Health and Social Care Bill

I thank all noble Lords for participating in our discussion. I merely put it on record that I intend the noble Lord, Lord Warner, to be wound up to an absolute fury by the end. This is a small, technical but very important amendment. The noble Lord, Lord Warner, and I were both arguing two things: that assessment of individual needs must take place and be a regulated activity; and, from that, that the commission needs to be capable of assessing population needs across the piece and communicating it to Ministers. I must take issue with one thing that the noble Baroness said. She said that it would be the responsibility of providers to ensure that assessment of needs happened. We know that assessment is not happening today. Local authorities are simply not carrying out assessments of people’s social care needs. Why? Because they know that they cannot provide the service and what is the point of assessing something that you know you cannot meet? That becomes a self-fulfilling prophecy. We then, across the board and individually, have false presentation of the level of social care need. That is the central issue that we need to deal with and I will return to it. On the issue of staff, I assure the noble Baroness that I have read the regulations. It was precisely because I read the draft regulations that I tabled the amendment. On page 75, the examples of what would not need to be registered with the CQC include private arrangements between individuals, such as personal care carried out by family or friends—I understand that point. However, also not to be registered is the provision of personal care by a personal assistant engaged and directed by the person receiving their support, whether self-funding or using direct payments and/or individual budgets to fund the arrangement. That will be the majority of social care provision in many places in future. So at the same time as not considering the assessment process, we are narrowing down the scope of what has to be considered in terms of provision. Increasingly, people will be given individual budgets. In a sense, I am saying that, unless we retain our focus on the medical services in the NHS, to a large extent the provision in this amendment will become increasingly meaningless. I think that, by what is both included and excluded in this subsection, we are missing out key data and key parts of the whole process of establishing what is needed in social care. If the commission is set up under the existing wording, it will be deeply flawed and will have enormous difficulty in making some kind of strategic sense of social care across the piece. At this stage, I beg leave to withdraw the amendment, but I give notice that I shall probably have to return to both these issues. Amendment, by leave, withdrawn. [Amendment No. 31 not moved.]