World Sepsis Declaration
Baroness Pitkeathley Excerpts(11 years, 4 months ago)
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Earl Howe
My noble friend makes an important point. Public awareness is a key focus of the Global Sepsis Alliance’s declaration. On raising awareness, the NHS Choices website has extensive information about sepsis, its causes, symptoms and treatment. I do agree, however, that it is important to empower both patients and the public to ensure that everybody is on their guard against this very serious illness.
Baroness Pitkeathley
My Lords, since sepsis accounts for more deaths than bowel, bladder and breast cancer put together and for one-third of all the expenditure on critical care in the NHS, would the Minister agree that early diagnosis is the key here? I declare an interest as someone who recovered from full-body sepsis, thanks to early diagnosis.
Earl Howe
My Lords, I absolutely agree with the noble Baroness. The need to rapidly identify sepsis when it occurs is vital to ensure that unnecessary death is prevented. A crucial measure to tackle sepsis when it appears is early treatment with broad-spectrum antibiotics. My understanding is that once the bacterium has been identified, the treatment of choice is to have a more focused antibiotic, but rapid reaction is of the essence.
Autism
Baroness Pitkeathley Excerpts(11 years, 5 months ago)
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Earl Howe
Yes, my Lords, the autism strategy is a cross-government strategy and is already having an impact in areas such as employment and education. It includes activity to help adults with autism into work. The mandate to the NHS Commissioning Board particularly mentions those with learning disabilities and autism and their need to receive safe, appropriate and high-quality care. From 2014, when necessary, young people up to the age of 25 with special educational needs, which would include autism, will have an education, health and care plan. I assure my noble friend that work is going on across government in this area.
Baroness Pitkeathley
My Lords, last week on Carers Rights Day I spoke to a great many parents who raised the same matter as the noble Baroness, Lady Browning—the transition period for young people with autism. Does the Minister consider that it is a problem that parent carers are not yet referred to in the draft Care and Support Bill, which we are about to start scrutinising? What role does he think local Healthwatch and local well-being boards can have in this regard?
Earl Howe
My Lords, local health and well-being boards and local Healthwatch will be instrumental in ensuring the improvement of the quality of services for people with autism. As regards the transition from childhood to adulthood, the Department for Education is working with my own department to make the transition recommendations in the strategy the success that we all want them to be. A project funded by both departments and led by the University of York will report before the end of the year and will inform good practice in service at the point of transition.
Social Care
Baroness Pitkeathley Excerpts(11 years, 5 months ago)
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Baroness Pitkeathley
That this House takes note of the impact of changes in local authority budgets on the provision of social care and its integration with other health, housing and care services.
Baroness Pitkeathley
Well, my Lords, here we are again. It is almost exactly a year since I last introduced a debate on social care, and once again I feel like Captain Renault in my favourite film, “Casablanca”, rounding up the usual suspects. Noble Lords speaking today are once again those with form on this issue, although I am pleased to say that we have some new recruits to our numbers as well.
Last year’s debate focused on the report of the Dilnot commission, and it is a matter of great regret to me—and to many others, I am sure—that, in spite of general agreement around the House at that time that doing nothing was not an option, still no decision has been taken about these important proposals. Andrew Dilnot and his colleagues continue to press the issue with hope and enthusiasm, and we hear lots of rumours that we may have an announcement in the Autumn Budget Statement, next spring, next Budget or in the next spending review—but still no actual commitment.
In his response to the debate last year, the Minister said that we have an opportunity to get this right and we must not miss it. No one could possibly disagree with that but I must begin this debate by recording my intense disappointment that, one year on, we are no further ahead with implementing a long-term solution to the problems of social care.
However, we are focusing today on the immediate problems faced by local authorities and the impact of those on the rest of the system. When we discuss integration, as we often have during the past year, we usually focus on the particular interface between health and social care services. The topic of this debate is deliberately wider, though, acknowledging that care needs do not come in discrete packages but are stretched across the whole of an elderly or disabled person’s life, including their housing, their families and their income.
We must acknowledge that we are not in exactly the same place that we were last year. The Health and Social Care Bill that we were debating then is now an Act, and many promises were made about how it would make integration between health and social care easier. It perhaps is too early to say whether this is becoming a universal reality but none of the reports coming out of local authorities and the NHS fill one with hope. In a recent survey by the NHS Confederation, for example, 66% of NHS leaders said that shortfalls in local authority spending had impacted on their services last year. Delayed transfers of care cost the NHS about £200 million a year, and the human distress that such delays cause to patients and families is incalculable.
I know that the Minister will remind us that in last year’s CSR the Government transferred an extra £2 billion to social care by 2015, £1 billion of that coming from the NHS. Local authorities were grateful for that, of course, although it has been called a sticking-plaster solution. Even if it were to be allocated on a permanent basis, £2 billion is not nearly adequate to meet the needs of the social care system. While the transfer of funds from the NHS to social care has been crucial, not all areas have been able to use the money in the way intended—for example, on hospital discharge, reablement and intermediate care. These have made a difference in some areas but too often they paper over cracks in a system that is groaning and only storing up more problems for the future.
In summary—I will say this briefly since I know that the usual suspects are only too familiar with it—the system is not fit for purpose and we spend inadequate amounts on care and support both publicly and privately. Social care funding has totally failed to keep pace with demographic change. Since 2004, while spending in the NHS has risen by £25 billion, spending on social care has risen by just £43 million.
