacy. I recall a lady called Clare Beswick, whose brother is autistic and has learning difficulties. She said:
“A best interest decision was made that Paul should live closer to me in the south east … I had to go to extraordinary lengths to enable Paul’s needs to be met … without my support, advocacy and intervention, I believe Paul would never have had the opportunity to be moved to be near us”.
That is the importance of an advocate.
I declare an interest as a vice-president of the National Autistic Society. The society’s survey in 2012 found that 66% of respondents over the age of 50 had not had their needs assessed since they were 18. Independent advocacy could make a real difference to these people by helping them to access an assessment and ensure that it is fair and accurate in relation to their needs. Of course, from the point of view of autism, advocates must have training in the condition so that they can interpret questions effectively and help individuals who have difficulties communicating.
People with autism do not self-present. Autism is about a lack of the communication skills that we in this Chamber take for granted. If the Government were to take on board this new clause, I can simply say to the noble Earl that it would represent a major leap forward for people who need strong advocate support.
Baroness Hollins
My Lords, I want to speak briefly in support of Amendment 82B, tabled my noble friend Lady Meacher, which emphasises the need to facilitate access to information and advice services relating to care and support. This is particularly the case for vulnerable adults such as people with learning disabilities. They may benefit from specialist facilitation to access such information. I should say that I chair a social enterprise which makes information on health and social care issues easier to understand for people who find written information too difficult. I am also the carer for an adult who currently receives care funded by the local authority, and who himself needs easy information.
I hope that the Minister will agree that my noble friend’s emphasis on facilitation will add necessary strength to Clause 4(4), which states that information,
“must be accessible to, and proportionate to the needs of, those for whom it is being provided”.
Without appropriate facilitation, the information may not achieve its objectives for those for whom it is provided unless it is done in the right way and in a timely fashion. Certainly, my own experience as a carer is that at the moment far too much information of the wrong kind is often provided, which is confusing. Facilitation is also about helping to choose the right information at the right time so that people can make good use of it.
Lord Rix
My Lords, as we are approaching Statement time, I will be brief. I want to support the noble Baroness, Lady Browning, in her Amendment 88G, which advocates the need for advocacy. In the world of learning disability, advocacy is often totally essential. Information and advice which is not proportionate, frankly, can be quite useless. Advocacy may well come from parents and carers, but sometimes it can be the wrong advocacy. An independent advocate is essential to many people with a learning disability, so I wholly support this amendment.
Lord Mackay of Clashfern
My Lords, I have spent most of my life as an advocate, so I have to say how important advocacy is. I want to say a few words in relation to the point made by the noble Baroness, Lady Gale, about continuing NHS care. The point is important in that Clause 22, as the boundary between health and social care, is vital.
I would have thought—I may be wrong and obviously the noble Baroness will correct me—that it ought to be the general practitioner who advises a patient as to whether they need continuing NHS care. During our deliberations in the Joint Committee there was quite a lot of discussion about the question of continuing NHS care, and it is obvious that there is some conflict of interest. The local authority providing the care may wish to have it provided by the NHS since that would be free and not its responsibility, so the boundary between the NHS and local authorities is particularly relevant in this connection.
At the moment, I do not see how it can be for the patient to claim continuing NHS care. The GP should be able to say to the patient that they need it and that should be sufficient for it to be provided. The likelihood is that a patient would have great difficulty in assessing for himself or herself whether continuing healthcare was needed, so it must be a matter for professional advice. I think that the advice that we are talking about in this context is advice about local authority services, not about the services that the NHS can provide. However, as I say, the boundary between the two is vitally important. I hope that the point made so eloquently by the noble Baroness, Lady Gale, arising from her own inquiry, will be looked at with a considerable degree of care.
Baroness Greengross
My Lords, I hope that noble Lords will forgive me, but I forgot to speak to one of the amendments that is relevant to this group; that is, Amendment 86C. It is about people with dementia who have had a diagnosis. I know that the noble Earl will share the Prime Minister’s view and those of all of us who have looked at the number of people who receive a diagnosis of dementia. We now want to ensure that many more are diagnosed, and diagnosed early.
However, there are many reports that people diagnosed with dementia and their carers feel terribly abandoned after they have had the diagnosis. The Bill’s emphasis on access to prevention services and information and advice for people, particularly if their needs have not yet reached the threshold of eligibility for social care, is welcome. But there are no specific prompts to ensure that people receive the information they need at the time when it is most useful. The risk is that, although local authorities have set up information and advice services, the information does not reach people at the right time. A post-diagnosis information pack tailored to specific long-term conditions should be given to every individual who is diagnosed with one of those conditions. It would provide access to tailored information about the support that is available to them, and it would enable them to cope with the challenges of living with a long-term condition. The pack would provide information on the likely impacts of dementia and contain core information on national and local services. I think that this would be an important aspect of providing the right information and advice at the right time.
Lord Beecham
My Lords, this Bill has the potential to do for social care what Beveridge did for the welfare state and Bevan did for the health service. It is potentially the most significant development in, for example, residential care since the workhouses were replaced by a more civilised form of residential accommodation.
The noble Baroness, Lady Barker, anticipated precisely the point I was going to make, which is that this is not just a matter for local authorities. My principal reservation about these amendments, if I have one, is that it looks as though the entire burden of information and advice is to be placed on local authorities whereas of course, as the noble Baroness rightly said, there are other potential partners who clearly need to be involved. I scribbled on the grid that is helpfully provided by those who support the Front Bench on this side the words “in collaboration with”, and then I thought of a number of potential partners. Of course the health service is one of them, but in addition I would suggest that the Court of Protection needs to be involved. It has a supervisory and supportive responsibility for a particular group of people and, with the development of lasting powers of attorney and so on, their deputies as well. I have to say—I have said it before and I will say it again—that I am not convinced that the Court of Protection is doing a terrific job in this area, but that is another reason why it should be looked at as a potential partner.
There may be other partners. For example, in the case of younger people perhaps with a learning or other disability, there are roles for those involved in further education, the Department for Work and Pensions and the Department for Business, Innovation and Skills. Those bodies might look at their role in terms of what is available by way of education, training and so on. It seems to me that a range of organisations should be involved, certainly as a whole, but more particularly in the provision of information and advice.
On these Benches we support most of the amendments that have been moved and spoken to this afternoon, with the qualification that, where relevant and necessary, a reference to collaboration should be included. For example, in Amendment 82B, the first amendment moved by the noble Baroness, Lady Greengross, one would want to see “in collaboration with” appropriate partners.
We support the amendments, notably moved by my noble friend Lord Lipsey, around the provision of independent financial advice. That seems very important. I have a slight reservation about Amendment 86D, which is about payment of,
“the reasonable costs of a first consultation with an independent financial adviser”,
to be paid for “by the local authority”. If I am ever in need of this kind of advice, I would be able to afford that relatively easily. Given the pressure on budgets, is a universal application of that principle necessary or desirable? That, however, is a detail, that might be looked at later. Given the scale of the potential involvement and the potential conflict of interest referred to by several noble Lords, the independence and proper status of such financial advice are important considerations.
With regard to the amendment in the name of the noble Lord, Lord Sharkey, I will perhaps anticipate the Minister by quibbling over the word “demonstrably”. Frankly, I am not sure that that takes us very far. As the noble Lord admitted, what is demonstrable to some is not necessarily demonstrable to others. I do not think that that part of his amendment is particularly cogent, although I agree with the rest of it.
I have more serious doubt about the amendment of the noble Baroness, Lady Browning. Amendment 86H requires that the information and advice be provided by “social work-qualified staff”. It could be, but I am not sure that it should be a requirement that it should be, given the pressure on the service in dealing with casework as it is. I do not think that the skills of social workers are always consistent with the role of giving information and advice in the sense that is intended by the amendment.
Baroness Browning
It is important that qualified social workers are present for the initial assessment. One of the things that might come out of our scrutiny of the existing Mental Capacity Act is the fact that the assessment of capacity requires professionals. Social workers clearly have a part to play in that. Whether the person has capacity, partial capacity or no capacity at all, at that point some advice is given and direction is needed. It seems to me that that is not the role of an amateur.
Lord Beecham
That is absolutely true. Neither is the provision of information and advice. However, it is not necessarily the role of a professionally qualified social worker or a professionally qualified health visitor or other person. I agree—it is a point that the noble Baroness, Lady Barker, and I both made—that both sides, health and social work, must collaborate on this. It is perhaps the wording of the amendment, rather than the intention, that might be looked at.
There is a question about how best to proceed with the publicity that should follow the enactment of this legislation. The Joint Committee advised that the Government should work with all interested providers to launch a campaign to raise awareness of and support for the change. I hope that the noble Earl will confirm that that is the Government’s intention and bring us up to date on where the Government stands.
In the context of such a radical change, it might be desirable for there to be some pilots on the ground about this issue of information and advice, working in collaboration with the Local Government Association, the NHS Confederation and other major national partners, to look at how these matters can best be explained. There could also be, at a fairly early stage, some examination of good practice. I am not suggesting that the whole scheme be piloted but that in a few areas, after a relatively short period, there might be a process of peer review and an examination of how it is working on the ground. Given that local authorities retain their scrutiny role for health and social care, it would be worth while developing with the Centre for Public Scrutiny, the LGA and relevant health service bodies, a way for the new system to be subjected to useful scrutiny at local level, and for lessons learnt to be disseminated across the country.
There are questions about the advocacy role. There is clearly a case for advocacy being included. One notes that there is a glancing reference in Clause 8, which is the reason for the stand part debate. It looks a little odd situated between Clause 4 and Clauses 18 and 20, as it does not seem to relate specifically to either. It has been mischievously suggested that there might have been references to advocacy in other parts of the Bill at an earlier stage that were removed and this was left behind. Can the noble Earl indicate the Government’s intention in referring to advocacy in that particular clause? We are not intending to move that the clause should not remain in the Bill; this is purely a probe.
We see most of these amendments as contributing to a refinement of the Bill’s proposals and we welcome that. However, it is necessary to reiterate the need for caution about the role of local authorities, particularly in the context of the financial situation that they are facing, which will get worse under a very tight regime. The Government are making provision for this, but we must be careful that the sum is not divvied up across a range of things without seeing the whole picture. If we are to give priority to this issue of information and advice, it would be helpful if the relevant departments, together with the Local Government Association, could look at the real cost of this and ensure that it is identified and included within the total package. It is easy to add desirable things against a budget. We do not know the extent to which these matters have been costed, for example, in the sum that the Government have allocated. We know that the demand is constantly rising, partly as a result of demographic change, and that the costs are also inexorably rising. This will be a cost. It is a justifiable cost, but it needs to be identified, provided for and kept under review.
Having said that, we are very much in sympathy with the thrust of these amendments and we look forward to the Minister’s reply and to working with others of your Lordships’ House in ensuring that the Bill is capable of delivering what it sets out to deliver and that all relevant players are engaged and financed adequately, so that we can afford the best possible level of care to those—of any age and with any condition —who need it.
Earl Howe
My Lords, I am very grateful to noble Lords for tabling these amendments, which highlight the importance of access to good information and advice, including independent financial advice and independent advocacy, for those who have care and support needs or are planning how to meet future care and support needs.
First, I will address Amendment 82B, in the name of the noble Baroness, Lady Meacher, Amendment 86E, in the name of my noble friend Lord Sharkey, and Amendment 86F, in the name of the noble Lord, Lord Lipsey. Clause 4 introduces a general duty to make a universal information and advice service available to everyone in the local community. I say to my noble friend Lord Sharkey in particular that we are clear that the information and advice service must be accessible to all, whether they fund their own care or get some care and support paid for by the local authority, and in order to fulfil its duty the local authority will need to facilitate access. The noble Baroness, Lady Meacher, raised the issue of early information and advice about Alzheimer’s in particular; this will be one of the vital areas that the services should cover.
The clause deals broadly with what the information and advice service must cover. Subsection (2) sets out the essential requirements for the service but— intentionally—this is not a definitive list. With regard to Amendments 86B and 86H, subject to specific qualifications, it will be for local authorities to determine the precise scope and manner of the information and advice that they offer. We expect many authorities to offer access to independent sources of information and advice, working together locally with the voluntary, not-for-profit and private sectors. We set out our expectations and additional funding for local authorities, which rises to £50 million a year by 2017-18, in the Caring for Our Future White Paper.
I would say to my noble friend Lady Browning that some authorities have also used qualified social care staff as the first point of contact and have found that this can be effective, efficient and timely, helping people to the care and support that will help them most. Others have provided a first point of access to information through more general services, which connect information and advice on a wider range of local authority responsibilities as well as local NHS provision.
I emphasise that statutory guidance will cover how information and advice can be provided in an accessible way and be proportionate to the needs of those for whom it is provided. My noble friend Lord Sharkey expressed doubts about the phrase “seek to” and suggested that it was rather too weak. Statutory guidance will set out the clear expectations of what the local authority’s service should cover or what it should seek to do in order to ensure that the information and advice is sufficient.
My noble friend Lady Browning asked about the number of social workers. More than 1.6 million people are employed in the social care sector, including 200,000 social workers. We do not set out any national targets but we recognise the need to improve skills, capacity and retention. We are working with stakeholders, including the National Skills Academy for Social Care and Skills for Care, to produce new national minimum training standards, which will further raise standards and encourage new people to enter the sector. My noble friend referred to my letter of 27 June. I confirm that this referred to Health Education England. Health Education England’s remit does not extend to social care; it covers health and public health.
Amendments 83ZA and 86A, in the name of the noble Baroness, Lady Gale, cover information and advice on health-related areas and information to people with specific medical conditions. As for many services, there will be a need for the local authorities to work with NHS organisations and more widely to provide focused information and advice to those who would benefit from it. There are already good examples of how information and advice services from a range of organisations can work together with the health and well-being of the individual at heart. Many use the national information provided by NHS Choices as a base. A lot of local authorities are providing information and advice directly to those who may have an entitlement to NHS continuing care. In addition, regulations under the Bill will specify the circumstances in which the local authority must refer the adult for an assessment for NHS continuing care. We will of course work with interested organisations to include such examples in statutory guidance.
