Reform of Social Care

Baroness Thornton Excerpts

Monday 4th July 2011 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, with the leave of the House, I shall now repeat a Statement made in another place by my right honourable friend the Secretary of State for Health. The Statement is as follows:

“Mr Speaker, with permission, I wish to make a Statement on the reform of social care. This coalition Government have from the outset recognised that reform of the care and support system is needed to provide people with more choice and control, and to reduce the insecurity faced by individuals, carers and their families. By 2026, the number of people over 85 years old is projected to double. Age is the principal determinant of need for health and for care services. It is estimated that in 20 years’ time, 1.7 million more people will have a potential care need than do today.

People often do not think about how they might meet those costs in later life. They assume that social care will be provided free for all at the point of need, but since the establishment of the welfare state this has never been the case. Currently people with more than £23,250 in assets, often including their home, face meeting the whole cost of care themselves. The cost of care can vary considerably and it is hard for people to predict what costs they may face. The average 65 year-old today will face lifetime care costs of £35,000. However, as the Commission on the Funding of Care and Support notes, costs are widely distributed: one in four will have no care costs, but one in four will face care costs over £50,000 and one in 10 over £100,000.

The lack of understanding of how the system works and the uncertainty about costs means that it is difficult for people to prepare to meet potential care costs and there are currently few financial products available to help them. This means that paying for care can come as a shock to many families and can have a severe impact on their financial security.

Change is essential. That is why we took immediate action by establishing the Commission on the Funding of Care and Support last July. It was tasked with making recommendations on how to achieve an affordable and sustainable funding system for care and support for all adults in England. In response to its initial advice, we allocated an additional £2 billion a year by 2014-15 in the spending review to support the delivery of social care as a bridge to reform. This represents a total of £7.2 billion extra support for social care over the next four years, including an unprecedented transfer of funds from the NHS to support social care services that will also benefit health.

Since then we have taken forward wider reform. In November last year, we published our vision for adult social care setting out our commitment to a more responsive and personalised care and support system that empowers individuals and communities, including the objective that all those who wish it should have access to a personal social care budget by 2013, and in May, the Law Commission published its report, after three years of work, on how to deliver a modernised statute for adult social care. Making sense of the current confused tangle of legislation to deliver a social care statute will allow individuals, carers, families and local authorities more clearly to understand when care and support will be provided.

Andrew Dilnot’s report comes at the same time as the final report from the palliative care funding review, which I received last week. Tom Hughes-Hallett and Sir Alan Craft have made an excellent start in looking at this complex and challenging issue. We want to see integrated, responsive, high-quality health and care services for those at the end of life. We will now consider the review team's proposals in detail before consulting stakeholders on the way forward later this summer. We will also consider how best to undertake substantial piloting, as recommended in the report, in order to gather information on how best to deliver palliative services.

We are also responding to events at Southern Cross, which have caused concern to residents in Southern Cross care homes and their relatives and families. We welcome the fact that Southern Cross, the landlords and the lenders are working hard to come up with a plan to stabilise the ownership and operation of the care homes. We have also been clear that we would take action to make sure there was proper oversight of the market in social care. That is why, through the Health and Social Care Bill, we are seeking powers to extend to social care the financial regulatory regime we are putting in place in the NHS, if we decide it is needed, as part of wider reform.

A central component of those reforms will be the long-term funding of care and support. Over the past 12 months, Andrew Dilnot, the chair of the Commission on the Funding of Care and Support, together with the noble Lord, Lord Warner, and Dame Jo Williams have engaged extensively with many different stakeholders. They brought fresh insight and impetus to this most challenging area of public policy. We welcome the excellent work of the commission and its final report. I would like to thank Andrew Dilnot, the noble Lord, Lord Warner, and Dame Jo Williams for the work they have undertaken. It is an immensely valuable contribution to meeting the long-term challenge of an ageing population.

The report argues that people are unable to protect themselves against the risk of high care costs, leaving people fearful and uncertain about the future. The commission’s central proposal is therefore a cap on the care costs that people face over their lifetime of between £25,000 and £50,000; it recommends £35,000. Under the commission’s proposals, people who cannot afford to make their personal contribution would continue to receive means-tested support, but it proposes that the threshold for getting state help with residential care costs would rise from £23,250 to £100,000. People would make some contribution to their general living costs in residential care, but this should be limited to between £7,000 and £10,000.

The commission also proposes: standardised national eligibility for care, increasing consistency across the country; universal access to a deferred payments scheme for means-tested contributions; improvements in information and advice; improved assessments for carers and better alignment between social care and the wider care and support system; and to consider changing the means test in domiciliary care to include housing assets. It makes recommendations about how, as a society, we will organise and fund social care. We will now take forward consideration of the commission’s recommendations as a priority.

