I know about the approach that has been taken in Wirral and think that it is an excellent example. If we kept the CQC’s role in assessing how well councils are commissioning services, that is just the sort of thing that it would be able to spread. It is a real problem that that role is being removed. We will come later to our amendments that seek to return it to the CQC.
I will now turn to a group of new clauses on how better to identify and support carers. They stand in the name of Opposition Front Benchers, but really they are the work of my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), who has made sterling efforts in this regard. We have tabled them to give carers the focus and attention they deserve. They pick up on some of the points that the right hon. Member for Sutton and Cheam (Paul Burstow) made. New clause 19 would ensure that all health bodies have effective procedures in place to identify people who are or are about to become carers and ensure that they get the help and advice they need. New clause 20 would require local authorities to take all reasonable steps to
ensure that schools in their area identify young carers and put support in place. New clause 21 would require universities and colleges to do the same.
As the right hon. Member for Sutton and Cheam said, family carers—unpaid family members looking after the people they love—are the absolute backbone of our care system. They need and deserve more support. They are looking after their relatives because they want to, but they really need help. One in five family carers provide more than 50 hours of care every single week, and their own health suffers as a result. One in three have to give up work or reduce their hours, which means their income suffers and the cost to the taxpayer goes up.
The Bill puts in place welcome new rights for carers, building on the approach taken by the previous Labour Government, but they will be meaningless if carers are not identified in the first place. Many carers do not actually come into contact with local authorities. Macmillan Cancer Support has made a powerful case, showing that 95% of the over 900,000 carers of people with cancer in England have not received a carer’s assessment—only one in three of them have even heard of it. That is because they are mostly in touch with the health system. Unfortunately, hospitals and GPs still do far too little to identify carers of people who have cancer and other conditions, such as stroke and heart disease. I understand that GPs identify only around 7% of carers, and other health professionals, particularly in hospitals, identify only one in 10. We need clear duties on those bodies and proper processes in place, because too often at the moment there is just a tick-box approach. I recently had to move GP practice, and the form I filled out contained two pages on how much alcohol I drank, which was welcome, and a little box that asked, “Are you a carer?” I knew what that meant—but did it mean a paid care worker, or a health care worker? That is not good enough and needs to be thought through.
I also stress the need to do far more to identify young carers, who we know can see their lives and life chances suffer because of what they do to help look after sick or disabled parents. Many schools might not understand if kids are not doing their homework or not turning up on time because of their responsibilities. If young carers are lucky enough to get to university or college, they may find their studies hard because they are travelling to and from home to try to help support their loved ones. We believe there should be clear duties on those bodies to identify young carers.
New clauses 22, 23 and 24 are about getting people the right financial advice—an issue we discussed a lot in Committee. The Bill introduces a new and complicated system of social care funding with the so-called cap on care costs and new deferred payment schemes. It is complicated and I have lost track of the number of times people have said to me, “Well, it’s okay because at least my care costs will be capped at £72,000 now”, and I have to go through the process of explaining to them that that is not actually the case. People are unaware of the new system, and if they are looking at financial products to help them cope with later costs, they need decent financial advice.
Currently, financial advisers must have studied a range of different financial and regulatory subjects, and they must sign up to a statement of professional standing and a code of ethics and conduct. Has the Minister
talked to the Financial Conduct Authority about whether the training of financial advisers should change as a result of the Bill? Is he confident that all financial advisers can give people advice about the products they might want to take out to protect themselves against future costs, on the basis of the Bill?
I am concerned that unless people get high quality, proper financial advice, we could be in for another mis-selling scandal because the issue is complicated. People will have to figure out how much their average local authority rate will be for their area in five, six or seven years’ time, and how different that will be from what private providers charge. Will people’s care needs enable them to start counting towards the cap on care costs if they are not defined as “substantial”, as under current eligibility criteria? I would struggle to figure out all those finances, and we must ensure that financial advisers are properly trained.
New clause 22 states:
“The Financial Services Consumer Panel at the Financial Conduct Authority”
should publish an annual report on the
“availability, quality…and effectiveness of financial advice”
available to care users and their families. New clause 23 states that the FCA should consider raising the level of qualifications that financial advisers must have. We must ensure that people get high quality financial advice so that they are not mis-sold any products.