Turning to the amendments addressing access to regulated financial advice, the noble Baroness, Lady Greengross, and the noble Lord, Lord Lipsey, make some excellent points about the importance of appropriate financial advice for those who have or are planning for care and support needs. This kind of advice may be particularly relevant to people who are funding their own care and may include a financial adviser who is regulated by the Financial Conduct Authority, but there is no need for the Bill to set this out specifically. There are other kinds of advice that may be relevant to such people and, as I have mentioned, we think it is important to maintain the general terms of Clause 4.
I take on board the concern about the use of the term “independent financial advice”—that this may cause some confusion with the term’s general meaning within the financial industry and the Financial Services and Markets Act 2000. We are happy to consider this aspect in more detail to ensure that no confusion exists. However, we do not believe that taking independent regulated advice should be compulsory. Whether a person takes advantage of independent advice is a matter of personal choice. This is particularly important because some financial advice may be subject to a charge.
There will be individual circumstances in which it will be appropriate to recommend independent advice from a regulated financial adviser, such as when people are planning to meet future care needs or when people go into residential care and are weighing up financial options such as selling the home. The fact that an organisation or individual is regulated is in itself no guarantee that the person has knowledge or experience of wider care and support issues; for example, housing or other care-related options. All this makes the adult’s choice of an adviser a vital aspect. The local authority should advise about the importance of independent regulated advice and signpost the adult to offer a choice of where they can obtain the best and most relevant advice. Again, we intend to cover such issues in statutory guidance.
We will also shortly be consulting on the design and technical implementation of the funding reforms, including deferred payments. This will include how the new duties to signpost independent financial advice will work. The noble Lord, Lord Beecham, asked about an awareness campaign about the funding reforms themselves. We are scheduled to discuss amendments on that very issue in a later group and I hope that the noble Lord will be content for me to cover the issue at that point.
Baroness Meacher
I welcome the Minister’s assurance that Alzheimer’s patients will be a priority when it comes to the provision of information and advice— I shall have to clarify what that means in due course. I thank the Minister for his usual courteous and sensitive response to the many amendments that have been debated this evening. I am sure that many noble Lords will want to come back to those issues on Report—in particular, I hope that the noble Baroness, Lady Browning, will come back to her point about social workers being a suitable vehicle for providing information in their care planning work. It could save a lot of resource and waste of time. I beg leave to withdraw the amendment.
Schools: National Curriculum
(10 years, 10 months ago)
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The Parliamentary Under-Secretary of State for Schools (Lord Nash)
My Lords, with the leave of the House, I shall now repeat a Statement made in another place yesterday by my right honourable friend the Secretary of State for Education on the national curriculum. The Statement is as follows.
“With permission, Mr Speaker, I should like to make a Statement on the future of the national curriculum.
Our children are growing up in a world where the pace of change—economic, social and technological—is constantly accelerating. These changes promise wonderful new opportunities for future generations, but they also create immense challenges.
We are learning more every day about how our world works and how our minds work, how we can develop our civilisation and extend opportunity, and how we can improve learning and extend knowledge.
At the same time, however, we are also discovering just how competitive this new world is. As other nations modernise their economies and education systems, we cannot afford to be left behind in the global race.
That is why, when the coalition Government were formed, we asked officials in the Department for Education to analyse the best performing education systems in the world. They examined the curricula used in the world’s most successful school systems, such as those of Hong Kong, Massachusetts, Singapore and Finland.
Informed by that work and in consultation with subject experts and teachers, the department produced a draft revised national curriculum which we put out for public consultation five months ago. We received more than 17,000 submissions to our consultation and we have given them careful consideration.
Today, we are publishing a summary of the comments received and the Government’s response. The publication of our proposals has provoked a valuable national debate on what is, and what should be, taught in our schools. I have very much enjoyed this debate and the passionate engagement of so many great teachers and concerned parents.
It is absolutely right that every member of society should care about the national curriculum. It defines the ambitions that we set for our young people, and I, like the overwhelming majority of parents, want us to be more ambitious than ever before.
That is why we are demanding that children be taught how to write computer code, how to use 3D printers, how to handle more complex mathematical processes, how to appreciate a wider-than-ever range of literature and how to speak, read and write in more than one language.
The updated national curriculum framework that we are publishing today features a number of revisions to the drafts published in February. The revisions have been made on the basis of evidence and arguments presented to us during the consultation period.
In particular, we have revised the draft programmes of study for design and technology and for history. We have included more detail on modern design processes and more coverage of world history.
Among other significant changes are the inclusion of a stronger emphasis on vocabulary development in the programmes of study for English and greater flexibility in the choice of foreign languages which primary schools will now be required to teach.
Perhaps the most significant change of all is the replacement of ICT with computing. Instead of just learning to use programs created by others, it is vital that children learn to create their own programs. By demanding that children learn computational thinking and Boolean logic, we are determinedly raising the bar, but by equipping our children with the tools to build their own algorithms and applications, we are also helping to foster a new level of creativity in our schools.
It is my hope that these changes will reinforce our drive to raise standards in all our schools. I hope that they will ensure that the new national curriculum provides a rigorous basis for teaching and a benchmark for all schools to improve their performance, and I know that it gives children and parents a better guarantee that every student will acquire the knowledge to succeed in the modem world. That is why I commend this Statement to the House”.
My Lords, that concludes the Statement.
Baroness Jones of Whitchurch
My Lords, I thank the Minister very much for setting out the Government’s revised approach to curriculum reform. I am glad to hear that a number of the representations that we have been making from the beginning have finally been adopted by the Government. However, it has to said that it has been a very bumpy ride. The consultation has contained all the characteristics for which the Secretary of State has now become famous: first set out an ideological master plan full of reforming zeal; then rubbish anyone who raises concerns and questions, including educational academics, teachers and parents; and, finally, carry out a series of U-turns and admit that your critics might have been right all along. It is, quite frankly, exhausting and a long way from the thoughtful, grown-up national debate which should have been conducted from the outset, with the shared intent of improving young people’s life chances.
Nevertheless, we have some areas of agreement. We always said that it was a mistake to sideline speaking and listening skills in the teaching of English. This point was echoed by many employers and so we are pleased to see that this issue has now been addressed. We warned that the ICT curriculum was not addressing the technology needs of employers. Again, we are pleased that this has been updated. We welcomed the requirement for foreign language education in primary schools, but warned that it was unfair and divisive to limit the range of languages that could be taught. We are relieved that the Government have finally seen the error of their ways in this regard.
We argued strongly for citizenship to be included in the national curriculum; for young people to understand the contribution that they could make to the UK and as citizens of the world. We therefore welcome the Government’s belated conversion to the importance of citizenship education and the inclusion of human rights and international law at key stage 4. We criticised the removal of climate change in the geography curriculum, as we believe it is essential for an understanding of physical, social and economic geography. We are pleased that this has now been reinstated. Along with many eminent historians, we raised concerns that the history curriculum was too UK focused and lacked a world view. We are pleased that the programme has now been rebalanced.
However, in this notable and welcome list of U-turns, a festering anomaly remains, where the Government continue to ignore the best advice of those dealing on the front line with child health, sex and relationship issues. All the reasons why the teaching of other subjects should be spelt out in the national curriculum apply equally to PSHE, yet the Government seem determined to run away from their responsibilities on this issue. I hope the noble Lord, even at this late stage, will commit to reflecting further on this issue before a final decision is made.
Despite these welcome improvements, we still have a number of concerns about the proposals. First and fundamentally, the Government have underpinned all their proposals with a belief that education should be based on rote learning at the expense of developing young people who can problem-solve, think for themselves, be creative and work collaboratively. Young people need knowledge, skills and resilience. Can the Minister clarify whether he agrees that we need to reject the false choices that pitch knowledge versus skills and that we need to foster a more holistic approach in education?
Secondly, the new curriculum will apply to fewer than half of the secondary schools. If academies have the freedom to innovate, does that freedom not make sense for maintained schools as well? Does the Minister have a plan for addressing these contradictions?
Thirdly, the timing of the proposals and the implementation date of September 2014 put schools under enormous pressure to be ready for the changes, including having to provide the old and new curriculum in tandem for some age groups. Does the Minister recognise that many teachers felt ignored and ridiculed by the consultation process and morale is at an all-time low? Can he explain what professional development and resources will be made available to teachers to help them manage this transition? Does he accept that the presence of unqualified teachers in the classroom is a particular cause for concern when high-quality skills and experience will be required to meet this challenge?
Finally, does the Minister agree that particular support needs to be provided to children with SEN from a very early age, so that they are able to participate fully in the curriculum? Can he point me to where this support and flexibility are spelt out in the curriculum? How will parents be able to judge the progress of their children against their peers, particularly at primary school level, if the assessment levels and level descriptors are removed? Can we be sure that what replaces them will have the confidence of teachers and parents alike?
It feels as if this process of curriculum consultation has been unnecessarily rancorous. The Secretary of State has shown little skill or interest in managing the debate to achieve a consensual outcome. While we welcome the numerous U-turns, we remain concerned that the fundamental educational philosophy of this Government is backward looking, focused towards an outdated and divisive exam system and destined to do a disservice to the next generation of school leavers, who had a right to expect better. I hope the Minister will address these concerns and I look forward to hearing his response.
Lord Nash
My Lords, I thank the noble Baroness, Lady Jones, for her support for where we have arrived as a result of our consultation, if not for her comments on the journey we have taken to arrive at that point. As far as citizenship is concerned, we confirmed in February that citizenship would remain, along with other current national curriculum subjects.
The Government have reviewed the national curriculum in England since January 2011. In February this year, we published proposals that embodied a vision for a national curriculum that is slimmer, focused on essential subject knowledge and which—especially in the core subjects of English, maths and science—compares favourably with the curriculum taught in the most successful education jurisdictions in the world. Since then, there has been a vigorous national debate on the content and purpose of the national curriculum, which we have welcomed. It is right that every member of society should care about this. Our formal public consultation closed in April; we received 17,000 submissions; and we have published a summary of the consultation findings, as I said earlier. We intend to finalise the new national curriculum this autumn, so that schools have a year to prepare to teach it from September 2014.
The new national curriculum will retain the best elements of the drafts we published in February. We have, however, reflected carefully on the arguments we heard during the consultation period. That has led to some changes. In history, while we are pleased that many eminent historians welcomed the ambition of the draft, we also heard the concerns of history teachers that it was too prescriptive. We also acknowledged concerns that the curriculum was not sufficiently explicit that pupils should be taught about world history. In response, we have revised those proposals. They still set out that pupils should be taught a rich diet of British history within a clear chronological framework. However, the revised version also makes it clear that teachers will have the flexibility to design lessons that fire their pupils’ enthusiasm for history and teach the history of other societies around the world. The response has been very positive, even from those, such as the Historical Association and Professor Richard Evans, who had originally been critical of our plans. Similarly, we have revised the design and technology curriculum to ensure that it properly reflects our ambitions for teaching in this subject. The consequence of this revision will be that children are set on a path to be the next generation of designers and engineers.
We have made other changes, such as, as the noble Baroness mentioned, the inclusion of a stronger emphasis on vocabulary development in the programmes of study for English. We believe that these revisions will only serve to strengthen the national curriculum and ensure that all pupils get the education they deserve.
The noble Baroness, Lady Jones, mentioned SEN. The inclusion statement in the national curriculum framework document emphasises that teachers should set high expectations for every pupil and that lessons should be planned so that there are no barriers to every pupil achieving, including those with special educational needs. Organisations representing pupils with SEN have largely welcomed this statement.
We have discussed PSHE in this House on many occasions recently. The Government launched an internal review of PSHE in 2011 and the outcomes of the review were announced in March this year. After careful consideration, we have concluded that PSHE should remain a non-statutory subject without the addition of new statutory elements, although, as noble Lords know, I recognise that it is a very important subject and should be taught in all schools. We are exhorting all schools to teach PSHE and careers development at every turn.
On the advice of the expert panel set up to advise the national curriculum review, we have decided that levels and level descriptors should be removed. We have also borne in mind the feedback that we heard from many teachers that levels are unhelpful in that they distract teachers from ensuring that pupils master essential subject skills and knowledge and instead require assessments of progress to be made against vague, best-fit judgments. They are subjective and open to manipulation.
Our new national curriculum is designed to give schools genuine opportunities to take ownership of the curriculum. The new programmes of study set out what pupils should know and be able to do at the end of each key stage. This is particularly true at primary level for English, maths and science, and therefore assessments can be directly based on that rather than on vague level descriptors. Levels were designed as an assessment tool to summarise progress at the end of an entire key stage; they were never intended to be broken down into sub-levels and used to grade each piece of work.
I agree with the noble Baroness that it is time that we ended the circular debate about knowledge versus skills. We accept that it is essential that our pupils learn both these things. Our national curriculum is based on the latest cognitive thinking and practice around the world, including the work of Dan Willingham, whose book, Why Don’t Students Like School?, I recommend to anybody interested in this matter. It is also based on the experience in jurisdictions such as Massachusetts, where a knowledge-skills-based curriculum —although it is more knowledge-based—is followed. In recent years, this has led to what has become widely known as the “Massachusetts miracle” in terms of the turnaround in schools’ performance.
So far as the timetable is concerned, this Government are ambitious for our children and young people. However, international surveys show that in key subjects we are standing still while other countries and jurisdictions overtake us. To allow that situation to continue would be to neglect our duty and to sanction relative decline. We want pupils to start benefiting from the new curriculum as soon as possible. However, it is also the case that the timetable we are working to means that schools have over a year to prepare for its introduction. We are confident that they will use that time to prepare effectively.
We will of course be prepared to offer targeted support to schools when we think that that will be beneficial. We are working with the National College for Teaching and Leadership to identify what help might be required. However, our general approach, as noble Lords will know, is informed by the principle that schools know better than government what support they will need to teach the new curriculum in accordance with their own circumstances—hence our teaching schools and teaching school alliance programmes. Rather than top-down spoon-feeding, we will encourage schools to work with publishers, education suppliers, subject associations and each other to develop materials that respond to genuine need.
