Clause 102 - LETBs: appointment etc.

Care Bill [Lords] – in a Public Bill Committee am 5:00 pm ar 28 Ionawr 2014.

Danfonwch hysbysiad imi am ddadleuon fel hyn

Photo of Paul Burstow Paul Burstow Democratiaid Rhyddfrydol, Sutton and Cheam 5:00, 28 Ionawr 2014

I beg to move amendment 122, in clause 102, page 90, line 2, after ‘health’, insert ‘-related’.

Photo of Andrew Rosindell Andrew Rosindell Ceidwadwyr, Romford

With this it will be convenient to discuss the following:

Amendment 123, in clause 102, page 90, line 2, after ‘services’, insert ‘(including nursing homes)’.

Amendment 124, in clause 102, page 90, line 6, after subsection (c) add—

‘() a person who will represent the interests of carers.’.

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

The clause is simply about who serves on a LETB. Clause 101, which we have just voted on, gives the boards certain delegated responsibilities to do what they can locally to deliver and commission the appropriate health-related education.

I want quickly to talk about the three amendments in my name. Amendment 122 would simply widen the scope of membership beyond a narrow definition of health, to include health-related functions. The intention is to get a wider range of expertise on the LETBs, not least to help with the delivery of the agenda on integration across health and social care, but also beyond that, into other aspects of public health.

Amendment 123 is an attempt to raise with the Minister that, notwithstanding the fact that LETBs must have a majority of NHS providers on them, others have a legitimate interest in the delivery of training and education, not least those in the private care sector, who are large employers of nursing staff. I hope that the Minister says something about that.

Amendment 124 deals with carers. This has been a running theme in the Committee, as the hon. Member for Copeland has said. I make no apologies for that, not least because, according to the census, carers are twice  as likely as non-carer populations to have bad health. We know, from earlier debates, that all too often carers, even when in front of health care professionals, are not identified and do not get the support that they need to be able to carry on with their caring responsibilities. Given that the Government, in clause 102 recognise that a person representing the interests of patients should serve on a LETB, it is strange that someone representing the interests of carers should not do so.

Indeed, the Government’s own Health and Social Care Act 2012, which I helped take through this House, specifically mentions carers and the obligations on other NHS bodies when it comes to the involvement of patients. I hope that principle can be extended here, because we can help carers in no better way than to ensure that as part of their education health professionals are trained, right from the outset, to recognise, value and understand the additional health impacts of a carer’s responsibilities. I look forward to the Minister’s response.

Photo of Jamie Reed Jamie Reed Shadow Minister (Health)

I again extend my thanks to the right hon. Member for Sutton and Cheam. I want to speak briefly on this issue and I think that some common thought will emerge, as I think it is extremely important. I will be mercifully brief, the Committee will be pleased to hear.

The amendments seek to make additions to clause 102(3), which sets out the types of person who must be represented on a local education and training board. The provisions contained in the subsection are for persons who provide health services in their local area, those who have clinical expertise and the person who will represent the interests of patients. The amendment tabled by the right hon. Member for Sutton and Cheam would make eminently sensible additions to the clause.

My hon. Friend the Member for Leicester West and other Committee members have spoken at length about the need to recognise carers and ensure that their rights are protected, as well as ensuring that we give them as much support and guidance as possible. With that in mind, it makes perfect sense for someone representing the interests of carers to be included on the local education and training board. To be able to fully perform its duties, Health Education England and the local education and training board should have to include carers’ representatives in its membership. That has the double impact of ensuring that carers’ needs are properly represented, as they quite clearly should be, and of bringing great expertise to the table, which should be welcomed by us all, particularly HEE, with open arms.

Can the Minister explain this omission? I am eager to hear him reassure us that the provision in subsection 3(b) is sufficient to cover the omission, which would mean that persons who have clinical expertise of a description specified in regulations must be members of a local education and training board. Will the regulations brought forward cover carers in the definition, to enable their membership on the boards? If not, or if he cannot answer, will he commit to looking at the issue in greater detail? It would be of tremendous benefit if he did that.

It is entirely sensible to define health services to include nursing homes. Thousands of people rely on those health services and it is essential that providers of that kind are involved with training and education in the local area and the local health economy. Is the Minister able to give assurances that that will be so in  practice? It is right that membership of the boards should be expanded to include as wide a range of professionals, representatives and groups as possible, to ensure that local education and training boards can operate to their maximum potential.

I am confident that the Minister will give assurances in good faith. If the right hon. Gentleman presses his amendment, it would receive the Opposition’s support.