I am always aware of saying how inadequate our care provision is, lest it be seen as criticism of the many dedicated people who work in the system providing care and sometimes pushing the boundaries to focus on prevention and innovative ways of meeting need. We cannot avoid recognising that the way in which local authorities have dealt with the fact that need has far outstretched funding has been to increase charges and rapidly to raise the threshold at which you can qualify for care. You get care only if your needs are seen as substantial or critical.
In too many areas, services are provided only to those whose care needs are the most severe. The LGA has stated that it expects a funding gap for local authority services of £16.5 billion a year by 2019, or a 29% shortfall, between revenue and spending pressures. It further estimates that in the not-too-distant future, social care and waste spending together will absorb such a huge percentage of their funding that other services will have to take an 80% cut.
Without action on funding and integration, even very basic care—those basic 15 minutes a day, which is all that many elderly and disabled people can expect—will not be available in future. Only this week, the weather sees us having to factor into local authority budgets the huge extra costs that many of them will have as a result of the floods. Not only is this level of care completely inadequate but the fact that it is provided only to those with severe or critical needs makes a nonsense of the prevention that all sides say is the key to ensuring that care needs do not escalate to crisis point.
Moreover, this takes no account at all of the many people who currently meet their own care needs in full. Not only may they have to use local authority services in future but no attempt to preserve the quality of the services can be made for those people. Mencap provides clear evidence that local authorities are struggling with reduced funding from central government and increased demand for services. Over the past three years, one in three local authorities has closed day services and 57% of people with a learning disability no longer receive any day-service provision. Carers UK reports that carers are being affected by the closure of council-run services and by the cuts to grants to the voluntary sector, which provides vital services locally. One carer said that getting respite care service nowadays is like getting blood out of a stone.
When people’s care needs are not met by social care systems, what happens? They turn, of course, to the NHS. This results in increased demand for unplanned and emergency services and delays in hospital discharge. In addition, 88% of GPs surveyed recently by Carers UK report that their patients are being put at risk due to a lack of social care support.
These extra pressures come at a time when the NHS is already under severe financial pressure. The CSR protected NHS funding to some degree but did not take account of rising demand and rapidly increasing healthcare costs. We all know that the NHS is expected to make £20 billion of savings and efficiencies by 2014-15, and the recent report from the CQC paints a sad picture of how cost-cutting is being put ahead of patient welfare, with 16% of hospitals surveyed not meeting the CQC standards for having enough staff on duty to care properly for patients, and warns that this may lead to a culture in which unacceptable standards of care become the norm. Yesterday’s report from the King’s Fund paints a similar picture for the NHS of bed closures, lost services and low morale.
No one could possibly disagree that the NHS and all care services must be run as efficiently as possible. One of the most important ways in which to make efficiencies in either health or social care is through integrating services, an issue that we have debated many times in your Lordships’ House. The money transferred to local authorities from the NHS has helped to stimulate integration and certainly to develop interest in it, but evidence given by the King’s Fund to the Health Select Committee notes that a lack of urgency in delivering integrated care remains and, indeed, that the huge upheaval that we have seen in the NHS since last year has hampered progress and resulted in lost momentum. In this context, it was a positive step to see a paragraph in the recently published mandate emphasise the role of the Commissioning Board in driving and co-ordinating engagement with local councils. For the sake of the increasing numbers of people in urgent need of co-ordinated services, we must hope that the mandate delivers.
The other significant development since last year is, of course, the draft Care and Support Bill. I am honoured to be a member, along with my noble friend Lord Warner, of the pre-legislative scrutiny committee considering this. We shall spend many happy hours with colleagues from this House and another place hearing evidence, testing proposals and debating provisions. There is not time to go into the detail of that Bill here, save to say that there are many welcome proposals in it, and the Government are to be congratulated on an excellent attempt to achieve co-ordination of the many disparate strands of care legislation and to give greater recognition and more rights to users and carers.
In terms of the issue that we are debating today, it is hard to feel anything but anxiety about the extra duties placed on local authorities and on how on earth they are to be funded. Do not mistake me—I could not be more delighted that support for carers will be strengthened or that there will be an obligation on local authorities to provide information and advice to promote diversity and quality, or with the references to assessments and care and support plans, as well as a very much to be praised reference to national eligibility criteria. But even those far-reaching reforms could be viewed as a sticking-plaster solution if we do not tackle the fundamental problem of how social care is funded. The inconsistency between fully funded NHS care and means-tested social care not only confuses users and carers but inevitably hampers the delivery of a comprehensive care package.
Noble Lords may have noticed thus far my subtle references to a need for more money in the system. In conclusion, I want to focus on money. I know that the Government’s response to calls for more money in the system is always, understandably, “There is no more money”. As Andrew Dilnot frequently says, though, it is a question not of “can’t afford it” but of “won’t afford it”. Our GDP shows that we are five times better off than we were in 1948. Time and again, we find that social care properly delivered, of good reliable quality and with an emphasis on preventive care is a better way of caring for older and disabled people than healthcare, especially in a hospital bed, could ever be. If we pool the risk—after all, only one in five of us will ever need high levels of social care—and give it the priority that it deserves, we can afford it. It is a matter of priorities. We can easily find several billion pounds by stopping tax avoidance if we really put our minds to it.
We need to start thinking long-term about the real costs of failures in social care and think more broadly about what those failures will mean to the economy as a whole. I shall give an example. Diminishing social care from councils has hit business productivity. As fewer older and disabled people are able to access social care services, growing numbers of family members are being forced to give up work to care for their loved ones. An estimated 1 million people have given up paid work or reduced their working hours to care for their loved ones. The LSE tells us that the public expenditure cost of families giving up work is £1.3 billion a year in additional expenditure on carers’ benefits and lost tax revenues. If lost earnings are taken into account, the figure rises to £5.3 billion. These are the sort of long-term effects of the current shortages in funding that we should be considering.
