My Lords, care providers are responsible for ensuring that care workers provide the care for which the provider is paid. They must ensure that workers have the necessary training, skills and behaviour to deliver safe, effective and personalised care, and should allow workers sufficient time to travel between appointments. It is not acceptable for the provider to condone shortened or missed visits.
My Lords, I thank the Minister for that reply. When carers were employed directly by councils, local authorities thought it very important to have someone who acted as a supervisor. That person’s duty was to do spot checks and pop in to see whether someone was really there doing the job that they were being paid for. Recently, we have seen on television and read in the newspapers—and I have heard directly from carers—that some people are often simply not doing the job, they are popping in merely to sign for the hours for which they should have done the job. They are often leaving the client—they use the phrase “the client”—unchanged, unwashed and unfed, not even seeing that they get their necessary medication. Given the present situation, does the Minister consider that care agencies should pay for local councils to employ an inspector, or do the Government need to investigate and regulate to protect those vulnerable members of society who rely on home care?
My Lords, I should say at this point that the majority of carers do a superb job and look after everybody beautifully. Of course, even one carer giving poor care is not satisfactory. Local authorities have the duty to ensure that providers give a high standard of care. In 2014, tougher inspections were brought in and the CQC can penalise providers if the standards are not to those high expectations.
Has the Minister seen today’s report by Carers UK, The State of Caring, which shows that support for family carers, who are often there 24/7, is sadly lacking? The issue with paid carers is one part of that rather unfortunate jigsaw with which we find ourselves in the care market at the moment.
I thank the noble Baroness for her question. There are indeed problems, but we must remember that the Care Act 2014 places a duty on every local authority. Local authorities have care responsibilities under the Act to ensure that social care services that they arrange are safe, of a high standard and meet people’s needs.
My Lords, what steps are the Government taking to ensure that personal budgets or direct payments are set at a sufficient level to enable disabled people such as me—I declare an interest—who employ personal assistants or carers to fulfil obligations as legal employers, for instance, to cover holiday pay, stakeholder pensions and, most importantly the national living wage? That is not the case at the moment.
PAs are an important part of the care system. They enable people to employ someone who will give them the special needs that they require, and they deserve proper pay for an important job. The national living wage was taken into account in the spending review and an extra £3.56 billion a year has been given to local authorities to help with the national living wage. The Care Act states that when calculating the personal budget, the direct payments made for the employment of a PA must be sufficient to cover all legally required costs.
Does the Minister agree that we are putting processes before payments? Is she aware of cases such as that of the lady from Bradford who is receiving both health and social care support at home for ulcerated legs? The worse leg was being treated by the district nurse; the better leg was put into support tights by her care worker, who was later dismissed because of the cuts. The nurse was not allowed to help with the better leg until it deteriorated to the point where she was permitted to dress that one too. One leg was NHS and the other was social care. Is that what the Government mean by integration?
Clearly not—that is not acceptable behaviour. Local authorities have an absolute duty to make sure that providers provide proper care for the people they are looking after, and there are strict regulations in place which are carried out by CQCs to make sure that that happens. If it does not, it is important for people to complain to the local authorities to make sure that proper care is given.
Will my noble friend not agree that the underlying problem here is the provision of sufficient funding to deliver social care? In that case, I was concerned by the reply from my noble friend Lord Prior of Brampton to a question that I asked on 5 May in relation to the better care fund, when he intimated that the better care fund will not be delivered until there is proper integration between health and social care. Could my noble friend assure me that that is not the case, and that the reality is that the better care fund will be delivered and is being delivered? If so, how much will be received into the social care system to enable providers to deliver care in the community in an efficient and effective way this year?
Well, my Lords, an added £1.5 billion is available for social care, and is going direct to councils, not the NHS. Social care protection is a national condition of the better care fund. Also, we must remember the social care precept, which allows councils to increase council tax by 2%. The national living wage was taken into account at the spending review, in which we gave an extra £3.56 billion a year. That is going to be backdated, allowing councils a four-year settlement, so they can plan their spending properly for the future.