Clause 3 - Promoting integration of care and support with health services etc.

Care Bill [Lords] – in a Public Bill Committee am 3:30 pm ar 9 Ionawr 2014.

Danfonwch hysbysiad imi am ddadleuon fel hyn

Photo of Jamie Reed Jamie Reed Shadow Minister (Health) 3:30, 9 Ionawr 2014

I beg to move amendment 68, in clause 3, page 3, line 32, after ‘support provision with’, insert ‘housing’.

Photo of Andrew Rosindell Andrew Rosindell Ceidwadwyr, Romford

With this it will be convenient to discuss the following:

Amendment 69, in clause 3, page 3, line 41, at end insert—

‘(1A) Housing providers must exercise their functions with a view to ensuring integration of services as set out in subsection (1).’.

Amendment 78, in clause 5, page 5, line 40, at end insert—

‘(g) the importance of ensuring adults with needs for care and support have access to suitable living accommodation;’.

Amendment 83, in clause 6, page 7, line 40, at end insert—

‘(i) housing providers.’.

Amendment 35, in clause 6, page 6, line 38, after ‘housing’, insert

‘or other provider of housing for vulnerable or older people’.

Amendment 36, in clause 6, page 6, line 45, after ‘housing’, insert ‘and town planning’.

I call Miss Kendall.

Photo of Jamie Reed Jamie Reed Shadow Minister (Health)

Thank you, Mr Rosindell, I appreciate that we look alike. [ Interruption. ] “I should be so lucky”, says the Minister of State. He is indeed correct. As we go through the proceedings, I have been struggling to develop a description of the Minister’s style and I think I have now found it. It is one of emollient loquacity. I very much enjoy the style and the manner with which he conducts himself throughout these proceedings. I shall speak to amendment 68 and the others in my name and that of my hon. Friend the Member for Leicester West, as well as about the amendments tabled by the right hon. Member for Sutton and Cheam.

Clause 3 places a duty upon local authorities to carry out their care and support responsibilities—including carer's support and prevention services—with the aim of joining up services with those provided by the NHS and other health-related services such as housing. Under the Bill, this duty will apply where the local authority considers that integration of services would promote the well-being of adults with care and support needs—including carers—contribute to the prevention or delay of developing care needs or improve the quality of care in the local authority's area.

Amendments 68, 69, 78 and 83 in my name and that of my hon. Friend seek to promote the integration of care and support into the area of housing. These amendments attempt to remove ambiguities, clarify responsibilities and make duties more explicit, with a view to achieving effective integration. Amendments 68 and 69 extend to housing providers the duty to promote integration. As the Bill stands, only local authorities are given the duty to promote integration between health and care services, but housing services are critical in relation to meeting the health and care needs of any individual or community. Amendment 68 extends the duties of local authorities to promote the integration of health, care and housing services. Amendment 69 gives similar duties to all housing providers, and both are complemented by amendment 83, which makes it obligatory for councils to co-operate with housing providers in shaping their social care policy.

Amendment 78 specifies that a local authority must promote the efficient and effective operation of a market in services for meeting care and support needs, and in particular must have regard to the importance of adults’ access to suitable living accommodation—by no means an easy task. We find it difficult ourselves to find suitable accommodation of our own, despite being well salaried and able-bodied. Imagine, then, the difficulty for adults whose care and support needs are profound. There is little sense in imposing legal accountability and responsibilities upon local authorities to achieve better integration of health and social care if housing is omitted from these responsibilities.

Amendment 83 is an extremely important amendment with regard to integration, and has most import for clause 6(7). Subsection 7 lists various organisations and bodies that local authorities have a duty to co-operate with as “relevant partners” when providing care and support—for example, Ministers, NHS bodies, and local police and probation services. Amendment 83 adds housing providers to this list, making it obligatory for councils to co-operate with housing providers in order to provide better, more integrated care.