I know, as do all noble Lords, that the Minister cannot make a commitment here today to put more much needed money into the system. However, I know him to be a man of commitment and vision, as well as a very busy one today—I also know that the whole House will be delighted with the award that he received last night—and I ask that he commits to taking the message from your Lordships’ House back to his department and to the coalition Government and tries to persuade colleagues to see that investing properly in social care is just that—an investment, not a drain. It saves costs down the line, assuages one of the worst worries of citizens and will earn the thanks of the nation, both those in need of care at present and all of us who may need it in future.
As for the argument that says that times are hard and this is not the time to enter into major extra commitments, I remind your Lordships that the Beveridge report of 70 years ago was published and accepted in the middle of a world war, yet our forebears had no problem with the vision and commitment to take on those far-reaching changes even though the country was, in the words of one noble Lord in this House this week, absolutely skint. We are not skint. We live in a time of relative peace and prosperity. Should we not be prepared to follow in the footsteps of those courageous forebears? I beg to move.
Baroness Pitkeathley
My Lords, it is a comfort to me that the number of usual suspects swelled gratifyingly for this debate—a sign, perhaps, that we are getting nearer to understanding that this is the pre-eminent social issue of our times, in terms of both the current gap and the need for long-term solutions.
We have had a wide-ranging debate and a powerful set of speeches. There is agreement that there is a crisis—or rather a series of crises, in the short, medium and long term—and suggestions for how to tackle those. We have had ideas and examples focusing on innovation, integration, efficiency, and we have even had ideas about how we can get more money into the system. We also have agreement about the urgency of the need and about the importance of that old chestnut for many of us, integrated care.
The Minister has given us his usual thoughtful response, for which I thank him, and we all know his sincere commitment to finding a solution to the problem of social care, although I find it hard to recognise the picture of local services he paints from the ones presented to me. I shall take pleasure in checking this out with the group of 200 carers whom I am addressing tomorrow at a carers’ rights day. I shall ask them for their opinion of the situation.
I return to my original thought—which others have echoed, including the Minister—that social care should be seen as an investment, as a way of saving money, especially for the NHS. But this needs much more sharing of money and much less silo thinking, and more focus on the consequences of not doing it rather than on the cost of doing it. For example, if we just take Dilnot—and I am grateful for the calls from many Peers for Dilnot to be implemented—we know that the cost of implementation is about £2 billion. It is not the whole solution, as many noble Lords have said, but no one has yet found a better place to start. To set that £2 billion in context, family carers are contributing care worth at least £119 billion a year. If only 10% of them give up because they are too exhausted, stressed and poor to continue, that will cost £12 billion—six times the cost of Dilnot. Can we not afford to make the investment that local authorities, the NHS and, above all, the users and carers deserve?
The issue of social care needs radical thought and change, and leadership at national level. As has been said, the inexorable arithmetic of the demographics means that we cannot ignore it and put it into the “too difficult” box, however tempting that may be. Without tackling the resource issue, things will only get worse. Will we be here again next year, reporting on how the situation has deteriorated further? I sincerely hope not. I thank all noble Lords who have spoken, and beg to move.
Mental Health Act
Baroness Pitkeathley Excerpts(11 years, 6 months ago)
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Lord Lloyd of Berwick
My Lords, perhaps I may speak later. I thought that the Liberal Democrat Benches wished to speak.
Earl Howe
My Lords, the review by Dr Harris will take into consideration any lessons that need to be learnt. We have asked him to take into account any other possible lessons that we should take on board, particularly in the run-up to April 2013. However, I am happy to reassure my noble friend that her request will be passed on. If there is a relevance to the Mental Capacity Act, I will ensure that Dr Harris takes it into account.
Lord Lloyd of Berwick
My Lords, like the noble Lord, Lord Hunt of Kings Heath, I would hope that the Minister could tell us a little more about how these irregularities came to light only last week. The problem, of course, is that there is a well known maxim of the law that the delegate of a power—that is to say the person to whom a power is delegated—cannot delegate it to another. I think that it is expressed in Latin as delegatus non potest delegare.
It is no doubt that maxim which has caused the lawyers to have had some doubt about the lawfulness of the detention in these cases. Indeed, it is perhaps surprising—again, the noble Lord might be able to give us some understanding about this—that these irregularities have not come to light before. Now that they have, I agree with the advice given by First Treasury Counsel that there is here a need for absolute clarity and that the best way to achieve that is by legislation. The whole point of it is that it should have retrospective effect. I end by congratulating the Government on reacting so quickly.
Earl Howe
I am extremely grateful to the noble and learned Lord, Lord Lloyd. In front of me, I have a very detailed timeline of the events which have led to the current situation, starting from the early summer of this year when the doctor who was turned down for approval in Yorkshire and Humberside SHA challenged the decision. Subsequently, he dropped his appeal but the legal advice taken on his grounds for appeal highlighted the possibility that the arrangements for the panel convened by the Rotherham, Doncaster and South Humber NHS Foundation Trust to exercise this function were unlawful. From that point, questions were asked not only in that strategic health authority but in neighbouring strategic health authorities and the department was alerted a few days ago.
The noble and learned Lord rightly asked how this could ever have happened and not been picked up. We will rely on the review by Dr Harris to tell us the answer to that question, but I am grateful for his support.
