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Care Bill 2013-14
The Care Bill was announced in the Queen's Speech on 8 May 2013 and aims to modernise adult social care law, in order to clarify the issues of eligibility and service delivery.
The Bill will allow for:
- the consolidation of existing adult social care law, and the modernisation and simplification of what is currently a complex legal system
- giving people greater control of their care budget and allowing them greater choice, building on the progress made with personal budgets
- Health Education England to be established as a non-departmental public body
- the Health Research Authority to be established as a non-departmental public body
- the creation of a London Health Improvement Board
The Bill draws upon the recommendations made in the Law Commission's report on Adult Social Care, published on 10 May 2011. The Law Commission recommended a straightforward consolidation Bill that would draw together and simplify existing law in the area, as well as addressing the eligibility framework and local authorities' duties of care.
The review that led to these recommendations was concluded a year earlier than expected in order that the government could consider them alongside the findings of Andrew Dilnot's Commission on Funding of Care and Support. The Dilnot report made much more far-reaching recommendations on social care funding, including the proposal that a £35,000 cap on individual's lifetime contributions to their care, beyond which they would be eligible for full state support.
The government welcomed the Dilnot report, and was expected to move towards the implementation of some of its recommendations in the 2012-13 Parliamentary Session.
The announcement of the draft Bill was broadly welcomed by stakeholders, but many, including the Patients Association and the ABI stressed that funding reforms would be the key to solving the problems of adult social care. The Local Government Information Unit expressed concerns about the plans, and urged the government to seek proper consultation before bringing forward the final Bill.
During pre-legislative scrutiny into the draft Bill and the policies it seeks to implement, the Joint Committee invited interested organisations and individuals to send written submissions by 11 January 2013 as part of the inquiry. During the scrutiny period, the committee highlighted the same concerns as Independent Age on third party top-up fees (clause 27), stating "we are not satisfied that clause 27, as currently drafted, provides sufficient protection from improper practices of the type highlighted by Independent Age (among others)."
The Bill was finally introduced to the House of Lords by Earl Howe on 9 May 2013.
Should the Bill become an Act, it will extend to England and Wales only.
During the second reading stage in the House of Lords, peers raised concerns around the eligibility threshold, local government resources, young carers, palliative care and healthcare assistant training. Health minister Earl Howe said the national minimum eligibility threshold would be announced as part of the spending review on June 26 and regulations would follow, in time for them to be debated in committee. Following a short debate, the Bill was passed to a Committee of the Whole House.
During the Care Bill's first day of committee in the Lords, the role and make up of Health Education England and Local Education Train Boards were scrutinised along with the issues of appropriate workforce training and planning. On the second day of the committee stage, peers debated amendments relating to the education and training of healthcare professionals, and the duty to promote medical research. All the amendments were withdrawn barring government amendments to require the Health Research Authority to appoint an independent committee to provide advice on applications to process confidential patient information.
Peers continued to consider the Care Bill in committee on day three with just a handful of technical government amendments agreed to. Members introduced a number of probing amendments on topics including the co-ordination and promotion of regulatory practice at the Health Research Authority, and the regulatory functions of CQC and Monitor. On the fourth day of committee, peers raised questions about the reviews and performance assessments and provisions to cover the increasing costs of social care.
Amendments were raised which probed whether the duty to promote the well-being of individuals should be extended to the secretary of state, for local authorities to be obliged to take proactive preventative measures and the well-being of parent carers.
Peers debated amendments relating to the equal consideration housing should be given in health and social care on the fifth day of committee stage debate for the Care Bill. They also discussed how to fully secure the promotion of health and social care integration, and the duties that should be placed on authorities to provide information about services. Lords also discussed the clauses around information and advice, including financial advice and advocacy.
Discussions about provisions for the market making role of local authorities and the importance of ensuring quality of services also took place. Assessments of needs were also covered. Amendments 87A to 87E were the only amendments to be agreed, which included the terms "carer of a child" or "young carer" in parts of Clause 7.
In day six of committee for the Care Bill, peers discussed specialist assessments, the eligibility criteria threshold, powers of local authorities to charge for costs of care and the cap on care costs. Other amendments dealt with the duty to promote information about the changes in the Bill, the annual adjustments to care costs, top-up fees, the nursing care allowance, financial assessments, care and support plans, the personal or independent budget resulting from the assessment of the adult's and carer's needs, and care accounts and direct payments.
The seventh day in committee dealt with detailed amendments about cross-border placements and arrangements when those needing care assessments moved house. Peers also looked at the finer details of the government's proposed universal deferred payment scheme, with amendments calling for the introduction of the scheme to be put off until 2016, in line with the introduction of the care cap.
Peers debated amendments on the duty on a local authority when they suspected a person in care was at risk and to assess their needs; the financial regulation of care providers; oversight of commissioners; and support for young people in care, and carers. No changes were agreed to the Bill beyond minor government amendments.
In the final day of committee, Lord Warner (Lab), member of the joint committee on the draft Care and Support Bill and Dilnot Commission, spoke to an unsuccessful amendment looking at the much finer details of the funding commitments in the Bill, calling for a review by the Office for Budget Responsibility. Government amendments to clarify the interface between local adult safeguarding boards and prisons were approved, and the government said it would publish guidance on how local authorities could better support people newly certified as sight-impaired or severely sight-impaired. Peers also debated end of life care, with the government maintaining they were still considering introducing a national offer on the choice to die at home. The Bill was passed to the report stage.
