Clause 4 - Providing information and advice

Care Bill [Lords] – in a Public Bill Committee am 3:45 pm ar 9 Ionawr 2014.

Danfonwch hysbysiad imi am ddadleuon fel hyn

Photo of Liz Kendall Liz Kendall Shadow Minister (Health) (Care and Older People) 3:45, 9 Ionawr 2014

I beg to move amendment 71, in clause 4, page 4, line 19, leave out ‘and maintain’ and insert

‘maintain and facilitate access to’.

Photo of Andrew Rosindell Andrew Rosindell Ceidwadwyr, Romford

With this it will be convenient to discuss the following:

Amendment 56, in clause 4, page 4, line 32, at end insert—

‘() suitable living accommodation, and the choice of providers, available in the authority’s area.’.

Amendment 72, in clause 4, page 4, line 32, at end insert—

‘() available housing options, and the choice of providers, available in the authority’s area,’.

Amendment 75, in clause 4, page 4, line 32, at end insert—

‘() how to access advice on housing options’.

Amendment 73, in clause 4, page 4, line 46, at end insert—

‘(c) ensure that such advice is provided by appropriately trained individuals and to an appropriate standard.’.

Amendment 74, in clause 4, page 5, line 2, at end insert

‘and anyone else who might benefit from receiving it’.

Amendment 76, in clause 4, page 5, line 3, at end insert—

‘(4A) The advice and information made available to adults with care and support needs must include tailored information for individuals with specific medical conditions and complex individual needs.’.

New clause 7—Public awareness campaigns—

‘The Secretary of State and local authorities shall ensure through national and local public awareness campaigns that there is a high level of public awareness and understanding of the terms and implications of the cap on care costs.’.

Photo of Liz Kendall Liz Kendall Shadow Minister (Health) (Care and Older People)

I shall go through the first couple of amendments quickly before I get to the issue that I want to focus on. Amendments 71 and 74 seek to clarify the degree to which local authorities will be required to be proactive in giving people information and advice and whether they will be required to provide information and advice not only to people who are about to use, currently use or are at risk of using a care service, but to people more broadly. Many hon. Members will know that there is a hell of a lot of information and advice out there about all sorts of things, but people often do not know where it is. Unless they have the time, energy and willpower to seek it out, it is often difficult to find.

Photo of Grahame Morris Grahame Morris Llafur, Easington

The point about whether local authorities will have to proactively make the information available, or whether they will only have to compile a database, is really important. What does my hon. Friend think about the estimated 5 million people—many of whom are older people—who do not have internet access? If the database is available only on the internet, many of those people will be disfranchised in terms of housing information.

Photo of Liz Kendall Liz Kendall Shadow Minister (Health) (Care and Older People)

My hon. Friend is right, although there is an increasing number of silver surfers, including my parents, not that they are silver-haired yet; sorry, mum and dad. Nevertheless, there are many older users on the internet.

It is difficult to get all the information and advice together. Amendment 71 seeks to probe whether local councils will be required to get the information out there and reach out to people, rather than simply putting it on their websites and on leaflets, and whether the information will be made available to the public more widely. We are probing those things because the clause, which is about information and advice, is about not only the care and support services that are available, but the independent financial advice about the new system for funding social care that will be introduced. We need to ensure that as people get older they think about and plan for the future. As we live for longer, even if the retirement age increases, we need to think about our finances. I hope the Minister will clarify whether the information and advice—particularly information about the new funding mechanism—will be available more widely.

Amendments 72 and 75 essentially repeat some of the issues we heard in the debate on housing. Information and advice should be provided on the choice of available housing options. We have all experienced this problem, either in our own families or through our constituents. Nobody wants to leave their own home, and they probably never will, especially if they think that the only option available to them is a poor-quality residential home, or even a good-quality one. However, there are some excellent, innovative extra-care housing developments available, which provide a little extra help and support while allowing residents to feel as though they are living an independent life. Information on such developments must be made available. Amendments 72 and 75 would give councils a duty to provide information and advice on different housing options and ensure that a variety of housing options are available.

I want to focus on amendments 76 and 73 and new clause 7. Amendment 76 is designed to ensure that information and advice is tailored to individuals based on any medical conditions or any complex needs that they have. Many people will find generic information and advice about social care services helpful, but for others it will not fit the bill. The Leicester and Leicestershire Alzheimer’s Society contacted me last year, or maybe the year before, when funding for its advice line for families with dementia was cut. That cut, which came, I believe, from the county rather than the city, meant that the organisation could not afford to provide the advice line for everyone so the whole thing was transferred to a generic, in-house council advice line. Individuals who called the new advice line with specific questions about dementia did not receive the answers that they needed. That is hardly surprising, because it is much easier for someone who has experienced dementia in their family to provide such support.