The commission recognises that implementing its reforms would have significant costs that the Government will need to consider against other funding priorities and calls on constrained resources. In the current public spending environment, we have to consider carefully the additional costs to the taxpayer of the commission’s proposals against other funding priorities. Within the commission’s recommendations, it presents a range of options, including on the level of a cap and the contribution people make to living costs in residential care, which could help us to manage the system and its costs. That is why we intend to engage with stakeholders on these issues, including on the trade-offs involved.

Reform in this area will need to meet a number of tests, including: whether proposals would promote closer integration of health and social care; whether proposals would promote increased personalisation, choice and quality; whether proposals would support greater prevention and early intervention; whether a viable insurance market and a more diverse and responsive care market would be established as a result of the proposals; the level of consensus that additional resources should be targeted on a capped costs scheme for social care; and what a fair and appropriate method of financing the additional costs would be.

The Government have set out a broad agenda for reform in social care. We want to see care that is personalised, that offers people choice in how their care needs are met, that supports carers, that is supported by a diverse and flourishing market of providers and a skilled workforce who can provide care and support with compassion and imagination, and that offers people the assurances they expect of high-quality care and protection against poor standards and abuse. Andrew Dilnot’s report was never intended to address all these questions, but it forms a vital part of that wider agenda.

To take it forward, we will work with stakeholders in the autumn, using Andrew Dilnot’s report as the basis for engagement as a key part of a broader picture. This engagement will look at the fundamental questions for reform in social care: improving quality, developing and assuring the care market, integration with the NHS and wider services, and personalisation. As part of that we want to hear stakeholders’ views on the priorities for action from the commission’s report and how we should assess these proposals, including in relation to other priorities for improvement in the system. As the right honourable Member the Shadow Health Secretary and I have discussed, we will also engage directly with the Official Opposition in order to seek consensus on the future of long-term care funding.

We will then set out our response to the Law Commission and to the Dilnot Commission in the spring, with full proposals for reform of adult social care in a White Paper and a progress report on funding reform. It remains our intention to legislate to this effect at the earliest opportunity. The care of the elderly and vulnerable adults is a key priority for reform under this Government, and I commend this Statement to the House”.

My Lords, that concludes the Statement.

[Baroness Thornton]

First, my Lords, I thank the Minister for repeating the Statement today. It is difficult to imagine a more important issue for us to consider. Care of the elderly and vulnerable is probably the most difficult and intractable problem facing our society. It is one that we have to resolve; we cannot afford to let it go on and on unresolved. We can all agree about this.

It should be a cause for celebration and pride that one in five of us alive in Britain today will now live to be 100, and that our children can expect to spend one-third of their lives in retirement. Instead, thousands and thousands of us approach old age in fear—fear that we will need care that will not be there or will not be good enough, fear that our savings will be wiped out by an open-ended cost, fear that we cannot protect our families from this cost, and fear of becoming a burden or being left alone. That is why we on these Benches welcome the Dilnot report and the Statement.

These proposals contain many important elements that were in the plans that we set out when we were in government in our care White Paper prior to the general election. I join the Minister in congratulating Mr Andrew Dilnot and his colleagues, my noble friend Lord Warner and Dame Jo Williams on the excellent job that they have done. I know that many of the organisations concerned with this issue—Age UK, the Alzheimer’s Society, Care UK and others—have been very impressed by the way in which the commission has carried out its tasks, but they are now, quite rightly, very keen to ensure that the momentum created by this excellent report is not lost. Many noble Lords will have seen the letter, signed by 32 of these organisations, pleading with us not to pass up this opportunity. I welcome the Minister’s confirmation that detailed and important involvement of stakeholders will continue.

I am very impressed with the way in which all the members of the commission have seen it as their mission to explain to the widest possible audience what lies behind their recommendations and why they have reached the conclusions that they have. I know that my noble friend Lord Warner has been in major media contact since the early hours of this morning; many of us will have been treated to the masterclass from Andrew Dilnot on the “Today” programme.

In response to the report my right honourable friend Ed Miliband, the leader of the Labour Party, has said on behalf of the Labour Party that we would be willing to put aside our party’s pre-election proposals in order to try to find a solution. I invite the Minister to agree with me that it is just as well that politicians sometimes ignore the cynicism and negativity of commentators, such as Mr Nick Robinson of the BBC, who I heard recently, and show an understanding of the importance of reaching a national consensus on these matters. We will all need to show the kind of determination that my right honourable friend the leader of the Labour Party is showing. Will the Minister comment on suggestions in the media, including from members of the Conservative Party, that suggest that the Treasury is already lining up to kill these proposals? I hope that this is not the case and that the tweet today quoting Stephen Dorrell as saying that the Government must show willingness to find the money for Dilnot’s long-term care overhaul is more accurate.

