Clause 23 - Exception for provision of housing etc.

Care Bill [Lords] – in a Public Bill Committee am 3:00 pm ar 16 Ionawr 2014.

Danfonwch hysbysiad imi am ddadleuon fel hyn

Photo of Grahame Morris Grahame Morris Llafur, Easington 3:00, 16 Ionawr 2014

I beg to move amendment 90, in clause 23, page 22, line 2, at end add—

‘(2A) Where a local authority is unable to meet the adult’s needs for care and support without the provision of housing of a specified nature or location, subsection (1) does not apply.’.

I declare an interest: I am vice-chairman of the all-party group on learning disability. I want to raise some issues relating to housing which have been highlighted by Mencap. I tabled the amendment to ensure that local authorities are provided with the flexibility they need to deliver housing solutions for vulnerable people with complex needs. Without that flexibility, people are at risk of remaining or ending up in institutional care. I remind the Committee that, as the Bill stands, clause 23 states that the local authority may not meet care and support needs by doing anything that they are already required to do under the Housing Act 1996.

The division of housing and care and support duties concerns a number of organisations, including Mencap and the Challenging Behaviour Foundation. We have already discussed how crucial it is that the Bill recognises that appropriate housing is an integral part of meeting care and support needs. I do not want to rehearse the arguments we had earlier in the week or about section 177 of the Health and Social Care Act 2012—just for the record, it was on 10 March 2011, at column 667. It is important that we meet care and support needs as well as being mindful of the importance of keeping costs down. It is fair to say that there was a general agreement by both sides of the Committee that that was a reasonable principle that we should apply.

The amendment is concerned with addressing the position of an individual with very complex needs, such as learning disabilities and behavioural issues, that can be triggered by environmental factors. In those  circumstances the type of housing or the location of the housing would be critical in ensuring that a person’s care and support needs were met. The Minister has made several statements to the House on this issue following the events at Winterbourne View, but under the Government’s transforming care programme, the intention was that local areas had to ensure that the 3,500 people—if my numbers are correct—with a learning disability and challenging behaviour currently living in units such as Winterbourne View were moved back into their communities.

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

The hon. Gentleman is raising important issues, but I want to correct his last point. If someone is in institutional care inappropriately and they are able to live independently with support, that is what should happen.

Photo of Grahame Morris Grahame Morris Llafur, Easington

That is a fair point; I should have used the word “appropriate”. The Minister is absolutely right: it is important that people receive the appropriate care and personalised support in an appropriate community setting where possible. Indeed, many individuals will require bespoke, tailor-made housing and support packages to be developed. As hon. Members will know from their own communities, a common solution is to come up with a standard self-contained flat or an adapted house shared with three or four others, but that simply would not work for people with complex special needs. Often, individuals will need to live on their own; and, with the relevant support staff, they might need additional space or they might need to live in a detached property, because their challenging behaviour produces excessive noise. Such housing options must be made available now and in the future to meet the housing and support needs of people with a learning disability and challenging behaviour.

The Minister has said several times that we must not agree amendments that have unintended consequences, but it is important that we do nothing to work against the Government’s commitment, restated by the current Care Minister, to ensure that people with learning disabilities are not put at risk of abuse in institutional settings such as Winterbourne View and are able to live fulfilling lives in the community, where appropriate, with the support that they need.

I am concerned that the Bill as drafted will mean that social services, or the care and support arm of a local authority, might be prevented from taking innovative approaches to solving housing problems. Perhaps the Minister will comment on that. For example, they may wish to provide capital to ensure appropriate housing of the right type or in the right location can be bought or built to meet the needs of people with a learning disability. If the local authority is not able to do that, the only option where the housing authority is unable to meet high rental or capital costs will be for a local authority social services department to place a person in institutional care, as they would have no power to secure appropriate housing.

It is crucial that clause 23 allows for the local authority, in the discharge of its care and support function, to provide property or capital to make up any shortfall in rental payments. I hope the Minister will assure me that that will be possible. The local authority should not be prevented from doing that.

Mencap has given me examples that focus on the importance of enabling the resettlement of people stuck in institutions such as Winterbourne View. However, many other people with a learning disability are at risk of being sent to inappropriate institutional settings if there is no flexibility in the system to deliver appropriate housing solutions. It is sad but true that three quarters of the parents of people with a learning disability have not planned for the time when they are no longer able to care for their son or daughter in the family home.