Baroness Pitkeathley
In further clarification to the response that the noble Earl gave to my noble friend about communication with patients, will he tell the House more about how that communication is to take place, whether there is a timescale for it and whether the communication also will extend to patients’ families who will be particularly worried by some of these developments?
Earl Howe
My Lords, I would willingly give the noble Baroness further details. Unfortunately, I do not have any beyond those that I gave to her noble friend Lord Hunt. I will gladly pick up the very valid points that she has made and let her know as soon as I can. Perhaps when we reach Second Reading of the Bill, which I believe has been timetabled for Wednesday, I shall have a more detailed answer to give her. If she is not in the Chamber, I shall make sure that she receives it by other means.
Care Services: Elderly People
Baroness Pitkeathley Excerpts(11 years, 6 months ago)
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Earl Howe
My Lords, we need to focus on a mixture of things. As my noble friend rightly says, we need to look at workforce numbers and capacity. We need to look at minimum training standards, which I have referred to, and we need to look at quality. We are doing that by targeting for the first time personal assistants and their employers with greater support and learning through the Workforce Development Fund, which will help with recruitment and retention. We need better leadership because high-quality leadership is essential for the delivery of all the proposals in the care and support White Paper, and we are setting up a new leadership forum to bring together expertise. I should add that we need better intelligence on the ground as well, and that we shall see from the local Healthwatch organisations when they are established.
Baroness Pitkeathley
My Lords, the Minister has pointed out that the employer, the provider, is responsible for the recruitment and training of care workers, and I am sure he will confirm that that applies whether they work in the private, the public or, indeed, the voluntary sector. In view of some of the scandals that there have been involving care workers, does he agree that we need to encourage value-based recruitment so that people are recruited not only for their technical skills, which can be provided through training, but for their compassion and empathy?
Earl Howe
Yes, I firmly agree with that. It bears upon the point that I alluded to very briefly, which is that the risk assessment process should not just be a tick-box exercise. It should assess the suitability of the individual and their own characteristics, the environment in which they will be working, the kind of people for whom they will be working and whether they have the right skills and characteristics as the people required to do that job.
Social Care: Sustainable Funding
Baroness Pitkeathley Excerpts(11 years, 10 months ago)
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Earl Howe
My Lords, I am not aware of the Worcestershire example. What I will say is that the best local authorities are those that enter into a two-way dialogue with service users to see what is best and most appropriate for them in their circumstances. I recognise that this is a challenging settlement for local government, but if local authorities are prepared to reform their services and drive down costs, we believe that the additional investment from the NHS to social care, which we announced in the spending review, will enable local authorities to protect the care that people receive. Many councils are making the necessary changes to ensure that there is no drop in eligibility criteria.
Baroness Gardner of Parkes
My Lords, in view of the answers to the previous supplementary question and to the first Question, which stated that decisions should never be made purely on grounds of cost, is the Minister aware of a case in one of the London boroughs where a woman who has had multiple sclerosis for years and has been cared for by a very loving husband has now been told that she may be obliged to go into a care home because providing her care package at home is costing £79,000, while a care home could be provided for £71,000? That would perhaps not destroy, but put a terribly unfair strain upon, her marriage after all these years. Can the Minister assure us that in the Government’s plans for health and social care, factors other than cost will be considered?
Earl Howe
It would not be right for me to comment on an individual case such as the one mentioned by my noble friend, but I would say that local authorities have a duty to meet people’s eligible needs, and they should take account of a person’s resources as they do so. If a local authority were to change someone’s personal budget, we would expect it to consult and discuss with the service user how their needs and goals could best be met within the new budget. It should not, in most cases, descend to forcing any options on anybody.
Baroness Pitkeathley
My Lords, I was happy to give way to the noble Baroness, especially on her birthday. The Minister’s words may be comforting to many families when contemplating the future, and may provide comfort that the Government have plans for the future. However, what comfort will he give to my neighbour Margaret who is caring for her husband, who is in the last stages of Alzheimer’s, and is in despair with his and her physical and mental distress? Today—now—they face huge costs for care that is intermittent and often of very poor quality. How does the Minister address the poor-quality issue in the face of such a shortage of funds?
Earl Howe
My Lords, as I made clear, the Government and my department have made a very significant sum of money available to local authorities to bolster their social care funding. In the announcements we made last week we said that we were directing additional money to local authorities to support integrated care. I regret the instance that the noble Baroness cites, but it is part of the reason why, in our White Paper and in the announcements we made last week, there is a particular focus on quality and on ensuring that the tick-box approach—which I am afraid some local authorities have taken—should be a thing of the past.
Carers: In Sickness and in Health
Baroness Pitkeathley Excerpts(11 years, 10 months ago)
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Baroness Pitkeathley
To ask Her Majesty’s Government how they intend to address the issue of the health of carers in the light of the report In Sickness and in Health, published on 18 June.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, we welcome the report and its focus on important health issues for carers. This echoes the priority that the Government attach to supporting carers to remain physically and mentally well, as set out in the coalition Government’s carers’ strategy, Recognised, Valued and Supported: Next Steps for the Carers Strategy. The department published its draft mandate to the NHS Commissioning Board for consultation on 4 July. It includes an objective about improving the support that carers receive from the NHS.
Baroness Pitkeathley
I thank the Minister for that Answer. In view of the shocking statistics in the report—that more than 80% of carers have found their health, both physical and mental, adversely affected by caring—does the Minister consider that there is perhaps an increasing risk of carers simply ceasing to care and the cost therefore falling on social care services or resulting in increased emergency hospital admissions? How will the announcement that the noble Earl is about to make ensure that the prospects are better for the health of carers and for the continued willingness of families to go on providing the vast majority of social care?