The last thing Britain needs is for Andrew Dilnot’s proposals to be put into the long grass, or even the medium-cut grass. This is a once-in-a-lifetime opportunity that we must address. It is what the Government do with it now that counts. My right honourable friend the leader of the Labour Party has made a big offer to the Prime Minister to put politics aside and to work to see a better long-term system of social care put in place for elderly and disabled people in our country. We on this side are willing to talk to and work with the Government and all other parties to do so, because we know that any system of care must give all of us the long-term confidence to know what will be on offer for us and our families. It requires the Prime Minister to give a lead, because agreeing an affordable and sustainable system involves important parts of government beyond the reach of the Health Secretary. It requires the Prime Minister to give a guarantee that the Government will not kick Mr Dilnot’s recommendations into the long grass, because the system needs urgent and lasting reform. Will the Minister give us that guarantee today? If the Government are serious, we in the Labour Party are serious. If the Government are serious, we need to hear what the plan is going to be as we move forward.

Mr Dilnot recommends a White Paper by December this year, but this already seems to have slipped to the spring. Will the Minister say which is it? Will he also tell the House when we can expect a draft Bill—are the Government aiming for this to be in the next Queen’s Speech? In the absence of the noble Baroness, Lady Campbell of Surbiton, will the Minister confirm that the Government welcome and will take forward recommendation 6 on the portability of care assessments? Will the Government be supporting her Private Member’s Bill on this? Does he agree that cross-party talks are required and that the Prime Minister should give this lead? How and when will this start?

Finally, I know the Minister agrees that there is a need for the House to have an opportunity to have a more thoroughgoing debate about this matter, the report and its recommendations. I hope that we can also join forces in trying to secure that opportunity.

NHS: Health Improvements

Baroness Thornton Excerpts

Wednesday 29th June 2011 Lords Chamber

Asked by

[Baroness Thornton]

To ask Her Majesty’s Government how they will ensure that the NHS delivers strategic health improvements requiring levels of technology and expertise appropriate to regions or cities with large populations.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, our commissioning proposals will establish a national NHS commissioning board providing oversight of commissioning in the NHS and directly commissioning some services, including specialised services, where it makes sense to commission for larger populations. The NHS commissioning board will have a sub-national presence and local commissioning will be undertaken by clinical commissioning groups. The NHS commissioning board will have a duty to promote integrated services for patients, both within the NHS and between other local services.

--- Later in debate ---

[Baroness Thornton]

I thank the Minister for that Answer, as far as it goes. The successful reorganisation of stroke services in London, which has saved many lives, was led by clinicians, as it should have been, but the commissioning and its delivery were in fact only brought about by NHS London, the ability of the strategic health authority to manage the PCTs and through great collaboration with the providers. Apart from the providers, all of these bodies are being dismantled and abolished as we speak. In the new system, how precisely would similar improvements be brought about? Who would take the lead and who would ensure their delivery?

[Earl Howe]

My Lords, where it is deemed appropriate to commission a service at scale but below the level of the NHS commissioning board, as I described in my original Answer, it will be open to clinical commissioning groups either to establish a lead group to take control of the commissioning and to agree budgets and pathways or for clinical commissioning groups to collaborate jointly. The advantage of the system that we are proposing is its flexibility. Depending on population size and the needs of an area, commissioning can be done at several levels.

NHS: Clinical Excellence Awards

Baroness Thornton Excerpts

Monday 27th June 2011 Lords Chamber

[Earl Howe]

My Lords, as I have just said, we believe that financial rewards, in the form of clinical excellence awards, should remain. It is just a question of how that system is designed. We have not said that non-financial recognition should take the place of financial awards. They would operate alongside financial awards; they would not in any way supplant them. However, we think that there is a role for perhaps more imaginative thinking in areas like speciality-based awards or departmental or division-based awards, for example, or indeed ad hoc recognition for outstanding clinical leadership. The DDRB is looking at these questions too.

[Baroness Thornton]

My Lords, I commend the noble Lords, Lord Walton and Lord Ribeiro, on doing a really admirable job as the shop stewards for distinguished clinicians—and quite right, too—but I would point out that innovation and excellence cuts across all NHS staff, including nurses, midwives and therapists, who often introduce wonderful innovation at their level. Could the Minister tell us what incentives are in place in the system that recognises that excellence as well?

[Earl Howe]

The noble Baroness is absolutely right. We do need to incentivise all staff, both clinical and non-clinical in the NHS, to innovate. We can do that in a variety of ways. She will know that the noble Lord, Lord Darzi, proposed a number of ways of doing this, including innovation prizes and innovation funds, which are extremely popular. We also can incentivise through the tariff. As she will know, we have protected the research budget, which in the long term will serve us well in driving through innovation in the NHS.

