Clause 12 - Assessment under sections 9 and 10: further provision

Care Bill [Lords] – in a Public Bill Committee am 10:30 am ar 14 Ionawr 2014.

Danfonwch hysbysiad imi am ddadleuon fel hyn

Photo of Liz Kendall Liz Kendall Shadow Minister (Health) (Care and Older People) 10:30, 14 Ionawr 2014

I beg to move amendment 86, in clause 12, page 11, line 47, at end insert—

‘() specify when an assessment must be carried out face to face.’.

Clause 12 sets out some further issues in relation to the assessment of adults for services and support. The amendment would ensure that the regulations that the Government will be bringing forward on how assessments are carried would specify the kinds of cases where assessments must be conducted face to face. Amendment 87 would ensure that local councils work closely with organisations like the Alzheimer’s Society and others that have a track record in knowing how to get the best possible assessments of people for care and support. This might seem like a minor issue, but getting the assessment right is vital. If the assessment is right, everything can then flow from that.

Photo of Emma Lewell-Buck Emma Lewell-Buck Llafur, South Shields

Does my hon. Friend agree that without a face-to-face assessment, serious safeguarding issues may be missed? How can assessments be done over the phone? Unless a person is seen in their environment or their home, it is not possible to know what is going on with them.

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

My hon. Friend hits the nail on the head. In some cases it might be possible to do an assessment over the phone, but I know from my family’s experience that even issues that should be relatively straightforward are not. Often older people do not want to admit that they are struggling or have any issues or problems. They do not want to say that they might need a few home adaptations, and that might be in a relatively straightforward situation. However, I know from my family experience that when one goes to the house and sees the conditions, one realises straightway that this person is struggling—they are looking a bit stressed, worried and concerned. They do not want to ask for that help, but it would really benefit them, as the family carer, and the person they are caring for.

I am all for using technology for assessments—not that we would necessarily think a telephone was technology these days, although we might call our smartphones technology. However, although I am all for using IT, phones and the like, I am concerned that unless we specify that there are many cases in which face-to-face assessments are essential, we will end up with a tick-box approach that does not meet people’s needs. I know that the Government hate that kind of approach.

Let me turn to advice lines. They are a separate matter, but offer an illustration of an issue relating to amendment 87. We need advice lines to offer help from people with specific experience and expertise.

Photo of Bill Esterson Bill Esterson Llafur, Sefton Central

To reiterate the point about using evidence from previous campaigns, does my hon. Friend agree that the evidence of encouraging older people, over many years, to take up the benefits to which they are entitled shows exactly the same point? Unless people are prepared to go and see people, and particularly older people, they are reluctant to sign up for benefits, because there is a reluctance, a pride and a misguided desire not to impose on others. We have had evidence of that already for many years in a number of areas, including benefits. This assessment could have the same impact.

Photo of Andrew Rosindell Andrew Rosindell Ceidwadwyr, Romford

Order. I will clarify for the shadow Minister that we are dealing with amendment 86, not amendment 87, which we will come to next.

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

I thank our wonderful Chair. I was trying to deal with both amendments to move on swiftly, because the two are related, and I forgot the specific procedures of the Committee for a split second. I shall stick to face-to-face assessments.

My hon. Friend has raised an important issue. We have seen the impact of not having that kind of face-to-face advice in a number of areas, not just social care. This is not simply a matter of making sure that people get the right help and support, absolutely central though that is; it is also about value for money. If the assessment is not good and does not identify a person’s needs, and if that person does not get the right help and support, we will not help people to continue living in their own homes, which is exactly what they want and what taxpayers need to make sure that we get the best value for taxpayers’ money.

Most importantly, we need to make sure that face-to-face assessments take place for people suffering with dementia. Dementia is still a frightening condition for many families and there is still too much stigma associated with it: people are worried and embarrassed if a loved one is struggling with dementia. Our concern is that if light-touch assessments are too generic and are not carried out face to face, people will not receive the best possible help and support. Amendment 86 seeks to ensure that when the Government come forward with regulations, they contain a substantial chunk about when face-to-face assessments are appropriate.

The Alzheimer’s Society and other organisations have pressed us on this issue; I hope the Minister either accepts the amendment or gives a clear response about what will be included in the regulations.

Photo of Grahame Morris Grahame Morris Llafur, Easington

As well as supporting the points made by my hon. Friend the Member for Leicester West on dementia and Alzheimer’s disease, and the importance of a face-to-face interview as specified in amendment 86, I want to say a few words about autism and the importance of ensuring that assessments are complete. The amendment would require the Government to come forward with further regulations about assessments. I have met local representatives of the National Autistic Society in my constituency. They raised particular concerns with me about the operation of guidance in the Autism Act 2009: that when assessments are made the assessors are trained in understanding autism.

