New Clause 21 - Accounting

Care Bill [Lords] – in a Public Bill Committee am 10:15 am ar 4 Chwefror 2014.

Danfonwch hysbysiad imi am ddadleuon fel hyn

‘(1) The Secretary of State shall make provision for accounting guidelines for persons and organisations offering care services to be published.

(2) All persons and organisations offering care services shall have a duty to follow guidelines published in accordance with subsection (1) in charging for those services and shall, in particular, ensure that all accounting paperwork is easy to understand, fully explains any interface with the local authority and is complete.’.—(Liz Kendall.)

Brought up, and read the First time.

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

I beg to move, That the clause be read a Second time.

I will not delay the Committee for too long on this practical new clause, which deals with the new accounts for care services that people will be getting and reports from councils about how much they have paid towards the so-called cap on care costs. The clause says that there needs to be guidance from the Secretary of State on how people are presented with information such as the amount that they are charged for services. We all have personal experience of getting information from  different bodies—usually private sector, but often public sector. I am thinking about pension communications or—God forbid—electricity bills when the information is completely indecipherable and no ordinary person can figure out what on earth is going on. It is important that information about care charges—and, I would argue, anything relating to a cap on care costs—is presented really simply so that people know where they stand. Such information can be complicated at the best of times, but if it is being set out for somebody who is vulnerable or has dementia, or whose charges and services are complicated, it needs to be presented simply and straightforwardly.

This new clause was initially tabled by a Conservative peer, Baroness Byford, to make the point that we need guidance on how to set out information on such an important issue. I make a plea to the Government: let us make this simple and clear for people. The Government should produce guidelines on how best to achieve that so that people do not end up terribly confused about what they have been charged and what they have paid towards their care. If they do not know that information, how will they know that they are going to reach the cap on care costs, and how can families plan for the future? Simplicity and clarity are really important, so guidance is needed.

This is not a question of ordering people to do something; it is about good practice. Such a measure would make a practical difference to people and might end up preventing appeals or concerns from arising later down the line. I therefore urge the Minister to think about this important issue.

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

I agree with the sentiment of what the shadow Minister says. She raises the important issue of protecting vulnerable people from overpaying for the care and support services that they need. I begin with the observation—I hope it is incontrovertible—that it is completely unacceptable for providers to exploit the vulnerability of people purchasing services by overcharging them, so I fully support the new clause’s intention. There has been a market in care and support for many years. We are keen that that develops further, as that should not only lead to increased choice and better outcomes for individuals, but drive innovation, which should result in improved quality.

Martin Green, the chief executive of the English Community Care Association, has set out some really interesting ideas about driving innovation, such as the care home becoming a hub in the local community and offering a range of services to people with care needs in the surrounding area who live in their own home. Such innovation is to be welcomed, as providing new services to people in their own homes could provide a new income stream for businesses that provide care and ensure that they remain sustainable.

In this market, the prices agreed with providers as part of a contractual discussion are ultimately for the agreement of the parties involved. To ensure that the process is fair, it is important that individuals purchasing services have clarity about their costs, which is why all providers of health and adult social care registered with the Care Quality Commission must meet a registration requirement relating to fees.

If a service user is responsible for paying the costs of their care or treatment, either in full or partially, the provider must produce a statement that sets out the terms and conditions of the services to be provided, including the amount—and method of payment—of any fees. That statement must be in writing and, as far as practicable, be provided before the commencement of services. In addition, any instances of theft or misappropriation of service users’ money could breach the CQC registration requirement on safeguarding service users from abuse, quite apart from being a serious criminal offence.

I am clear that the effective oversight of registered providers is essential to protect service users. The CQC is transforming its regulatory approach so that it will hold providers to account with much greater rigour. Its new specialist inspection teams will know what good care looks like. The inspectors will focus on five key questions: is the service safe; is it effective; is it caring; is it responsive; and is it well led? We now have a chief inspector of social care to focus attention on not only failures in care, but great care, as it is important that we also celebrate examples of great care.

When providers fail to provide an acceptable standard of care, I will expect the CQC to take action including, in the most serious cases, by bringing prosecutions. The Government, along with the CQC, are changing the arrangements to make it possible to bring prosecutions against care providers without having to serve notice first, as that process means that it is often impossible ever to bring a prosecution.

More widely, the Bill includes provisions that will support people to make informed decisions when they purchase care services. Clause 4 requires the local authority to make available to all people in its area information and advice about care and support services.

Photo of Debbie Abrahams Debbie Abrahams Llafur, Oldham East and Saddleworth 10:30, 4 Chwefror 2014

I wonder whether the Minister is aware of the problem in the pensions industry due to the lack of transparency when comparing fees and charges for pensioners? Does he think that that might be a problem here? Will he reassure us about how, within the registration parameters, there will be total transparency and an opportunity for fees to be compared?

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

I understand the hon. Lady’s concern about pensions. Our objective is to ensure that information is clear. I have already explained what the care provider must set out in the statement, preferably before a person enters care, but in emergency situations when someone has to be brought into a care or nursing home very quickly, that might not be possible. The essence of contract law—I speak as an ex-lawyer—is that terms are known and agreed, and there will be a requirement for transparency about how the charges are calculated.

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

Of course. The more the local authority focuses on its duty to develop the care market and to provide information and advice about the services that are available locally, the more possible it will be for people to compare what is on offer.

I refer the hon. Lady to the NHS Choices website, which contains details of every provider registered by the Care Quality Commission. People can use the website to find out critical information about those providers, and to make comments about providers in a TripAdvisor fashion. That has the potential to be very powerful, because there will be no hiding place if poor care is exposed. We will be able to provide links on the website to the CQC’s findings after inspections and so forth. This whole shift is towards the transparency that the hon. Lady calls for so that people are able to understand what they are agreeing to and to compare different options.

The Joint Committee on the draft Bill rightly raised the importance of helping people to access independent financial information and advice. We accepted that argument and redrafted the Bill accordingly. Clause 4 now makes it clear that local authorities must provide sufficient information and advice to enable adults to consider the financial aspects of meeting their care and support needs, and to make plans for how they might meet any future such needs.

Clause 5 requires local authorities to shape a diverse, high-quality and sustainable market that meets people’s needs. The aim is that that market will offer people a range of high-quality services that enable them to exercise choice and control over the services that they use. Critically, that will drive up quality. Although I fully support the intentions behind the new clause, it is not required, because the Bill and regulations will provide for the transparency that the Opposition seek.

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

I am happy to beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.