We are also providing £2 million in additional funding to teaching schools to build on the excellent work that they are doing. The National Centre for Excellence in the Teaching of Mathematics will be funded to provide improved maths teaching, and our national support schools have also received additional funding to ensure the required CPD. The National College for Teaching and Leadership has established expert groups to support institutions delivering ITT in preparing trainees to teach the new curriculum.
We understand that we are asking a great deal of teachers and head teachers as we seek to make our education system truly world class. However, we also know that we are fortunate to have the best generation of teachers ever and we are sure that, supported by a national curriculum that is stretching and focused on teaching essential knowledge, they will rise to the challenge. We want schools to see the full picture of GCSE reform, A-levels, curriculum and the accountability framework at one time. It means an intensive programme of reform but we have slipped so far down the international league tables that we cannot afford to wait. Each year that we wait leads to more children being insufficiently challenged and educated. We believe that this curriculum will equip our children and young people with the knowledge and skills they need to compete in the world and enable them to have the education they deserve.
Lord Quirk
My Lords, I am grateful to the noble Lord for repeating the Statement that was made in the House of Commons yesterday. As one who studied the February draft in excruciating detail, I am happy to congratulate all concerned at the DfE on the quite striking improvements to be seen in this new version of the national curriculum, especially in the very lengthy English section. For example, in that section there is a far greater emphasis on spoken English and a far deeper recognition that continuous vocabulary development is central to the whole of education.
However, I have a couple of questions for the Minister. Can he assure us that teachers, confronted now with a good deal of extra excellent material and ideas to bring to life in the classroom, will, wherever necessary, be brought fully up to speed so that they can deliver on the new demands required of them? It is a big task and the curriculum will come to life only in the classroom.
Secondly, the importance of English and maths is obvious in their needing more space in the voluminous curriculum document than all the other 10 subjects put together—rightly so, since English and maths not only possess the precious content which is peculiar to them but also comprise the tools, as the Minister has just said, for shaping all else in education. Therefore, can the Minister assure us that English and maths will remain the sine qua non throughout school life from the ages of five to 18?
Lord Nash
I am grateful to the noble Lord for his comments, particularly about English. We are focusing heavily on ensuring that teachers have the resources to deliver this new curriculum, largely in the way that I outlined earlier. English and maths will be essential right the way through the curriculum until the age of 16, and grammar, punctuation and spelling will feature much more across the curriculum than they have done in the past. They will not be essential beyond the age of 18, although we have said that all pupils who have not achieved grade C in English or maths will go on studying English and maths until they are 18 and have reached that standard.
Lord Storey
My Lords, first, I welcome my noble friend’s Statement on the curriculum. These Benches have argued for a long time that we should have a shorter and more focused curriculum that prioritises essentials. It is interesting to note that the national curriculum has been reduced from 468 pages to 281. I do not see it as a U-turn; I see it as a reflection of the consultation process, particularly on the issue of speaking and listening and on climate change.
I have a number of questions. One of them resonates with the comments of the noble Baroness, Lady Jones, and concerns continuing professional development. How do we make sure that schools are fully equipped? In some areas, for example, there are no training schools. Are we going to see resources go directly to those schools? What is the position on equipping non-teachers? As we know, in free schools and some academies non-teachers are taking classes. We also know that in all schools teaching assistants are covering PPA time and taking lessons. Therefore, what continuing professional development will be provided for those staff?
There is one area of great concern. I am delighted that a modern foreign language will be taught, but in primary schools there is often no one on the staff with that ability. What resources will be given to primary schools?
Lord Nash
I am grateful for my noble friend’s comments; I know that they are well based on his 25 years experience of primary education in Liverpool.
On CPD, we believe that we now have about an 89% coverage of the country on teaching schools and the teaching school alliance, but, as I said, our belief is that teachers are best placed to develop best teaching practice through teaching in schools and school support by modelling good practice. An increasing number of products are emerging on the marketplace to help teachers, including MyMaths and Ruth Miskin’s phonics materials. Those are particularly suitable for primary schools.
Baroness Massey of Darwen
My Lords, I thank the Minister for repeating the Statement. The document is sprinkled with references back to the Education Act 2002, with its emphasis on promoting spiritual, moral, intellectual and cultural development of pupils and developing a balanced and broadly based wider curriculum. I agree with that, but I am not sure that the document fulfils it. I agree with my noble friend Lady Jones that ICT—computing—spoken skills in English and the subject of climate change are welcome. As a former foreign language teacher, of course I would say that foreign languages are welcome. I will come to PSHE later, but I hope that the Minister realises that some pupils need a basis of interpersonal skills and self-confidence to be able to learn anything. They cannot simply be filled with facts and knowledge.
I am pleased that there was consultation on the original document. I know that some concerns were expressed there. For example, 36% said that the curriculum was then too focused on knowledge and that there should be greater recognition of the value of skills. I reflect on last Thursday’s debate in this House, instigated by the noble Baroness, Lady Shephard, to which the Minister responded, in which across the House we expressed concern about careers education and the development of soft skills such as teamwork, communication and so on. I am not sure that that is sufficiently covered in this document. I am also concerned about the space for creativity and the prescription and progression between stages.
It does not seem to be recognised that citizenship and personal education are taught in a cross-curricular way, with certain formal inputs. I note that in the document there are 20 lines on citizenship but nothing on PSHE; there is reference only to sex and relationship education. Sex and relationship education is part of PSHE; it should not be given overemphasis. Things such as obesity, alcohol, drugs and smoking are equally important.
Is the Minister confident that this curriculum will deliver skills of communication and encourage self-confidence in pupils? Is he confident that culture, arts and sports are given sufficient emphasis? Is he confident that personal, social and health education and citizenship education are given sufficient reference in the document? Perhaps he can briefly respond.
Lord Nash
I know that the noble Baroness shares my concern about PSHE being an essential part of any school, particularly interpersonal skills and self-confidence. I do not think that we are apart at all on the necessity for all schools to teach that. Indeed, that is what good schools do; it is all part of a good education. The difference between us is that we do not feel that we should legislate for every ingredient of such education to be statutory.
For instance, on career education, I was in Norfolk today, where we were whipping up support for schools in Norfolk, which have consistently been below national standards. One of our meetings was with business leaders. There is no shortage of enthusiasm from the business community to engage with schools to help them with careers advice, work placements and so on. I then visited Wymondham College, one of our top state boarding schools, where we got into a conversation about careers. I said that I was constantly being asked whether careers advice should be more consultancy-based in schools and whether that was sensible for schools. It was absolutely clear. Everybody in the room—the top eight teachers in the school—said that a careers session of 50 minutes at the end of your school life was a very poor substitute for a good education and that they engaged widely with businesses for careers advice. They already practise the suggestion from my noble friend Lord Cormack of career panels.
That is the best practice, which we should encourage all schools to do, so that all schools fulfil the ambitions of the noble Baroness. As I said, however, what is between us is that we think that to legislate for it in a box-ticking way would lower expectations rather than encourage all schools to aim for the highest.
Lord Phillips of Sudbury
My Lords, I should declare an interest as the founder and president of the Citizenship Foundation. I, too, would like to congratulate the Government on the outcome of their consultation and a lot of hard work all round. To have 17,000 people respond to a consultation must be a high response compared to some that we have had recently and it reflects the intense concern of people across the social spectrum—of course, including teachers and parents. I also recognise the dilemmas that the Government have in arriving at a curriculum, because so many subjects today call for inclusion, and there has to be some point at which you say, “Sorry, no more space”.
I particularly congratulate Michael Gove on resisting the advice from his expert panel and keeping citizenship education in the core curriculum at key stages 3 and 4. It has always seemed to me—and, probably, everybody in the Chamber—that the democratic world of today is unbearably complex. The work of this House is often beyond the ability of its Members to grapple with. It is irresponsible of us to the point of being hypocritical not to give our school leavers the chance, through a minimum level of competence, to take their part in this hyper-complex society—in particular, their democratic part. I fully endorse the conclusions reached that citizenship is part of the essential knowledge that we have to give our citizens, no less than teaching them the Highway Code before they get into a motor car.
I should like to ask my noble friend four questions. The framework document issued this week starts by saying, of citizenship, that the purpose of study is a high-quality citizenship education. I would be grateful if my noble friend would consider the extent to which we need rather badly to have a much greater quantity and quality of teacher education for that difficult subject. Secondly, I agree with my noble friend Lord Storey that this is a subject where you could bring in people from outside the world of formal teacher qualification. Very quickly, I think—
Baroness Garden of Frognal
My Lords, perhaps I may remind my noble friend that this debate is for brief questions to the Minister.
Lord Phillips of Sudbury
I would be grateful if my noble friend would consider extending the Ofsted inspection to cover citizenship education. If it is not within the compulsory Ofsted inspection, that lowers its status. That is certainly not needed. Finally, I do not see why this subject should not be as necessary, compulsory and essential for non-maintained schools as for maintained schools.
Lord Nash
I am grateful to my noble friend Lord Phillips for his comments. I believe that we have greatly improved the citizenship curriculum, not least with the helpful advice from noble Lords such as him that it should be a much less issues-based curriculum, with greater focus on the political systems in this country. So far as Ofsted is concerned, I will look at that point in the context of what Ofsted already inspects for in terms of a rounded conversation and whether we can do anything further on that. As far as the core subject is concerned, I rather refer back to my earlier point that some independent schools teach citizenship very effectively in a much wider way. As far as teaching quality is concerned, we are doing all that we can to improve the quality of teachers. I may want to discuss with my noble friend further his specific points about citizenship teachers to see whether we cannot do more in this regard.
EU: Police and Criminal Justice Measures
(10 years, 10 months ago)
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The Minister of State, Ministry of Justice (Lord McNally)
My Lords, the following Statement was made by my right honourable friend the Home Secretary in the other place earlier today.
“With permission, Mr Speaker, I would like to make a Statement on the decision on whether the UK should opt out of those EU police and criminal justice measures adopted before the Lisbon treaty came into force.
As honourable Members will be aware, this is a stand-alone decision which the Government are required to make under the terms of the Lisbon treaty by 31 May 2014, with that decision taking effect on 1 December of that year. It covers around 130 measures, some of which it is clearly in our national interest to remain part of. But if we wish to remain bound by only some of the measures, we must exercise our opt-out from them all, en masse, and seek to rejoin those that we judge to be in our national interest.
The Government have committed to a vote in this House and the other place before formally deciding on this matter. We shall honour that commitment in full. Next week, honourable Members will have the opportunity to debate and vote on this approach. Following our discussions in Europe, another vote will be held on the final list of measures that the UK will formally apply to rejoin.
Let me briefly set out the rationale by which the Government have approached this decision. We believe that the UK should opt out of the measures in question for reasons of principle, policy and pragmatism and that we should seek to rejoin only those measures that help us to co-operate with our European neighbours to combat cross-border crime and keep our country safe.
On principle, I am firmly of the belief that the UK’s international relations in policing and criminal justice are first and foremost a matter for Her Majesty’s Government. In policy terms, the UK has—and will continue to have—the ability to choose whether it should opt in to any new proposal in the field of justice and home affairs. It is therefore right that we take the opportunity to consider whether we wish to retain measures that were joined by the previous Government and to decide on a case-by-case basis whether we are willing to allow the European Court of Justice to exercise jurisdiction over them in the future. Finally, the Government are being pragmatic. I have said before that we will not leave the UK open to the threat of infraction, and fines which run into many millions of pounds, by remaining bound by measures we simply cannot implement in time. That would be senseless.
In a number of areas, the measures relate to minimum standards in substantive criminal law. Even before their adoption, the UK already met or exceeded the vast majority of these standards and will continue to do so, whether or not we are bound by them. As people have become more mobile in recent years, so too has crime. The Government have sought and listened carefully to the views of our law enforcement agencies that combat it. We understand that some of the measures covered by this decision are important tools which they need to protect the British public. The Government have identified 35 measures which we will be seeking to rejoin in the national interest.
That set of measures, on which we propose to begin our discussions with the European Commission and other member states, is laid out in Command Paper 8671, which is published today. I want to be clear: what must happen next is a process of negotiation with the European Commission and other member states. These negotiations will determine the final list of measures we formally apply to rejoin, but we promised that we would set out these measures clearly and give honourable members time to consider them before asking them to vote, and this is what we have done.
One of the measures that we will seek to rejoin, and on which I know many honourable Members have strong views, is the European arrest warrant. I agree with our law enforcement agencies that the arrest warrant is a valuable tool in returning offenders to the UK. Its predecessor, the 1957 European Convention on Extradition, had serious drawbacks. The arrest warrant has helped us to secure and accelerate successful extradition procedures—as shown by the case of Osman Hussain, one of the failed London bombers of July 2005, who was extradited back to the UK from Italy in less than eight weeks. More recently Jeremy Forrest, the teacher who was sentenced last month for absconding to France with one of his pupils, was extradited back to the UK less than three weeks after his arrest. Since 2009 alone, the arrest warrant has been used to extradite from the UK 57 suspects for child sex offences, 86 suspects for rape and 105 for murder. In the same period 63 suspects for child sex offences, 27 suspects for rape and 44 for murder were extradited back to Britain to face charges. A number of these suspects would probably have not been extradited back to Britain without the arrest warrant. We owe it to their victims, and their loved ones, to bring these people to justice.
However, the European arrest warrant has its problems too, as honourable Members have eloquently explained in this House. The previous Government had eight years to address these concerns and did nothing. This Government have taken action and today I am proposing additional safeguards to rectify these problems and increase the protection offered to those wanted for extradition, particularly British citizens. A number of honourable Members have explained how European arrest warrants have been issued disproportionately for very minor offences. I will address this by amending the Anti-social Behaviour, Crime and Policing Bill, which is currently in Committee, to ensure that an arrest warrant can be refused for minor crimes. This should stop cases like that of Patrick Connor, who was extradited because he and two friends were found in possession of four counterfeit banknotes.
We will also work with other states to enforce their fines and ensure that in future, where possible, a European investigation order is used instead of a European arrest warrant. This would mean police forces and prosecutors sharing evidence and information without requiring the extradition of a suspect at the investigative stage.