Drugs: Prescribed Drug Addiction and Withdrawal

Baroness Thornton Excerpts

Thursday 23rd June 2011 Lords Chamber

[Earl Howe]

My Lords, my noble friend will know that we have set aside a very considerable sum of money over the spending review period to expand the availability of talking therapies. I entirely agree that it is an important avenue of treatment.

[Baroness Thornton]

Following on from the noble Earl’s supplementary question on how to ensure that good practice becomes standard practice, how will that sit with the dismantling of strategic health authorities, PCTs and other levers that might be used to ensure progress? Who or which organisations in the proposed restructuring of the NHS will be able to ensure that patients who have an addiction to prescription drugs receive the support that they desperately need? I agree with the noble Earl that this is an emergency; it is not the first time that we have discussed this on the Floor of the House.

[Earl Howe]

My Lords, the responsibility for commissioning these services in future will lie with local authorities, supported by Public Health England. The noble Baroness will be aware that it is our proposal to ring-fence the public health budget. Local authorities will be informed by the joint strategic needs assessment that they carry out and will work in partnership with local delivery organisations and with local GPs, who, as I have mentioned, will be even better informed than they are at the moment thanks to the Royal College guidance.

Health: Hepatitis C

Baroness Thornton Excerpts

Monday 20th June 2011 Lords Chamber

[Earl Howe]

In the case of hepatitis C, treatments recommended by NICE are of course available that, if taken early enough, can dramatically affect the course of the disease. I think we are in danger of straying into legislative territory that is perhaps the occasion for a wider debate as to how, if at all, we might expand the scope of the Human Tissue Act so as to reach those cases that I think the noble Lord is referring to.

[Baroness Thornton]

My Lords, we all welcomed the Government’s Statement in January announcing increased support for those with hepatitis C. Will the Minister please tell us what progress is being made to deliver the exception from means-testing of the new payments and the provision of prepayment prescription certificates, and which national charities are in receipt of the additional funding of £100,000 to support the victims of hepatitis C and their families?

[Earl Howe]

My Lords, the Caxton Foundation has been established to address the group of hepatitis C victims identified in the Government’s Statement earlier this year: that is, those victims of the contaminated blood disaster who went on to develop hepatitis C. I understand that the foundation will begin to make payments later this year that will include payments to those who are eligible for the free prescriptions service to which she referred.

NHS: Future Forum

Baroness Thornton Excerpts

Tuesday 14th June 2011 Lords Chamber

[Baroness Thornton]

My Lords, I thank the Minister for repeating the Statement. I start by paying tribute to him for the way in which he has facilitated the debate about the future of the NHS thus far across the House. The all-Peer seminars benefited hugely from the fact that his office ensured the input from senior department officials. I have to add that his noble friend Lady Northover attended every one of those seminars. They have continued and, I believe, have ensured a greater understanding of the Bill from which it can only benefit. Notwithstanding Nick Clegg waving about his list of changes and claiming all, I think we might find out as we move on how influential the Minister has been in bringing about changes to the Bill. However,

“there is more joy in heaven when one sinner repents”.

About a year ago the Minister gently chided me, when he launched the health White Paper, by saying:

“I hope that when the noble Baroness digests this White Paper, she will come to view it rather more favourably than she has indicated”.—[Official Report, 12/7/10; col. 535.]

On this occasion, lest the noble Earl misunderstands me, I will say that I welcome the findings of the Future Forum, although I think that we would both agree that it cannot possibly have covered all the important issues in the NHS in eight weeks. In the detailed response that accompanies the Statement, the Government have gone further than the Future Forum in their proposed changes to the Bill; they are very significant. I particularly welcome issues such as the commitment to the NHS constitution. However, it begs the question of whether we might need a whole new Bill, or no Bill at all, if we all now agree that evolution is better than revolution.

I will mention the process. In this House we are more familiar with the parliamentary process whereby you consult, legislate and implement—not the other way around, which is what seems to have happened here. However, the Future Forum was a device that I think everyone understood. There was a pressing political need to get the coalition Government—Nick Clegg, David Cameron and in particular Andrew Lansley—off the hook. I will say this only once, despite severe temptation; the uniformly fulsome and enthusiastic welcome from Nick Clegg and David Cameron for the White Paper and the Bill ring rather hollow today. However unworthy the motivation, the end of the pause means one very good outcome for which we should all be grateful—probably none more so than patients and staff—namely, that the Prime Minister, Deputy Prime Minister and Secretary of State will cease their endless visits to hospitals to prove how much they love the NHS.