I have worked as a housing officer, before the local authority in question, which was my own local authority, Copeland borough council, transferred its housing stock to a social housing association. During my employment as a housing officer, I was responsible for many functions, some official, some unofficial—mediating disputes between neighbours, enforcing tenancy agreements, managing rent arrears, organising repairs, and ensuring that vacant properties were safe and suitable to be let. My official responsibilities reflected the local authority’s statutory responsibilities. However, like many public servants or anyone who works in an outward-facing role that requires interaction with the public, I inevitably assumed a pastoral or advisory role for some tenants. This role was unofficial. I am sure it is a role that every Member of Parliament across the House recognises. Those responsibilities included contacting the police, giving debt advice, signposting people to the citizens advice bureau, and even giving what I would loosely term medical advice.

Photo of Jamie Reed Jamie Reed Shadow Minister (Health)

That is why I use the term “loosely”. This advice would vary from urging parents of young children to let their children sleep at their grandparents’ house if their home was too cold and the children were ill,  asthmatic or suffering from some other condition to urging, for instance, an elderly widow with a perfectly well-kept garden and an immaculate home, but who could not manage the stairs or had suffered a fall, to go and see her doctor. Where these people went to see their doctor, they would receive a hospital referral and perhaps an appointment for an operation. They would receive pain medication and a variety of medical interventions and treatments, but how much easier it would have been and how much better for the tenant, the local health service, the local authority and everyone else involved with these episodes of care if the housing provider had had regard to the health and well-being of those tenants. How much more beneficial, too, this would be to those people blighted—I use the term advisedly—by two-tier local government.

Photo of Bill Esterson Bill Esterson Llafur, Sefton Central

That was a timely mention of two-tier local government, after what I said earlier. We heard recent reports of a return of housing problems and an increasing incidence of rising damp, resulting in ill health. Does my hon. Friend think the amendments would help to deal with issues of poor health arising from deteriorating housing conditions and be a way of reducing those problems?

Photo of Jamie Reed Jamie Reed Shadow Minister (Health)

I thank my hon. Friend for his intervention: that is precisely what we are trying to achieve with the amendments. As constituency Members of Parliament, from whichever party, we see the profound health problems that people are increasingly facing due to inadequate housing. It is no exaggeration to say that it is a time-bomb facing the country, in particular for those peripheral economies and communities in what might be described as areas of market failure. That needs to be acutely and rapidly addressed and the amendments seek to go some way towards doing that.

Amendment 83 extends the principle of integration to housing and is complemented by amendments 68 and 69, by which, again, we seek to introduce the principle of equal participation as a key component of integration. The amendments seek to extend the duty to promote integration of health, care and housing services to housing providers as well as to local authorities and health bodies.

It is worth paying attention to the contributions of noble Lords with regard to these issues. Lord Best, president of the Local Government Association and also a chair of a housing association told the other place in October last year that

“…everyone's care needs are inseparably connected to the place where they live and where, for most older people, they spend all their time. The right accommodation can sustain our independence and well-being even if we face the illnesses or long-term conditions that afflict many of us in older age. The right accommodation can pre-empt and prevent the need for domiciliary and residential care and hugely reduce costs to the NHS and local authority social services.”

I am sure we have all seen examples of that with our own eyes in our constituency mailbags. During the same debate, my noble friend Lord Warner reminded us that at the inception of the NHS, health and housing were covered by the same ministry and that

“…we have missed many opportunities over a long period of time, to bring housing into the party as the population has aged. All it has done is increase the burden on adult social care and the  NHS. It would be a missed opportunity if we did not rectify some of that now.”—[Official Report, House of Lords, 9 October 2013; Vol. 748, c. 101, 106.]

The noble Lord was entirely right. The amendments seek to rectify those shortcomings in an explicit and, again, unambiguous way.

Let me be absolutely clear. Duties upon local authorities and housing providers such as those proposed by the amendments will help to facilitate the provision of better housing to meet the long-term care needs of individuals and communities. Surely that is a key consideration for legislators as we consider the policy requirements of an ageing society.