The term “autism” is fairly broad and when I talk about it I refer to all conditions on the spectrum, including high-functioning autism, Asperger’s syndrome and classic autism. Like others, I welcome the Government’s amendment to the Care Bill that was brought forward in another place, enabling the development of regulations that specify where community care assessments should be carried out by assessors with specific expertise. We touched on this a little earlier. However, although this was debated in the other place, it is still unclear whether autism will be included in the regulations. Perhaps the Minister can help.

Proper assessments are needed so that people with autism receive the right support that will meet their needs and, as we just heard from my hon. Friend the Member for Leicester West about people with dementia and Alzheimer’s disease, these needs are often hidden and difficult to identify. I understand that autism is a complex condition. Some people are able to live relatively independent lives, but others suffering from a more acute form of the condition may need ongoing specialist support or more low level support. As well as a knowledge of the difficulties that a person with autism can face, I would argue that an assessor needs specific skills to carry out the assessment successfully.

In the statutory guidance published after the passage of the Autism Act in 2009, the Department of Health provided clear direction that autism training is essential for community care assessors to ensure the needs of adults with disabilities are fairly assessed. What we seek in this amendment is an assurance that the regulations for this Bill will look at the specific needs of adults with autism in line with that guidance. The statutory guidance states that an assessment should be carried out by “trained practitioners” who have a “good knowledge of autism” and should take account

“of the communication needs of adults with autism”.

The guidance also states that local areas should develop or provide specialist training for those in key roles that have a direct impact on access to services for adults with autism. These could be GPs or community care assessors, so that

“within each area, there are some staff who have clear expertise in autism”.

I am not saying that everybody has to be trained, but otherwise—I hate the expression “pin the tail on the donkey”—but we could end up with a postcode lottery.

In order to meet these duties, assessments need to be carried out by specialist assessors, so there is a need to reinforce the recommendations of the statutory guidance. National Autistic Society research found that just over half of English local authorities had specialist training available for their staff. There is clearly a deficiency that needs to be addressed.

I recognise that the Government’s proposed new regulations present a opportunity to stop poor community care assessments for people with autism, or at least address that deficiency. Too often those needs are not identified and, as my hon. Friend the Member for Leicester West pointed out, it is not purely for altruistic reasons, or because of complaints, that we need to do this. If we do not pick up these needs and provide an appropriate level of support, the consequence for the public purse is often very much more when these people default either to hospital or other institutions for more expensive in-patient care. There are complex and variable ways in which autism can affect a person’s ability to function in everyday life and engage effectively with an assessment process. As is the case with those who suffer from dementia, it is often difficult to interact with someone who has autism and to find out what their needs are. Those of us with local authority backgrounds know that it has proven difficult for non-specialist assessors to understand and respond to those challenges.

I am grateful to have the opportunity to raise this issue. I ask the Minister respectfully whether he agrees that regulations requiring specialist arrangements for  those with autism would reinforce the existing requirements in the Autism Act 2009. To that end, will he confirm that autism will be included in the regulations and guidance that he issues?

Photo of Debbie Abrahams Debbie Abrahams Llafur, Oldham East and Saddleworth 10:45, 14 Ionawr 2014

I rise to make a couple of points in support of the amendment. I support what my hon. Friend has said about the importance of face-to-face assessments for families caring for those with dementia. I have personal experience of the issue because my mother died of Alzheimer’s disease last year, and I got a very different perspective on the problems that my stepfather faced over the phone than I did when I was actually there. A telephone conversation does not give any sense of how someone is dealing with the circumstances that they face. A face-to-face assessment is absolutely vital.

I had a visit from a constituent who is Hungarian, for whom English is a second language. Her son came to the surgery to represent his mum’s views. She was caring for her husband who was in the late stages of Parkinson’s disease and she had chronic back problems, but she was not able to communicate the issues that she faced on a day-to-day basis, so she was managing stoically. I was able to make representations on her behalf, but that should not be necessary. I emphasise the importance of a face-to-face assessment and someone who can speak the appropriate language in such circumstances.

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

I will pick up quickly the points made by other hon. Members before I move on to the shadow Minister’s speech. I am grateful to the hon. Member for Easington for raising autism, and he made a good point. To return to the discussion with the hon. Member for Sefton Central about the power of legislation, we are in quite a good position with the Autism Act and the autism strategy that underpins it, but we know that implementation is patchy. We have a long way to go before people with autism are treated properly by the health and care system.