The chairman of the Future Forum said that opposition to the Bill stemmed from “genuine fear and anxiety”. He went on to say that NHS staff feared for their jobs, and feared that their NHS was about to be broken up and—their word—“privatised”. Thank goodness the Future Forum had the wisdom to listen to what so many people have been saying for a year to the Prime Minister and the Secretary of State: during the consultation period, after the Bill was published, with increasing volume during its passage in the Commons, and despite two very sensible Health Select Committee reports. Does the Minister think that the terrible mess that the Government have found themselves in could have been avoided, and have they learnt their lessons?

Since we are now promised significant changes, will the Minister confirm that there will be a new and proper impact assessment and a new set of Explanatory Notes, and that there will be consultation on the changes proposed through amendments before recommittal? Will there be a formal response to the well argued report of the Health Select Committee and its recommendations, not all of which agree with the Future Forum report? Most importantly in many ways, if there is to be a long period of enactment when the Bill is passed—and, as the Minister explained, no drop -dead moments—a very strong recommendation of the Future Forum report must be acted on; namely, the production of a timetabling and transition plan. This must be in place as soon as possible and must be robust. When does the Minister envisage that it will be published?

As the House would expect, since Part 3 is still in the Bill we will seek reassurances on competition, the composition of consortia, NICE, the minimum references to social care that are there, and, for example, the lack of references to mental health. We will pursue all these issues in due course. Will it be possible for the Minister to use his good offices to ask the Government to make time available for a longer debate in the House about these issues before we receive the Bill? When does the noble Earl think that we might start consideration of the Bill?

While the uncertainty continues, the NHS is going backwards. The Future Forum suggested—and we all know—that there is widespread demoralisation and even fear in the NHS. Good managers are being denigrated and made redundant, front-line staff are facing the sack and major projects and initiatives have been put on hold, as nobody knows what structures will be in place in the next few weeks, let alone the coming months. That is the result of the earlier rush, which can now be remedied by a robust transition plan.

It is to the credit of all the organisations—patient groups, carers, long-term conditions, medical and others—that have persisted in making their views known and whose views the Future Forum heard. During this period, my colleagues and I concentrated on asking people to look at and understand the Bill because we were confident that the more people understood this legislation, the less happy they would be about the threat to our NHS and to patients. We will be doing the same with the new Bill. We will look at it carefully in detail, and I will again be asking whether it meets the concerns that they and their organisations have raised. I say that because almost every single suggestion in the Future Forum report was put down as an amendment by my colleagues in the Commons in Standing Committee. I suggest to the Government that they might save a lot of time and trouble if they adopted all the other amendments that we put down that were not in the Future Forum. Honestly, what a way to conduct the reform of our most precious national asset. The lesson I take from the past year is this: it is very important not to suspend our critical faculties, even in the face of what seems a huge and, at the moment, welcome change. I am sure that this House will not do that. We have a very important job to do in making sense of this Bill and in ensuring that whatever the Government say today, their rhetoric is matched by the reality. We need to consider these suggested changes in this light. We have much work to do, and the sooner we start, the better.

[Earl Howe]

My Lords, I am grateful for the constructive and positive tone that the noble Baroness adopted in her response. I am grateful to her for her welcome of the Future Forum report, and I thank her for expressing appreciation for the seminars which my department is continuing to run. I can return the compliment in expressing my gratitude for the seminars that she has organised to inform Peers.

There is no disguising the fact that this is an extremely wide and detailed programme of modernisation. There is a great deal to absorb. It is important for noble Lords to understand as fully as possible what the proposals amount to before the Bill reaches your Lordships' House. She is right: they are significant changes. However, I would disagree with her about there being no need for a Bill. Since these changes are so extensive, it is appropriate that Parliament should have the opportunity of approving what is proposed for the National Health Service which, as the Statement said, is designed to be an enduring structure that successive Governments can back. Certainly, lessons have been learnt. I think that when we consulted on the White Paper last year, it was clear that there was general acceptance of the key principles that we set out in it, but when the Bill, which set out how we proposed to implement those principles, was published, the concerns bubbled to the surface, which was why we thought it right, and I still think it right, to have the listening exercise.

The noble Baroness asked me whether we would publish a new impact assessment and Explanatory Notes. We will be updating the impact assessment and Explanatory Notes to reflect the changes to the Bill. They will be published when the Bill is introduced in this House in accordance with normal protocol. She also asked me about timetabling. We want to ensure that the Bill is given sufficient scrutiny in both Houses. We hope that the stronger consensus for change that has been built as a result of the listening exercise will be reflected when both Houses consider timing issues and that the Bill will come to this House at the earliest appropriate moment. Currently, I cannot tell the noble Baroness when that will be. It is, of course, not for us to dictate to another place how it should manage its business. She also asked about the possibility of time being available for a health-related debate. The Leader of the House is sitting beside me, and I am sure he heard that request and that it will be discussed in the usual channels.

