My Lords, I will speak to two amendments standing in my name in this grouping. The first is Amendment 86H, to which the noble Baroness, Lady Pitkeathley, has put her name. This deals specifically with proportionality and early identification in providing information and advice.
In its report on adult social care, the Law Commission argued that it was essential that the issue of proportionality be addressed in the regulations setting out the assessment process. The Law Commission stated that where a person has complex or multiple needs, a proportionate assessment would require an in-depth and comprehensive exploration of those needs—something which we have already heard about this afternoon. Defining complex needs can be difficult, with the full extent of needs not always immediately identifiable. For instance, older people in particular do not always present their needs accurately on first or subsequent contacts.
Deploying qualified social work staff across all areas of service provision, including the information and advice stage, would help—as this amendment seeks to do—to ensure that the potential for complexity is recognised early on and the individual receives signposting to non-statutory services and/or initial statutory sector support proportionate to their needs.
Looking round the Chamber, I see several people who I meet on a weekly basis as we are currently carrying out post-legislative scrutiny of the Mental Capacity Act. The assessments of capacity across a range of people—not just the elderly, who are very important, but even much younger people—are extremely important. It is extremely important that there are qualified social workers who are involved in this exercise.
To have the social worker available at the pre-assessment stage, as part of an information and advice team, would allow unqualified staff the benefit of accessible professional support. I am aware that the College of Social Work supports this measure and the duty on local authorities to ensure that in providing advice and information, qualified staff are deployed in sufficient numbers to ensure that all aspects of need are taken into account. This would ensure that people are put in touch with the most appropriate services for them from the earliest opportunity.
I am aware of the letter that my noble friend sent to the noble Lord, Lord Hunt, dated 27 June, in which he covered in the first paragraph the query by the noble Lord, Lord Warner, about ensuring that there are sufficient skilled workers. When he responds, would he cover this question of sufficient qualified social workers? His reply to the noble Lord dealt mainly with staff employed in the health service as opposed to social services. We have heard a lot in these debates about the need for multidisciplinary teams in decision-making, so I would be grateful if he would address the question of the number of skilled social workers who
might be deployed, particularly at the initial information and advice stage when early assessments are carried out.
My second amendment in this group is also in the name of my noble friend Lady Barker. It addresses the question of independent advocacy and proposes a new clause. Of course, I am aware of the role of, and the statutory requirement for, IMCAs in the Mental Capacity Act. I will not pre-empt the findings of the post-legislative scrutiny committee on the Act, but I will explain why I felt it necessary to propose a new clause in the area of independent advocacy. I refer the Committee to my interest in the register, and in particular my ongoing interest in autism, mental illness and people with learning disabilities.
The right to advocacy is essential to enable the people who find it hardest to communicate to exercise their rights, represent their interests and obtain the services they need. Clearly, if somebody is deemed not to have capacity, there is already statutory provision for an IMCA to assist them with decision-making. However, it is also vital that those who experience substantial difficulty in understanding, retaining, using or weighing information relevant to an assessment, and then expressing and communicating their views, should also have access to an advocate. I referred just now to autism. People on the autistic spectrum might be deemed to have capacity but their disability might mean that they would have difficulty on their own, without the help of an advocate to explain and help them work through the decision-making process. That group is not adequately covered by the provisions of the Mental Capacity Act.
Advocacy is separate from information and advice. It provides support to some of those who are most vulnerable and most in need of services, including those with autism. There was a recent commission on autism and ageing chaired by the noble Baroness, Lady Greengross. Both she and I have had to forfeit the presentation of that report to be here in the Chamber. The report found that the families of people with autism frequently act as their advocates. Ninety-six per cent of parents with a son or daughter with autism recently told a National Autistic Society survey that they were concerned about what would happen when they passed away or were unable to support their children. This fear is common to parents of people with many different lifelong disabilities, not just autism. Families frequently say how worried they are about what will happen when they can no longer perform an advocacy role, and that independent advocates must therefore be available.
If the Bill is to help ensure people access the support they need—including people who are currently missing out—advocacy will play a vital role. I ask my noble friend to consider this large group of people who are not covered by existing statutory provision, for whom the new clause would provide a safety net to enable their services and package of care to go forward, thereby ensuring that they have equal opportunity to access the services that we are discussing in relation to the Bill.