Mencap commissioned a study in 2012 entitled “Housing for people with a learning disability”, which is recommended reading. For many families of people with a learning disability, planning for the future comes too late, when a family carer either becomes ill or dies. Indeed, the hon. Member for Totnes highlighted that in a debate on an earlier clause, when we were talking about end-of-life care. It is not always possible to plan for such situations, which creates a crisis situation for someone with a learning disability and a need for emergency housing and care provision.

People with learning disabilities and complex needs who live with elderly relatives are not homeless. Although they are vulnerable, they might be on a council waiting list for many years before suitable accommodation in the right location to meet their complex needs becomes available. Local authorities must have the flexibility to secure suitable housing for some of the most vulnerable people in our society. It would be a scandal if those with the most complex needs were destined to remain in, or continue to be sent to, institutions.

As the Minister has told us, the Bill aims to reform and transform care and support, with the well-being of individuals at its heart. We applaud that, but the amendment would help to ensure that there are no unintended consequences and that the Bill’s aims become a reality for people with learning disabilities and the most complex needs.

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

I thank the hon. Gentleman for his contribution. He and I share a determination to ensure that people with learning disabilities get treated as equal citizens. The horrors uncovered both at Winterbourne View and by the subsequent review of treatment centres showed that so many still lived in institutional care—at the taxpayers’ expense, outrageously—in the wrong place. Sometimes, they were at risk of neglect and they were certainly not receiving appropriate care to meet their individual needs.

As a preface to my remarks, may I say that I will always listen to Mencap? It is a good organisation that has done important work in this regard to help the Government to respond properly and effectively to Winterbourne View. I have described the task of changing the behaviour of commissioners with regard to people with learning disabilities as like wading through treacle backwards. This is not about money, because we have spent enormous sums of public money on putting people in inappropriate care—I think the average cost at Winterbourne View was £3,500 per patient, per week.

This is therefore not about the Government being mean with public money. In my view, it is about commissioners at a local level sometimes being lazy and  not taking proper account of the rights of people with learning disabilities to lead as good a life as they can. Instead, sometimes they are shoving them away hundreds of miles from home and forgetting about them. That scandal has to end. However much pressure we have to keep applying to commissioners to change their habits, we will apply it. If there are continuing concerns about what the hon. Gentleman has raised, I will continue to listen to Mencap about them—and, indeed, to the hon. Gentleman.

Let me reassure the hon. Gentleman that we agree that housing can play a vital role in meeting care and support needs. We have already discussed how we amended the Bill in the other place to make express references to housing to increase its prominence throughout the Bill. To be clear, specialised housing—for example, extra-care housing, supported living or minor adaptations—could already be provided to prevent or to meet the needs for care and support under the Bill. Where meeting an adult’s care and support needs require some form of accommodation, that may be provided under the Bill, as acknowledged by clause 8(1)(a), which, as an example of how to meet needs, states:

“accommodation in a care home or premises of some other type”.

The words “premises of some other type” are important, as that covers other options as well.

Further, the general duties to promote integration in clause 3 and the co-operation duty in clause 6, which apply to all the local authorities’ care and support functions, would require consideration of housing issues where relevant to care and support. Clause 3(5) expressly clarifies that housing is a health-related service, which local authorities must aim to integrate with the provision of care and support and health services when exercising its functions under the Bill.

The point of clause 23 is to clarify the difference in law between a local authority’s duties to provide adult care and support, which may include certain specialised housing services, and its duties to provide general housing under other legislation so as to avoid duplication. The clause does not place a bar on local authorities providing accommodation where that is necessary to meet care and support needs. What it does is prohibit local authorities from using care and support law to provide general or social housing that is not related to a person’s care and support needs. That is only right and proper to ensure clarity about roles and responsibilities.

I hope that that reassures the hon. Gentleman that the amendment is not necessary and that he is content to withdraw it. I repeat that I am happy to discuss his concerns with him and with Mencap so as to ensure that we get this right.

Photo of Grahame Morris Grahame Morris Llafur, Easington 3:15, 16 Ionawr 2014

I am grateful to the Minister for his sympathetic response and his offer of further consideration of the points raised by Mencap through me. In the light of his comments, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 23 ordered to stand part of the Bill.