National Health Service and Community Care Bill

HL Deb 18 June 1990 vol 520 cc612-703

3.16 p.m.

The Parliamentary Under-Secretary of State, Department of Social Security (Lord Henley)

My Lords, I beg to move that the Bill be now further considered on Report.

Moved, That the Bill be further considered on Report. — (Lord Henley.)

On Question, Motion agreed to.

Clause 48 [Assessment of need for community care services]:

Lord Seebohm moved Amendment No. 168A:

Page 52, line 27, after ("services") insert: ("(a) shall carry out an assessment of his needs for those services giving due consideration to his views and the views of his carer; and").

The noble Lord said: My Lords, I see that this amendment is grouped with Amendment No. 169 and Amendments Nos. 177 to 179. I gather that if my amendment is agreed to, which of course it will be, the other amendments will not be moved. However, I cannot speak for the movers of those amendments because they may feel rather differently about it.

This amendment requires that as regards assessment the client and the carer should be consulted and their views should be given due consideration. At first sight that seems to be common sense and, therefore, the amendment appears unnecessary. However, I must raise some points from the Association of Directors of Social Services which throw rather a new light on the subject. It seems to the association to be a particularly glaring omission that the draft legislation does not require the views of the consumer to be taken into account during the course of assessment. Incidentally, I have seen the draft guidance on planning which I received today and I can find nothing in that on this subject. Therefore, this amendment would require the local authority to consult both the consumer and carer when undertaking an assessment. It does not place a duty upon local authorities to carry out the wishes of the person assessed but it establishes the principle that the views of such a person should have equal weight with other relevant organisations; for example, the general practitioner, the community nurse and so on. It is clear that the views of the consumer must have the greatest weight.

The association goes on to say that the social services departments are trying to escape from the charge that the professional knows best. Therefore, reaching an appropriate assessment should be seen as a partnership between the local authorities and those who need their services. Setting out the consumer/carer rights in law gives them the importance which they deserve. That reflects the principles of the White Paper and the whole government strategy which is constantly being asserted.

It is very easy to fall back on the rhetoric of caring and referring to the unsung army of carers and so on. However, the Social Services Select Committee Report published on 7th June shows that much more need to be done to enhance the status of carers and the value we all place on their activities. That can be done only through primary legislation. I beg to move.

Baroness Seear

My Lords, as I have tabled Amendment No. 169 I support this amendment but I hope that if it is passed my amendment will not be overlooked because of the greater emphasis that it places on carers. It is of the greatest importance that the needs of carers should be taken into account in exactly the same way as the needs of the person being cared for. That is in the interests not only of the carers themselves but of the person being cared for and the community as a whole. If the carers break down—and unless sufficient assistance is given they will break down—the burden will be thrown back on the community and the cost to the community as a whole will be greater than anything that would have been necessary to support the carer.

In particular I draw attention to the phrase in my amendment—it is not reflected in the amendment of the noble Lord, Lord Seebohm—which states: shall not assume that the carer will continue to provide care to the person where the carer is unwilling to do so". That may seem to some people as encouraging carers not to accept the responsibilities that they ought to accept. I hope that we do not take that attitude. It must not be assumed when these plans are being made that because there is someone in the family who can be described as a carer or possible carer that person will automatically and indefinitely assume responsibility. If that happens it will be very much the worse for all concerned. I hope it will be found possible to incorporate the amendment on the face of the Bill.

Lord Carter

My Lords, we are pleased from these Benches to support this amendment. In Committee we discussed an amendment that dealt with the needs of carers which was not accepted. These amendments deal with paying proper attention to the views of the person being assessed and also the views of the carer. After all, the carer is likely to know much better than anyone else what those needs are.

I am sure we all agree that all governments have shamelessly exploited carers. It is not right to assume that a carer will go on caring. We should also consider the importance of the training of carers. I believe that £2 million has been allocated to the training of managers of social services. It will be interesting to learn how much has been allocated specifically for the training of carers. Where private and residential home care is in the community care package that is to be designed, how will the Government ensure that suitably qualified staff will be engaged in caring?

We should remind ourselves that the Social Services Committee report in another place, Community Care: Carers, stated in its recommendations: We share the view put to us that the needs of carers should be assessed separately, but at the same time as those of the dependant. In some cases we believe the carer herself or himself, who may know the disabled person's needs much better than any of the professionals, could also be the dependent person's case manager". The report goes on to say: We recommend that local authorities consult carers and their representatives regularly and appropriately about their community care plans and about plans for individual packages of care". I hope that the Government will feel able to accept the amendments.

Lord Mottistone

My Lords, in principle I support all these amendments. I shall not say more at this stage.

Lord Henley

My Lords, when we debated this clause in Committee—it was then Clause 45—my noble friend Lady Hooper made clear the Government's position on similar amendments. It appears to be simply a question of whether these proposals should be on the face of the Bill.

We have repeatedly explained why we do not think it is necessary to place such a provision on the face of the Bill. Our guidance on assessment and case management will make it clear that the person concerned and any carers should be fully involved both in the assessment of care needs and in the subsequent decision about what services should be provided. I am sure that that is the most appropriate way of dealing with the point.