The noble Baroness rightly insisted on a robust transition plan, which I believe we have. She will have noticed from the Statement that we have adjusted quite significantly the pace at which these changes will be rolled out. I believe that those working in the health service will be reassured by that because in some quarters there was anxiety that we were going too fast for some to be sure that they would be ready in time.

The noble Baroness asked a number of questions, many of which will be the subject of a paper we plan to publish during the next week or so. The paper will set out more precisely how we plan to implement the changes proposed by the NHS Future Forum. I am not in a position to provide all the answers today but it is clear that, above all, the NHS needs certainty, which we can now give to those who work in it. However, I can say today that there is hardly anything in our proposals that does not represent a natural evolution from the policies and programmes pursued by the previous Government: that is, the development of the quality agenda initiated by the noble Lord, Lord Darzi; extending patient choice; developing the tariff; clinically led commissioning at primary care level, which is a natural extension of practice-based commissioning; completing the foundation trust programme; the continuation of the co-operation and competition panel established by the previous Government but now within the framework of a bespoke healthcare regulator; strengthening the patient voice by the evolution of links to HealthWatch; and augmenting the role of the CQC. None of that is wholly new: the difference is that for the first time we are setting all these things out in one coherent programme and not, as did the previous Government, in a piecemeal fashion.

I believe, and I hope, that we have the basis for broad consensus. We will see when the Bill reaches this House whether that belief is borne out. Not for a minute would I wish the noble Baroness to suspend her critical faculties, or for any other noble Lord to do that. I look forward to those debates in due course.

Health: Transmissible Spongiform Encephalopathies

Baroness Thornton Excerpts

Monday 13th June 2011 Lords Chamber

[Earl Howe]

My Lords, the noble Baroness will know that the independent Advisory Committee on the Safety of Blood, Tissues and Organs—SaBTO—has advised that there is evidence that a particular filter can reduce potential infectivity in a unit of red blood cells. It has recommended the introduction of filtered blood to those born since 1 January 1996, subject to a satisfactory clinical trial to assess safety. We are undertaking an evaluation of the costs, benefits and impacts to inform a decision on whether to implement that recommendation, and we are awaiting the results of clinical trials, which are expected in early 2012.

[Baroness Thornton]

My Lords, following on from the noble Countess’s Question and linked to the need for continuing research, can the Minister assure the House that the scientific teams at the HPA and elsewhere will be kept together when the HPA has been broken up, and that during the period of establishing the independent health research agency the work will not be interrupted?

[Earl Howe]

My Lords, we are keen to see a smooth transition in the creation of Public Health England, which will include the current HPA. The expertise in prion research in this country is largely independent of the HPA. There is expertise particularly in Edinburgh and in the national prion unit in London, but her point is well made.

Contracting Out (Local Authorities Social Services Functions) (England) Order 2011

Baroness Thornton Excerpts

Monday 13th June 2011 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, the purpose of the order is to allow local authorities taking part in two pilot programmes to contract to outside organisations certain adult social services functions conferred on them by a variety of legal provisions. The pilots are, first, adult social work practices pilots and, secondly, right to control pilots. In short, the SWP pilots will test various models of social worker-led organisations undertaking adult social care functions for which local authorities are currently statutorily responsible. The right to control pilots will test the exercise of disabled people’s right to manage the state support they receive to live their daily lives. I will explain each pilot programme in greater detail as I go along.

The Government’s vision for adult social care set out a new agenda for adult social care based on a shift of power away from the state to the citizen by putting people, personalised services and outcomes centre stage. We are committed to the devolution of decision-making close to those who are responsible for the service delivered and, wherever possible, into the hands of those who are the service beneficiaries. This is an integral component of our wider personalisation agenda. We also want to ensure that individuals, carers, families and communities work together with local services, balancing family and community action with state support. Again, this is an integral component of our big society vision.

Since 2008, the Department for Education has funded SWP pilots to deliver services for children and young people in care. The pilots have seen the creation of independent, social worker-led organisations, including social workers moving out of public sector employment to form their own employee-owned social enterprises. The pilots also co-ordinate and monitor services provided to the children and young people in the SWP. They are independent of the local authority, but work closely with it and in partnership with other providers. The local authority pays the SWPs for the services provided.

Last November, my right honourable friend the Secretary of State announced that the Government wanted to test this concept in the adult social care sector, with pilots running for two years starting this summer. The emerging evidence from the Department for Education pilots strongly suggests that both clients and staff will benefit from service delivery by SWPs. That is why we are giving local authorities this opportunity to test the potential benefits of the SWP model and adopt a completely innovative approach to delivering services for adults and their carers.