As MPs, we know that some people have complex mental, physical and social care conditions. I am genuinely concerned that we will go down the route of providing tick-box, generic advice that will be of no use to anybody. In the other place, Earl Howe said that it was up to local authorities to determine the scope and manner of information and advice that they provide, and that he expected them to work with other sectors. He said that it was unnecessary for the Bill to require local authorities to provide tailored information because guidance would be provided. I seek an assurance from the Minister that the guidance will tell local authorities that they do not have all the necessary information or skills, and encourage them to work with local branches of the Alzheimer’s Society, the Royal National Institute of Blind People and others to provide detailed information and advice.

Amendment 73 and new clause 7 are related. Local authorities will be under a duty to ensure that people have access to independent financial information and advice, and amendment 73 would ensure that that information and advice was of high quality and provided by appropriately trained individuals. I cannot overstate the importance of that. The Government’s new system of funding social care—the cap on care costs, the deferred payment schemes and loans, and the raising of the means-tested threshold—is extremely complicated, and as the Minister knows, it is difficult to get one’s head around it. I am sure people have asked him, as they have asked me, how it will affect them. Even though I have done my best to study the Bill in detail, however, I would not want to advise people on the system because it is incredibly complicated. The Bill states that independent financial advice should be available to people, but who will provide that advice? [Interruption.] I am sorry. I have been uncharacteristically put off my stride.

Photo of Andrew Rosindell Andrew Rosindell Ceidwadwyr, Romford 4:00, 9 Ionawr 2014

Order. If there are any difficulties in turning off a mobile device, would the hon. Member leave the room in order to deal with the problem?

Photo of Liz Kendall Liz Kendall Shadow Minister (Health) (Care and Older People)

That happened to me once during wedding vows—[Laughter.] Not my own; I am not married—sorry, too much information.

Local authorities will be required to ensure that people have access to independent financial advice and information, but who will provide that advice? The new system is incredibly complex, and the complexity of the  system has not been helped, to put it mildly, by some Ministers’ repeated claims about the new system, which do not stand up to scrutiny. I know that the Health Secretary is not here to defend himself, but he has been a repeat offender in that regard. He has regularly claimed that no one will have to pay more than £72,000 for their care when they will, and that people will not have to sell their homes to pay for their care when they will, and implied that raising the means-test threshold will mean that anyone with income or assets below £118,000 will not have to pay for their care when they will.

The Minister is often more careful in his choice of words, but this is a very important issue. People need to have the facts and the information if they are to plan for the future. The issue is not just the basic elements of the system. The different ways in which the elements of the package interplay with one another are very complicated.

Lord Lipsey, who many hon. Members know is one of the country’s leading experts on social care funding, raised an issue in the other place about the interplay between raising the means test and attendance allowance. He said that people may apply for help under the increased means-test threshold and find that they are worse off, because although they get a little help through the means test, they lose their attendance allowance. Lord Lipsey told me afterwards that he was not even aware of that issue until he looked at the situation in detail. If a long-standing expert such as Lord Lipsey has only just discovered some of the complexities, how will other people manage? This may be wrong; I am just repeating what Lord Lipsey said in the House of Lords. The system is very complicated and, as the Bill stands, anyone could provide advice about care finances, with no requirements to ensure that the advice is high quality or provided by people who are properly trained. The Minister could write to me on the point about attendance allowance if he would find that easier.

I am genuinely concerned that we could end up with, even if not mis-selling, some kind of misinformation scandal because of people giving financial advice that simply is not borne out by the facts. This amendment is not calling, which some have suggested, for the independent financial advisers giving advice about this matter to be regulated. I think that there is a debate to be had about that. The amendment is the very least that the Government should accept. Local authorities should have some safety system to guarantee that the people giving independent financial advice—this is not advice about care services—are appropriately trained and have proper skills.

New clause 7 takes that one stage further, because it calls on the Secretary of State and local authorities to ensure, through public awareness campaigns, that there is a high level of awareness and understanding of the new system of funding social care, including the so-called cap on care costs, that is being brought in by the Bill.

Lord Warner, who was a member of the Dilnot commission on reforming long-term care funding, rightly pressed the case in the other place for public awareness campaigns, saying he was “incredibly depressed” by people’s lack of understanding of the existing care system, let alone the new one proposed in the Bill. I do not blame people for not understanding the system; I blame us for not being clearer about what it means.

