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Address in Reply to Her Majesty’s Most Gracious Speech

My Lords, I add my congratulations to the two noble Lords who made maiden speeches on subjects very dear to my heart. I congratulate the Ministers on the Front Bench on their return or promotion and the new people on the Front Benches opposite. I also pay tribute to the predecessor of the noble Lord, Lord Hunt, the noble Baroness, Lady Hollis, whose superb grasp of social security and related issues was outstanding. I do not propose to speak on DWP issues today, other than to say that I look forward to the very important conclusions of the Turner commission, the reforms to incapacity and housing benefit and perhaps, in particular, the Bill to regulate equity release products, which I hope will be enacted as soon as possible because that is a very important issue. I want to concentrate mainly on health and social care and to touch on, to begin with, what was in the gracious Speech. There is a Bill to provide for better protection of children and vulnerable adults. Following the Bichard report, I await that Bill with interest as I have long been concerned about gaps in protection, especially from people who are unsuitable to work with vulnerable adults but who do not have a criminal record. That very difficult subject needs to be tackled. We need to make the protection of vulnerable adults lists work better and to close the gaps, particularly for people who work in day centres, the NHS and the non-personal aspects of domiciliary support which are not covered. Will the Bill cover non-physical abuse—for example, financial abuse? We debated that on the Mental Capacity Bill in the previous Session, but they are important issues. Perhaps we need a step change in attitude as well as legislation, as we have seen with age discrimination more generally. I hope that the Government will make this part of the ““respect agenda”” which we have been reading about—I think it would be a good idea to consider it as such. Obviously the hospital hygiene Bill is very important, but will it apply to long-term care homes as well as hospitals? It should but, if it does, that means that the sector providing such homes should be fully consulted by the department about its impact. I turn to the Older People Commissioner (Wales) Bill. I very much welcome it. I think that commissioners for older people could become very important as a way in which older people’s rights are better respected and better recognised. Again, that could be seen as part of the respect agenda and might reflect the importance of valuing older people and their needs and appropriate ways of meeting them, especially perhaps helping older people with complaints on health and social care issues. Those issues are a nightmare for older people and their families to deal with at the moment, and they are not always dealt with very successfully. Will the Government consider extending such appointments across England, or could they do so if they are not considering it at present? The Equality Bill is very important. It was covered in last week’s debate but I mention it as an important development in education, health and social affairs. I look forward to taking part in that Bill’s passage through this House. I congratulate the Government on removing the age limit on student loans. That was an excellent step in combating age discrimination. The mental health Bill is a long overdue reform of mental health laws, but worries have been expressed by Age Concern, among other organisations, that it will work to the detriment of many people with long-term mental health problems because in many aspects it is too prohibitive and punitive. When the Bill comes to this House, I would like reassurance that that will not be the case. It needs very careful scrutiny. There are other issues which are not in the gracious Speech but which require consideration at this stage. I welcome the recognition in the Green Paper on adult social care of the importance of low-level social care, but we all know that that will need funding. Individual budgets may help to give many vulnerable people, particularly older people, much more control over the services that they receive. Housing is key to the quality of life of older people and those with disabilities, as the noble Baroness, Lady Wilkins, has made clear. It is excellent that the needs of such people will be regularly assessed and that the strategy will be forward-looking and run over the next 10 to 15 years. A current Counsel and Care survey about what older people want, chaired by Malcolm Dean, highlights the importance of low-level care. Older people tend to underplay the help that they need. Much of that help is not social care; it might be window cleaning or shopping, for example. We need to think in new ways if we are to meet the needs of vulnerable people. We must go into the realms of Internet shopping and dial-a-ride services, not just traditional home-help services. The government Strategy on Ageing, published last March, is a very important step forward. It contains many challenging aspects—for example, the proposed observatory on ageing to look at the wider impact of our changing demography. I hope that the newly formed Cabinet sub-committee on ageing will be instrumental in ensuring that promises are delivered, for example, on lifelong learning, the imminent abolition of age limits and other aspects of life, which will reflect a wider shift in attitude to the effect that education and training are, and should be, lifelong. It is the same across health and social affairs. As vice-president of Age Concern, I welcome the OFT’s recent report on care homes. I hope that the Government will respond with action as a priority, because the problems of paying for care are excessive. It must include the impact of local authority care provision. The importance of social care will, I believe, be highlighted by the forthcoming Wanless report, commissioned by the King’s Fund. We need clarity about continuing care—the Health Ombudsman recently highlighted the ongoing scandal. I should like a more proactive and open stance from the Department of Health on that issue. We need clarity about the definition of health versus social care versus nursing care. I remain convinced that more people, if assessed for continuing care under the Community Care (Delayed Discharges etc.) Act 2003, should be eligible to receive it. Lastly, on end of life issues, today’s Help the Aged report makes for salutary reading. It states:"““Older people who die in hospital often endure their final days in dirty and noisy wards where busy medical and nursing staff can devote little attention to them””." That is a scandal. As Macmillan Cancer Relief also highlighted, most older people would like to die in their own home but do not. End of life is an area in which Her Majesty’s Government can and should do much more.