Other honourable Members have expressed concern about lengthy and avoidable pre-trial detention. I will amend our own Extradition Act to ensure that people in the UK can be extradited under the European arrest warrant only when the requesting state has already made a decision to charge and a decision to try, unless that person’s presence is required in that jurisdiction for those decisions to be made.
Many Members, in particular my honourable friend the Member for Enfield North, will recall the case of Andrew Symeou, who spent 10 months in pre-trial detention and a further nine months on bail in Greece, only to be acquitted. The change that I am introducing would have allowed Andrew Symeou to raise, in his extradition hearing, the issue of whether a decision to charge him and a decision to try him had been taken. It would likely have prevented his extradition at the stage he was surrendered and, quite possibly, altogether. We will also implement the European supervision order to make it easier for people like Mr Symeou to be bailed back to the UK.
Other honourable Members are concerned about people being extradited for conduct which is not criminal in British law. I will amend our law to make it clear that in cases where part of the conduct took place in the UK, and is not criminal here, the judge must refuse extradition for that conduct.
I also intend to make better use of existing safeguards to provide further protections, so I will ensure that people who consent to extradition do not lose their right not to be prosecuted for other offences, reducing costs and delays. We propose that the prisoner transfer framework decision should be used to its fullest extent so that UK citizens extradited and convicted can be returned to serve their sentence here. Where a UK national has been convicted and sentenced abroad, for example in their absence, and is now the subject of a European arrest warrant, we will ask, with their permission, for the warrant to be withdrawn and will use the prisoner transfer arrangements instead. This change could have prevented the extraditions of Michael Binnington and Luke Atkinson—sent to Cyprus, only to be returned to the UK six months later.
To prevent other extraditions from occurring at all, I intend either to allow the temporary transfer of a consenting person so that they can be interviewed by the issuing state’s authorities or to allow them to do this through means such as video-conferencing while in the UK. Where people are innocent, this should lead to the extradition request being withdrawn.
These are all changes which can be made in UK law—and which could have been made by the party opposite during their time in government. Co-operation on cross-border crime is vital, but we must also safeguard the rights of British citizens. The changes that we propose will do that.
Before I conclude, I am conscious that honourable Members want to know our approach to the new Europol regulation. Let me say that I fully recognise the excellent work of Europol and its British director, Rob Wainwright. Honourable Members will recall Operation Golf, a joint operation led by Europol and the Metropolitan Police, which cracked down on a human-trafficking gang operating in Ilford and led to the release of 28 trafficked children and the arrest of 126 suspects. It is for reasons such as this that we are proposing to rejoin the existing Europol measure.
On the new proposal, the Government have today tabled a Motion as the basis for a ‘Lidington-style’ debate on the floor of the House next week, following the debate and vote on the plan that I have outlined today. That Motion states that we should opt in post-adoption, provided that Europol is not given the power to direct national law enforcement agencies to initiate investigations or share data that conflict with our national security.
For reasons of policy, principle and pragmatism, I believe that it is in the national interest to exercise the United Kingdom’s opt-out and rejoin a much smaller set of measures that help us to co-operate with our European neighbours in the fight against serious and organised crime. I also believe that Her Majesty’s Government must strike the right balance between supporting law enforcement and protecting our traditional liberties. What I have outlined today will achieve both those goals. I commend this Statement to the House”.
Baroness Smith of Basildon
My Lords, I have to say that I wonder if this is the Statement that the Home Secretary really wanted to make to the other place today. When we think of the rhetoric that we have heard on this issue, it is something of a surprise to hear today’s Statement, because the Home Secretary’s and the Government’s anti-European credentials have taken a bit of a battering. The rhetoric is still there, but common sense has appeared to force some moderation in action.
Last October, the Home Secretary confirmed that the Government’s “current thinking” was that the UK should opt out of all pre-Lisbon measures and rejoin them where it was considered in our national interest to do so. An example often used by the Government to explain this position is the European arrest warrant, as we have heard from the noble Lord this evening. The Sun newspaper was briefed on why the UK should reject it, the Prime Minister said it was “highly objectionable” and, just recently, the Government’s MPs voted, on a three-line Whip, against the Labour Motion that would have retained it. However, the Government now have to admit that it is effective and that, without it, criminals can evade justice. They could seek to evade British justice abroad and would be able to hide in the UK to evade the justice of other countries. I welcome the Government’s U-turn on this issue but there are still questions to be answered before we will be satisfied that public safety is not at risk.
I listened carefully to the Statement and have looked at the other documents but am not 100% clear what we are opting out of and why, and what impact that will have. I have not had the opportunity yet to read the 159 pages of the Command Paper but I am confident that the Minister has—I hope he has—and wanted to ask him a very specific question about the exact number of practical, workable and working measures that the Government are seeking permanently to opt out of. Of the 133 crime, law and order, and policing measures, the Government want to opt back in to 35. An additional seven have already been replaced and the Government have opted in. However, of the measures that the Government are seeking to opt out of: some are out of date and no longer in operation; some we have never used so we do not have to; others are agreements to co-operate, and my understanding is that the Government intend that co-operation to continue; and the Statement itself refers to measures that relate to minimum standards that we have already met or exceeded. With all of those, there is no impact or effect.
Other opt-outs include: a directory of counterterror officers that no longer exists; a temporary system for dealing with counterfeit documents that has already been replaced; a bundle of measures applying to Portugal, Spain and Croatia that do not even apply to the UK; and a number of measures relating to extinct manuals, specialist handbooks et cetera. In some ways, dealing with these is a useful tidying-up measure, but it is hardly an impressive list of repatriation of powers. I have a very specific question for the Minister, knowing that he has read the document: how many of the measures that the Government want to opt out of permanently are relevant to the UK and currently being used, and what impact will their removal have? I look forward to the answers from the noble Lord as, having heard the Statement, I really have no idea.
The Government now accept that the 35 measures that they want to opt back into are essential. If there is an opt-out, there must be a quick opt-back-in. Can the noble Lord confirm that the Government have secured a guarantee that we can opt back in to these important measures? If not, will the Government still opt out without such a guarantee? What timescale does the noble Lord envisage from the opt-out until the process of opting back in is completed? Are the Government seeking to amend any of the 33 measures, other than the European arrest warrant, and what are the implications and consequences if we fail to opt back into any of the measures, including financial consequences? Does the Minister really believe that the only way of making changes is to opt out and then opt back in? I find that strange when the Government refused to implement the European supervision order relating to the European arrest warrant, which they could have done long before now.
If any opt-back-in is not immediate, it is essential that there are transition measures. For example, the European arrest warrant is a legal framework that allows countries to extradite. Transition measures would have to be legally robust to ensure the satisfaction of the courts and lawyers dealing with any extradition. Given that pre-European arrest warrant transition arrangements have expired, will there be separate transition measures for all countries currently covered by the European arrest warrant? How long will negotiations take and are we at risk of a time gap during which criminals will be able to hide from UK justice and hide in the UK from justice in other countries? What will happen to the existing European arrest warrants where a person has not yet been arrested but there is a warrant out for their arrest? Will the warrants just lapse with the opt-out, allowing wanted criminals to evade justice from the UK overseas or leaving foreign criminals in the UK without the powers to remove them? The Statement also says that the Home Secretary,
“will amend our own Extradition Act to ensure that people in the UK can be extradited under the European arrest warrant only when the requesting state has already made a decision to charge and a decision to try”.
Can the noble Lord confirm whether this will apply to foreign citizens in the UK as well as to British citizens? Is it likely to make it harder to extradite those wanted for questioning for crimes in their own country?
There remain so many questions on the impact and the detail that I will not detain the House with another list which I could easily provide this evening. Genuine scrutiny, at which your Lordships’ House excels, will be so important in this debate. I hope that the Minister does not say this evening that these issues are for further discussion, because we are running out of time; he smiles at me, so perhaps that is the note that he has been passed. A vote will take place in the other place in less than a week, and the matter will then be brought to your Lordships’ House. The Government must have worked out the detail by now. We need that detail to inform our decision-making in your Lordships’ House. I hope that the Minister is able to respond to the points that I have raised, and I greatly look forward to his doing so.
Lord McNally
I am grateful for the noble Baroness’s response to the Statement. I noted that she thought that it had common sense and moderation. Indeed, there were times during her response to the Statement where there was a suggestion that we had shot her fox, in that all the disasters to which she was hoping to point—about not taking note of national security and effective policing—are not there. The Statement of my right honourable friend the Home Secretary puts those matters right to the fore, as is demonstrated in the list that we have put before the House today.
There was hardly a hint that this little problem was left by the Labour Party’s negotiators for the Lisbon treaty. As the Home Secretary mentioned in her own remarks, the then Government did precious little to address these issues while in office. We therefore make no apologies for having used our time in office to look at these matters in detail. My point when we were discussing this at Questions the other day was that they are serious issues that deserve proper and serious consideration. The document published today, Command Paper 8671, is a sign of the candour and transparency with which the Government intend to approach this matter. The document contains not only the full list of the measures with an explanation of the protocol under which they have been produced, but also six Explanatory Memoranda from various concerned departments, which we hope will be of help to both Houses in the debates to come.
I make no apologies for our now embarking on some interesting negotiations. We have taken the matter seriously and have produced a list which anybody objectively looking at the exercise will see goes to the core of the issues left by Protocol 36.
I have just been told that we published five Explanatory Memoranda, not six—stop press.
Baroness Smith of Basildon
I hoped that the noble Lord had been passed answers to the questions I had asked him.
Lord McNally
I am answering the questions. For example, the noble Baroness asked whether foreign citizens charged in the UK would be safeguarded. Yes, the safeguards will apply to all those subject to the European arrest warrant. The noble Baroness asked on what basis the decisions would be taken. The Government believe that we should exercise the opt-out and then seek to rejoin the measure where it is in the national interest to do so. The Government have considered the impact of each measure on public safety and security, whether practical co-operation is underpinned by the measure and whether there would be a detrimental impact on co-operation if we pursued it by other mechanisms. The impact of the measures on civil rights and liberties has also been considered.
The noble Baroness asked me if I had done a word count on the various issues. We have said that we intend to opt in to 35. As she says, a number—we think abut 14—of the original list have been repealed and replaced. There are about another 20 measures that retain the minimum European standards. However, the noble Baroness’s kind of quizzing approach really misses the point of what this exercise is about. Through today’s Statement, the Government have sent a clear message that we have addressed the problem left by Protocol 36—which would have been faced by any British Government and which the previous Government showed little enthusiasm for addressing—in a very practical way that will give both Houses of Parliament the time and the opportunity for input into negotiations which the Government will pursue with due seriousness and the intent of success.
Lord Taverne
My Lords, I am glad that the negotiations between the Conservatives and the Liberals inside the coalition have come to a sensible conclusion. In passing, one wonders what has been achieved in exercising the block opt-out; what we are left with having opted out of is not of any great significance.
The Conservatives have sensibly given way, contrary to their original stance, on the major measures for police and crime co-operation in the European Union. There is nothing more difficult in politics than changing your mind in the light of the evidence. It appears as if that is what the Conservatives in the Government have done, and I applaud them for that.
It is also fair to say that this has been a major victory for the Liberal Democrats in the coalition, and for this House, particularly the important work and results communicated in the Bowness and Hannay committees. It is also of very great importance that it has been a signal defeat for the UKIP-and-Tea-Party tendency inside the Conservative Party.
I ask two questions of the Minister. Is there any indication of the present attitude of the Commission to the opt-out proposals and what sort of timetable is envisaged? Secondly, will the Conservative leadership in the Government, including the Lord Chancellor and the Home Secretary, now join with Labour and the Liberal Democrats in exposing UKIP as the party which is soft on crime?
I am sure the Minister will agree that since UKIP rejects any legislation for co-operating on crime in the European Union, its policies can only benefit people-traffickers, porn-merchants, paedophile rings, money-launderers and other criminals who operate across borders, as they increasingly do.
Lord McNally
My Lords, on these specific questions, I have seen only the initial response from the Commission that was carried on the news-tapes; as far as I could see, that response was constructive in terms of welcoming this approach from the British Government. Of course we have had to get to this point before going into more formal discussions, but officials have had technical discussions with the Commission and the Council, focusing on the legal framework under which the decision will be made, to ensure a shared understanding of the legal processes around the 2014 decision. I know that my right honourable friends the Justice Secretary and the Home Secretary spoke today to Commissioner Reding and Commissioner Malmström respectively. There is no doubt that the Commission has responded in a way that we find constructive. I will cover another point made by the noble Baroness, about whether there would be gaps and lacunas in this. That would not be in the interests of any of us; we will negotiate with both sides to make sure that the move from one jurisdiction to another is a smooth one.
On the question of UKIP and how our respective parties respond to it, that is a matter for the political campaigners. However, in this Statement my right honourable friend the Home Secretary has demonstrated what we would expect of her, given her high office. She has taken account of the national security and policing needs in coming to these decisions, and she should be congratulated on that.
Lord Hannay of Chiswick
My Lords, I apologise for remaining on my feet, but as the noble Lord, Lord Richard, said, I chaired the committee that wrote the report to which the Government have not found it in their wisdom to refer in this Statement.
One consequence of the Statement, which I thank the Minister for repeating, is that the committees which have worked together on this issue will now reopen the inquiry and provide the House with a second report before any final vote is taken. Does the Minister agree that this Statement makes, frankly, a pretty good mockery of the Government’s undertaking to engage with Parliament on this issue? The original decision was announced in Rio de Janeiro, rather further away than the studios of the “Today” programme, which is the normal distance from Westminster at which such things are said. That was followed up by a Statement in the House which preceded any consultation with this House, with the other place, with the devolved parliaments and with the professions.
Now we have a Statement that simply ignores the views of your Lordships’ EU Select Committee, which was supported by members of all three parties and of none and which came to the conclusion that the Government had not at all made a convincing case for triggering the block opt-out. That they do not even find room in the Statement to refer to that report is perhaps to be explained by the fact that the Government’s response to it is now two weeks overdue, and we have not yet seen it.