It is the case that 60% of the population think that social care is provided by the NHS. For people to get their heads around this new, complicated system will be  very difficult. That is why the Dilnot commission itself strongly argued that the Government should have an awareness campaign to inform people about the proposals. Indeed, in the other place Earl Howe accepted that public awareness is “lamentably low” but said that legislation was not necessary because joint programmes with local government were under way. Where? My local council is struggling to get its own head around this system. I have never seen a public awareness campaign about what is happening. I think councils are struggling to get to grips with what this will mean. That is why we have tabled the new clause. I think we get to vote on it later. The issue about independent financial advice is the one I am really worried about, so I will certainly press that to a vote.

Photo of Paul Burstow Paul Burstow Democratiaid Rhyddfrydol, Sutton and Cheam

I rise briefly to speak to amendment 56, which stands in my name, and perhaps to touch on some of the other issues raised by the hon. Lady. The amendment goes back to the debate we have just had about housing and the important place it needs to have in relation to information and advice. I hope that the Minister can give us some further reassurance about how that will be built into the implementation. The hon. Lady referred to the work between the Department and local government. I understand there is a joint unit working between the two, another example of the co-productive nature of not just the conception of the Bill but its execution. That marks it out as a pretty unique endeavour. But there are still some unanswered questions raised by amendment 73 and new clause 9.

Amendment 73 opens up the question about regulated financial advice. In the debate on Third Reading in the other place Earl Howe made some helpful comments. He confirmed that local authorities should take this duty as a proactive one. However, he said that when it comes to the relevance of the availability of regulated independent financial advice, it should be a facilitative role for local authorities. We need to be clear in clause 4(3)(a), which is all about identifying those people who might benefit from financial advice, whether being facilitative is sufficient and whether it means more than just providing a list of anyone who might give financial advice.

When we considered this in the Joint Committee we were clear that independent advice was needed. The Lords were right to identify the question of regulated financial advice, not least because one in four self-funders fall back on public resources at some point during their care needs and 40% of self-funders, according to the Personal Social Services Research Unit, would benefit from an existing product that is available in the market today. The Dilnot reforms were effectively about taking away tail-end risk and longevity risk. We therefore need to see this market grow in terms of private products that enable people to meet their care cost needs in various ways, such as equity release.

Photo of Liz Kendall Liz Kendall Shadow Minister (Health) (Care and Older People)

Is the right hon. Gentleman aware of any new products that have emerged so far on the basis of the Dilnot proposals?

Photo of Paul Burstow Paul Burstow Democratiaid Rhyddfrydol, Sutton and Cheam

That goes to a point that the hon. Lady was making just now. It would be foolhardy to have an awareness campaign at this point and there is the question  of the legality of a Government having an awareness campaign before they had got a Bill through the House. Until the Bill is in place and until all the elements are there and clear, it would be highly surprising to see a sudden surge of new products in the market. Having said that, it is interesting that Swiss Re, which is the reinsurer here, has come back into the market. It is actively engaged in discussing with those who are involved in the design of products. There is activity going on. I have certainly been heartened by some of my conversations with people who want to see certainty around this market development.

That brings me to my final point, which is the point that Lord Warner made. I would describe it as the nasty little secret about social care, which is that it is not free. Most people do not know that. They still do not know it today. When this welcome set of changes is enacted and implemented from April 2016, many will turn up to their local authority and still be horrified to find themselves being asked to pay substantial amounts of money. However, they will be asked to pay substantially less and bear substantially less risk as a result of this legislation.

If there is to be an awareness campaign—and we recommended this in the Joint Committee, as did the Dilnot commission—it is absolutely essential that the campaign enables people to make a fair comparison between what the Government are implementing and what went before it. In that comes understanding of the benefits and risks. This allows a judgment to be made about how to proceed as an individual and how the Government are then properly judged as well. I hope that is why the Government, regardless of these amendments, will do the right thing when it comes to awareness campaigns once this Bill becomes—

Photo of Paul Burstow Paul Burstow Democratiaid Rhyddfrydol, Sutton and Cheam

My hon. Friend caught me on my last word.

Photo of Sarah Newton Sarah Newton Ceidwadwyr, Truro and Falmouth

Does my hon. Friend agree that we should look towards the trusted voices that already exist and the networks of really excellent organisations like the CAB and Age UK, which have both well-regarded national web-based and strong face-to-face advice services? Local authorities will be in an ideal position to forge even greater partnerships than exist already, to make sure of really good promotion once it has been agreed and ensure that advice and services that are available are promoted in partnership with them.