Earl Howe
I shall have to ask the noble Baroness to be patient for a few more minutes regarding the Statement I am about to make. However, I can tell her that the White Paper and the draft Bill will make a reality of our vision for transforming care and support both for carers and for the people they look after. As for the noble Baroness’s first point, she is absolutely right to flag this up as a concern. In the last financial year, we provided funding of almost £1 million to the Royal College of General Practitioners, Carers UK and the Carers Trust to take forward a range of initiatives, of which I am sure she will be aware, to increase awareness in primary healthcare of carers of all ages, including better training for GPs, and also to look at how we can build on that for the future with the medical colleges and nursing organisations and in hospitals and community health services. The NHS Health Check programme could be a very important ingredient in making sure that the health of carers is monitored and taken fully into account.
Dementia
Baroness Pitkeathley Excerpts(11 years, 10 months ago)
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Baroness Pitkeathley
My Lords, I thank my noble friend Lord Touhig for securing this debate and for introducing it so passionately. In your Lordships’ House, we often talk about the ageing of society. People are living longer—a lot longer—and this is a subject for rejoicing and a tribute to developments in society and health provision. However, as we have heard, one of the other consequences of this development is undoubtedly the increase in dementia. We are all aware of the figures and I will not repeat them. Although there have been some welcome developments in recent years, not least as a result of the publication of the dementia strategy and, latterly, the Prime Minister’s commitment, there is still a very long way to go. Most people with dementia and their carers are not living well.
Although we have made progress, we still have a lack of awareness. Dementia is not something we really want to discuss, still less plan for within our families. I always remember when I was leading the carers’ movement that we managed to get a dementia storyline placed in one of the leading soap operas. However, it did not last long because the issue of incontinence might have had to be faced and the producers felt that the viewers did not want to know about having to wash soiled sheets.
There are also great difficulties in diagnosis. Let us not forget that up to 40% of acute hospital beds are occupied by dementia patients, but of that number as many as 80% have their condition diagnosed after they have been admitted. They are, therefore, being nursed and treated by non-specialised staff who may have little or no experience of the condition and of whom it is unfair to ask the skills and competences which such patients need.
It may be that GPs are reluctant to diagnose dementia because, as the noble Lord, Lord Wills, has reminded us, they believe there is no cure or because they do not want to depress either the patient or his or her relatives. However, without proper diagnosis, there is no hope at all of putting patients and their families in touch with the services they badly need. We should not forget either that the number of people with dementia that each individual GP sees during their career is relatively few and we should not expect them, therefore, to be an expert in diagnosis. What we can and should expect is that they are willing to make referrals to experts who can make a diagnosis. Talk to the family of any dementia sufferer and they will almost invariably tell you a long and distressing tale of how long and how much persistence it took to get a proper diagnosis.
The third thing is the lack of support. Dementia can be coped with but support services are vital and they are in short supply, and I am afraid they are getting shorter. Caring services are in crisis due to lack of funding. Talk to anyone engaged at the sharp end and the story is the same. Fewer and fewer older people, including those with dementia, qualify for local authority support, and many services provided by the community and voluntary sectors are disappearing. Those services especially under threat or gone already include those aimed at preventing those with low-level needs from reaching a crisis situation.
Let me tell your Lordships about Raymond, who is 85 and cares for his wife, Margaret. He says that Margaret,
“has been diagnosed with dementia. My caring changes from day to day and week to week. You are living on a knife edge—you don’t know what the next hour or day will bring … I have a nurse who comes to get”,
Margaret,
“up at 7.30 in the morning and then puts her to bed at 7.30 in the evening”,
but her visits are now only 15 minutes long—and Raymond has been told that they have to be cut down to nine minutes in the next year. Margaret,
“goes to a care home from 9.30 until 3 in the afternoon”,
every Wednesday,
“which is a great help. They have games and entertainment. I can get down to my jobs while”,
Margaret is away. It used to be Wednesday and Thursday, but it has been cut down to one day a week. He goes on to say:
“Caring is very tiring. I try to cope to the best of my ability but I find I can’t take it in my stride. Life is very stressful, especially the practical work. I prepare meals and do the housework … I pay someone to sit in with”,
Margaret, once a week,
“while I go out … I go to a carers’ meeting on a Friday. It’s like opening another door. I can get back to normal. The tension goes away and my head clears. We talk among ourselves and there is a pleasant atmosphere. We all have a tale to tell. I find out how other carers overcome their problems. It’s an escape valve. You are with your own kind—people who know what you are experiencing. Without the day centre and the carers’ group I couldn’t manage … I don’t know what I would do”.
Although Raymond is 85, he does not want to give up caring for his wife. However, unless he has what he calls his escape valve, what will happen to him? I have to tell your Lordships that the day centre provision is under threat and the carers’ group, which was set up by a local authority worker, is now run by carer volunteers.
The noble Lord, Lord Touhig, reminded us how important it is to support the families who provide the bulk of care for dementia sufferers. As I often remind your Lordships, they are saving the nation £119 billion a year, so it is in all our economic interests to keep them in a caring role. But it is also important for the future because we will need many more carers. If they are not also going to become a drain on our economy in their old age, we have to support them now and enable them to stay in paid work as long as they can. The recent report published for Carers Week, In Sickness and in Health, tells a very distressing story about the health of carers as a direct result of their caring responsibilities. No fewer than 87% of them said that caring had a negative impact on their mental health and 83% on their physical health.