My noble friend explained to the Committee on that occasion that there is already provision for carers to be consulted when the needs of disabled people are being assessed by virtue of Section 8 of the Disabled Persons (Services, Consultation and Representation) Act 1986. To that extent no further statutory provision is required. In addition, as we have already made clear on several occasions, guidance on case management and assessment will stress the need to involve users and carers at all stages and to take their views into account. This guidance can be reinforced, if necessary, by directions. I feel this is as far as we can go.

However, there are two safeguards. First, local authorities will have to publish their arrangements for assessment as part of their community care plans. Those arrangements should make it clear how the views of users and carers will be taken into account. If these plans are published and are the subject of consultation—consultation which has been considerably widened in scope as a result of amendments now incorporated in the Bill—there is ample opportunity for local debate about the arrangements and for local voluntary organisations and users and carers to see that there are sufficient opportunities for views to be taken into account.

Finally, if people are denied the opportunity to express their views and subsequently feel dissatisfied with the service provision, they will have to write to complain under the new complaints procedure set out in Clause 51 of the Bill. Although in an ideal world it might be possible to provide users and carers with the services they want, any realistic and affordable community care scheme must be based on providing services to meet the need for care. The final decisions about what those needs are and the best way of meeting them must be left to those responsible for arranging the services concerned; in other words, the local authority. Thus, any duty to have regard to users' and carers' wishes would have to be subject to qualifications which would rob it of much of its force. Indeed, in the opinion of the Government it would do so to an extent that would not make it worth including it in the Bill.

In moving the amendments on which we divided in Committee the noble Baroness, Lady Seear, said: It is essential that the carers' position and the carers should be on the face of the Bill".— [Official Report, 10/5/90; col. 1561.] I have to tell the noble Baroness that I still disagree with her on that point. As I said, our guidance will cover the need to consult carers and to take account of their views. As regards community care support for himself or herself, the carer can of course ask for an assessment just as anyone else can. There is thus no reason to put anything about taking account of the views of users and carers on the face of the Bill, however highly desirable the noble Baroness and her supporters may think that to be. I have to tell her that I am unable to accept the amendments and I hope the noble Lord will withdraw his amendment.

Lord Swinfen

My Lords, before my noble friend sits down, he said that in Section 8 of the Disabled Persons (Services, Consultation and Representation) Act 1986 there is a duty on local authorities to consult carers. I have the Act with me. Section 8(1) states that: the local authority shall, in deciding that question, have regard to the ability of that other person to continue to provide such care on a regular basis". The authorities have to bear in mind the ability of the person, but there is nothing in the Act, as I read it, that makes them consult the carers. The authority may decide that the carer is capable of carrying on, but the carer may know quite the reverse. Perhaps my noble friend will comment on that because I do not believe his arguments stand up.

Lord Henley

My Lords, my noble friend's interpretation of Section 8 probably differs slightly from mine. My understanding is that if authorities have to take into account the ability of carers, that would require a certain degree of consultation with the carer.

Lord Seebohm

My Lords, I find that a very airy-fairy explanation of why the amendment should not be accepted. I believe that it is important for the amendment to be included on the face of the Bill for another reason. We shall come to Amendment No. 168B which is about complaints. Very often the complaints are that there has not been proper consultation beforehand. In other words, I believe this amendment is a great protection for everyone concerned in regard to complaints. I cannot therefore accept the explanation and I must press the amendment.

3.29 p.m.

On Question, Whether the said amendment (No. 168A) shall be agreed to?

Their Lordships divided: Contents, 87; Not-Contents, 107.

DIVISION NO. 1
CONTENTS
Addington, L.	Leatherland, L.
Allen of Abbeydale, L.	Llewelyn-Davies of Hastoe, B.
Ardwick, L.
Aylestone, L.	Lloyd of Kilgerran, L.
Birk, B.	Lockwood, B.
Bonham-Carter, L.	McFarlane of Llandaff, B.
Boston of Faversham, L.	McIntosh of Haringey, L.
Bottomley, L.	Masham of Ilton, B.
Carmichael of Kelvingrove, L.	Mason of Barnsley, L.
	Milner of Leeds, L.
Carter, L.	Molloy, L.
Cledwyn of Penrhos, L.	Monson, L.
Clinton-Davis, L.	Morris of Castle Morris, L.
Cocks of Hartcliffe, L.	Mulley, L.
Cox, B.	Northfield, L.
Crook, L.	Oram, L.
Darcy (de Knayth), B.	Peston, L.
David, B.	Phillips, B.
Davies of Penrhys, L.	Porritt, L.
Donaldson of Kingsbridge, L.	Robson of Kiddington, B.
Dormand of Easington, L.	Russell of Liverpool, L.
Ennals, L.	Sainsbury, L.
Ezra, L.	Seear, B.
Falkland, V.	Seebohm, L. [Teller.]
Fisher of Rednal, B.	Serota, B.
Fitt, L.	Shannon, E.
Gallacher, L.	Shaughnessy, L.
Galpern, L.	Soper, L.
Gladwyn, L.	Stallard, L.
Graham of Edmonton, L. [Teller.]	Stedman, B.
	Stoddart of Swindon, L.
Halsbury, E.	Strabolgi, L.
Hampton, L.	Swinfen, L.
Hanworth, V.	Taylor of Blackburn, L.
Hayter, L.	Thomson of Monifieth, L.
Hirshfield, L.	Thurlow, L.
Hollis of Heigham, B.	Tonypandy, V.
Houghton of Sowerby, L.	Tordoff, L.
Hunter of Newington, L.	Wallace of Coslany, L.
Hylton-Foster, B.	Walston, L.
Jenkins of Putney, L.	Whaddon, L.
John-Mackie, L.	White, B.
Kilbracken, L.	Williams of Elvel, L.
Kilmarnock, L.	Wilson of Langside, L.
Kinloss, Ly.	Young of Dartington, L.