Photo of Paul Burstow Paul Burstow Democratiaid Rhyddfrydol, Sutton and Cheam

My hon. Friend is right. They are key partners in delivering an effective information and advice operation at a local level. However, clause 4(3)(a) requires us to go further and ensure that there are suitable arrangements for local authorities to signpost in a proactive way financial advice provided by independent advisers who have been independently and properly vetted in the processes that come with that. I hope that the Minister can give us some sense of how that will work in practice.

Photo of Heather Wheeler Heather Wheeler Ceidwadwyr, South Derbyshire

Declaring my position as an officer of the all-party group for insurance and financial services, the right hon. Gentleman  just finished noting the fact that independent financial advisers should be used at all times. I concur with that, but could we make it absolutely clear that they ought to be regulated by the Financial Conduct Authority and people should be signposted only to those regulated by the Financial Conduct Authority and not to anybody else?

Photo of Paul Burstow Paul Burstow Democratiaid Rhyddfrydol, Sutton and Cheam

I agree with that, for the reasons that the hon. Lady gave. It is why, when it comes to identifying those who will benefit from financial advice, this is made absolutely clear, so there is no misinformation at that crucial point. However, there are many other advice agencies that could provide a better insight into the way in which the care system works such as the CAB and Age UK. It is about how those two things are blended effectively, so that people get the right, regulated financial advice, but also get an insight into how the system and their options might play out. With that, I look forward to the Minister’s response.

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

Again, I find myself in agreement with much of what has been said. I agree with the shadow Minister that it is very important that we are all clear about what these reforms do and do not do. I will come to raising public awareness, but, as my right hon. Friend and the shadow Minister made clear, the degree of ignorance out there—that at the moment if you have more than £23,250 you are literally on your own and you pay everything—is very high, so clarity and straightforwardness are incredibly important.

I have a gentle jibe for the other side, because there have been occasions during the debate on all this where there have been misleading challenges, for instance on interest on deferred payment arrangements. There was an assertion that this was hidden away in some way. We have been completely open about it and never sought to hide away the fact that there will be an interest charge and that local authorities will not be out of pocket as a result of the universal offer. However, I share the shadow Minister’s point about the importance of us all being straightforward and clear about this. In a way, I hope that in due course, there will be a settled political consensus to support the reforms, so far as the cap is concerned; I know that the hon. Lady calls it the so-called cap, and we can disagree about that. The reforms will achieve much greater force if there is ultimately a settled political consensus. I do not know where her party is at on the issue at the moment. I think there is something of a debate going on in her party—[Interruption.] She smiles gently in response to that. The sooner we can get to a point where people out there, including the financial services industry, know that this is there for the long term, the better. It would give the reforms the best possible chance of succeeding.

Photo of Liz Kendall Liz Kendall Shadow Minister (Health) (Care and Older People)

My point was that the interest charged on the loan does not count towards the cap. I never said that the Government had not said that there would be interest on the loans, but that it does not count towards the cap. If someone takes out a loan on their care costs, and they are told that their costs are going to be capped, but the interest on the loan does not count towards the cap, it does not feel like a cap. That is one of many reasons.

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

Let me proceed with my contribution. The availability of information and advice is essential for people to make good and well-informed choices about the care and support they want to receive. Clause 4 will set out the high-level requirements for an information and advice service that the local authority must provide

There is little that we disagree with in the amendments, and we are wholeheartedly in tune with the intentions behind them, but we believe that they are unnecessary, so I will address each in turn.

Amendments 71 and 74 draw attention to the need for the local authority to facilitate access to its information and advice service to all those who might benefit from it. We have been clear that such services must be accessible to the authority’s local population, and specifically to those who may have a need for information and advice relating to care and support.

That intention is already clearly stated in clause 4(4) as currently drafted:

“Information and advice provided under this section must be accessible to, and proportionate to the needs of, those for whom it is being provided.”

That includes any person who may benefit from the information and advice provided by a local authority. As such, the service must be accessible and available to all people in the local authority’s area, regardless of whether they have eligible care needs. How that will work in practice is best and most appropriately covered within statutory guidance and by allowing individual local authorities to be able to respond to the differing needs of their local populations.

Regarding amendments 56, 72 and 75, the Bill will make it clear that the provision of accommodation to meet care and support needs—except for the provision of general housing, as excluded by clause 23—should be considered an integral part of care and support. We do not consider it appropriate to provide a comprehensive list of what the information and advice duty is intended to cover, not only because the list would change over time, but because anything left off the list may look less important.