Better housing, better suited to care needs would lead to enormous benefits for patients, carers, taxpayers, local authorities and Governments of every colour. Better housing would enable quicker discharges from hospitals, freeing up huge amounts of hospital capacity. Right now, delayed discharges are costing the NHS £20 million every month. Instead of spending that money on delayed discharges, and accruing other associated costs with the pressure that then places right across the NHS, the money could be better spent on 1.5 million more hours of home care for vulnerable older people.

Consider what that means in the near future. I am grateful to Age UK for providing me with the following information. In terms of housing demand, we know that between 2008 and 2033 about 60% of projected household growth will be made up of households with someone aged 65 or older. Right now, 93% of older people live in mainstream housing, not in specialist retirement housing or residential care.

Poor and inaccessible home design often means that older people are forced to carry out home adaptations or are pushed into specialised housing or expensive residential care against their preference. We have heard from right hon. and hon. Members about the trauma associated with such enforced moves.

Age UK believes that the health and wellbeing boards need housing firmly embedded in their remit to ensure that the role of housing and housing support services for older people are not overlooked. The amendments seek to ensure that the role of housing and housing support services for older people, and all people with care needs, is not overlooked.

Photo of Paul Burstow Paul Burstow Democratiaid Rhyddfrydol, Sutton and Cheam 3:45, 9 Ionawr 2014

I wish to speak briefly to amendments 35 and 36 in my name. I would like to pick up on a point about Lord Best’s contributions to the housing debates on the Bill in the Lords. I also draw the Committee’s attention to the work done in the past year by the Hanover housing association, which he chairs. It has commissioned publications on practically everything imaginable, addressing itself and its perspective to the challenges of housing in an ageing society. It speaks to many of the issues about why housing must be more closely aligned to the care agenda—indeed, I would rather say the well-being agenda—than it has been, not least in relation to amendment 35.

The amendment picks up on the earlier question from the hon. Member for Strangford. The vast majority of the current generation of older people live in owner-occupied accommodation: 76% own their own homes. As a consequence of that, they do not, or cannot, move into social housing. As currently drafted, I do not think—I look forward to the Minister either confirming  that my understanding is right or reassuring me that it is not—that the Bill fully reflects the need to engage with private providers of accommodation for vulnerable and older people. That is essential, given the Bill’s well-being focus and universal offer on information, advice, prevention and integration. Such groups must be part of the picture. My amendments to clause 6 widen the scope of the list of bodies to make it clear that private providers of housing are included.

Amendment 36 is about how we ensure that the market-shaping duty works well and that it is seen as a whole-council responsibility. If it is seen simply through the lens of an adult social services department, I do not think we will get the best results from the point of view of citizens wanting new, innovative approaches to the delivery of service. We will not get the economic development benefits of working-age disabled people being able to participate in the work force, nor will we get the benefits from an ageing society that is expected to work longer and the support that that will entail. The opportunities on offer are significant, but they will be better realised if seen as a whole-council responsibility.

My amendments specifically seek to say that, in part, we need to go beyond housing officers and care officers engaging with each other and co-operating. We also need an obligation to engage town planners. They should be part of the mix as well, not least to ensure that they are focused on the way in which the demographics are moving and aware of the opportunities that that presents. That is the purpose of my two amendments, and I very much look forward to the Minister’s response.

Photo of Norman Lamb Norman Lamb The Minister of State, Department of Health

Again, I agree with all of the points made by the shadow Minister and, indeed, by my right hon. Friend the Member for Sutton and Cheam. I rather enjoyed the shadow Minister’s description of a former life. I got the impression of a benevolent public servant. I am not sure that I would have wanted to take medical advice from him, but, in all other respects, I would have appreciated being a tenant under his watchful eye.

We agree that housing plays a vital role in supporting independence, well-being and prevention. Indeed, that is why we were able to move such a long way in the other place to strengthen the prominence of housing throughout part 1 of the Bill. I am sure that that is acknowledged and appreciated by the Opposition. Specific references to that now feature in the first three clauses, as well as in clauses 6, 8 and 23.