Can the Minister confirm that a second vote will be taken in this House, as in the other place, before any final decisions are reached, and that that debate and the vote will be taken in the light of the Government’s success in negotiating with the Commission and the Council on the measures that they wish to rejoin? Will the Government provide both Houses with a report on those negotiations well in advance of the second vote? Frankly, it is pretty odd to ask both Houses to vote on a 159-page White Paper within about a week.
Lord McNally
My Lords, on the point about the committee’s report, we will respond to that in due course. I hope that as we move forward we do not get bogged down in the niceties of protocol. The report from the noble Lord’s committee was influential in the discussions that have taken place. This is a little bit like a game of three-dimensional chess. In reaching decisions, the Government are trying to keep both Houses informed and to keep relations and channels open to the Commission and to member states. I hope Members of the House will understand that the issues covered by the 2014 decision are numerous and complex. We have been conscious of the need to ensure that any information we provide is as accurate and as informative as it can be.
Members of the House will be aware that the document today with its five explanatory memorandums is a measure of that commitment to put the information before the House as quickly and as fully as possible. Of course, I think it is implicit in everything that has been said that a second vote will be taken when the outcome of these negotiations are known. Common sense dictates that this will not be finessed through or carried through with smoke and mirrors. Both Houses, with all their experience and expertise, will demand the full facts on which they will base that second decision.
Lord Davies of Stamford
My Lords, is there not something very odd and illogical—weird, bizarre, even—about this Statement? It goes at some length into the merits of the proposals, or measures, that the Government intend to opt back into, so why opt out of them in the first place? It does not say anything at all about the de-merits of the measures that the Government want to abandon definitively. It is not surprising that the House seems to have come to a consensus this evening that what the Government have been conducting is essentially a charade. Will the noble Lord accept that this is a charade not entirely without cost? There will be the cost of an unnecessary negotiation. There will be the exasperation caused to our partners by the fact that we treat them in this particular way. There is, of course, the risk that we will not be able to renegotiate in exactly the fashion we want our resumption of the measures to which we wish to adhere in future—unless of course the Government have already received assurances in advance about that, in which case I hope the noble Lord will be frank and tell the House. Is it not also true that the Government embarked on this quite unnecessary, gratuitous and risky course simply for reasons of the most squalid party-political nature—designed simply to buy off their own Eurosceptics and to keep UKIP from making inroads into the Tory Party vote?
Lord McNally
That intervention would have a scintilla of credibility if it did not come from the Benches that negotiated the specific option with which we are now dealing. The noble Lord cannot get away from that fact. For heaven’s sake, why was Protocol 36 negotiated in the first place if it was not for the opportunity that the House is now taking? The noble Lord can score all the party-political points that he wants, but this was the legacy of the Benches opposite; the Government are dealing with it—like many other things. We are dealing with this, as my right honourable friend has emphasised, with a clear focus on the best assistance we can give to our policing and the best protection we can give to our national security. I am very happy that the Government are able to bring forward such a coherent programme, which is now open to both Houses to study and for a negotiation to progress.
Lord Lloyd of Berwick
My Lords, I will be very brief. I rejoice that the Government have decided that, after all, we need the European arrest warrant, together with Eurojust and Europol and the cross-border police co-operation. These are on any view the most important of the 35 measures which are due for retention—if, of course, we are able to opt back in.
Given the uncertainty surrounding the opt-in process, and given the fact that we are already subject to the jurisdiction of the Court of Justice of the European Union in respect of all the many police and justice measures that we have opted into since 2009, are we not taking an unjustifiable risk in opting out of what is good, including the 35 measures which are agreed to be in the national interest, in order to get rid of the other 95 pre-Lisbon measures, which are of no real importance to us, nor even of great relevance to us, one way or the other? It seems to be an unjustifiable risk we are taking for no apparent reason.
Lord McNally
I concede a lot of logic in what the noble and learned Lord has said. The fact is, however, that we had the Protocol 36 exercise to carry through; we have discussed it inside Government and with Parliament on a regular basis; and we have listened to the views of the committee of the noble Lord, Lord Hannay, and others. We have suggested a way forward. Is it a way forward with risk? Yes it is. All such enterprises have an element of risk. However, we can move forward with a degree of confidence once we get past some of the nitpicking about who did what, where and when, and get down to the central issue of whether we can successfully negotiate with our European colleagues on matters of our national interest and, I respectfully suggest, of Europe’s interest. What has encouraged us is that the soft soundings that we have taken have led us to believe that we can carry out meaningful, fruitful discussions and negotiations that recognise the risks that the noble and learned Lord mentioned, but, because we will do this with good will and an intention to succeed, and with colleagues who have similar good will and want us to succeed, will minimise those risks.
Lord Bowness
My Lords, I thank my noble friend for repeating the Statement. He will not be surprised to know that, as the former chairman of one of the sub-committees that prepared the report, I associate myself with the regret expressed by the noble Lord, Lord Hannay, that we have not had a response within the normal and required time, although there appears to have been time to produce the 159 pages of White Paper.
The noble and learned Lord who spoke just now referred to risk. At the seminar on this issue held by the European Union Select Committee, a distinguished participant said, vis-à-vis risk and the difficulties of renegotiating re-entry, that the game was not worth the candle. I endorse that 100%.
I turn to specifics. The Statement says that the Government wish to rejoin the existing Europol measure. It also says that they do not intend at this stage to opt into the new measure. I regret that because it means that we will not have a vote in the negotiations, and a future opt-in to the new Europol provision will depend on certain matters being dropped from the current draft.
In preparing a list of the 35 measures, did the Government take account of the report to your Lordships’ House on the UK opt-in to the new Europol regulation that I believe was debated last week, which makes it absolutely clear that there are four other Council decisions that may not be repealed and replaced by the current Europol proposal, and which Europol advised were directly connected—that is, the existing Europol and a possible new Europol? It follows that whatever happens with the new Europol, if we wish to stay in the old Europol and are successful in renegotiating that, we will need the four separate Council decisions that are listed in footnote 39 on page 10 of the report. As far as I can see, none of them is included in the 35 circulated today. Am I correct? Is it an omission? If it is an omission, will it be put right? If it is an intentional omission, what is the thinking behind it?
Perhaps I may ask my noble friend, in all sincerity, whether we may have a very close examination of all the other measures before we go to Brussels to renegotiate, in order to make sure that there are no others that we should have opted into.
Lord McNally
I regret that we have reached 20 minutes. I say to unlucky Members who did not get in—I made a mess of this last time—that this is just the beginning. We have a long way to go and there will be lots of opportunities to examine both Europol and other matters.
I make it clear that we support Europol as it currently exists. This is why we wish to rejoin the existing Council decision on Europol. The new regulation proposes additional obligations that could put at risk the independence of our law-enforcement agencies. We do not support it and have indicated that we will seek to opt into the new regulation, post adoption, provided that Europol is not given the power to direct national law-enforcement agencies to initiate investigations or share data that conflict with national security.
There is no contradiction here. Our recommendation on the Europol regulation is about participation in a future measure governing Europol. It has no impact on our current participation in Europol. The Government continue to value Europol, but we feel that the Commission’s proposals go too far in an area that we consider poses a risk to the independence of our law-enforcement authorities. Our message is clear. We should get the required changes and we will seek to opt into the new regulation, post adoption, provided that Europol is not given the power to direct national law-enforcement agencies to initiate investigations or share data that conflicts with national security.
I shall read Hansard carefully and if I have not covered the points made by the noble Lord I shall do so in a letter. However, I am already overrunning my time and we shall return to this matter.
Care Bill [HL]
(10 years, 10 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Baroness Emerton
Baroness Emerton
My Lords, in moving this amendment I shall also speak to Amendment 86PA.
Clause 5 emphasises quality, which is to be welcomed, and places promoting diversity and quality in the provision of services in the Bill. However, on behalf of nurses, the Royal College of Nursing thinks that it is not enough merely to quote “quality”. Local authorities are responsible for commissioning services from providers and have a duty to ensure that these providers and services are effective to meet the needs of the individual. It does not believe that at the moment local authorities are fulfilling these duties and responsibilities if they commission providers who fail to deliver high-quality care and, worse, provide care that detrimentally impacts on the health and well-being of individuals, as has been demonstrated in some recent high-profile cases.
As commissioners, local authorities must be part of a system-wide approach to safeguarding vulnerable groups. They are therefore falling negligent in their role if they commission providers and services that are not sustainable and fail both financially and clinically.
The potential impact of this was demonstrated recently with Southern Cross, where the health and well-being—and, indeed, lives—of care home residents were put at risk following the failure of its business model. For this reason, I believe that local authorities have a responsibility for ensuring that services that are commissioned by them are of high quality and sustainable. The two amendments are to that effect. Amendment 86HA seeks to insert the word “sustainable” and Amendment 86PA seeks to insert the words,
“the importance of ensuring the sustainability and high quality of the providers it commissions”.
I beg to move.
Lord Hunt of Kings Heath
My Lords, as this is my first intervention, I refer noble Lords to my interests as president elect of GSI, chair of an NHS foundation trust and a consultant and trainer with Cumberlege Connections.
I have three amendments in this group. Amendment 86J seeks to delete “high quality services” and instead insert,
““services appropriate to their needs as identified in the needs assessment and carer’s assessment”.
The problem with the draft as it currently stands is that it is very vague and entirely subjective depending on who is defining “high quality services”. Perhaps the noble Earl can clarify how the Government think it ought to be defined. Otherwise, there is a risk of uncertainty and inconsistency which, certainly when it comes to eligibility criteria, the Bill is designed to eradicate.
My second Amendment 86K would ensure that those in receipt of care and those involved in providing care are involved in shaping the market, as required under Clause 5. I have received a number of submissions about the market-making role of local authorities, and I was concerned to receive a submission from the Association of Directors of Adult Social Services, which said that while the intention of Clause 5 in promoting quality and diversity within the market is laudable, ADASS was of the view that the proposed duty placed on local authorities is wholly unrealistic. It points to a large number of providers that have no relationship or contact with local authorities, and says that combined with increased personalisation and limited leverage through the regulation framework, the ability of local authorities alone to influence diversity and quality of service is restricted.
I was very disappointed with that response, and rather taken aback by it. I hope that the noble Earl will share my view that in fact local authorities ought to be able to influence not only the market but the quality of care provided by private providers to a very great extent. Would the Minister accept that, to be effective, local authorities need to have a strong engagement both with users of services and carers, and with those who are providing services, too? That is why I tabled the amendment.
I listened with great interest to the noble Baroness, Lady Emerton, and I very much agree with her about the need to ensure quality in provision of service. That brings me to my own substantive Amendment 86P, which is very much concerned with the conditions under which care workers are employed in the main by the private sector. This is a hugely important issue. Clearly, we have a growing number of disabled and older people who need care and support. The people working in the care sector are vital. We need quality people who are highly trained and who can give the right commitment to the vulnerable people they are asked to care for. Clause 5 is important because what we see is a very fragmented industry delivering care that in many cases is of questionable quality and employing insecure, low paid, unregulated staff. Amendment 86P is concerned with the importance of fostering a sustainable workforce to encourage the acquisition of skills and decent working conditions that support the continuity and quality of care.
I was shocked to see a parliamentary Answer from the Minister’s honourable friend Mr Lamb recently, showing that more than 300,000 people working in the care sector are employed on zero-hours contracts. The point that I wish to make is this: how can people who do not have the security of knowing what they will earn pass on a sense of security to the people whom they care for? The rise in zero-hours contracts is bad for service users, many of whom are, of course, extremely vulnerable. There is another issue. People who are being cared for want to see the same person to have a continuity of care relationship. We know that that is severely hindered by those wretched zero-hours contracts. I believe that secure employment would allow staff to concentrate on caring rather than worrying about whether they are earning enough money for themselves and their families to live on.
I ought to declare an interest as a member of UNISON, which produced an excellent report, Time to Care, which undertook a survey in 2012 of care home workers. It showed that 80% of those who responded had to rush work or leave a client early to go to another call on what is called call cramming— in other words, too many calls for a care worker to undertake—and 56% received between the national minimum wage and £8 an hour. The majority did not receive set wages. Not surprisingly, turnover is high, while wages and conditions are poor.
Here is a shocking statistic. Nearly 57.8% are not paid for travelling time between visits. This morning I met a carer in Southwark who works roughly 20 hours on a zero-hours contract. She reckons that, because of the travelling time, she actually works for 27 hours, but is paid for only 20. The problem is that there is a race to the bottom because local authorities are, in my view, neglecting their responsibilities for ensuring that, when they place contracts, they are with good quality organisations. The companies who are exploiting their workers in this way are winning contracts at the expense of companies who treat their employees wisely. No wonder, therefore, that 36.7% of respondents are often allocated different clients on a daily basis, so that there is no chance of any relationship being developed.
There are many other statistics. The scandal of the 15-minute visit is well known. Indeed, the UK Homecare Association survey shows that three-quarters of all trips to old people have to be completed in less than half an hour and one in 10 is limited to no more than 15 minutes.
In Committee last week, I discussed with the Minister whether the CQC could be persuaded—or indeed, I hope, instructed—by your Lordships, to prioritise the regulation and inspection of local authorities in their commissioning duties. We have heard a lot about the CQC’s past failures and future hopes. It is clear that the focus is going to be on the NHS. I do not disagree with that, but when you think of the thousands of vulnerable people dependent on care workers, I wonder if the priority is right. If I were in the CQC’s shoes, I would focus on the care sector and particularly on local authorities and their own responsibilities. That is probably the best way to get into this issue.
We could have a debate about the regulation of social care workers. We could debate mandatory training and the noble Baroness, Lady Emerton, has tabled an amendment which would very much focus on that. I hope the Minister will recognise that we have a problem here. If we are to see this legislation enacted in the way that we all hope it will be, I am convinced that we have to look at the way that workers in the care sector are employed and do everything we can to prevent the abuse that we are seeing with these zero-hours contracts.
