Asked by
To ask His Majesty’s Government what assessment they have made of
the Equality and Human Rights Commission’s report Challenging
adult social care decisions in England and Wales, published on 28
February; and what steps they will take to make local authority
care challenge procedures more accessible and transparent.
The Parliamentary Under-Secretary of State, Department of Health
and Social Care () (Con)
The Government have noted the findings in the report. Encouraging
a culture of feedback and learning is vital if we are to improve
services and people’s experiences of social care. The CQC’s local
authority assessment framework, which went live on 1 April,
includes oversight of local authority assessment and eligibility
frameworks for adults and unpaid carers accessing social care and
support. This includes looking at transparency and accessibility
and whether people can appeal decisions effectively.
(LD)
I thank the Minister for his reply. The EHRC report clearly
demonstrates the problems facing social care users who have
challenged local authority decisions, and it is a pretty bleak
picture. But while there is much for local authorities to do to
improve their complaints system, there are also important
recommendations in the report aimed at government, including
making the Local Government and Social Care Ombudsman the
statutory complaints authority for social care in England. When
and how do the Government intend to respond to these
recommendations? Does the Minister agree with me that the
shortcomings at local level will be remedied only by long-term
sustainable funding of adult social care—not made easier by the
Government’s announcement on 4 April, when Parliament was in
recess, to hold back £50 million of the money promised to help
plug staff shortages?
(Con)
First, we will respond in detail to the report the noble Baroness
mentions. On funding, as I have mentioned before, the £7.5
billion over the next two years is a 20% increase and is
substantial by any measure. I spoke to Minister Whately about
this issue this morning, and she was at pains to say that, in
terms of funding and overall numbers, everything is in place in
this latest programme. Also, £600 million is being held in
reserve to follow up in the areas that really need it.
(Lab)
My Lords, the report underlines just how difficult the current
social care system is to navigate and challenge, as we have just
heard, yet it showed that fewer than two-thirds of local
authorities commission advocacy services that can be accessed by
users and unpaid carers to help them challenge vital decisions on
care and support. The postcode lottery, the complexity of local
challenge systems and the overall lack of consistency, national
standards and effective monitoring prevent vital decisions about
care being overturned. How are the Government ensuring that, as
per the 2014 Care Act requirement, independent advocates are
available across all parts of the country to help users and
carers understand and access the system?
(Con)
As the noble Baroness says, it is a statutory part of the 2014
Care Act that advocacy be provided where people need such
additional support. That is why we were keen to bring in the CQC
to oversee local authorities, which it has from 1 April. This is
one area where it will be making sure that advocacy is
provided.
(LD)
My Lords, Section 72 of the Care Act 2014 empowers the Secretary
of State to regulate for an appeals system through which people
can challenge social care decisions. It seems odd that we went to
the trouble of legislating for this and yet, nearly a decade
later, it still has not been implemented. What more evidence do
the Government need to come to a decision about whether the
benefits of such an appeal mechanism would outweigh the
costs?
(Con)
The main point is that we already have two levels of appeal. In
the first instance, someone can appeal to a local authority and
if they are not satisfied with that, they can appeal to the local
ombudsman. Thousands of people do this every year, and compliance
in terms of replies to them is very high. I must admit that I am
not sure whether an additional, third level of appeal is really
necessary in this case.
(Lab)
My Lords, once again, a Question in your Lordships’ House has
pointed out the inadequacy of the social care system, be it
funding or personnel. In answer to an earlier Question, the
Minister teased the House a little about the workforce strategy.
Can he be more specific in answer to this Question?
(Con)
First, I take issue with the inadequacy comment. Some 89% of
people expressed a high level of satisfaction with the social
care provided, which, although not 100%, is pretty good, as I
think everyone would agree. As I said, the workplace plan has
been drafted. I am afraid I cannot give an exact date of
publication—I believe there are local purdah issues now—but I can
say that it will be soon.
(Con)
My Lords, one of the things this House has heard about many times
is our reliance on unpaid carers and the important role they play
in helping people who draw on adult social care to navigate the
system. The 2014 Care Act put a duty on local authorities to
identify unpaid carers, but that is not happening. What can the
Government do to identify unpaid carers, so that we can support
them more readily?
(Con)
I thank my noble friend for that question. The Government
absolutely recognise the role that unpaid carers play—I have
fulfilled such a role myself for a number of years—and it
something we are working towards. We have introduced the leave
provisions and a certain level of payments for them; that may be
modest but it is a step in the right direction. Again, the whole
idea of getting the CQC in this space is that it can start
monitoring local authority provision and ensure that it is
identifying unpaid carers, among other things.
(CB)
My Lords, last week or perhaps it was the week before—time
flies—there was a report on the number of people occupying health
service beds who are fit for discharge but are not being
discharged, largely due to the absence of social care provision.
Are the Government taking seriously reports of that kind?
(Con)
Yes, we are taking them very seriously. The House has heard me
talk many times about the 13% of beds that are blocked. This is a
key issue for the whole flow of the system, which is backed up
right the way through. That is why we introduced the discharge
fund. Again, Minister Whately is very focused on this issue.
of Hudnall (Lab)
My Lords, further to the question asked by the noble Lord, , in response to my noble friend
Lady Pitkeathley, the Minister referred to an 89% satisfaction
rate among people in receipt of social care. However, as the
noble Lord, , has just pointed out, the
issue is not the people in receipt of social care but those who
are not, of whom there are far too many. That is exactly what is
causing some of the problems the noble Lord referred to. Does the
Minister agree?
(Con)
Again, this goes to the point about the massive increase we have
put in place of £7.5 billion. I have not heard of but would be
pleased to hear about any plans on the other side of the House to
increase that funding, since £7.5 billion is a very large
figure—a 20% increase. Clearly, we will continue to review
whether more is needed; we have put in increases each year. The
importance of ensuring social care provision is completely
understood.
(Lab)
My Lords, can the Minister clarify his last answer? In replying
to me on a previous occasion, he conceded that a very substantial
part of the money he has just announced is from local authority
council tax. Can he confirm that?
(Con)
Yes, absolutely; a large part of it is from central government
funding and a large part is from local authority funding, given
local authorities’ ability to use a precept and increase council
tax. Of the 153 local authorities, 151 have taken that
opportunity to increase the council tax.
(Con)
My Lords, does the Minister agree that in talking about the costs
of health and social care, we seem to have forgotten that 40
million people in this country are moving slowly towards suicide
by putting too many calories in their mouths, which is costing
£27 billion every year?
(Con)
I will answer quickly to allow a final question, but yes, our
anti-obesity strategy is very much about that.
(Con)
I am most grateful to my noble friend, who is a glutton for
punishment. I wanted to follow up on the point made by the noble
Lord, . It is all very well saying
that the money is coming from local government, but the problem
is that the tax base in local authority areas does not reflect
the demand in those areas. Therefore, there is unmet need where
the need is often greatest, is there not?
(Con)
I knew that was coming. As a former local authority deputy chair
of finance, I very much understand the problem my noble friend
describes. My Treasury colleague has gone, but we all agree that
local authorities have a very important part to play in this. The
mix between local and central funding is clearly something we
need to work on.
