Care Bill's passage through the House of Lords

First and second readings of the Care Bill

The first reading of the Care Bill began in the House of Lords on 9 May 2013 and it was introduced by Earl Howe (Conservative). The Care Bill brought to life many of the improvements set out in the Caring for Our Future white paper.

It was set out in three parts:

• Part 1 brought together existing care and support legislation into a consolidated statute; set a cap on care costs; strengthened the rights of carers; set national eligibility thresholds; and focused on wellbeing and personalised care.
• Part 2 responded to the recommendations made by the Mid Staffordshire NHS Foundation Trust Public Inquiry. This part also laid the foundations for a ratings system and made provision for a new single failure regime for NHS trusts.
• Part 3 of the Bill established Health Education England and the Health Research Authority as statutory, non-departmental bodies.

Earl Howe presented the Care Bill for its second reading in the House of Lords on 21 May 2013; setting out the bill's potential to simplify the confusing social care system. Baroness Wheeler (Labour) welcomed the bill, but expressed:

• concern that the bill was only a partial solution and there was still a need to address the budgetary pressures on local authorities
• anxiety that the level of the cap would risk excluding the 'squeezed middle'
• concern that the bill was considered only a partial response to the Francis inquiry recommendations and did not address the failures in hospitals and care homes
• a fear that the bill did not necessarily lead to better integration of health and social care services.

Committee stage of the Care Bill

On 4 June 2013, the bill began its House of Lords committee stage, for which there were eight sittings, culminating in the final debate on 29 July 2013. Issues raised during the committee stage included:

• the provision of training across both social care and health to promote integration and the role and regulation of healthcare assistants/carers
• the role of Care Quality Commission (CQC) in developing a performance rating system for health and social care providers
• the way in which health bodies and local government would undertake their duties to have regard to the wellbeing of individuals when developing guidance and regulations
• the role of preventative services (including the role of housing services)
• eligibility requirements for social care and the proposed cap on care costs
• the importance of portability and continuance of services for users
• the need to ensure service users would be protected from abuse.

The bill contained a duty of cooperation between local authorities and partner organisations, where a local authority was seeking to meet a service user or carer's assessed need. A government amendment was made to extend that duty to include cooperation for a young carer's assessed needs and services. It was also agreed that an adult's care assessment could be combined with the assessment of a young carer's needs.

Report stage of the Care Bill

The report stage began on 9 October and concluded on 21 October 2013 after four sittings. Numerous government amendments were tabled and agreed. The most significant were:

• giving the Secretary of State for Health a duty to have regard to local authorities' functions relating to wellbeing, when issuing guidance and making regulations
• specifying that housing was a health-related service, which local authorities must aim to integrate with care and support services when exercising their functions
• requiring local authorities to have regard to the importance of fostering a workforce whose members are able to ensure high quality service delivery
• requiring local authorities to have regard to promoting the wellbeing of service users and their carers when procuring care services
• ensuring continuity for service users moving from one area to another by obliging the first local authority to make contact, and maintain ongoing contact, with the new local authority the service user was moving to
• a new clause which promoted the independence of the Care Quality Commission
• a provision for people to have access to an independent advocate during their assessment process
• a provision to enable local authorities and clinical commissioning groups to share budgets under the Better Care Fund to facilitate greater integration
• the establishment of a statutory duty of candour which obliged registered care and health service providers to ensure that patients and service users are told when something unexpected or unintended occurs in the course of their treatment
• the introduction of a new offence for providing false and misleading information, so that providers of health and social care services in England would be subject to criminal sanctions if they supplied or published false or misleading information.

Lord Low (crossbench) proposed a clause which made the provision of care and support a public function under the Human Rights Act 1998. Despite government resistance, the proposed amendment succeeded (247 votes for v 218 against).

Third reading of the Care Bill

The care bill received its third reading in the House of Lords. Discussion points included the promotion of individual wellbeing and the provision of financial advice to support people to plan for future social care needs. Earl Howe, for the government, put forward an amendment to include 'feelings and beliefs' in the definition, which succeeded without a vote.

Following its third reading, the Care Bill completed its passage through the House of Lords on 29 October 2013.