Committee (6th Day)

Part of Care Bill [HL] – in the House of Lords at 4:38 pm on 16th July 2013.

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Photo of Lord Low of Dalston Lord Low of Dalston Crossbench 4:38 pm, 16th July 2013

My Lords, in moving Amendment 88M, I will speak also to Amendment 92ZZN, both of which are in my name. These amendments would ensure that regulations specify in what circumstances a specially trained person must carry out an assessment or reassessment. A number of groups of disabled people may need a specialist assessment. For a deafblind person, for example, the ability to access a specialist assessment carried out by someone who understands the impact of deafblindness is a critical first step in the process of getting adequate and appropriate care and support. Assessors who do not have these specialist skills—for example, a generic assessor who assesses older people or a single sensory assessor who knows about visual impairment but not about deafness and blindness and how they interact—often offer deafblind people inappropriate mainstream or single-sensory services which are inaccessible and do not meet their needs.

Similarly, community care assessors can easily misunderstand the needs of someone on the autistic spectrum if they do not have experience and knowledge of how to communicate with someone with autism, or of the impact of the condition of autism on someone’s day-to-day life. People with autism can lack insight into their own condition and may struggle to define their needs. For example, if a person with autism is asked, “Are you able to wash yourself on your own?” they may reply, “Yes”, but omit to mention that this is with verbal prompting at every stage. I hesitate to venture on to this ground with the noble Baroness, Lady Browning, in the Chamber. Perhaps she will intervene in the debate later to supplement or, indeed, possibly correct what I am saying. However, what I have said so far is a fair reflection of the situation as it has been explained to me.

In addition, some people with autism may be non-verbal or have limited capacity to communicate or take part in the process unless substantial adjustments are made. People with profound and multiple learning difficulties and people who display challenging behaviour are two further groups where it is vital that they have a specialist assessment undertaken by an expert. People with PMLD do not use formal communication such as words, signs or symbols and may rely on others to speak up for their needs. Staff carrying out the assessments will need to have skills to ensure that people with PMLD can be meaningfully involved in the assessment process and have the opportunity to influence decisions made about their lives. It is also important that people with PMLD have advocates who are trained in non-instructed advocacy techniques.

Councils in England and Wales have to follow statutory guidance on how to provide care services for deafblind people. This guidance, Social Care for DeafblindChildren and Adults, requires local authorities, when assessing the needs of a deafblind person, to ensure that an assessment is,

“carried out by a specifically trained person or team, equipped to assess the needs of a deafblind person—in particular to assess need for one-to-one human contact, assistive technology and rehabilitation”.

In the five years following the introduction of the Social Care for DeafblindChildren and Adults guidance in 2001, we saw the number of deafblind people provided with appropriate specialist support increase by 60%, which says a lot about the importance and value of specialist assessments of the kind I am talking about. The RNIB has obtained figures from the National Adult Social Care Intelligence Service showing that the numbers of blind and partially sighted people in receipt of local authority-funded care and support dropped by 35% between 2005-06 and 2011-12. This compared with a drop of only 16% for all adults with care needs. This is worrying and could indicate that generic needs assessments inadequately capture the needs of blind and partially sighted people and reduce their chances of being judged eligible for social care.

Following the passing of the Autism Act 2009, councils in England have had to follow statutory guidance —known as, Implementing Fulfilling and Rewarding Lives—on improving support for adults with autism. The guidance is clear that councils should develop specialist training for community care assessors. It recommends that,

“as far as possible, assessment of needs be carried out by a professional who has a good knowledge of autism and reasonable adjustments made to the assessment process to enable the adult with autism to take part fully”.

However, research carried out by the National Autistic Society found that only just over half of English local authorities had training available for their staff.

Where assessors are not trained to assess people with PMLD, or people with challenging behaviour, they will not get a full grasp of the complex needs that the individual has and understand what needs to be put in place to meet those needs. This will place the subsequent package of care at higher risk of failing or being inappropriate. This was the case for many of the individuals who ended up in assessment and treatment centres like Winterbourne View. They did not get the right support that they needed to live in the community.

The Law Commission in its report on adult social care recognised the importance of specialist assessments, particularly for deafblind people, stating that,

“in some cases, a specialist assessment should always be required and indeed this is acknowledged in statutory guidance. At a minimum, we suggest that the existing requirement in statutory guidance for a specialist assessment for deafblind people should be elevated to the regulations”.

The Care and Support Alliance was pleased when the draft Care and Support Bill included in Clause 12, which set out matters to be covered in regulations, paragraph (c), which reflected the Law Commission’s recommendation to,

“specify circumstances in which a person with expertise in a specified matter must carry out the assessment on behalf of the authority”.

The draft Care and Support Bill also included a similar paragraph relating to reassessments. Unfortunately, the relevant paragraph—paragraph (f)—in Clause 12 in the current Bill has been changed so that the obligation is to,

“specify circumstances in which the local authority must, before carrying out the assessment or when doing so, consult a person who has expertise in a specified matter”.

Furthermore, the reassessment paragraph has not been included at all. The CSA is very concerned that this will lead to many disabled people being assessed by someone without specific training in their disability. This would be a retrograde step. Consulting someone with the relevant expertise is not enough; the assessment should be carried out by such a person. These amendments would reintroduce the wording from the draft Bill into Clauses 12 and 27 to provide the necessary strengthening. I beg to move.