I was pleased to hear from my hon. Friend the Under-Secretary that he hopes the refresh to the mandate for Health Education England, on which he is working, will contain something specifically focusing on autism and the need to improve the understanding and awareness of health professionals and others about such issues. The hon. Member for Easington will be aware that we are currently undertaking a review of the autism strategy, and he should feel able to contribute to that if he wants to. He may already have done so.

We must do more to implement the Autism Act and the underpinning strategy locally. In clause 12 we have the power to ensure that the assessment is “appropriate and proportionate”, which includes ensuring that the assessor has the appropriate experience of carrying out specific assessments, such as on autism. They can also consult people who have experience in that area. I refer in particular to clause 12(1)(f), which refers to the ability to consult a person with expertise, so that issue is specifically addressed.

We have also been consulting on specific groups, in terms of the regulations. We have identified and been clear about deaf-blind people, but we have asked about other groups that it may be appropriate to consider in that regard. The hon. Gentleman made the point about autism and that has been noted.

The amendment would provide for a power that specifies when an assessment must be carried out face to face. We believe that local authorities should be given the flexibility to determine how assessments are carried out on a case-by-case basis. The clause as drafted provides power for regulations to make provision to ensure that assessments are carried out in

“an appropriate and proportionate manner”,

which is the phrase that is used. The regulations that we intend to make will require local authorities to consider the adult or the carer—whomever the assessment is done on behalf of, or with—their preferences and the extent of their needs to ensure that the assessment is both appropriate and proportionate.

Photo of Bill Esterson Bill Esterson Llafur, Sefton Central

The Minister has not come on to the point put to him by several hon. Members about the need for a face-to-face assessment. He made the point that the decision should be taken by the person being assessed, or presumably, their carer. Will he say a bit more about that? Does he accept that sometimes—my hon. Friend the Member for Oldham East and Saddleworth made this point from personal experience—the individual is not best placed to judge their situation? Does he feel that there is a time when there is perhaps a need for intervention of some kind that insists on a face-to-face assessment?

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

I completely accept that. The point was made by the hon. Member for Oldham East and Saddleworth and by the shadow Minister about the risk sometimes in not getting the full picture by telephone, and I understand that completely. The point I am making is that I think that it needs to be done on an individual basis, and not mandated for specific categories of cases, because I think we could end up with unintended consequences. There will be cases in which an appropriate and proportionate approach can be delivered only by a face-to-face assessment. I completely accept that. Was the shadow Minister waving her hand in agreement, or did she want me to give way?

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

I wanted to intervene. I really want to press that issue, because of my personal experience of somebody in my extended family, who is in their 70s, who has had multiple different problems with cancer, and who is looking after somebody else in their late 70s who has had multiple heart failures and heart operations, and who now has Alzheimer’s. An assessment was given over the phone. The person who I am referring to was so worried about coming forward anyway, because they thought that it was embarrassing for the family member to have dementia. She did not question the phone assessment and I said, “Why on earth are you having a phone assessment? Why is that person not round there?” It was done on the phone, so this is already happening. We do not want to specify individual groups of people, laying down in detail every single person, but this is happening and it is a problem already. Council budgets are being squeezed and as ever more carers are going to be assessed under the Bill, the problem will get worse. That is not good for anyone and I do not feel that I have enough crunch from the Minister about what he will do about it.

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

I am grateful for that intervention. I would say that the circumstance that she describes does not meet the test in the clause, in that the assessment must be appropriate and proportionate. She describes a complex set of circumstances in which a proper and thorough assessment would absolutely be needed.

Other hon. Members have made points about the type of assessment. The assessment that we are legislating for here is not just a question of “Do you pass or fail a eligibility test?”. It has a much richer purpose than that, which is to identify what can be done to reduce the deterioration of a condition and what can be done to help an individual and their family to support themselves—a point made by the hon. Member for Sheffield, Heeley last Thursday. That is what we should seek to do; not just offer replacements, but help people to manage and build on their assets and their abilities, to help them be more resilient. With a thorough assessment, we possibly end up achieving a saving further down the line. A rushed box-ticking exercise is a false economy. As the shadow Minister says, the Government are focused on getting rid of tick-box exercises that achieve nothing, other than satisfying the Government inspector.

I am with the shadow Minister completely on the importance of proper assessments taking place, but I do not think it makes sense to mandate specific circumstances. I am clear that face-to-face assessments are appropriate in many complex circumstances.

Photo of Grahame Morris Grahame Morris Llafur, Easington 11:00, 14 Ionawr 2014

I am grateful to the Minister for giving way. I do not doubt his sincerity or integrity. I listened carefully to the assurances he gave. I understand the reluctance to place a firm commitment to face-to-face assessments in the Bill. Is it possible to achieve the same ends through fuller guidance? What is running through my mind are the debates we had on the 15-minute care visits. They should not be standard practice. There is an argument over whether they are reasonable or not, but rather than outlaw them, because there might be circumstances in a small minority of cases where there is some merit in them, we—

Photo of Andrew Rosindell Andrew Rosindell Ceidwadwyr, Romford

Order. May I remind the hon. Gentleman that he is making an intervention, not a speech?

