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Health and Social Care Bill

My Lords, I welcome much in the Bill and join in congratulating the Minister on his clear and concise introductory words. I have a few reservations, but I am sure that those and everyone else’s will be well discussed in Committee. I will be very brief; much has already been mentioned. I want to talk about two areas: that relating to self-funders seeking social care, and the vexed issue of human rights. I apologise in advance, with a very heavy head, if I do not make it to the end of the evening; I hope that the Minister will forgive me if I do not. I was pleased to hear the Minister confirm that the Government were considering how best to achieve the same rights under the Human Rights Act for people receiving contracted services as those who receive services from the state. Only 37,500 care home places are provided by local authorities out of 420,000 places in the United Kingdom. The other 373,000 are in private or charitable care homes. The majority of those residents are not covered under the Human Rights Act, as we know, but we have a duty to protect those people. As my noble friend Lady Howe mentioned, the recent Joint Committee on Human Rights report highlighted how vulnerable people in homes can be to lack of respect and dignity, and even to abuse. Of course many homes have excellent facilities, and most provide adequate if not good care, but many give us cause for concern. Malnutrition and dehydration, lack of privacy and dignity, neglect and bullying are just a few of those concerns, not to mention the fear of eviction if a resident or relative makes a complaint, if someone becomes increasingly frail or ill, or if the care home is sold or closed rather suddenly. There is a fairly straightforward way to close this loophole. It could be achieved through this Bill with less recourse to other departments of state—in particular to the Ministry of Justice—than might be the case if we have to wait for a Bill of Rights. If we wait for a Bill of Rights there are many very frail, very vulnerable and very old people who will be dead by the time that Bill becomes law. There should be a duty in this Bill to assess any person entering a care home. Such a person should be assessed either by a GP or by a hospital doctor if they are in hospital or by a qualified social worker. After such an assessment, which would be carried out by somebody in the public sector, the human rights protection would follow that person wherever they go, whether it is to a public, a private or a voluntary care home. I hope that the Minister will consider a government amendment to the Bill to achieve this fairly simple change. I turn to the issue of self-funders. We are a country of homeowners. Many people have saved throughout their lives to buy their home. Quite a few managed to do so by taking advantage of the right-to-buy legislation. They are not wealthy people but it is very difficult to own a home worth less than £21,500 in this country, whatever sort of home you have. These people are in trouble if they go into a residential or nursing home. Nearly one person in five has to sell the family home to fund a place in a care home. Often they are charged more than other residents who are paid for by the local authority because the local authority can negotiate lower fees than an individual or a family can. The care home can sometimes compensate for those lower fees by charging an extra fee to self-funders and/or their relatives—a top-up or, in my view, an unauthorised tax on those self-funders. That discriminates against self-funders. We cannot say that two people in adjoining rooms in a care home have different rights, either in terms of their human rights being protected or being treated equally. When working to receive social or healthcare, it is often difficult to differentiate between what is health and what is social care and what can be funded one way and what can be funded another. People just do not know what they have a right to receive. People who have worked and saved, often over many years, must no longer be excluded from the advice, the help and the necessary and adequate services they need because they happen to have saved some money during their working lives. I hope the Minister can assure us that these situations will be remedied.