Legislation to transform adult social care has cleared its first hurdle in the House of Commons following an often partisan debate in which Labour refused to lend its support.
The Care Bill, which has already been approved by the House of Lords, passed its second reading in the Commons on Monday and will now be considered in detail by a committee of MPs in the New Year.
But the cross-party consensus that had accompanied the foundations for the legislation – the Law Commission’s proposals to reform social care law and the Dilnot Commission’s proposals to ‘cap’ individuals’ social care liabilities, both published in 2011 – has fractured.
During Monday’s debate, Labour tabled a “reasoned amendment” to put on record its opposition to the Care Bill, which it claimed was “an inadequate response to the scale of the challenge facing social care”. The amendment was defeated by 289 votes to 231.
Shadow health secretary Andy Burnham said the bill would not address the under-funding of adult social care – highlighted by research published this week that showed 453,000 fewer people were receiving council-funded care in 2012-13 than would have been had eligibility been retained at 2005/06 levels. He said proposals under the bill to set a national eligibility threshold equivalent to the current ‘substantial’ band used by the vast majority of councils were too restrictive.
He also said many people would face higher bills for care than the £72,000 ‘cap’ that the government is bringing in to protect people from facing catastrophic care costs. This is because, in line with Dilnot’s proposals, only the sum that their council would pay to meet a person’s eligible needs would count towards the cap, not what they actually pay, which is often much higher.
Burnham also attacked the government’s decision to remove the Care Quality Commission’s duty to inspect local authorities on their commissioning of adult social care – though this has not been enforced since 2010 – saying it would prevent action to tackle issues such as the purchasing of 15-minute care visits for people.
“The truth is that in the end, the bill will not stop catastrophic care costs that run into hundreds of thousands of pounds, or stop people losing their homes,” he warned. “It will not improve services now as it promises only a vague review of the practice of 15-minute visits, and strips the Care Quality Commission of its responsibility to inspect local authority commissioning, which is often responsible for such things.”
Burnham’s criticisms were echoed by fellow Labour MPs, including former social workers Meg Munn, Emma Lewell-Buck and Madeleine Moon, but they were rejected by care and support minister Norman Lamb.
Burnham favours a system of care free at the point of need, fully integrated with the NHS, but Lamb said he had failed to set out how he would pay for it.
“Opposition members’ criticisms can only be of any real value if they can answer the question about how they would pay for anything that costs more,” added Lamb.
Lamb’s ministerial predecessor, fellow Liberal Democrat Paul Burstow, also issued a strong defence of the “landmark legislation”, which he himself was responsible for publishing in draft form in 2012. Burstow said the provision to place councils under a duty to promote individuals’ well-being in the exercise of their adult social care functions – a move designed to switch the system away from crisis intervention – would “provide a new governing purpose for our social care system”.
He also hailed new rights for carers to have an assessment if they appear to have needs to support, and, for the first time, to have a right to a service if they have eligible needs, as delivering “parity of esteem” between carers and service users. Burstow also pointed out that the Association of Directors of Adult Social Services had said that the proposed national eligibility threshold was more generous than the current substantial band in being closer to the lower ‘moderate’ threshold. Burstow also praised the £72,000 cap policy as moving the social care system away from being “a nasty, mean system that is means-tested”.
However, Burstow was among a number of MPs to propose ways in which the Care Bill should be amended. While the bill would allow the Care Quality Commission (CQC) to carry out inspections of councils on their adult social care functions, for example if there is clear evidence of failure, this would require ministerial approval. Burstow said this requirement should be removed to enable the CQC to effectively tackle situations when poor social care provision is attributable to poor commissioning.
He also joined Conservative MP Sarah Woolaston – a former GP – in calling for social workers to be given the power to enter people’s homes, with court approval, where abuse is suspected of a vulnerable adult but access to them is being barred by a third party.
Woolaston said this could help address the small number of cases where older or disabled adults were at risk of abuse from family carers.
“We need to reserve a power of entry in exceptional circumstances where there are very serious concerns about individuals who may be vulnerable and unable to communicate easily,” she said.
However, so far the government has been steadfastly opposed to such a power on the grounds of an apparent lack of public support and the belief that social workers have sufficient powers to intervene in such cases but simply needed to improve their legal knowledge of these.