We want not only to improve the experiences and outcomes for people in vulnerable circumstances, but also to empower social workers to do their jobs effectively, and we want to reduce the unnecessary bureaucracy that so often gets in the way. The programme will bring people who need health and care support closer to those who provide the services they need by reducing bureaucracy and encouraging innovation and personalised services. It will also give social workers the freedom to run their own organisations in the way they want within the constraints of their contract with the local authority. Evidence shows that staff working in employee-owned organisations have greater job satisfaction, leading to lower staff turnover and capacity for greater innovation.

SWPs will discharge the functions of the local authority in providing adult social care services and be responsible for providing the support to people receiving services from the SWP to achieve better experiences and better outcomes. They will also be responsible for undertaking delegated social work functions, managing day-to-day support, co-ordinating and monitoring service provision, and of course this will differ between the pilot sites. The local authority will keep its strategic and corporate responsibilities and will manage the contract and partnership with the SWP. I will speak a little later about concerns that noble Lords may have about possible risks associated with the delegation of these functions.

The SWP pilots will give local authorities a unique opportunity to test the potential benefits of various models and to adopt innovative approaches to delivering services for adults and their carers. The Department of Health is providing funding in the region of £1 million to help the pilots get up and running and to provide initial support. The pilots are an opportunity to test different models to see what works well and what does not, and they will be evaluated fully both during and at the end of the two-year period.

Primary legislation specifically allowed councils taking part in the Department for Education pilot programme to delegate their statutory functions in relation to looked-after children to SWPs. There is no equivalent legislation to allow the delegation of adult social care functions. However, the Deregulation and Contracting Out Act 1994 allows the making of orders allowing such delegation, and that is why we are seeking to introduce the order under discussion today.

The right to control, introduced by the previous Government in the Welfare Reform Act 2009, gives disabled adults greater choice and control over certain state support they receive to go about their daily lives. The right is based on the principle that disabled people are the experts in their own lives and they can decide what support they need and how it should be delivered. It is essentially a variant relating solely to disabled people within the general concept of personalisation.

The right is being tested in eight local authorities in England. These trailblazers, funded by the Office for Disability Issues, will evaluate the best ways to implement the right and will be used to inform decisions about whether and how to roll out the right more widely. Disabled people accessing the right to control will have a right to be told how much money they are eligible to receive for their support. They will be able to choose, in consultation with the public authority delivering the funding stream, how that money is used to meet agreed outcomes. They will be able to choose different degrees of control over their support.

One local authority has asked us whether it could test the delegation of its statutory duty to review social care assessments to third parties such as user-led organisations. As part of their vision for adult social care, the Government have stated their expectation that by April 2013 councils will provide personal budgets for everyone eligible for ongoing social care, preferably as a direct payment. Evidence shows that people who have their circumstances reviewed by fellow service users under appropriate supervision are far more likely to have their care and support needs met to their satisfaction and to request direct payment of their personal budgets to enable them to make their own support arrangements. We were therefore happy to agree to the request and the order allows delegation of the assessment functions under Section 47 of the NHS and Community Care Act 1990, which is also available to the councils piloting SWPs.

I said earlier that I would address concerns that noble Lords might have about the powers provided by the order. I fully understand how the delegation of council functions to outside bodies might raise concerns about potential risks to service users. It is always a balancing act when people are given the freedom to try new ways of doing things with the aim of improving other people’s quality of life. On the one hand, might service users be exposed to unnecessary risks, while on the other, might they not benefit from being able to make more decisions for themselves? Functions in social work practices have to be carried out by or under the supervision of a registered social worker or, in the case of right to control, by a person with requisite competencies or qualifications. I should like to assure noble Lords that accountability for the care delivered to vulnerable people will not change. Each local authority will retain overall responsibility for the services delivered by the SWP it contracts to, just as it does in relation to other local services. In this respect, the contract between the local authority and the SWP will be critical. We expect councils to monitor closely the outcomes of the practices, identifying issues early and providing support, while allowing them the scope to innovate and make decisions about the best packages of support and services for their population. Any potential risks will, of course, be reflected in any recommendations coming out of the separate evaluations.

In conclusion, we see this order as an important marker of progress in the developing world of personalisation. On the back of persistent requests from within the sector for greater freedom of choice and control for both staff and service users, this order has the support of councils and their representatives, as well as service users and their carers. It will enable the release of new partnerships and new ways of working to the benefit of individuals and their communities as a whole. I commend the order to the House.