Carers and the people they care for already pay for services. If they are not eligible for social services or their income is above a threshold, they have to pay, which can range from domestic assistants to care workers. Services can be arranged with the local authority or trust, and others through private companies. This is often the cause of financial distress for carers. With the introduction of personal independence payments and changes to employment and support allowance, this may lead to substantial numbers of people losing benefits, which may mean that the person being cared for can no longer purchase the service. That means that carers will have to find alternative ways in which to pay for a service by dipping into their savings, getting into debt or simply going without.
In the current economic climate, there are concerns that an already struggling system is going to be further hit. Cuts to services will only make matters worse. For some carers, the ultimate impact will be giving up caring themselves because their health has deteriorated so much that they can no longer do it. That comes at a significant cost, as the person they care for will need to be admitted to residential care. For others, they are storing up serious problems for their future. Who will be there to provide the care in their place, if carers can no longer carry on?
I have three questions for the Minister, who I know is very aware of carers’ problems. Indeed, I was most grateful to him for attending a carers event that I hosted last week and for taking time from his very busy schedule to speak to carers and hear their problems. I appreciate that and know that he has always been concerned about this issue. Let me put the three questions to him. When will the Government act on the issue of sustainable funding for social care? The reform of the law on care is very welcome and I understand that we will hear about that shortly in the White Paper but we have to address properly the funding issues. How can we ensure that there is ongoing support for carers, including giving them a break—the kind of break that Raymond has just once a week that enables him to keep going? We heard rumours at one point from one of the Ministers that the Government were planning to enable GPs to prescribe respite care for carers. Is there any truth in that? On the subject of general practitioners, how in the new structure of the NHS do the Government plan to monitor the performance of GPs with regard to carers, since they are so important for them as a first port of call?
Social Care: Legislation
Baroness Pitkeathley Excerpts(11 years, 11 months ago)
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Baroness Pitkeathley
My Lords, the Minister will know that many older people are concerned not only about how they will fund residential care, should they need it, but also about its quality. How will the White Paper ensure adequate and indeed satisfactory quality for the delivery of residential care, and also the competence of those who deliver it?
Earl Howe
As the noble Baroness will know, one of the main reasons that we wanted to engage widely in recent months with the sector was the very issue that she raised. The quality of social care, the training of those in the workforce and the supply of carers, both paid and unpaid, are concerns going into the future. As the noble Baroness will find out, this will be a major focus of the White Paper.
Health and Social Care Bill
Baroness Pitkeathley Excerpts(12 years, 2 months ago)
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Baroness Hollins
My Lords, I support the amendment. I note that one of the reasons given for not considering statutory regulation for this group is that there is a very high turnover of staff in this grade. This seems to me to be a symptom of an unsatisfactory situation and perhaps points to the poor job satisfaction and lack of prospects for healthcare workers. My noble friend has pointed to the problems with skill mix. I think that she was really talking about skill mix across the whole range of mental and physical healthcare settings and not just physical healthcare. Within that, she would have included people with learning disabilities.
It seems to me that there must be some minimum requirements for training and supervision. I know that the Government suggest that it is the responsibility of the employer, and perhaps also of the commissioner, to ensure that the service which is provided reaches minimum standards. Perhaps that requires that, in order for commissioners to contract with an employer, a service has to have been appropriately accredited. A service which has been accredited has of course been accredited for the whole service, not just for the work of individual staff, who are subject to their own regulatory authority.
This morning, I revisited the Royal College of Psychiatrists’ accreditation standards for adult in-patient wards for people with learning disabilities—I should remind noble Lords that I am a past president of the Royal College of Psychiatrists and a psychiatrist myself. The college’s general standards very helpfully include attending to recruitment and retention of staff, training, supervision, management of complaints and so on. It is helpful to think about the relationship between the necessary accreditation of services and the need to attend to the training and aspirations of all those staff who work in such services: retention and job satisfaction are key to this.
Baroness Pitkeathley
My Lords, I join with others in paying tribute to the noble Baroness, Lady Emerton, for her tenacity and commitment in keeping the issue of healthcare assistants before your Lordships’ House. She may not be my noble friend in the political sense, but she has been my friend in the professional sense for many years.
I am sorry, therefore, to disagree with her on this particular issue. Indeed, it seems that I am a lone voice disagreeing with her. I certainly want to emphasise that I do not disagree about the problem with regard to healthcare assistants which has been so thoroughly and persuasively set out by her and other noble Lords. But the Council for Healthcare Regulatory Excellence, the organisation which I chair, disagrees with her, as she knows, about statutory regulation being the solution to these problems. The CHRE has had the opportunity of speaking to many of your Lordships in two seminars organised by the Minister, so I do not need to take up time here repeating the arguments. I will say only that mechanisms already exist to deal with the difficulties which your Lordships have set out. These include ensuring that those supervising healthcare assistants take their supervisory responsibilities seriously. The Nursing and Midwifery Council is providing strong direction on this with its codes. Employers are required to ensure safe systems of work, which include giving support to healthcare professionals in delegating and supervising effectively. There is also the vetting and barring scheme, whose aim is to prevent unsuitable people from entering or remaining in the workforce.
Add to this the expense and relative slowness of statutory regulation and it seems to add up to a case showing that the increased public protection that we are all seeking can be achieved by applying existing mechanisms more firmly. We should consider other ways of making this large group of workers, low paid as they are and with a 30 per cent turnover, as we have been reminded every year, feel more acknowledged and valued. There may well be a role for a professional association with a voluntary register, but principally we must use existing processes effectively before we embark on statutory regulation.
