My Lords, I shall speak also to Amendment 92ZZAC and Amendment 92ZZAF.
I declare an interest as a long-term user of social care services. I have lived all my adult life in the same local authority. Like other disabled and older people who use social care services, I would find it impossible to move out of my local area because I could not be sure that my needs would be adequately met. Noble Lords will be aware that I have been very keen to change this deeply discriminatory state of affairs since I moved my first ever amendment in this House in May 2008 during the passage of the Health and Social Care Bill. I have returned to the issue several times in the past five years, culminating in my Private Member’s Bill on social care portability, which I recently introduced for a second time. Therefore, I am delighted that the
Government have decided to put right this fundamental flaw in our social care system. I have been privileged to be closely involved in the Government’s deliberations on this issue for nearly three years. The Minister in another place told me very recently that my Private Member’s Bill was used as a template for the provisions in this Bill. That was very flattering, but flattery will not get you everywhere, and, on this, we are not quite there yet. There are a few points to be ironed out if social care portability is to work in practice.
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My Amendment 92ZZAB ensures that service users and carers are informed about how their case is progressing. My Amendments 92ZZAC to 99ZZAE require the second authority to pay appropriate attention to the existing care plan so that the individual can continue to do the things that they currently do. Finally, Amendment 92ZZAF ensures the provision of a safety net if the process is not as seamless as it should be. I will now explain why such provisions are of critical importance.
We surely all agree that the adult who moves, and their carer, should be kept informed of what is happening throughout the process. Knowledge is power, and lack of knowledge is disempowering. Up-to-date information is vital for reassurance and confidence. Clause 36(4)(a) requires the second authority merely to provide the information that it thinks is appropriate to the adult and their carer. It says nothing about keeping them updated. My Amendment 92ZZAB corrects this omission. It ensures that communication about the transition is clear and regular.
Moving home is always exceptionally stressful, especially for disabled and older people. Stress exacerbates impairments and ill health, particularly mental health conditions. For those with a significant care package, an interruption in care may mean not being washed, dressed and fed—the fundamentals of life. That runs entirely counter to the Bill’s emphasis on well-being and prevention. I will give an example.
Dave Morris was a severely disabled man who required 24-hour care. He was appointed as a senior policy adviser to the Mayor of London. He had to relocate and found suitable accommodation for his needs. He took his personal care assistants with him for a few weeks, aware that the new authority might not have finalised his care package. He was right. Although it had had three months’ prior notice, nothing had been organised. For five months, while they argued over payment rates and systems, he relied on friends such as me to pay towards the cost of his PAs and to help him survive. The new authority failed to keep him informed. It failed to consider his existing support and what he wanted to secure so he could take up the post, and there was clearly no safety net. He nearly lost his job and he could easily have ended up in hospital. He was a clever and articulate man—so what hope is there for those who are not?
As my noble friend Lady Grey-Thompson said last year:
“The success of the Paralympics opening and closing ceremonies was because of Dave Morris’s inspired vision”.
Sadly, he did not live to see them. He died just before the Games. This is just one example of the barriers faced by disabled and older people who move from one local authority to another. Most cannot take the monumental risk Dave Morris was willing to take, which took its toll on him.
Even with the provisions in the Bill, service users cannot be certain that the care and support they receive in a new locality will enable them to lead their lives in the same way they do now. To have the same opportunities in education and work, and the same enjoyment of private and family life, the care and support must result in the same outcomes. Under Clause 36(7), the second authority must “have regard” to the existing care and support plan, or the existing support plan for a carer, when it carries out its assessment. My Amendment 92ZZAC would require the second authority to “have due regard” to the existing plan. This involves appropriate and conscious consideration—a stronger duty than having regard.
Critically, my Amendment 92ZZAD proposes that, when the second authority considers the existing plan, it does so with the aim of securing the same outcomes as far as reasonably practicable. It recognises that there may be occasions when the same outcomes are not possible. This goes to the heart of the continuity of care—to get as seamless a transition as possible—and it reflects the underlying intention of my Bill.
During Second Reading of the Care Bill, the Minister said in his winding-up speech:
“The noble Baroness asked why there was no requirement for equivalent services when somebody moves”.—[Official Report, 21/5/13; col. 829.]
Let me put the record straight. Neither I nor my Private Member’s Bill expect the second authority to offer the same service. That is a total misunderstanding. My clear intention, as reflected in my Bill, is that the second authority should enable the individual to have the same end result—what the Bill describes in Clauses 9 and 10 as,
“the outcomes that the adult wishes to achieve in day-to-day life”.
Amendment 92ZZAE makes this clear by referring back to those provisions. For example, it might mean taking your children to school but not by taxi if an accessible bus service is available, or having opportunities to keep fit or enjoy leisure activities but not by the same means.
When I talk about outcomes, I am talking about ordinary day-to-day activities. However, without genuine continuity of care, they stop altogether. For example, I received a letter from a young woman who moved to her neighbouring authority. The new authority honoured the existing plan, providing homecare assistance three times a day, but it refused to offer this at times which would fit in with her office breaks and childcare pick-ups, so she could not use the toilet or collect her children—same assessment needs; totally different outcomes.
I turn to my final amendment, Amendment 92ZZAF. It is clearly intended that the process of putting in place care and support should be completed by the day of the person’s move. Clause 37(1) states that, if this has not happened, the second authority must
meet the same needs that the first authority has been meeting. Clause 37(6) says that from the day of the move the first authority has no more responsibility. However, as my earlier example showed, that does not provide any safety net if the second authority does not comply with its duty or it delays in doing so. The Local Government Ombudsman told the Joint Committee on the draft Care and Support Bill that failures may occur, which could have a major impact on the provision of care and the person’s experience. As noble Lords will know, the process of assessment and care planning can be arduous and lengthy. It would be far better for the first authority, which has the relevant experience, to continue to meet the person’s needs if the second authority is not ready to do so by the day of the move. That should continue until the second authority has put its own arrangements in place. It is too risky to assume that nothing will go wrong. Dave Morris’s story gives the lie to that.
If the first authority has to step in, it should of course be refunded by the second authority. That would provide an incentive for the second authority to act without delay. My Amendment 92ZZAF provides for this. This is the position under my Bill and the Joint Committee recommended a similar provision.
I genuinely congratulate the Government on this first attempt to secure social care portability, but as yet it is not deliverable. I have done my homework and have consulted local authorities and service users on this issue for nearly five years. Please let us honour Dave Morris’s memory by getting continuity of care just right. I beg to move.