We also want much greater efforts to raise public awareness of the new capped cost model introduced by the Bill. Under the Bill, local authorities have a duty to raise awareness, but new clause 24 would make that much stronger and require them
“to prepare, publish, consult on and implement”
a proper plan for raising awareness among their local residents. That is important so that people know about the new system and what it means for them.
I support new clause 11, which would ensure that all users of publicly funded or arranged care have direct protection under the Human Rights Act 1998. Under the law as it stands, the fundamental protection and access to individual redress offered by the Act are not applied equally in all care settings. In the other place, Lord Low tabled the former clause 48, which sought to close that loophole. There was a long discussion on it in Committee—the clause was passed in the House of Lords but the Government voted to remove it in Committee. The Minister’s argument was that it went too far, because it would mean that the Human Rights Act applied to entirely privately funded and arranged care. He also claimed that the clause was not needed because the CQC could deal with the problems.
5.30 pm
Since that Committee, the Joint Committee on Human Rights has published its analysis of the measure. It states:
“The Bill provides an opportunity to fill the gaps in human rights protection for all those receiving publicly arranged care…and we recommend that the opportunity to legislate to this effect not be missed”.
The Joint Committee proposed new clause 11, to which the right hon. Member for Sutton and Cheam and I have put our names. It differs from the former clause 48
by making it clear that its scope is confined to regulated care services that are either publicly arranged or publicly funded.
The Joint Committee on Human Rights says that the law must be clarified. Organisations including Age UK, Mind, the Alzheimer’s Society, Mencap, the Law Society and the Equality and Human Rights Commission agree. New clause 11 deals with the concerns that Ministers and others have raised. It is an important point. Why should people who have their care arranged by the local authority but pay for it themselves not have the same rights? Someone who has entirely publicly funded and arranged care can get redress under the Human Rights Act. We need to fill that gap.
I support new clause 9, which is an important one. It would require the Department of Health’s joint care and support reform programme board to produce an assessment of the adequacy of funding for the provisions of the Bill and the ongoing costs of implementation. It would also require the programme board to conduct a five-yearly review of the short and medium-term costs of setting the eligibility criteria at the level set out in the regulations, which, according to the Government, will be substantial.
Local councils will be required to take on substantial new work as a result of the Bill. That includes assessing thousands of additional users and carers, who currently do not get an assessment because they fund their own care; setting up new care accounts to keep track of how much money people have spent, in order to figure out when they reach the so-called cap on care costs; establishing and running the deferred payment schemes; running information campaigns about the new system; and training staff in the new capped-cost model of funding.
The Local Government Association and the Association of Directors of Adult Social Services have strongly argued that there needs to be a thorough assessment—it is only an assessment—of the costs of delivering the new roles, so that the Bill can be properly implemented. Why is that so important? Many councils thought they would get additional resources to support the Bill’s provisions. In the spending review, the Government said that the money would be new funds for the Bill. However, when the details of the local government funding formula were revealed in July, it transpired that the money was not new money for the Bill—the Government were simply top-slicing existing council budgets. That means that councils will have to take money from existing care users, many of whom are desperately struggling with low levels of, and poor quality, care and support, to set up the extremely complicated new system of care accounts, the capped-cost model and deferred payments. We need openness and transparency about what the measure will cost and where the money will come from if we are to assess whether the priorities are correct.
The five-yearly review of the short and medium-term costs of the eligibility criteria for social care is extremely important. Hon. Members will know that many organisations that work with older and disabled people and their family carers welcome the framework set out in the Bill to promote well-being, to prevent the need for care and support, and to integrate local care and health services, but those organisations are very concerned that these objectives will not be achieved if the eligibility criteria are set too high, which will mean that people lose out on care and support. This is not good for them
and does not make sense for taxpayers. If older people do not get the grab rail that helps to prevent them from falling, or decent care and support at home that helps them get up, washed, dressed and fed, and they end up having to go into hospital or more expensive residential care, it is not good for them and it costs us all more.
For working-age disabled people—