We intend the detail to be covered in more depth in guidance. [Interruption.] I am conscious of all sorts of things appearing and disappearing next to me. It is disarming. We will make it clear that information and advice should cover and draw together the wider housing options that might be available through general or specialist housing, such as extra care housing and support living, as well as adapted housing and home adaptations.

On amendment 73, how could we not agree with the principle that the information and advice service provided for under clause 4 should be of a good standard and that where appropriate it should be delivered through suitably trained individuals? We absolutely agree, but we do not agree that the amendment is required to make that happen. First, clause 4(4) already states that the information and advice provided by local authorities needs to be proportionate and accessible to the needs of the recipient. In some cases, the needs of the recipient may be such that that can be achieved only if the person delivering the information and advice is appropriately trained.

Secondly, general public law principles mean that local authorities must look to meet their duties to an appropriate standard. Statutory guidance is the preferred  and right approach to beginning to address the complexity and variety of circumstances and the mechanisms through which information and advice to individuals can and will be provided. Work has begun on that and we have, through the “Think Local, Act Personal” partnership, already published “Principles for the provision of information and advice”, a short practical framework that sets out the main issues that councils need to consider when developing a comprehensive and coherent local care and support information and advice strategy. We will develop on that through statutory guidance and further supporting documents.

Amendment 76 draws attention to the need for local authorities to provide focused information and advice for individuals with specific medical conditions and complex individual needs.

Photo of Paul Burstow Paul Burstow Democratiaid Rhyddfrydol, Sutton and Cheam

I have a quick request. Could the Minister, following discussion after today’s Committee with his officials and those working with others on the guidance, return to the Committee with a letter to say what the Government’s approach will be to regulated financial advice? It would be helpful to have a letter, so that we are clear about it.

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

I will certainly consider the point. I seek to be helpful.

Such advice and information can be provided effectively only by the local authority working together with health organisations. The duty to promote integration of care and support with health services is covered in clause 3, which sets out that local authorities must exercise their functions with a view to integrating their care and support provisions with health provision and health-related provision. That is applicable to information and advice services under clause 4.

With local authorities and the NHS, the voluntary sector plays a key role in supporting access to good, reliable information on specific medical conditions. Many such organisations already work with local authorities and the NHS in that area. There are too many examples for me to detail today, but I commend the joint approaches taken with the Stroke Association, the National Autism Society and the Alzheimer’s Society—all excellent examples. We will reference and detail such examples to support statutory guidance, which will cover circumstances and opportunities to provide tailored information and advice for people with specific medical conditions and complex individual needs. That guidance is being developed at the moment with the direct involvement of the field, citizens and wider interests.

Finally, on new clause 7, we agree that it is critical that people are made aware of the reforms and what they mean to them. We accepted the Dilnot commission’s recommendation to undertake an exercise in raising awareness. We have confirmed that commitment on a number of occasions and I repeat it today. Clause 4 requires local authorities to provide information and advice that is accessible to their whole population, and that includes information on paying for care and the cap. We accept that local awareness raising alone might not be sufficient and that the Department also has an important role to play at the national level. For an awareness raising campaign to be successful, it needs to be delivered in partnership, with national and local  government working together alongside the wider care sector, and indeed the financial services sector has an incredibly important role to play. I agree with the comments my right hon. Friend made: although we have not yet seen the emergence of specific policies from the financial services industry, I have been encouraged by the degree of engagement it has had and its interest, and by the potential the legislation has to lead to the development of new products in the market, like those Andrew Dilnot argued for in his report.

We have already, without legislation, embarked on a joint programme with local government to implement the reforms. Awareness raising will be part of that. The Department will co-ordinate the message to ensure that a simple, coherent campaign can be delivered nationally and locally. We are engaging with the voluntary sector, care providers and the financial services industry, to make sure that we can play our part in communicating these reforms. We also need to improve the data on public understanding of care and support, so we have also taken steps to develop and include new survey questions for the annual health survey for England. The new questions will be used to monitor and track public awareness over time. Together, these steps will inform the ongoing implementation and policy development process that will take place in the years to come. The work on awareness raising is underway and is continually evolving, so adding a specific duty to the Bill is not necessary. I do not think that a Labour Government have ever legislated for a public awareness campaign. That is something that obviously should happen with a major reform, but legislating for it would be inappropriate.

There is unanimity on the principles underlying the amendments. I hope that I have assured Committee members that there are already adequate provisions in the Bill and that these are supported, critically, by the statutory guidance that will emerge, allowing them to be put into effect. Therefore I respectfully ask the hon. Lady to withdraw her amendment.