With regard to voluntary registers, which have been mentioned so much this morning, or accredited registers, as proposed by the Bill, much work has already been done by the CHRE. We are using the term “assured registration” to distinguish it from the old notion of voluntary registers and to describe the process of organisations assuring the individuals on their register and then the CHRE accrediting the organisations and their registers, thus creating accredited registers. I remind your Lordships that the whole purpose of such a scheme is to enhance consumer protection. The standards to be met by organisations which hold accredited voluntary registers will include standards of competence, education and training, registration of complaints and information provision. I certainly do not want to argue that this is the same as statutory regulation, but for many professions it offers further safeguards for patients and public, and that is what we are all seeking.
Lord Kakkar
My Lords, my noble friend Lady Emerton moves a very important amendment that comes to the very heart of this Bill. The purpose of this Health and Social Care Bill is to ensure ultimately that quality is driven throughout the healthcare system and that standards are driven to the very highest levels. It seems counterintuitive that such an important group of healthcare professionals as healthcare support workers is not subject to any mandatory training or mandatory continuing professional development or, indeed, any form of statutory regulation. I suspect that many of our fellow citizens would find that a very peculiar situation, which they would not automatically recognise, when going into the hospital environment.
I would like to ask the Minister two questions, specifically with regard to proposals for ensuring strong voluntary registration of this particular group and members of other disciplines who are responsible for the provision of healthcare. The first relates to the role that the Secretary of State might play with regard to standing rules and providing guidance to commissioning groups on the action they should take and the requirements they should make of qualified providers. Will it be the case that commissioners will be in a position to demand of a qualified provider that all of their healthcare staff, be it doctors, nurses, or other healthcare professionals, are members of some form of registered regulatory scheme, be it a regulatory scheme for certain healthcare professionals or voluntary schemes for others? Will it therefore be possible for clinical commissioning groups in the future to refuse to commission from a potential qualified provider if that provider was unable to demonstrate that all the staff it employed were registered appropriately?
My second concern relates to a plurality of registers for a single discipline of healthcare worker. That seems counterintuitive: surely, if there is going to be a voluntary register for healthcare support workers, there should be a single register, not multiple ones, because multiple registers would provide less confidence to the general public. The general public should know that there is a single regulatory body and that that body has responsibilities with regard to setting certain standards, with regard to ensuring that there is appropriate training and with regard to the possibility of receiving complaints and disbarring individuals from working in that professional area.
Baroness Howarth of Breckland
My Lords, if the noble Earl thought I was being unkind to the noble Baroness, Lady Emerton, he may think that I am being even more unkind when I come to address him. I want to make it absolutely clear that I was asking the noble Baroness whether she had seen the defect in her amendment. Delegated powers would go from health professionals to the social care professionals and not from the social care professional leaders in establishments down to social care providers. That was a significant defect which I think the noble Baroness herself noted, as did other noble Lords, during the course of the debate. That was all I was raising but it leads on to this debate about the social care profession and how it is valued when compared with other professions. That is why this debate, at this moment, is crucial to social workers.
I ask the Minister this question. Is it the Government’s intent to remove the profession of social work from the nation’s vocabulary? That may sound an unkind question, but social workers are beginning to feel that they do not belong anywhere. Their name is not in any of the Bills. Indeed, their professional organisation is being wiped out, as they see it. I will not repeat the points made my noble friend Lady Meacher about some of the protections around people practising and training with clients. They have to practise alone. They are not supervised day-to-day by having someone with them who is also registered in a proper way. All of these things undermine the profession.
When the Conservatives were in opposition, the Conservative Party set up an inquiry to look into social work, taking the view that it wanted to encourage and enhance the social work profession. I was very grateful and felt that it had made a real difference to the way that social workers were valued. In that inquiry, the Conservative Party acknowledged the difficult work that social workers undertake with disruptive families, the mentally ill, children, the disabled and those with learning difficulties—in fact most of the groups in our society that other people do not wish to have to deal with day to day. Those people can be intransigent, difficult and often stubborn and social workers have to develop new skills in order to move families on into change, particularly in the present environment. That moved on to the Munro review of child protection and the hope that social workers would gain more control over their lives and the way that they worked, lessening the bureaucracy and enabling them to do more.
However, to have their designated regulatory body removed and to be absorbed into what they see as a healthcare organisation will detract from all of that. The people you meet out there who are involved in social work worry about where they stand in terms of the whole of the social care sector. If you talk to them alone, you will find that they are pretty low, depressed and fragile and that affects the way that they carry out their work. It affects the enthusiasm and joy with which social work can be carried out.
I am having real difficulty. Perhaps the clerks will recognise that. I do not want to speak at length because what I have said is to the point. I will not go through the amendments. Other noble Lords will do that in detail. Of course, a principal social worker would make a difference. In a former position, the noble Lord, Lord Laming, made a huge difference to the social work profession. It felt that someone, somewhere, was there on its behalf. We have people in the Department of Health, but they are not given the strength and status that Herbert had when he stood in that position and made that difference.
There were difficulties with the regulator, but I have just spent eight years working in another organisation that had difficulties. If you work hard enough and long enough, you can get it right. It is not right to give up in the middle and to change things so fundamentally that people do not recognise that it has anything to do with them. Certainly, social workers are not recognising that the new regulator will have anything to do with them.