Photo of Daniel Poulter Daniel Poulter The Parliamentary Under-Secretary of State for Health 5:15, 28 Ionawr 2014

With regard specifically to amendment 122, I reassure my right hon. Friend the Member for Sutton and Cheam that Health Education England LETBs will plan in an integrated manner, and forge strong partnerships across the health and care system. We recognise that this is essential to deliver a more joined-up approach to health and care. We all recognise that over time the boundaries between health and care will become blurred, and staff will need to be sufficiently skilled to work across those boundaries.

If we are to reduce the silo working that has sometimes taken place, not only between primary and secondary care in the NHS but across health and care, we need a work force with the skills to work in all care settings. That is very much at the heart of what we do and at the heart of the first mandate of Health Education England. I am sure that my right hon. Friend will be reassured to see that this is also contained in the next mandate. Although HEE does not have specific responsibility for the social care work force, it will be expected to work closely with the social care sector at a local and national level to ensure that work force plans properly align, and training meets the future needs of patients.

Amendments 123 and 124 seek to broaden the membership of LETBs to include persons providing nursing home services and persons representing the interests of carers. The Bill is clear in clause 101 that the primary role of LETBs is to discharge HEE’s duties under clauses 95 and 96, in respect of health workers in the health service. In setting up HEE and LETBs, the Government are looking to place greater responsibility on local employers to come together to collectively plan the development of the work force across the NHS and the public health system. For too long, local employers have been distanced from the important work force planning that needs to be undertaken to shape the future work force model and ensure high quality education and training. We hope that LETBs will put this right.

Consequently, the Bill requires LETBs to ensure that the majority of their members are drawn from providers of NHS and public health services in their geographical area. As my right hon. Friend made clear in his speech, this is very important. Clause 102 is clear that LETB boards must include members who provide health services in the LETB area. These people should be in the majority, as the primary purpose of the LETB is to plan and commission on behalf of local health care providers.

However, clause 102 also makes provision for LETBs to include people with clinical expertise, people who can represent the interests of patients, and people with an involvement in the education and training of health care workers, such as people from universities. I hope my right hon. Friend will feel that his amendments are unnecessary, because LETBs may also include partners from other sectors and their boards, as set out in  clause 102(5). Given that HEE and LETBs are required to have regard to the desirability of integrating health provision with health-related or care and support provision, this provides HEE with the flexibility to enable representatives of such groups to be members where appropriate. I hope that my right hon. Friend can withdraw the amendment.

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

I am grateful to the Minister for his response. His response on amendments 122 and 123 is persuasive, but his response on amendment 124 is not. I have not heard a single indication of why it is appropriate to include patients, but not to have a carer’s voice. I wonder if the Minister might answer that.

Photo of Daniel Poulter Daniel Poulter The Parliamentary Under-Secretary of State for Health

My right hon. Friend is right to pick me up on that. In attempting brevity, I neglected an important point. He is right to highlight the importance of carers in delivering health care and of supporting them to do that. The Bill makes provision for the representation of carers in clause 100(2)(c). That clause requires HEE to ensure that it receives representations on the exercise of its functions from a wide range of stakeholders, including carers for people who receive health services or, as specified in clause 100(3), those organisations that represent carers for persons to whom health services are provided. Clause 100 also requires HEE to seek advice from patients or those groups that represent them.

I should also point out that clause 104 permits HEE to direct the local education and training board to involve specific groups in the preparation of its education and training plan, which will allow carers’ organisations to play an appropriately full part. I hope that that is further reassurance for my right hon. Friend.

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

The fact that HEE has those obligations is very helpful, as are the further undertakings on the potential to direct local education and training boards. I hope, however, that the Minister will continue to reflect on the fact that, as a Government, we have an opportunity at a local level not just to pay lip service to the issue of carers, but to ensure that it is part of the remit of one of the bodies that delivers education. With that, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 102 ordered to stand part of the Bill.

Schedule 6 agreed to.

Clauses 103 to 107 ordered to stand part of the Bill.

Schedule 7 agreed to.

Clause 108 ordered to stand part of the Bill.

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

Adjourned till Thursday 30 January at half-past Eleven o’clock.

 Written evidence to be reported to the House

CB 24 British Medical Association

CB 25 Staffordshire County Council

CB 26 Unite the Union

CB 27 Social Landlords Crime and Nuisance Group

CB 28 Chartered Institute of Housing

CB 29 Colin Slasberg