That is absolutely right. This is not, as it can sometimes be portrayed, a case of “Let’s just have a tick-box”; it is about signalling a set of changes that need to happen in the culture of the organisation, so that when a patient visiting their GP or a consultant is accompanied by a member of their family or someone else who is supporting them, that instinctively forms part of the conversation about signposting and information about carers.
At the moment, just 7% of practitioners always signpost for a carers assessment. That is why we need to make sure, through this new clause, that we place a simple duty on the NHS so that it plays its part in identifying carers. One of the most shocking statistics is that 64% of health professionals think that that is necessary. They think that it will help them in their day-to-day practice and in ensuring that the issue is put up the agenda.
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In Committee, the Minister talked about the work that NHS England is doing and its commitment to carers and the action plan that is being developed through consultation with carers and carers organisations. That is incredibly welcome and a good step in the right direction, but what are needed are effective procedures and systems to identify carers right across the NHS. The Government must make that a priority and the Bill provides an opportunity to do so; otherwise, only those places that get it will continue to do it, while those places that do not will not, and we will not see the progress we need.
The Minister also said in Committee that he would give consideration to statutory guidance. If there is to be such guidance, it has to have very clear requirements on the NHS. As I have said, it should be not a tick-box exercise, but a kick-start for the culture change to make sure that carers are properly valued and respected and given access to the support intended by the Bill.
New clause 4 is about charging. The change proposed is small, but its potential impact is huge. The Bill provides for regulations to be used to govern the way in which charges are set for local authorities with regard to providing or arranging care and support. In Committee, I raised a concern that I first raised in the Joint Committee’s
scrutiny of the draft Bill—that the removal of section 17(3) of the Health and Social Services and Social Security Adjudications Act 1983, which requires that charges should not be more than is “reasonably practicable”, is an important issue of principle and of protection and safeguarding in the system. The Minister undertook to give the issue careful consideration and in a letter to members of the Committee on 12 February he offered some reassurance. He wrote that, under the Bill, a local authority would have to consider what a person
“would be likely to be able to pay towards the cost”.
Regulations would then go on to prescribe the formula for calculating the minimum amount of income with which a person should be left.
My hon. Friend also pointed to the duty on both the local authority and the Secretary of State to have regard to the duty for well-being, which is the first guiding principle of the Bill. Will he confirm, therefore, that, in coming to a view about the reasonableness or otherwise of a charge, a court would examine it against whether someone was
“likely to be able to pay”
and the duty under clause 1? It would be very helpful for future interpretation if he clarified that.
New clause 13 deals with another issue that was raised in Committee, but it takes a slightly different tack. Many, particularly the Local Government Association, have suggested that we should have a national scheme to operate deferred payments. However, they have also said—many think this is necessary—that at this stage, given that deferred payments can be equated with other financial instruments that are regulated in a more strict way than that intended for deferred payments, the Government should at the very least provide assurances that they will carefully monitor what will happen with the increased numbers of direct payments, not least because of the concern that we may wind up with people being mis-sold the products with less redress than they might have with regard to other financial products.
New clause 15 relates to fair fees and to new clause 9, which I will come on to in a moment. It was striking that in Committee we returned on a number of occasions to issues relating to procurement decisions by local authorities. I proposed a mechanism for adjudicating disputes between councils and providers about the fees on offer to the providers. However, it is not adjudication that we really need, because that is the wrong end of the pipe—it is what happens when things have broken down, relationships have not worked and fees have been set at an unsustainable level. What is needed is transparency and certainty in the way the fees are set.
The Bill provides for people paying for their own care to ask the council to arrange their care in return for a fee. The concern is that, without transparency on the rate setting, councils will drive the price for care to unsustainable levels. Indeed, that is already happening in some care markets around the country. Only providers that sacrifice quality, reduce staffing and generally cut corners would still be able to stay in the market. For those who rely on such services, the consequences would be higher staff turnover, limited choice and poorer quality.
In that regard, both Care England, which represents residential care providers, and the United Kingdom Homecare Association have grave concerns about the
unintended consequences of some of the measures. When I met UKHCA members in February, they were very clear that below-cost pricing by local authorities was a growing problem. According to Laing and Buisson, English councils are paying £480 on average for residential care, although the assessment of a fair market price was about £651. The issue concerns the use and abuse of monopsony power in a financially challenged market. It also relates to new clauses 7 and 9, which I will come on to in a moment.