Photo of Liz Kendall Liz Kendall Shadow Minister (Health) (Care and Older People) 4:30, 9 Ionawr 2014

I am happy to beg to ask leave to withdraw amendment 71 and will not press amendments 72, 75, 74 and 76 to a vote, because the Minister has said publicly that there will be both local and national awareness-raising campaigns, which is excellent news. However, we have not heard enough about amendment 73 and I should like to vote on that, because following the little interchange between the hon. Members for South Derbyshire, for Member for Truro and Falmouth and the right hon. Member for Sutton and Cheam, I do not think that the Bill is clear in that regard.

Yes, we want Age UK and others to provide information and advice on services, helping us support those things, but we only want financial advice to be given by properly regulated independent financial advisers, otherwise it will be a big disaster. The Bill is not clear about that.

I hope that the Minister is considering writing to all Committee members, not just the right hon. Member for Sutton and Cheam, because the Bill is a bit of a mess in this regard and is not clear about financial advice. I am concerned about that. I want to vote on amendment 73, which would at least mean the Bill contained something to the effect that advice should be provided by appropriately trained individuals, trained to an appropriate standard.

I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Photo of Paul Burstow Paul Burstow Democratiaid Rhyddfrydol, Sutton and Cheam

I beg to move amendment 30, in clause 4, page 4, line 32, at end insert—

‘() how to complain about a decision made under this Part.’.

Photo of Andrew Rosindell Andrew Rosindell Ceidwadwyr, Romford

With this it will be convenient to discuss the following:

Amendment 31, in clause 4, page 5, line 11, at end insert—

‘(7) Regulations must make provision for an effective and independent system for revolving disputes between individuals and local authorities regarding decisions taken under this Part. Regulations shall also set out the conditions that apply to each party to a dispute and when decisions made are binding.’.

New clause 8—Appealing decisions taken by the local authority—

‘(1) The local authority must have in place a procedure, which includes a review element that is independent of the local authority, by which adults or carers can appeal a decision made by the local authority about—

(a) whether an adult or carer’s needs meet eligibility criteria under section 13;

(b) whether to charge for meeting needs under section 14;

(c) the result of a financial assessment under section 17;

(d) the content of a care and support plan or support plan under section 25;

(e) the amount of a personal budget made under section 26 or independent personal budget made under section 28;

(f) the payment of an “additional cost” under section 30.

(2) Regulations may make further provision about any aspect of the appeals procedure mentioned in subsection (1).

(3) Wherever a decision has been made of a type referred to in subsection (1), the local authority must make the adult or carer aware of their right of to appeal the decision and how to request details of the appeals procedure. Details of the procedure must be made available on request.’.

Photo of Paul Burstow Paul Burstow Democratiaid Rhyddfrydol, Sutton and Cheam

I want to go through this argument as quickly as I can, because it is important, given the previous debate about access to advice and information. The amendment is about how people can seek redress and challenge decisions that have been made under the legislation. It is also about ensuring that, when things go wrong, there is a clear route by which a remedy can be achieved. At the moment, the system does not really allow that to happen as well as it might. We have local complaints arrangements and, ultimately, routes through to the ombudsman and judicial review.

The Law Commission, on embarking on its review of social care law in 2008, argued that it should consider the efficacy of the legal structures in place for complaining about and seeking redress for failures in decision making and service provision local authorities, including whether a tribunal should be established. The Government at the time took the view that there was no desire to include that in the scope of the review and it was ruled out of scope, and the Law Commission did not include it. Despite exclusion from consultations, numerous people responding to consultations over the subsequent years said that they felt the issue of redress was not dealt with adequately and needed to be dealt with better in a reformed adult social care system.

The issue was raised again during the evidence sessions of the Joint Committee scrutinising the Bill. One organisation that told us of its concerns was the Local Government Association, which was concerned that the Bill

“does not provide for any means of redress other than through judicial review.”

For me, the Bill’s well-being and advocacy principles are all about shifting the balance of power away from public bodies and providers to individuals and their carers. That seems to me to be one of the shifts that is crucial to delivering the legislation. However, when it comes to complaining about decisions made under part 1, all the power still sits with the local authority. The relationship is unbalanced on those issues. That is why the Joint Committee said:

“We believe that the significant extension of local authority responsibility for assessment, and the introduction of the well-being principle into decision making, warrant an urgent review of arrangements for providing redress and complaints resolution. The Government should reconsider establishing a care and support tribunal to provide independent merit reviews of decisions made by local authorities.”

