Carers victory in the Lords
The Health and Care Bill currently going through Parliament repeals the Community Care (Delayed Discharges etc.) Act 2003 and with it, the duty on NHS trusts to ensure that hospital discharges are safe – by consulting with any carer (or potential carer) of the patient before the discharge occurs.
The Government’s Social Care Impact Assessment to the Bill states that ‘carers may be asked to take on additional hours of care which could mean that they have to reduce their hours of work or give up paid work entirely … while we anticipate that in some cases carers may choose to there is an expectation that unpaid carers might need to allocate more time to care for patients who are discharged from hospital earlier… . The impact on unpaid carers is difficult to assess and we are unable to quantify the impact on unpaid carers at this stage’.
If the government believes that the primary responsibility for care rests with families (a Poor Law principle) then it is – in effect – saying that women should stay at home as it is a simple fact that they provide the majority of unpaid care. It is also locating responsibility for ‘disability’ within the family and not the wider society and thereby pushing back on the underpinning principle that shaped the Beveridge reforms and produced the NHS Act 1946 and the National Assistance Act 1948.
The erosion of carers’ hard fought for rights is part of a recent trend. By way of example, the 116 page 2003 hospital discharge guidance[1] contained 266 references to carers and the 48 page replacement 2020 guidance[2] contained only 4.
Baroness Pitkeathley, with support of Carers UK, tabled an amendment to the Bill to neutralise the impact on carers of the 2003 Act’s repeal. This requires that when an NHS Trust is aware that the discharge of a patient is unlikely to be safe – unless care is provided by one or more unpaid carers – that the Trust is under a duty to consult the carers as to whether they are able and willing to provide the necessary care. Baroness Pitkeathley’s speech[3] deserves to be read / listened to (for the recording of the speech click here – and for the Hansard transcript click here). Her amendment was opposed by the Government, but she received support from Members from all sides of the House and she insisted that there be a division. She succeeded, with her amendment being carried by 205 votes to 155.
The Bill will return to the Commons, and it is to be hoped that the Government will accept that the removal of this statutory right of carers is profoundly regressive and discriminatory. People die as a result of poor and often rushed hospital discharge arrangements and emergency readmissions due to inappropriate discharges place considerable additional burdens on the NHS.[4] The repeal of the duty to involve carers in discharge decisions makes no moral, practical or financial sense.
[1] Department of Health ‘Discharge from hospital: pathway, process and practice’ (2003) Gateway Ref: 1074.
[2] Department of Health and Social Care Hospital Discharge Service: Policy and Operating Model (2020).
[3] House of Lords Hansard, Volume 819 Health and Social Care Bill debate 7 March 2022 column 1129.
Posted 8 March 2022.