Baroness Greengross
My Lords, I rise to speak to the amendments in my name—Amendments 86L, 86M, 86N and 86Q. These amendments are all about quality of care. We know what happens at the moment. There is the opposite of a monopoly in that there are lots of sellers, but largely one buyer of care. Many care homes know this. The local authority is in a very strong position and will tell the care home managers—in the private or voluntary sectors—that they will take 20 beds and negotiate a price which is very low. That means that the care home cannot provide a decent quality of care at that unrealistic price. This has been talked about and written about by Laing and Buisson and various other bodies. It is a known fact among those who follow very closely what goes on, but at the moment it is not really known to the public.
Lord Lipsey
My Lords, I rise to support the amendments of my noble friend Lord Hunt and the remarks just made by the noble Baroness, Lady Greengross.
There have been a number of scandals, both about care at home and care in care homes, over the past year. I am astonished that the situation is not much worse than it is. When you see the pay and conditions imposed, and the people working under absurd and exploitative conditions in this sector—I use that old-fashioned word, exploitative, because it is the only one that applies—it is quite remarkable how many of them still care and still work their heads off for the people for whom they care We should pay due tribute to all those people.
Approaching this objectively, and it has been this way for some time, we have a situation that would be solved readily in a free market. The supply of people providing care is going down, and it will continue to go down, largely because of the Government’s crackdown on immigration; many of the workers in this sector are immigrants, as can be seen when visiting nearly any care home. The demand is going up year after year, if only for demographic reasons. What you would expect to happen would be for pay to go up, attracting more and better workers to the sector, thus resolving the situation. However, that is not happening.
Why? Because, in effect, there is a monopoly purchaser: the local authority. However, the local authority can only buy with the money it is allowed by the Government. As we know, the amount available for care, which should have been going up, has been going down. You can call on the CQC or local authorities to pay more but they are in an impossible position. If they do not connive in the appalling conditions inflicted on these workers, they will not be able to provide the services at all. So they try to get through another year and accept a lower tender or another company, even though they know that their standards are appalling. This is not the fault of the local authority. It is the fault of our national failing to put money into care while we have continued to ring-fence money for health and education.
I was once asked by a Care Minister, if I had money to spend in the care sector—having studied it quite a bit on the royal commission—how I would spend it. I said that I would give them all £1 an hour more and improve the standards of their training. I would say exactly the same thing today. I am supportive of the Dilnot proposals; I think that it is wonderful that we are spending more than £1 billion to help richer people not to be wiped out by their care costs. It is a great thing. However, it is not as great a thing as it would be if, at the same time, we were providing the money to allow local authorities properly to look after and provide basic services to people who need them, and to provide the money that would enable those providing those services to live decently and with pride in the wonderful job that they have been given to do.
Lord Low of Dalston
My Lords, I support Amendments 86N and 86Q tabled by my noble friend Lady Greengross, to which I have added my name.
This is a very important debate. As has been said, these amendments are all about quality and speak to many of the concerns to which the noble Lord, Lord Hunt, has just given powerful expression. The Care Bill introduces a number of important new duties and responsibilities to help place the right values at the heart of our care system. The well-being clause, for example, provides a foundation stone for the principles that should inform the whole of social care. However, our social care system is only as strong as the services that are actually commissioned. With budgets getting tighter and tighter, and demand getting ever greater, local authorities all too often commission care and support services based solely on finding the cheapest possible option. Unless we can ensure that the way in which services are commissioned drives the quality outcomes that we all want to see, important changes such as the well-being principle will remain simply a pious aspiration.
Amendment 86N would oblige local authorities to adhere to minimum standards in the way that they commission services and would give the Government power to make regulations for appropriate minimum standards. Amendment 86Q would provide for regulations to ensure that care visits lasted long enough to deliver the support needed. This would exert an important influence on the quality of services for disabled and older people. Focusing too much on cost creates an unacceptably high risk that care will be of the poor quality that we have heard too much about of late, which does not meet the basic needs of vulnerable people for support to enable them to live with dignity.
There are some fantastic examples of high-quality services across the country, despite severe budgetary constraints, and much can be learnt from how some local authorities have been able to build quality into what they do. However, there are also too many examples of people suffering as a result of poor-quality commissioning and receiving totally insufficient support, which consists simply of fleeting visits from carers who barely have time to say hello, let alone get to know and understand the needs of the person they are supporting.
I have heard of many cases of care workers rushing in to deliver care in visits of 15 minutes or even less. Fifteen minutes is not long enough to help people wash, get dressed, prepare a meal and use the bathroom. It is hardly long enough to take your coat off. It certainly is not long enough to promote people’s well-being. Care visits can be the only contact that socially excluded and vulnerable people have in a day. It is sobering that Leonard Cheshire Disability has recently announced that it will not accept contracts that provide for visits of 15 minutes or less.
A recent survey of local authorities found that 90% still pay providers according to the time they spend with the service user rather than the outcomes they achieve. This simply encourages a race to the bottom. The Bill needs to contain provisions that will help to ensure that quality of service is a key consideration in commissioning decisions. There must be checks and balances in the commissioning process and quality must be part of the equation. If we want a society that provides care based on need and not merely that which can be provided at the lowest cost, we need to support these amendments.
Ministers in the Department of Health have made a number of positive statements about improving quality in care. I hope that the Minister might be willing to accept these or similar amendments, but I ask him at the very least to clarify what the Government intend to do to make the positive rhetoric on quality a reality when it comes to commissioning services.
Baroness Jolly
My Lords, I will speak briefly to Amendment 86N, in the name of the noble Baroness, Lady Greengross. We have had an interesting debate, with quality at the heart of it. That is absolutely right because the whole principle of shaping markets has to be around providing quality and safe services for vulnerable people.
I was interested in the response to this that the noble Lord, Lord Hunt, had from ADASS. Certainly, I do not recollect from when it came to give evidence that that was its reaction, but I will look that up.
The other thing that I want to reflect on is this business of changing people for domiciliary care. That is not what people want. What people want is to be cared for by people they know; they do not want different people coming in day after day. My mother has a team of eight or nine people who call on her but she knows them all. That gives flexibility to the agency that sends them her way. It is not impossible. People need to know their care staff. My mother knows a week in advance who is coming, on what day and at what time, which is hugely reassuring.
I also have huge sympathy with those who have pointed to the scandal of zero-hours contracts. Whatever can be done to try to stop that practice must be looked at with some urgency. This is all about quality.
The amendment would ensure that services commissioned from providers are of high quality and provide a high level of safety for patients or those being cared for. The scrutiny committee recommended linking quality and safety with the NICE quality standards. That is really very straightforward: the NICE care quality standards exist, so why should services not be commissioned based on them?
Will my noble friend explain how quality will be assured and what the rationale is behind abandoning, or not taking up, the NICE link? Is he able to offer assurance by putting into regulations the link with those NICE standards?
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, in tabling these amendments, the noble Lords, Lord Hunt of Kings Heath and Lord Beecham, and the noble Baronesses, Lady Greengross and Lady Emerton, bring to the attention of the Committee the important role that local authorities have to play in fostering a market that offers people genuine choice between a range of high-quality care and support services.
To support choice and control for individuals, and to improve quality of care, it is critical that a range of types of care and support is available locally, and that the market in services is able to grow and adapt over time to meet people’s needs.
The Care Bill marks the first time that local authorities’ responsibilities to promote the market in local care and support services has been captured in law. This recognises the importance of ensuring the availability of a variety of high-quality services to meet the needs and preferences of all local people, not just those whose care is arranged by the local authority.
The duty is about ensuring that the market meets the needs of local people with a choice of quality services; it is not simply about promoting a market for its own sake. This focus on quality should be understood in a broad sense. High-quality services will be fit for purpose and appropriate to an individual’s needs. Consequently, the important issue raised by Amendment 86J, of ensuring that local authorities shape markets that offer people a choice between appropriate services, is already covered by the clause: propriety is an important component of quality. I say to the noble Baroness, Lady Greengross, that Clause 5 requires local authorities to shape diverse markets in care and support services. I do so in the light of her concern that low-paying local authority contracts might preclude smaller, voluntary sector organisations from playing a part in the market. The provision will include ensuring that people are able to choose from a range of providers, including small and micro providers.
In fulfilling the duty, it is vital that local authorities engage with adults using services, their carers and providers, as Amendment 86K emphasises. The Bill therefore requires local authorities to consider how providers can meet current and future demand for services, and the importance of fostering innovation and improvement in their local area. Consequently, I reassure noble Lords that it would not be possible to fulfil the duty as it stands without engaging providers, adults who are using care and support services, and carers.
A number of the amendments relate to one of the most important ways in which local authorities can shape local markets: their commissioning decisions. Local authorities are required by Clause 5 to consider the importance of ensuring sustainability. This requires a strategic perspective on the strengths and demands placed on care and support providers now and in the future. It means that local authorities must consider how their actions may impact on the stability of their local market. They should not act in a way which might risk the sustainability of the market. Looking especially at Amendment 86L, local authorities that set unreasonable or undeliverable prices which undercut the financial sustainability of the provider market would therefore not be fulfilling this duty. However, it is important to emphasise that the normal and effective operation of any market includes some providers entering and exiting the market. The Government do not wish to prevent exit, or require local authorities to prevent exit. It would not, therefore, be appropriate for local authorities to promote the sustainability of individual providers rather than the market in general. For that reason, I cannot support the amendments proposed by the noble Baroness, Lady Emerton, although, of course, I sympathise with her concerns.
The noble Baroness, Lady Greengross, expressed the worry that low-paying local authority contracts might lead to the subsidy of providers by self-funders. The introduction of the cap on care costs will mean that a person who chooses to meet their own needs will be able to compare what they might pay to meet their needs with what the local authority pays. If a person wants to, they will be able to ask the local authority to arrange to meet their eligible care needs so that what they pay to the local authority to meet their needs would be the same as the figure that counts towards the cap. I hope that is helpful.
Lord Campbell-Savours
Does that mean that a self-funder in a home would therefore know what the local authority rate was going to be? That is what I understand the noble Lord to have just said. The information would flow through, would it not?
Lord Campbell-Savours
I am sorry to press the noble Earl. As I understand it, in many homes, self-funders are completely unaware of what the local authorities pay.
Earl Howe
Under the cap arrangement, there will be for all to see a notional rate that the local authority will pay for care. That is the rate at which the progress against the cap will be measured for a particular individual in a particular area. We are moving to a different system.
Lord Hunt of Kings Heath
We are almost anticipating a later debate when it comes to the Dilnot cap. This is an important issue. It is well-known, is it not, that self-funders essentially subsidise those people funded by local authorities. We know that some homes simply would not be viable if they existed only on local authority rates. In a transparent era, will self-funders put up with that? The cap relates only to local authority rates, so self-funders, in many cases, will have to pay much more than £72,000 before they can look to the local authority for support. If they now know that in addition to having to pay well above the £72,000 they have actually been subsidising people who have been supported by local authorities, I think it is going to lead to some severe problems.
I do not expect the noble Earl to be able to respond in detail, and perhaps this is in anticipation of the debate that we will have in our next session, but I am not sure whether the issue of fairness has been factored in to an understanding of how this is going to work in practice.
Earl Howe
Local authorities and individuals can pay different prices for care. That can be because individuals have consciously chosen premium facilities or because the local authority has negotiated a lower price in exchange for buying care for a larger number of people, which can often happen as well. As is the case now, local authorities and providers will continue to negotiate arrangements and fees for providing care and support. This process should ensure that contracts reflect the market price for providing care. Local authorities that fail to negotiate properly with providers and do not have regard to the actual cost risk legal challenges to the care fees that they set. However, in response to the noble Lord, Lord Campbell-Savours, I would say that in future the independent personal budget will set out the cost to the local authority. That is the transparency point that I was trying to get at earlier.
Lord Campbell-Savours
I am very sorry but the point is being missed and I think that my noble friend on the Front Bench tried to qualify it. Up to £75,000, the self-funder is paying the full whack. As I understand it, what is being said is that in the same home the local authority rate either will be or will not be available to the self-funder who is paying that full rate. All I want to know is: if they are paying under the £75,000 cap, will they know what the local authority rate is? That is what I am trying to find out.
Baroness Greengross
My Lords, I have mentioned to the noble Earl another aspect of this which I think needs to be taken into account. Not only will this funding by some people of other people—or the “secret tax”, as I call it—become better known but there will be a strong incentive for self-funders to dispose of their assets so that the local authority pays the local authority rate for them, even if they pay in more on top of that. Therefore, I think that the Government need to take into account the huge extra cost on local authorities which we have not thought about so far. If self-funders were to go to a financial adviser and ask for advice, I imagine that many financial advisers would say, “Dispose of some of your assets and at least the local authority will pay that rate for you”.
Earl Howe
But for somebody with assets who is looking to be taken care of in a residential home the incentive to dispose of their personal assets is surely going to be a great deal less than it is at the moment. I would have thought that that incentive was much greater now than it will be in the future, when we hope that there will be financial products on the market to enable people to insure up to the level of the cap. Therefore, I am not sure that I completely understand the force of the point that the noble Baroness is making. Obviously there will be some incentive for people to dispose of their assets but I suggest that it will be less than she has stated.
To move on to the noble Baroness’s Amendment 86M, there will be a dispute between a local authority and a provider as to the prices proposed or other matters. Occasionally, disputes may become intractable. Therefore, I completely understand why the noble Baroness proposes through her amendment to, in effect, require a new independent adjudicator to arbitrate in any unresolvable disputes. However, it is our view that any disputes arising as part of a contractual negotiation must be resolved through that process. Appointing or establishing a new independent adjudicator would be likely to add unnecessary cost and bureaucracy to the process of commissioning. We also believe that it will be likely to increase disputes by providing a means of challenge which would soon become a standard process.
Baroness Emerton
My Lords, I thank noble Lords who have contributed to this debate, which has been extremely wide and meaningful when, as the Minister said, it is the first time that legislation has tackled the issue of going to the market place for care. Enough has been said by noble Lords to express the great concern that there is for the standards of care and its sustainability. I thank the noble Earl for his responses, but we would like to take this away to think more about some of the issues raised tonight.
It has been helpful to have the debate and to bring out the issues. Perhaps we can now be slightly more constructive in looking at the way forward. I beg to leave to withdraw the amendment on the basis of reflecting on the issues raised.