In response, the Government made a welcome set of comments. They said:

“We agree that the role of local authorities is changing significantly and that it is important to ensure that the arrangements for providing redress and resolving complaints are effective in this context.”

They went on to say that the right hon. Member for Cynon Valley (Ann Clwyd) and Professor Tricia Hart would be consulted on a number of issues, and that the Government would consider appeal mechanisms and so on. That was all good news. My amendment attempts to address that direction of travel.

Photo of Anne Marie Morris Anne Marie Morris Ceidwadwyr, Newton Abbot

I am pleased to hear the proposed amendment, and I thoroughly support it. Does my right hon. Friend agree that perhaps there is another issue that the tribunal does not entirely address? There is no body with any oversight over a local authority in the exercise of such decisions in the same way that the CQC has oversight over the NHS. Although I applaud his suggestion about a tribunal, that will deal only with individual problems, whereas we might get better decision making from local authorities if there were another body that reviewed and considered how they made those decisions.

Photo of Paul Burstow Paul Burstow Democratiaid Rhyddfrydol, Sutton and Cheam

My hon. Friend makes an important point that I hope we will have the chance to debate when we get to clause 61, which involves whether the CQC should have in its purview any role in reviewing the commissioning decisions of local authorities. I hope that we will have a good debate, and that she will catch the Chairman’s eye, but this debate is about decisions made about an individual by a local authority under this part of the Bill.

Having suggested in our recommendation in the Joint Committee that it could be done by establishing a tribunal, I accept fully that there are concerns about the cost and cumbersomeness of such processes, and the time involved. Therefore, I am not suggesting that in my amendment. The amendment creates a mechanism by which the Government, through consultation and co-production, could make regulations to introduce an appropriate mechanism for dispute resolution and redress.  This is an area in which regulation-making powers are more suitable, in order to allow flexibility and adaptability over time.

The framing of my amendment may not be perfect—I am sure that parliamentary counsel could come up with a better formulation—but I think that that is how the spirit of the Government’s response to the joint Committee could be honoured and the balance of power struck differently, so that when someone feels that they are being wronged by their local authority and not getting what they are entitled to in order to promote their individual well-being, they have a route to get their day in court and resolve the issue without actually having to go to court and incur all the costs involved. With that, I look forward to listening to the Minister’s response.

Photo of Liz Kendall Liz Kendall Shadow Minister (Health) (Care and Older People)

My comments echo those of the right hon. Member for Sutton and Cheam. New clause 8 would allow adults or carers to appeal decisions made by the local authority on a series of matters, including whether their needs have met the eligibility criteria, whether they should be charged for meeting their needs, the result of the financial assessment by the council, the content of their care or support plan and the amount of personal budget they have been given, which is an increasingly important issue. I am a big champion of personal budgets and I am worried that they are going to get a bad name, as the budget does not end up being enough to cover the needs identified.

New clause 8 goes through the things that people will inevitably and rightly want to question. The issue has not been dealt with in the Bill and we have not seen regulations or enough of a move on it so far. It is important because the system is very complicated. We should not forget that increasing numbers of people will come into the system because the so-called cap on care costs will apply to those who meet eligibility criteria. There are all sorts of issues here. Normally self-funders do not get any advice or support, but they will under the new system, so there will be more people coming through.

In the other place, the Minister Earl Howe accepted that

“…it is likely that some changes are needed”.—[Official Report, House of Lords, 14 October 2013; Vol. 748, c. 327.]

He said that there would be a consultation and that he would update the other place in December. I am not sure whether that happened. It would be good if the Minister could update the Committee and at least give a commitment that there will be a route to appeal, not just on assessment and care decisions but on financial decisions, precisely to avoid what we all see, which is constituents coming to us because the whole thing has got too far down the road and it will end up in court. People are distressed and everybody is miserable, so we need a proper appeals process. I look forward to hearing what the Minister has to say.

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

I agree that it is important to ensure that the arrangements for resolving complaints and providing redress are effective, particularly given the changes that are being brought about by the Bill. We have consulted on the issue in “Caring for our future: consultation on reforming what and how people pay for their care and support”.

There is a range of approaches to resolving complaints and providing redress. We believe it is best to have a flexible system that works at a local level and in a manner that is proportionate to the type of complaint. I appreciate that we are dealing with a range of types of complaint. We have been reviewing the existing complaints arrangements as they relate to care and support and are assessing whether they currently provide an effective means of challenging local authority decisions, or whether amendments need to be made to them.