Photo of Grahame Morris Grahame Morris Llafur, Easington

I am trying to ask whether the Minister could confirm the matter in guidance.

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

To respond to that neat and concise intervention, I am sure that we can develop the guidance further.

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

That is what amendment 86 says. Clause 12 says:

“Regulations must make further provision about carrying out a…assessment”

It then lists things that those regulations should do, to which the amendment adds,

“specify when an assessment must be carried out face to face.”

We are not saying, “Put it on the face of the Bill.” We are saying that the regulations must include it. I do not mean to be pedantic, just accurate.

Photo of Meg Munn Meg Munn Llafur, Sheffield, Heeley

May I draw the Minister’s attention to an issue that also affects the whole process of assessment? Too often, the people who are in need of care, as the shadow Minister has said, have no idea what is out there. An assessment should be a proper assessment of need, rather than, “Do you need shopping?” or “Do you need personal care?” Getting to a point where there is a proper understanding that the assessment is about need, and therefore asking someone one or two questions over the phone will not suffice, is fundamental to doing it properly.

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

I absolutely agree. It must be a proper and thorough assessment of need, as the hon. Lady says. If I may, I will respond to the shadow Minister’s intervention, which came before that of the hon. Member for Sheffield, Heeley. Whether the circumstances in which assessments should be face to face are mandated in the Bill or in regulations, the amendment still mandates such assessments. There will still be a regulatory requirement. That is the point that we are making and indeed resisting. I will give way to my right hon. Friend.

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

I am grateful to the Minister; he is being very generous.

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

I am sure that others assessing the Minister’s performance might conclude that. I want to say that guidance is good, but it is not sufficient. It is not sufficient even to have it in regulations or in statute; it is essential to have it in heads and hearts. Practice has to change to reflect the difference that the legislation will bring about: an asset-based rather than a deficit-based approach; a focus on outcomes; and a future focus rather than a focus on needs in the here and now. Such things require a significant shift in training. Can the Minister tell us what discussions he has had and what discussions he intends to have with the College of Social Work and others responsible for setting curricula in this area, because this is about the training of the future generation of social workers and the retraining and reskilling of the existing ones who will be doing assessments under this legislation?

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

I am grateful to my right hon. Friend for elevating us to a higher plane for our aspirations. I am not being rude to the shadow Minister, but my right hon. Friend talks about the need for the culture shift, and I completely agree with him on that. It is a hearts and minds thing, and the training of social workers is central to that. I can assure him that we will have  discussions with the College of Social Work and others to ensure that training is consistent with what we are trying to achieve.

We have heard that people’s needs are often complex and should be considered locally on an individual basis. Face-to-face assessments are likely to be suitable in many cases, but they should be determined according to presenting needs and the details of the cases. They should be decided by the local authority, which will be best placed to do so. What is suitable in one case may not be so in another, so the amendment provides for over-prescriptive regulation-making powers. That is always a temptation, I know, for the Labour party—sorry. We believe that local authorities should retain the flexibility to consider each case individually when determining how the assessment is to be carried out. As I have stated, what is most important is that assessments are “appropriate and proportionate”—the wording in the clause—to the person’s needs and outcomes. We believe that that will allow for more effective assessment.

I hope that Opposition Members will agree and feel reassured that the clause as drafted ensures consistent practice in the assessment process, and will withdraw the amendment.

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

The reason why I have spoken about this issue is that I saw a phone assessment done and was very angry about it, because it was not fair or right. We need to change that, and of course we need to change the practice on the ground. No one wants to be over-specific in the legislation. If the Minister will not accept this amendment, which is about what the regulations will cover, but will at least confirm that the issue of face-to-face assessment will be mentioned in the guidance that is put out, or anywhere in the regulations, so that councils will consider it, I will be happy to withdraw the amendment.

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

I am happy to reassure the shadow Minister that that will be more than mentioned. It is important. One point that we should remember is that there are plenty of face-to-face experiences that people have that are also deeply disappointing and that do not achieve their aim. If someone is not listening and understanding and is going through a tick-box exercise, a face-to-face assessment can be just as bad. As my right hon. Friend the Member for Sutton and Cheam says, this is more about elevating the whole culture and having it much more person-focused to ensure that people’s needs are understood and then addressed.

Amendment, by leave, withdrawn.

Ordered, That further consideration be now adjourned. —(John Penrose.)

Adjourned till this day at Two o’clock.