“( ) “Carer of a child” means a person who is a carer for the purposes of section 57.
“( ) “Young carer” has the same meaning as in section 60.”
Lord Low of Dalston
“( ) whether, and if so to what extent, the provision of a structured programme of care provided for a limited period to help a person maintain or regain the ability to live at home could contribute to the achievement of those outcomes,”
Lord Low of Dalston
My Lords, I shall also speak as briefly as I can to Amendments 88PA, 88PB and 88PC, on which my name also appears.
The purpose of Amendment 87H is to ensure that intermediate care and reablement needs are considered as part of the assessment process so that a holistic approach to meeting care and support needs is taken. In the White Paper of July last year, the Government promised that the new system would,
“promote wellbeing and independence at all stages to reduce the risk of people reaching a crisis point, and so improve their lives”.
As part of their vision for care and support, the Government accepted that they needed to move away from an approach that saw people as having to wait for a crisis before they could access care and support. The White Paper included a number of references to reablement, which the Government saw as helping people regain their independence at home.
The Bill, however, needs to be strengthened to take this perspective more fully on board and so that local authorities are clear about the steps they need to take to adopt a genuinely preventive approach to meeting needs for care and support, particularly as regards providing or arranging for reablement. At present reablement, for all the many promising words in the Caring for Our Future White Paper, remains conspicuously absent from the Bill. Whether it is enabling someone who has recently had a stroke to regain through their rehabilitation the skills they need for independent living, easing a person’s discharge from hospital, helping people when difficulties start to arise following a bereavement or after a fall, or providing aids and adaptations following the onset of sensory loss, reablement can be crucial in determining whether someone experiencing acute health problems goes on to develop long-term care needs or, on the contrary, feels confident enough to go on living independently.
There are a number of definitions of reablement, but broadly it refers to the relearning of self-care skills following a stay in hospital or the onset of an illness or disability. The aim is always to reduce the need for longer-term support. The social policy research unit and the personal social services research unit at the University of Kent and the LSE have analysed home care reablement services and found that reablement is associated with a significant decrease in subsequent use of social care services. The cost of the services they examined, used by a reablement group over 12 months, excluding the cost of reablement itself, was 60% less than the cost of the services used by those in a conventional home care group who did not receive reablement. To ensure that needs assessments properly factor in the potential health and well-being gains associated with a structured programme of reablement, Clause 9 needs amending to ensure that authorities assess the extent to which reablement or intermediate care would help people achieve the outcomes specified as a consequence of Clause 9(4)(d).
Amendment 88PB is the parallel amendment in relation to Clause 13, on eligibility. Its purpose is to avoid people who are judged ineligible for care packages also being denied intermediate care and reablement services or enduring unnecessary delays, by ensuring that the benefits of providing this help are considered when a local authority makes a determination on a person’s eligibility for care. Too many people do not get offered this preventive support, with the result that many of them are left to struggle on their own. This merely delays the moment when their needs worsen and they require more expensive support.
A lot has been written about reablement over the past five years or so in Green Papers and White Papers, but not yet in statute. What intermediate care and reablement have in common is that they are time-limited interventions that can be provided to a person independently of their eligibility for longer-term care and support. Crucially, as we have seen, they are also cost-effective. Curiously, the Bill does not mention reablement by name, although Clause 2(4)(d) paves the way for it when it speaks of regulations making provision for,
“services, facilities or resources which … are provided for a specified period only”.
Reablement or intermediate care can make all the difference between a person going under and remaining independent. A report produced by Deloitte for Sense and four other charities estimated a net return of 52% to a local authority that invested in a communicator guide and a rehabilitation service for deafblind adults who need help gaining news communication skills. It is essential that local authorities consider whether, and if so to what extent, a person would benefit from the provision of these time-limited but effective services. This does not place them under a duty to provide intermediate care and reablement services but, at a minimum, it ensures that they consider the value of putting in place those services where this would help maximise independence and also save the council money in the long run.
Such a battery of heavyweights have their names on Amendment 88PA that I hardly need to say anything about it—they will make the case better than I ever could. The amendment slightly expands the duty on local authorities to consider preventive support following a determination on eligibility. It provides that local authorities must consider not only whether service users would definitely benefit from the provision of preventive services under Clause 2, or information and advice under Clause 4, but whether they “would be likely to” benefit from such services. We have to be wary of placing burdens on local authorities that they cannot meet but this amendment is careful not to do that. It just opens the gateway to preventive services a little wider and makes it more difficult for local authorities to use unreasonable justifications for refusing to provide preventive support.
Baroness Browning
My Lords, I speak to Amendments 88B and 88N in this group. The noble Lord, Lord Touhig, has added his name to Amendment 88B, which is about the need to co-ordinate between two pieces of legislation: this Bill and the Children and Families Bill, which is also going through the House. It focuses on assessment, particularly at the time of transition from children’s to adult services. That is a very sensitive time, and the Minister will not need reminding that it was the weakness in the system of transition that prompted the initiative for the introduction of the Autism Act. There is much well documented casework about young people on the autistic spectrum who move from children’s to adult services that gives us a great deal of cause for concern. As the noble Lord, Lord Low, has just pointed out, if people do not get their correct assessment and services at the right time, they simply move on to more serious deterioration in their condition. Just looking at the bottom line, it is usually a crisis management situation, which is not good for the individual and certainly costs the statutory services a lot more money than it would have done if the transition had been smooth and matters had been dealt with properly.
Amendment 88B therefore calls on the Government to consider how this new system of SEN reforms in the Children and Families Bill will fit with the changes that are proposed in this Bill. Appropriate planning and support in the move to adult services is very important, and it is important that these two areas are co-ordinated. There is a danger that they could be done quite separately from each other, which would not be in the interest of the individual concerned. Under the Children and Families Bill, some young people—for example, those with autism—will be able to access an assessment for the new education, health and care plans, which of course will replace what we used to refer to as statements, up to the age of 25. This creates a clear overlap with care assessments under the Care Bill, which the same young people with autism may be eligible for from the age of 18. It is very important that the two systems of assessments and plans talk to each other.
In particular, that means that when a local authority carries out a needs assessment, as in Clause 9 of the Care Bill, it must ensure that it is co-ordinated with any assessment for an education, health and care plan that may also be under way under a separate piece of legislation. I have mentioned autism—I am sure that will not surprise my noble friend—but of course it will apply to young people with other conditions as well. However, this is particularly important for the autistic community because we know that it is during that move from the structure of full-time education in school into adolescent and adult services that you start to see a great deal of change in the individual, as the structured routine of the day starts to move to more adult choices and ways of doing things, including education.
I therefore hope that my noble friend can reassure me tonight that these two pieces of legislation will be compatible, that discussions have taken place between the two departments to make sure that there is no overlap, and that that famous word “seamless”, which I have heard so many times related to transition from children’s to adult services, will genuinely mean “seamless”. I spent 18 years as a Member of Parliament but did not see much that I would recognise as seamless. We have the opportunity to make this seamless. I hope that my noble friend will assure me that that will happen tonight.
I will speak very quickly to Amendment 88N. I tried with an earlier amendment to get my noble friend to agree that social work-qualified staff played a greater role in providing information. I will now have another go, as when he replied earlier I got the hint that he did not seem to accept my argument. I will try again in terms of their role of assessment, which is much more narrowly defined in Amendment 88N. That amendment ensures that information and advice are not only proportionate, but that the local authority must employ social work-qualified staff to provide the information and advice in cases where present or foreseeable needs are classified as complex. Of course, this goes into regulation, which is what this part of the Bill requires.
I hope that my noble friend will look more kindly on this particular recommendation because these are complex needs or—and this is important—foreseeable complex needs, so you are dealing with some of the most difficult cases. You are almost certainly looking at cases where there is some lack of capacity for a start, as well as people with multiple diagnoses and those with very complex situations. It is important that social workers are there. I am asking a Minister with responsibility for health to recognise that unless we in this House bring social work and healthcare together in statute, whatever our best intentions, it will not happen. Again, from all that casework I dealt with—I raised this at Second Reading—as a Member of Parliament, when somebody sat in my surgery and said, “What you need is to get all these people together round a table”, I, the MP, could never work out why nobody ever took responsibility for it. By bringing into regulation the role of the social worker, you make some progress in ensuring that in these very complex cases things are not only speeded up but that there is a much better outcome.
Baroness Wilkins
My Lords, I will speak to Amendment 88A. This amendment relates to Clause 9, which requires a local authority to carry out an assessment where an adult may have needs for care and support. The clause sets out things that the local authority must consider, for example the outcomes the person wants to achieve in their day-to-day life. There are similar provisions in Clause 10 in relation to a carer’s need for support. There is, however, an anomaly between Clauses 9 and 10. Under Clause 10(6), the local authority also has to take account of whether the carer works or wants to work, and whether the carer is taking part—or wants to take part—in education, training or recreation. That provision is missing from Clause 9, while in other respects the two clauses closely mirror one another. Surely the same provision as Clause 10 proposes in relation to carers should apply to people in need of care and support? While many of those with a need for care and support may be elderly, or may not be able to—or want to—work, others will want to. Many will be interested in education, training or recreation. This is an important gap that sends an unfortunate message about the ability or desire to work of those with needs for care and support.
Of course, it may be that the Government will argue that this is covered by Clause 1(2)(d), which includes in the concept of well-being,
“participation in work, education, training or recreation”.
If that were so, however, presumably the separate provision for carers in Clause 10(6) would not be needed.
I understand that overwhelming evidence exists that carers are often forced to withdraw from education or employment. That may well be why the Government felt they should include the emphasis on these things in relation to the assessment of carers’ needs. Possibly there is not as much evidence in relation to disabled people, and, as I have said, many social care users are older people. That does not mean that they will not be interested in education, training, recreation or even work. One in three people who use social care services are disabled people of working age.
In the recent report The Other Care Crisis by five disability organisations, the researchers found that time and again disabled people told them that the right care and support was critical in finding and sustaining work, studying and keeping fit or enjoying the arts. How can you hold down a job if the hours and type of support you are provided with take no account of a course you may be studying or of a job? What if the job starts at 9.30 am but your carers do not come to get you up until 9 am, or they turn up at different times each morning because of short-staffing?
Carers UK and others have rightly worked very hard to show the impact of caring on employment chances. As I say, this may well be the reason why the Government has included Clause 10(6). The Government may simply not have realised, however, how this would come across to users of social care services who wish to work. I hope the Government will want to rectify this anomaly.
Baroness Meacher
My Lords, I shall speak to Amendments 88SA, 88SB and 92ZZCZA, all of which are designed to ensure that parents who have care and support needs receive sufficient services to ensure that the caring burden on their child is not such as to impede their education and well-being.
Young carers are, of course, children and young people under 18 who provide regular and ongoing care and emotional support to a family member who is physically or mentally ill, disabled or misuses substances. The 2011 census identified 178,000 young carers in England and Wales; an 83% increase in the number of young carers aged five to seven years old; and a 55% increase in the number of eight and nine year-old children caring. I find these numbers staggering. We are talking about a lot of children of a very young age caring for a very considerable number of hours each week.
Why are the amendments important? Apart from a concern for the well-being of children, the issue is important for taxpayers. Young carers whose parents do not receive the support they need have poor educational and employment outcomes and suffer from negative health, with obvious cost implications for the Treasury. These amendments and the resulting early intervention could alleviate those problems and avoid crises, family breakdown and child protection issues, which, again, are a tragedy not only for the family but for the taxpayer and society.
Lord Touhig
My Lords, I will be very brief in speaking in support of Amendment 88B. Certainly, I very much welcome the opportunity to improve access to the right support for young people with autism. I have met many young people with autism who have found that times of change, such as the transition from school to adulthood, are very challenging. It is the time when families need the appropriate planning and support to move from children’s services to adult services. In recent times I have talked to quite a few young people and their families who tell me that life at the time of transition, as they move from young people’s services to adult services, is like standing on a cliff edge.
The noble Baroness, Lady Browning, made a very powerful case that she articulated very well when she said that there would be considerable overlaps between this Bill and the Children and Families Bill. It is important that these two systems talk to each other. They must not operate in silos or we will never, as the noble Baroness, Lady Browning, said, ever get round the table and sort these things out. That makes common sense and I hope the Minister will recognise that—although, when I was growing up my mother used to say to me, “Son, in life, you will find that sense is not that common”. However, I hope that in this case it will prove to be and that the Government will see the reasonableness of these proposals.
Baroness Tyler of Enfield
My Lords, I add my support to Amendment 88B and point out that, while it is in the name of the noble Lord, Lord Tyler, on the Marshalled List, it should have my name attached to it.
Both my noble friend Lady Browning and the noble Lord, Lord Touhig, have presented a cogent case. I am not going to say anything other than it is important that we have properly co-ordinated arrangements for the transition process and the assessment as young people move between children’s and adult services. Certainly, like my noble friend Lady Browning, my experience is that far too often, in far too many cases, it is far from seamless.
I also support the three amendments to which the noble Baroness, Lady Meacher, has just spoken on young carers. The separation of adult and children services proves a real structural barrier, in my experience, to supporting young carers. Simply improving guidance and the other methods that have been tried before will not ensure the clear accountability that is needed for supporting the whole family. I know that the Minister has spoken before in Committee about the importance that the Government attach to the family approach—a view that I share—but a recent evaluation carried out by the Children’s Society found that the professionals involved believe that the law must be changed so that there are clearer levers for the provision of care and support in a way that sustains the whole family, and clearer lines of responsibility and accountability for both adult and children services.
We have discussed this both at Second Reading and in Committee. It needs a fully joined-up response and, while I understand and accept the Minister’s argument that most of the heavy lifting, if you like, in this area will be done in the Children and Families Bill, these amendments are needed in the Care Bill to ensure that adults’ needs are met sufficiently so that children and young people are protected from inappropriate caring, and that we have proper joining-up and co-ordination, not simply between services on the ground but between these two important pieces of legislation.
Baroness Wheeler
My Lords, the issue of assessment is an important part of the Bill and key issues have been raised which need to be carefully considered by the Government to ensure that the Bill gets these provisions right.