I am sorry to speak so strongly and so generally but, sooner or later, someone has to speak up for those people who are doing what I call the dirty work of the nation on behalf of all of us. It may be that my cold is not helping and I am not my usual gentle self, but I feel extraordinarily strongly that, unless the Government take it upon themselves to encourage and make social workers feel valued, understand their work and differentiate them from the medical care area, we will have fewer social workers of ability on the ground and they will make more mistakes. More mistakes will mean more difficulties for children and old people, never mind the field day that the press will have, and we will be on a downward spiral. I ask the noble Earl to look at the issue that the noble Lord, Lord Hunt, is raising and to do what he can to stop that from happening.
Baroness Pitkeathley
It is a great pleasure to follow the noble Baroness, Lady Howarth, who I deservedly call my noble friend. I very much hope that the Minister will give her the assurances that she seeks. With regard to my noble friend’s amendments on the General Social Care Council, I take the view that we are where we are, however much I wished that different decisions had been taken. Noble Lords will appreciate that, as the first chair of the General Social Care Council, I would say that, wouldn’t I?
However, I take this opportunity to pay tribute to the councils and staff of both the General Social Care Council and the Health Professions Council for the professional and mature way that they have approached the difficult situations in which they found themselves. Their behaviour has been an example to us all and particularly, as far as concerns the GSCC, the fact that high staff morale has been maintained throughout this process is nothing short of a miracle and a great tribute to its leadership.
I agree with other Lords who have called the social work profession fragile. It needs to be promoted and defended if we are to maintain and extend the recruitment that the noble Baroness, Lady Howarth, has reminded us is so important for those people who do the difficult work in our society—which is rarely recognised until the tabloid press attacks it. I must draw your Lordships’ attention to the College of Social Work, which has just been established, which will have the promotion and defence of this fragile profession as part of its remit. It has had a difficult start, as is well known, but I believe that it has the potential to promote and support the profession to which we are all so indebted.
Baroness Finlay of Llandaff
My Lords, I have my name to two amendments in this group. They do not affect social work and therefore I have waited to intervene until the debate on social work had been completed.
I want to discuss two groups: clinical perfusion scientists and clinical physiologists. The clinical perfusion scientists are responsible for the single most invasive tool used in surgery today and are routinely responsible for the administration of potentially fatal controlled drugs. The numbers are small—there are only 350 clinical perfusionists—and they operate in a regulatory vacuum; they are the only non-regulated members of the cardiac surgical team. Yet their management routinely involves significant life-threatening risks to patients daily. Because they are not a regulated profession, in July 2009 the Department of Health produced a good practice guide to clinical perfusion in response to the Gritten report of 2005. It states that the Government fully recognise the need for clinical perfusionists to be regulated by statute and it draws attention to the fact that the document is an interim measure until they are subject to statutory regulation. Indeed, the document states that this has implications in law for their role in working with medicines.
Since the Gritten report in 2005, about a quarter of a million cardiac patients have had their hearts stopped for surgery by perfusionists, who use highly toxic substances and blood products. They feel that they need statutory regulation so that they can be supplementary prescribers, as there is a questionable legality at the moment around drug administration. They are in a unique position. It is this supplementary prescriber role that causes them much concern, because they would like to be assured that what they are doing falls fully within the Medicines Act. I hope that when the Minister responds he will be able to explain quite clearly precisely how, if they are not subject to a statutory register, everything they do complies fully with the Medicines Act.
As for assessing the risk and the need for a profession to be registered, the review of the Professions Supplementary to Medicines Act was debated in another place in 1999. The key test stated in that review is,
“whether there is the potential for harm arising either from invasive procedures or application of unsupervised judgement made by the professional which can substantially impact on patient/client health or welfare”.
In response to that test and in relation to clinical perfusionists, the right honourable Andrew Lansley, said:
“It seems to me that perfusionists entirely match that criterion”.
It seems odd, having had that debate and that being on the record, that clinical perfusionists are still trying desperately to argue that they should be subject to statutory regulation and feel that they are failing to achieve that.
The other group that I want to discuss is clinical physiologists. I suggest again that they fall within that criterion. They are a very skilled group of people who are often alone with patients, including children, in situations in which they are responsible for conducting sometimes complex investigations and interacting closely with whoever is the patient in front of them. For the past 10 years, they have had a voluntary register, which they feel is flawed and demonstrates the need for statutory regulation. As a group they will not gain either in status or financially by having a statutory register. They want it because they are concerned about patient safety. Their view is that there is currently no incentive to register; they are in short supply anyway and can get another job without too much difficulty.
As a group, they sent me an individual case study, which I found quite worrying. I will try to summarise for the House briefly, because this is Report. They cited a clinical physiologist who had been working unsupervised in a room alone with children and working one to one with them. Following a holiday to Amsterdam, he was found to be in possession of child pornography, prosecuted and placed on the sex offenders register. Among his papers, the police found that he was a clinical physiologist and alerted the appropriate group. They alerted the employers but discovered that even though he lost the job he was in, he was rapidly re-employed in another hospital, which they also alerted. They followed it up to find that he had changed his name and, under another name, again had sought employment. They are very concerned that this is one they know about but that there may be others they do not know about. The group does not see how its voluntary registration system gives patients and the public the protection that they ought to have.
The Deputy Chairman of Committees (Baroness Gibson of Market Rasen)
The noble Lord has not moved the amendment.
The Deputy Chairman of Committees
The noble Lord must move the amendment. Does the noble Lord wish to move the amendment?
Lord Patel
I was going to do so after I had heard the noble Baroness speak, because she interrupted my speech. I beg to move the amendment.