We recognise that more people will be brought into contact with the local authority, as the shadow Minister said, by the reforms to the care and support system. We also recognise the need for change and we will announce the next steps in due course. If necessary, we already have the power to make regulations under the Health and Social Care (Community Health and Standards) Act 2003. Regulations already exist. They are the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009, which I will refer to as the 2009 regulations.

Those regulations already require local authorities to have in place systems for dealing with complaints. The powers within the Act are wide-ranging, and we can achieve our intended outcomes by using the powers in the Act to make amendments to the existing complaints regulations.

Amendment 30 seeks to ensure that people have information and advice about the local complaints system. Clause 4(2) provides a high-level explanation of what the information and advice service should cover. Subsection (a) clearly sets out that the information and advice service that the local authority must establish and then maintain must cover information and advice on how the system provided for under part 1 of the Bill operates in the local authority’s area.

The term “system” has been used as a high-level explanation of what the information and advice service must include, without providing an exhaustive list in the Bill. There is, in addition, already an obligation on local authorities, imposed by the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009, to have a system for dealing with complaints about how it discharges its social service functions. Those regulations oblige the local authority to ensure that information about how to use a complaints system is made available to the public. The regulations will continue to apply to the functions under part 1 of the Care Bill, as those will be social services functions.

Statutory guidance, currently being developed and drafted with the wide involvement of the field for consultation later this year, will provide a more detailed explanation of what should be included in the information and advice service. It will be important that people are informed of how to complain about any decision under the Bill, and the statutory guidance will emphasise that complaints are part of the system and that every local authority must have and must publicise a system for dealing with complaints. The guidance will provide greater detail on complaints against decisions made in specific circumstances and at points in the process of assessments and meeting of care and support needs.

I certainly agree with the sentiment behind the amendments. I am sure nobody would disagree with the need for a system that resolves disputes between individuals  and the local authorities in an effective manner. Having that system in place is necessary to ensure that every local authority recognises the importance of doing it properly in the first place. We want to avoid having complaints; we want the system to work as effectively as possible.

Nor do I think anyone would disagree that a degree of independence is an important element of any system to resolve disputes. With that said, it would be premature to accept amendments in relation to an appeals system at this juncture, given that we already have powers for many of the policy options under consideration. I hope to make an announcement about that soon, and I hope hon. Members will feel able to withdraw their amendments in the meantime.

Photo of Paul Burstow Paul Burstow Democratiaid Rhyddfrydol, Sutton and Cheam 4:45, 9 Ionawr 2014

We are obviously now waiting with bated breath for that announcement. I hope that it will be as soon as possible. It is helpful to rehearse the pre-existing powers and how they might be used to comply with the 2009 legislation. One of the benefits of the Bill is that it is a consolidation—a simplification—of legislation, and therefore to have within it the mechanism to get redress would be an aid to understanding how the system works. Given that the legislation—believe it or not— is meant to be written in plain English, which it largely is, it would be a shame not to have the opportunity to provide such a mechanism as well.

The amendments were intended to probe the Government’s intent, which I think is good, and the Government are attempting to address the concerns raised. On that basis, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Amendment proposed: 73, in clause 4, page 4, line 46, at end insert—

‘(c) ensure that such advice is provided by appropriately trained individuals and to an appropriate standard.’.—(Liz Kendall.)

Question put, That the amendment be made.

The Committee divided: Ayes 8, Noes 10.

Rhif adran 4 Decision Time — Clause 4 - Providing information and advice

Ie: 8 MPs

Na: 10 MPs

Ie: A-Z fesul cyfenw

Na: A-Z fesul cyfenw

Question accordingly negatived.

Question proposed, That the clause stand part of the Bill.

Photo of Meg Munn Meg Munn Llafur, Sheffield, Heeley

The clause is enormously important, because time and time again people who are struggling with care responsibilities tell me that they do not know what help there is, what advice there is and what they  should be doing. Often, people get to the point where the level of care and the need is so great that they can hardly lift their head up to go and get that advice and information. So, a service that provides a wide range of advice, that is very visible and that enables people to get little bits of help early on is vital.

I do not disagree in any way with my Front Benchers’ concerns about financial issues, but those issues will affect people who are far into the system and looking at full-time care of some nature. The much wider range of issues affects people who are providing care for their relatives, and they probably do not even think about it as care. They will not see themselves as a carer and they will not have any idea that services are out there that might help them. Sometimes, that help might just be flagging up a service to help with gardening or cleaning—the small bits of support that take pressure off a family in the early stages of need. I hope that this clause will do as much for those people as it will for those who need much more significant care.

Question put and agreed to.

Clause 4 accordingly ordered to stand part of the Bill.