In the other place, we made two amendments to strengthen the role of housing. The Government amendment to clause 6 expressly included private registered providers of social housing in the list of persons with whom it may be appropriate for the local authority to co-operate. Lord Best—who was mentioned by both speakers—said that that was

“a very significant step in absolutely the right direction.”

I am sure that that is acknowledged by all hon. Members.

Lord Best also welcomed the Government amendment to the integration duty in clause 3, which he said ensures that

“in terms of the integration of services, housing will be classified as “health related” and will therefore be taken on board by clinical commissioning groups and the NHS Commissioning Board, NHS England. Both these changes are really positive”.—[Official Report, House of Lords, 9 October 2013; Vol. 748, c. 101-102.]

I understand the intentions of my right hon. Friend and the hon. Members for Leicester West and for Copeland in tabling their amendments, which seek to bring further attention to the vital role of housing in care and support. Amendments 68 and 69 seek to address housing and integration. Specifically, amendment 68 would include housing in the integration duty. As I have said, to make the point crystal clear, we have already strengthened clause 3. Subsection (5) states that the provision of housing is a “health-related” service. The amendment is therefore unnecessary.

Amendment 69 would place a duty on all housing providers to ensure integration, thereby effectively extending the Bill’s reach to the regulation of the private housing sector, such as builders and private landlords. Extending the duty in that way would be an additional and unnecessary burden on the private sector and, in a sense, it would be impossible for the private sector to achieve because it simply does not have control over integrating health and care, but I understand why that point has been made. The measure would also be unworkable because, in so far as housing providers are private landlords, they do not have any public or statutory functions to provide care and support or health provision. Accordingly, it is not in their power to ensure the integration of such services. Rather, the duty to promote integration needs to be imposed on the local authorities and NHS bodies, working together with housing providers and other health-related providers, as is currently proposed in the Bill.

My right hon. Friend asked whether local authorities are obliged to co-operate with private sector providers. Local authorities must co-operate with such persons as it considers appropriate. Clearly, given that the Bill absolutely recognises the central importance of housing in care and support, in integrating care and support and in preventing ill health, it seems to me to be appropriate for a local authority to do so. I hope that goes some way towards reassuring him.

Amendment 78 would include

“adults…have access to suitable living accommodation” in the list of matters to which local authorities must have regard in fulfilling their market-shaping duty. The market-shaping duty in clause 5 requires local authorities to promote diversity and quality in the provision of care and support services. Accommodation provided as part of that care and support already falls within the scope of the market-shaping duty.

Amendment 35, tabled by my right hon. Friend, and amendment 83, tabled by Opposition Members, would specify housing providers as a relevant partner of local authorities. Clause 6 includes the requirement for a local authority to ensure co-operation in delivering services relevant to care and support and to work co-operatively to ensure that services are joined-up. That includes private registered providers of social housing. Public law is limited on the extent to which it may place duties on private bodies. Extending the list to other housing providers would include private housing providers, such as private landlords, where they are providing housing to individuals, under entirely private contractual arrangements, which would extend the duty beyond those with whom the local authority holds a contractual duty.

Finally, on amendment 36, I recognise that town planning, and planning more generally, are an issue in relation to the provision of specialised housing. The  place to address such planning issues, however, is through the work of other Government Departments. I will be having more discussions with colleagues across Government about that issue. I hope that I have reassured my right hon. Friend and hon. Members about the prominent position that housing has in the Bill and the fact that the Government recognise that it has a central role in preventing ill-health and ensuring that services are integrated, with regard to well-being, prevention, integration and co-operation between health, housing, care and support.

Photo of Jamie Reed Jamie Reed Shadow Minister (Health)

I appreciate the Minister’s response. I do not seek to divide the Committee on the amendments in my name or that of my hon. Friend. However, should the right hon. Member for Sutton and Cheam wish to test the will of the Committee on amendments 35 and 36, he will receive our support. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 3 ordered to stand part of the Bill.