The first day of report stage for the Care Bill saw probing amendments on the duty to promote wellbeing and government amendments on personal dignity passed. Peers debated amendments about the provision for parents of disabled children and young carers in the Bill. The House divided on an amendment proposing a duty on NHS bodies on the integration of care. Amendments calling for access to independent advocacy, financial advice, hospital discharge and for provision of national awareness campaigns were debated. Amendments calling for commissioning of care visits to be regulated were also considered.
During day two of the report stage for the Care Bill, government amendments were brought forward to clarify the assessment process and to ensure links with the Children and Families Bill. Unsuccessful amendments were proposed on fluctuating conditions, end of life and palliative care, top-up fees, complex needs assessments. The house divided on an amendments on model deferred payment scheme and on the introduction of new clauses on elderly abuse, which were both disagreed to.
Day three of committee saw the government defeated in the Lords after peers voted for the extension of the protection of the Human Rights Act within the Care Bill, to private care providers. A series of government amendments were passed strengthening the legislation around the transition from child to adult care provision. The House divided over Lord Lipsey's amendment on circumstances where local authorities could recover benefits wrongly paid and on an amendment brought by Lord Patel of Bradford relating to mental health aftercare which were both unsuccessful.
On the fourth day of the committee, peers voted on new clauses to make changes to the trust special administrator regime, although government amendments were passed. While government spokesperson Earl Howe argued the changes were not a change of strategy, shadow minister Lord Hunt argued they were "nothing short of a major changeon the reconfiguration of NHS services".
The House divided on government amendments to the role of the Care Quality Commission and its review of local commissioning. An unsuccessful vote was held upon Lord Hunt's amendment on staffing levels. Government amendments on training standards for healthcare assistants were introduced and Peers warmly welcomed Earl Howe's indications in advance of the publication of the Cavendish review that a "care certificate" would be introduced by Health Education England for care workers.
Government amendments on the functions of Health Education England and on the Health Research Authority's duty to promote transparency in research were also passed. The Bill was subsequently passed to the third reading. The third reading of the Care Bill saw minor technical government amendments passed, while probing amendments were considered regarding the provision of financial advice on care costs and the limit of £23,250 on the non-housing assets people could have to qualify for the deferred payment scheme.
The Bill had its first reading in the Commons on 30 October 2013, where it was brought forward from the Lords, read a first time and ordered to be printed. The second reading took place on 16 December 2013 and after a short debate, the Bill was passed to a Public Bill Committee.
The first day of committee took place on 9 January 2014. The committee examined clauses 1-5 of the Bill. Clauses 1-4 were agreed to, with consideration of clause 5 continuing in the next session. The second day of committee was held on 14 January 2014. The committee considered clauses 5-16 of the Bill. Clauses 5-6, 8-16 were agreed to. Clause 7 was agreed to as amended. The third day of committee took place on 16 January 2014. The committee examined clauses 17-38 of the Bill. Clauses 17-24, 26-32 and 34-38 were agreed to. Clauses 25 and 33 were agreed to, as amended. In the fourth day of committee considered clauses 39-55 and schedules 1-2 of the Bill. Clauses 39-47, 49-55 and schedules 1-2 were agreed to. Clause 48 was disagreed to on division.
The fifth day of committee was held on 23 January 2014. The committee considered clauses 56-80 and schedule 3-4 of the Bill. Clauses 56-59, 66, 68-78, 80 and schedules 3-4 were agreed to. Clauses 60-65, 67 and 79 were agreed to, as amended.
In the seventh day of committee (30 January 2014), clauses 109-125 and schedule 8 of the Bill were considered. Clauses 109-117, 119-125 and schedule 8 was agreed to. Clause 118 was agreed to, as amended. The final day of committee was held on 4 February 2014. The committee considered New Clauses 1, 2 and 28. All of which were agreed to and added to the Bill. The Bill was reported with amendments.
The House of Commons considered the Care Bill as it had been amended during public bill committee on 10 March 2014.
Over 30 new clauses were debated by MPs relating to parts one and two of the Bill, none of which were added to the Bill. Government new clause 34 relating to care.data will continue its consideration in the second day of report stage.
Minor government amendments 1 to 7 were agreed to existing clauses.
Smith's new clause 27 which would introduce an offence of corporate neglect was rejected after a division, as was Burstow's clause 1 on the issue of power of access, something which Burstow had written to the prime minister about supported by 603 organisations including Age UK and the National Autistic Society.
Clause 9 which would provide for an assessment of the ability of local authorities to provide the extra provision the Bill outlined was voted down. New clause 19 which would have ensured that all health bodies had effective procedures in place to identify people who were or were about to become carers was also rejected.
The remaining stages for the Care Bill in the Commons took place on 11 March 2014. Debate continued on the government's new clause 34 which introduced further safeguards on the care.data scheme and the clause was added to the Bill. The opposition's clause which would have created a new, specific offence of the misuse of data provided by the Health and Social Care Information Centre (HSCIC) was not successful.
Controversial clause 119, which would provide the Secretary of State with powers to correct a failing hospital trust by ordering changes in the makeup of another local hospital's services, remained on the face of the Bill following unsuccessful attempts to remove and replace it.
Paul Burstow's new clause 16 did not survive a vote and shadow health secretary Andy Burnham's amendment 30 seeking to remove clause 119 outright was also rejected after a division. Minor government amendments were made in relation to the order making powers conferred on the secretary of state in the Bill.