As we know, the Bill extends the right to be assessed for care and support to self-funders and their carers which, in the estimation of major social care charities, will involve nearly 500,000 additional assessments being undertaken by local authorities on top of those for people whose care is provided by them.
We support the extension of entitlement to assessment to self-funders and their carers but we join with noble Lords who are concerned about whether local authorities can possibly carry out this major undertaking in the realities of the current funding crisis and the other duties being placed on them. It is vital that we hear from the Government whether they consider extra resources will need to be made available to support these new duties and whether the noble Earl is confident that the current funding settlement will enable the duties to be performed effectively.
Our Amendments 87J and 88D address the concern that noble Lords and care and support organisations have raised over including in the Bill the requirement—as part of the assessment—to consider whether and to what extent the adult’s or carer’s own capabilities, or any support available from family and friends, could contribute to achieving the outcomes identified in the care plan. It is a very important issue.
Clauses 9(4)(d) and 10(5)(f) were not part of the consultation on the draft Bill, which followed the Law Commission’s advice on making a clear distinction between consideration of care and support needs and how these needs should be met. Support from families and carers should be considered as a way of meeting needs rather than as a reason for deciding the person does not have needs.
The approach in the Bill runs a huge risk of the assessment not recognising the vital contributions of carers and the extent of needs if the carer is unable to provide care. The clauses, as they stand, blur the distinction between an assessment being about what the needs are and the ways of meeting them because they look at how needs can be met other than through the provision of services before any decision about eligibility has been made. They also raise concerns that a carer might be pressured into providing care that they do not feel able to provide—or even that the adult may be pressured into receiving care from a family member. I hope that the Minister will recognise the importance of these two paragraphs being deleted.
Instead our Amendments 92ZZF and 92ZZL propose putting the issue in other parts of the Bill where the vital distinction we are making will be clear. We are seeking to insert new subsections into Clauses 24 and 25 to retain the aim of a capability-based approach being properly considered—in other words one that draws on a person’s own abilities and available social networks. Our amendments would require this process to take place after needs have been defined and not before.
The proposed new subsection refers to the local authority duty to provide information and advice to people not eligible for care and support. It adds to the advice and information requirement to discuss with the person who has been assessed whether they have the individual capabilities or social or community resources that can help them achieve the outcomes they want. Clause 25 deals with the care and support or support plan for people eligible for support, and our amendment again would ensure that the individual’s capabilities and social or community resources are considered at this stage after assessment. This is vital to ensure at least some protection against either the carer or adult needing care being pressured into a caring relationship they do not want, or is inappropriate.
Our Amendments 88P and 88PA deal with the concerns raised under this and in a later group to ensure that assessments are undertaken by persons with expertise, in line with current guidance and practice. Amendment 88P provides for the local authority to be satisfied that the assessment of needs of the adult and carer have been appropriately and proportionately considered by an appropriately skilled or qualified assessor. The intention of Amendment 88PA is to tighten the duty on local authorities to consider preventive support following the determination of eligibility. We want to ensure that local authorities do not use unreasonable justification for refusing to provide or arrange for preventive support and consider what preventive services would or would be likely to benefit an adult.
The current guidance recognises the need for flexibility in certain circumstances on who undertakes the assessment, and this needs to be retained. For example, my local authority is in the last processes of undertaking effectively new assessments of existing clients under the transfer to self-directed support and personal budgets. As noble Lords will know, I am a carer and my partner has long-term health and care needs after suffering a major stroke. Our recent assessment was undertaken by a very competent member of the personalisation team who is not a qualified social worker but a former care assistant, so she fully understood home care support. However, she had access to a qualified social worker care manager for advice to whom we could also refer if we needed. I stress that this was an assessment of a care plan in operation for six years, and under a process that was not originating the plan but viewing it from the personalisation perspective. We both found the new, but demanding process— 44 page forms, as I might have mentioned before—very helpful in giving new perspectives on issues, such as risk when I am not at home or contingency arrangements if I am hospitalised, or fall under the proverbial bus. Most carers just cross their fingers and hope that it would never happen for their own and the cared-for person’s sake, but the assessment experience was a positive opportunity to take stock and a worthwhile experience, which I hope we are still feeling good about when the personal budget allocation comes.
Nevertheless, my point is that the original assessment was conducted by a qualified social worker with full understanding of care requirements for major stroke recoverers, and that assessment has stood the test of time six years on. Had this assessment been a first time assessment, however, it would have been vital to have had a qualified social worker, plus any specialist advice on stroke, if needed. Amendments 88A and 88DA tabled by the noble Baroness, Lady Emerton, require the local authority to involve the relevant health practitioner in the needs assessment for adults and carers under Clauses 9 and 10. We agree that they should be involved where their specialist skills are needed and that this will help ensure better integration of health and social care, and overall better patient care.
I also support Amendment 88 from my noble friend Lady Wilkins, which provides for the local authority to have the same duty under Clause 9 for adult assessments as is given in Clause 10 for carers’ assessments. This is a logical amendment and I hope the Minister will recognise that.
We have also had three important amendments tabled by the noble Baroness, Lady Meacher, which have been added to this group and which we support. These reinforce our messages in the debate in Committee last week on young carers—namely that adult assessments need to meet the needs of the adult, so that children are protected from inappropriate caring. The noble Baroness has stressed how important this is and I look forward to the Minister updating us on the developments over the interface between the Care Bill and the Children and Families Bill in respect of young carers and parent carers.
Finally, I would stress how important the assessment process is. The Government’s discussion document on eligibility recognises that they are an integral part of the system. As we have seen, there are many separate aspects related to assessments, and it is a pity that, in this instance, we have had to lump them all into one big debate. I would therefore urge the Minister, even if he does not agree with the very strong case presented by noble Lords for including these matters in the Bill, to undertake to take the issues of concern away and review this part of the Bill so that there can be full confidence in the legislation underpinning this important issue.
Earl Howe
My Lords, I thank all those who have contributed to an informed and very interesting debate. The amendments mostly focus on the assessment process, but some also refer to Clause 13 on the eligibility criteria which we will consider later.
The noble Baroness, Lady Wheeler, is quite right that assessments will remain an integral part of the reformed care and support system. However, rather than acting primarily as a gateway to the adult receiving care and support, the future system will place more emphasis on supporting people to identify their needs; understand the options available to them; plan for meeting care and support needs, and reduce or delay needs where that is possible.
The amendments tabled by the noble Lord, Lord Low, Amendments 87H and 88PB, rightly point out that intermediate care services, such as reablement, can play a vital role in helping people regain their independence and in preventing avoidable re-admissions. Under this Bill, local authorities would be expected to consider how the provision of reablement and other types of care and support could contribute to the achievement of an individual’s desired outcomes as part of the assessment process. Clause 13(2)(b) makes it clear that, in determining eligibility, local authorities must consider if the person would benefit from preventive services—whether or not they have eligible needs. This would include reablement services.
Amendments 88PA and 88PC, tabled by the noble Lord, Lord Low, look to build on the measures in Clause 13(2) about prevention. Amendment 88PC raises the issue of individual entitlements to preventive services, facilities and resources. I hope he would agree that Clause 2 is an important step forward in itself, capturing prevention in primary legislation for the first time. It will require local authorities to provide or arrange prevention services and actively to consider the steps that they should take. The Bill makes clear that prevention is a core part of care and support provision, not an optional extra. This duty is only one part of a broader approach throughout the Bill to preventing, delaying and reducing needs.
One of the aims of the pooled budget, to which the noble Lord, Lord Low, referred, is that local authorities and CCGs should spend it on preventive services. However, individual entitlements should be built around people with ongoing needs for care and support—as they are now. We do not think it is necessary, or would make sense, for there also to be individually enforceable rights to preventive services which would be too broad, and therefore carry a very significant cost burden for local authorities. I took note of the comments of the noble Lord, Lord Low, on that point but, despite these, our view is that any enforceable right in this area would almost unavoidably lead to very high budgetary pressures.
I turn now to Amendments 87J, 88D, 92ZZF and 92ZZL tabled by the noble Baroness, Lady Wheeler. We heard during consultation that assessment processes should look at what an individual wants to achieve and what they can do, not just at their “deficits” or what they cannot do. Assessments should help the person to identify their needs, strengths, goals and aspirations, and consider what type of proportionate intervention might support them. The purpose of Clause 9(4)(d) is not to suggest that such matters should replace more formal types of care and support. The clear purpose of the duty is to assess an adult’s need for care and support. However, it recognises that in order to make the connections to the variety of support available in the community, the local authority should consider how these matters, along with more formal care and support provision, could be of benefit in achieving the adult’s outcomes.
Amendment 88A, to which the noble Baroness, Lady Wilkins, spoke so powerfully, raises the question of employment, education and training, and in doing so repeats Clause 10(6). This re-enacts specific existing provision for carers in relation to such issues, which the Law Commission recommended should remain. We recognise that these areas are of equal importance to adults receiving care and support. However, it is not necessary to recreate this provision as local authorities must already consider during the assessment process the adult’s aspirations in relation to work, education, training or recreation when considering the outcomes they wish to achieve.
On Amendment 88B, I agree with the principle of joining up assessments when it is sensible to do so. The provisions in the Care Bill are compatible with those in the Children and Families Bill, and both Bills allow for joint assessment. I am satisfied that the Care Bill includes the legal framework to enable a co-ordinated approach. My noble friend Lady Browning asked how the Children and Families Bill will fit with this Bill in relation to care planning, and particularly in relation to those with autism. The Children and Families Bill will improve co-operation between all the services that support children with special educational needs and their families. This will require local authorities to involve children, young people and parents in reviewing and developing care for those with special educational needs. Local authorities will also need to publish information about what relevant support can be offered locally. The Care Bill and the special educational needs provisions in the Children and Families Bill require that there is co-operation within and between local authorities to ensure that the necessary people co-operate, that the right information and advice are available, and that assessments can be carried out jointly. We are in discussion with the Department for Education about the links between both Bills.
The noble Baroness, Lady Emerton, proposes in her two amendments that assessments must involve health professionals. In our view, this would not be proportionate because not everyone would have health needs or need to involve a health practitioner. The Bill already allows the individual to decide if they wish to involve a health professional, and Clause 12 includes a power to allow authorities to carry out a joint assessment with other bodies such as the NHS.
My noble friend Lady Browning and the noble Baroness, Lady Wheeler, made important points about the appropriate training and skills of assessors. Stakeholders have told us of the importance of having appropriately trained assessors. We have therefore extended the powers in Clause 12 and I can reassure both noble Lords that we will make regulations to require local authorities to ensure that assessors are properly trained.
My noble friend Lady Browning asked why we have not specified that a qualified social worker should carry out assessments on people with complex needs. The social care workforce, as she well knows, is a mixture of qualified social workers and care managers who have been trained to carry out tasks such as assessments. It is, we believe, for local authorities to determine the mix of their workforces. Local authorities should also make a professional judgment on who has the appropriate skills and training to carry out assessments, and I really do not think it would be appropriate to do this from the centre.
The noble Baroness, Lady Meacher, raises an important point through Amendments 88SA and 88SB about the eligibility criteria for adults with care and support needs helping to prevent young carers from taking on inappropriate or excessive caring responsibilities that can impact adversely on their lives. The draft regulations make clear that an adult’s needs for care and support will be eligible if, because of mental or physical impairment or illness, they are unable to carry out fully any caring responsibilities for a child, or need support to maintain family relationships. Our policy intention is to encourage local authorities to take a whole-family approach, both in assessing and supporting an adult needing care and support, meaning that an individual adult is not seen in isolation from their family circumstances. That would include having to identify the child.
The noble Baroness made the point that better support for young carers will save money for the taxpayer. We agree that better supporting young carers will improve both their well-being and that of the person they care for and that it is also likely to benefit the public purse. That is why we are working with the Department for Education to ensure that a whole-family approach is taken.
Amendment 92ZZCZA follows the same principle, but seeks to add to the duty to meet eligible needs. As I have set out, we see the appropriate way of dealing with the issue of avoiding inappropriate young caring roles to be through the eligibility criteria. We would not wish to create a new stand-alone duty in this regard, which may have a distorting effect on the duty in Clause 18, but rather to ensure that such matters are reflected in the determination of eligible needs. However, as I indicated in debate last week, we need to ensure that the developmental and educational needs of young people are appropriately considered in the context of children’s legislation and services. We will work with stakeholders, including the National Young Carers Coalition, to ensure that, for their part, adult care and support services make appropriate provision in supporting an adult’s needs for care and support to prevent inappropriate or excessive caring by a child. However, we also need to keep in view what should be provided through children’s services and that is what the Minister for Children and Families has committed to do.
The noble Baroness, Lady Wheeler, raised an important point about the impact of the funding reforms. We recognise that people will want to have their care costs counting towards the cap as soon as possible. If this Bill is enacted, people cannot begin accruing costs towards the cap until 1 April 2016. That does not mean that preparation cannot be made locally before that time. We believe that it is appropriate for local authorities to begin assessing people ahead of 1 April 2016. To ensure that local authorities can take advantage of this opportunity, we have provided £335 million to fund the implementation of our reforms. This should enable local authorities to begin assessing people’s needs for care and support around six months before April 2016, if they choose to do so.
I hope that I have reassured the Committee that we are putting in place the support to allow local authorities to manage the implementation of our reforms. We have had a very good debate on assessment and eligibility. I hope that I have reassured all noble Lords who have spoken that the Bill already addresses the concerns that have been raised and that the noble Baroness, Lady Meacher, will feel able to withdraw the amendment. I am sorry—it was the noble Lord, Lord Low.
Lord Low of Dalston
Yes, I was going to say that I think it probably falls to me to consider whether I withdraw the amendment. Before I do so I just want to thank the noble Earl for his full and careful response, and also all those who have spoken in a debate that has ranged quite widely. I have found the noble Earl’s response to the points that I raised very helpful and will consider whether I continue to feel that the Bill needs strengthening in the area of assessment and eligibility in the light of his comments. I listened carefully to what he had to say and feel it will be very helpful in considering how to deal with these issues during later stages of the Bill.