Legislation to transform adult social care in England has been approved by the House of Lords and will now go to the Commons for further examination. The Care Bill passed its third reading in the Lords, the final stage of its passage, on Tuesday.
Peers made significant changes to the Care Bill during its passage through the Lords, as the government made a number of amendments in response to concerns and criticisms from the sector.
To the delight of advocacy organisations, ministers have introduced a duty on councils to provide people with an independent advocate during assessment and support planning if they would otherwise have difficulty in understanding or communicating information, and have no one else to represent them.
It also changed the bill to enable regulations to specify when assessments of need must be carried out by someone with particular expertise. This was in response to concerns among charities in the deafblind and autism sectors that the legislation could leave people having their needs assessed by generic staff who did not understand their conditions.
Ministers have also strengthened the rights of young service users and carers reaching adulthood by placing a duty on councils to assess them if it appears they would need support on turning 18 and that it would be of significant benefit to carry out an assessment.
The government also changed the bill to ensure government policy took account of the duty on councils under the bill to promote the well-being of individuals through their adult social care functions. Concerns had been raised that, without such a provision, policy could be made that would undermine councils’ well-being duty.
Ministers also relinquished powers to direct the CQC in areas such as how it inspects providers and how frequently. More controversially, they also removed the duty on the regulator to routinely assess the performance of council adults’ services.
CQC duty to assess councils removed
Though this duty had not enforced since 2010, the Care Bill as originally drafted retained it, and provider leaders had argued for regular assessments of councils to be reintroduced to tackle perceived commissioning shortcomings, such as the use of 15-minute care visits.
However, ministers resisted pressure to retain the duty, instead introducing a provision allowing the CQC to assess councils in special circumstances, with government approval. This includes cases when an authority is failing or when poor provision of care has been linked to poor commissioning, as is widely believed to be the case with the use of 15-minute care visits.
Health minister Earl Howe also argued that other government amendments would put pressure on councils to improve commissioning by requiring them to take into account the impact of their commissioning decisions on individuals’ well-being and on the quality of the workforce.
The government also resisted pressure to strengthen the safeguarding aspects of the bill, including by defeating an amendment to introduce a power for social workers to gain access to a vulnerable adult whom they believe is being abused but being coerced into silence. Ministers argued existing legal powers were sufficient and social workers needed to improve their skills and knowledge in applying them to protect adults.
Government defeated over human rights
However, opposition peers defeated the government in introducing an amendment to make all providers of regulated adult social care services liable to challenge under the Human Rights Act 1998. Currently, the Act only binds public bodies and care homes, in respect of residents placed by local authorities or the NHS, prompting concerns that self-funding service users in particular are not having their rights protected.
The government is likely to overturn this amendment in the House of Commons, where the coalition’s majority should protect ministers against further changes they would not welcome.
A date has not been set for the second reading of the bill in the Commons, where MPs will have a debate on its general principles.