[Baroness Thornton]

My Lords, I thank the Minister for introducing the order and explaining its purpose so well. It is one of those orders the name of which belies its importance and its comprehensibility. As the Minister explained, the order is similar to one concerning children’s services from some years ago. Its purpose is designed to pilot flexibility at local authority level and test innovative approaches to delivering services to adults and their carers. As it is designed to foster new ways of delivering care on the ground with the caring and cared-for—in other words, user-led services—we would all agree that it is a good thing.

The meat of the order is in Article 3(2). Most of my questions centre on the practical details of delivery and how to ensure the safety of the adults concerned. The Minister has addressed some of those already. The noble Earl said that one local authority in the pilot involved the right to control. I wonder which authority that is, which seven authorities have been chosen and how they were chosen.

I am interested in the right to control. I should be grateful if the Minister could explain in more detail what the interface between the trailblazers funded by the ODI is. What benefits could there be to using those powers with the right to control, which is being explained in this order? I am not quite clear on how those would work. How will continued support and resources for co-production with disabled service users—an essential component of successful delivery of right to control—be maintained if there is a marriage between the two regimes?

How will the local authority authorise the third party to undertake social services functions? What criteria will they use, given that no guidance is to be made available with this order? Perhaps the Minister could paint us a picture or give us an example of that.

I should be grateful if the Minister could untangle the approved provider and independent mental capacity advocate by explaining who will be doing what under this proposed regime. Given that social work is regulated, as the Minister explained, can he confirm that that same framework will apply under this order? Can he confirm who—I assume it will be the local authority—will approve the individuals, businesses, charities and social enterprises that participate to ensure that their practice is of the highest standard when they deal with this most vulnerable sector of the community? If things are not working out properly for the person in receipt of care under this order, who would they go to and how would they do that?

Finally, if the person who is undertaking the functions under this order is not a registered social worker, what check will there be on their qualifications to carry out the functions required? I should be grateful if the Minister could explain who is undertaking the monitoring and reporting, and how long it will take. What does the Minister envisage the next steps would then be?

Winterbourne View

Baroness Thornton Excerpts

Wednesday 8th June 2011 Lords Chamber

[Baroness Thornton]

I am seeking assurance from the Minister that there will be a wide-ranging and independent review of this matter, held in public, that will shine a light on what happened at Winterbourne View and allow the wider lessons to be learnt. We need to know whether the CQC’s failure to monitor the treatment of residents was due to the fact that there was a shortage of CQC staff. Does the CQC have sufficient powers to act in this case and, if so, is it using its powers adequately? Could the Minister also comment on the wisdom of placing more regulatory tasks with the CQC, as the Government are proposing in the process of reorganisation? Surely we need to see that the CQC is carrying out its current functions adequately.

[Earl Howe]

My Lords, first, there is a criminal investigation under way and it would not be appropriate to launch an inquiry, even if we were minded to do so. As the noble Baroness knows, the CQC has launched its own internal investigation. It has admitted that there were failings in its processes. South Gloucestershire Council will lead an independently chaired serious case review, as has been mentioned, involving all agencies, which will look at the lessons to be learnt. The strategic health authorities involved have instigated a serious untoward incident investigation. The department will, after these reviews have been concluded, examine all the evidence and report to Parliament.

We want to understand not only the immediate facts and why things went wrong at Winterbourne View but also whether there are more systemic weaknesses in the arrangements for looking after people with learning disabilities and who exhibit seriously challenging behaviour. It is very easy to make the CQC into a scapegoat. It is difficult to ask of the CQC that it polices every room in every hospital at every hour of the day. We rely on the CQC and have been supportive of it. It does much good work and clearly it will want to review its own processes as part of this.

Health: Hospital-acquired Infection

Baroness Thornton Excerpts

Tuesday 7th June 2011 Lords Chamber

[Earl Howe]

The noble Baroness is absolutely right. The headline figures disguise considerable variations between the best and worst performers. Our approach has been to adopt a zero tolerance policy to all avoidable healthcare-associated infections. To support that we have introduced a number of specific actions, including establishing clear objectives under the NHS operating framework, which are requirements for all trusts to meet, and for primary care organisations, and extending to health and social care settings the regulations on infection prevention and control. We have also increased the requirements on publishing data trust by trust.

[Baroness Thornton]

My Lords, I welcome very much the fact that the Government have continued to bear down on this issue, which of course my Government made great strides on when we were in office. Can the Minister assure the House that the funding to continue bearing down on it will be ensured from a national level?

[Earl Howe]

My Lords, as the noble Baroness knows, we expect trusts and primary care organisations to utilise funds from within their global budgets to meet the requirements that I have just outlined, such as those in the NHS operating framework. These requirements are mandatory, and it appears that over the past few years, trusts and primary care organisations have really got to grips with this problem.