NOT-CONTENTS
Aldington, L.	Brougham and Vaux, L.
Alexander of Tunis, E.	Butterworth, L.
Allerton, L.	Caithness, E.
Ampthill, L.	Carnegy of Lour, B.
Annaly, L.	Carnock, L.
Arran, E.	Carr of Hadley, L.
Balfour, E.	Cavendish of Furness, L.
Belhaven and Stenton, L.	Cawley, L.
Beloff, L.	Clanwilliam, E.
Belstead, L.	Cottesloe, L.
Bessborough, E.	Cullen of Asbourne, L.
Birdwood, L.	Davidson, V. [Teller.]
Blatch, B.	Denham, L. [Teller.]
Boardman, L.	Dudley, B.
Borthwick, L.	Eccles, V.
Boyd-Carpenter, L.	Ellenborough, L.

Elles, B.	Nugent of Guildford, L.
Elliot of Harwood, B.	Onslow, E.
Erroll of Hale, L.	Orkney, E.
Fairhaven, L.	Oxfuird, V.
Faithfull, B.	Penrhyn, L.
Foley, L.	Peyton of Yeovil, L.
Fraser of Carmyllie, L.	Platt of Writtle, B.
Fraser of Kilmorack, L.	Quinton, L.
Gainford, L.	Rankeillour, L.
Gridley, L.	Reay, L.
Grimston of Westbury, L.	Renton, L.
Havers, L.	Rodney, L.
Henley, L.	Romney, E.
Hesketh, L.	Sanderson of Bowden, L.
Hives, L.	Savile, L.
Hood V.	Selkirk, E.
Hooper, B.	Skelmersdale, L.
Ironside, L.	Slim, V.
Johnston of Rockport, L.	Strange, B.
Kinnaird, L.	Strathclyde, L.
Layton, L.	Strathcona and Mount Royal, L.
Long, V.
Lovat, L.	Strathmore and Kinghorne, E.
Lyell, L.
Mackay of Clashfern, L.	Strathspey, L.
Macleod of Borve, B.	Swansea, L.
Malmesbury, E.	Teviot, L.
Manton, L.	Thomas of Gwydir, L.
Margadale, L.	Thomas of Swynnerton, L.
Merrivale, L.	Thorneycroft, L.
Mersey, V.	Trefgarne, L.
Monteagle of Brandon, L.	Trumpington, B.
Montgomery of Alamein, V.	Ullswater, V.
Mowbray and Stourton, L.	Vaux of Harrowden, L.
Murton of Lindisfarne, L.	Wedgwood, L.
Napier and Ettick, L.	Westbury, L.
Nelson, E.	Wolfson, L.
Newall, L.	Zouche of Haryngworth, L.
Norrie, L.

Resolved in the negative, and amendment disagreed to accordingly.

3.37 p.m.

Lord Kilmarnock moved Amendment No. 168AA:

Page 52, line 30, at end insert ("and (c) in the event of change of residence any existing assessment shall apply in whichever local authority the person becomes resident until the new authority is able to reassess their claim.").

The noble Lord said: My Lords, there is bound to be a good deal of migration or cross-boundary movement of people covered by Part III of this Bill. This amendment seeks to ensure the continuity of community care services for persons moving from one local authority to another. The amendment reads: in the event of change of residence any existing assessment shall apply in whichever local authority the person becomes resident until the new authority is able to reassess their claim".

There are various categories of people who will be affected by this amendment. In particular, people suffering from the HIV disease frequently have to move from one local authority to another. The most common reasons are the following: first, harassment. People with HIV are frequently subject to harassment and may need to move quickly to another area. I have here a number of examples to illustrate the point and some of them are pretty harrowing. I shall not go through them all but I shall give noble Lords two or three examples.

A couple are living in a privately rented flat in West London. One of them has full-blown AIDS and is extremely anxious and depressed. The conditions at the flat are poor. There is damp and the walls are covered with mould. In addition to problems of environment, the landlady of the flat found out about the AIDS sufferer's condition and started telling the other tenants. On one occasion she even went out into the street and broadcast the fact to passers-by. The sufferer applied to his local authority saying that he was homeless, but it refused his application on the ground that he actually had suitable accommodation despite the public harassment.

Another case involves a girl who moved to London from Edinburgh in order to seek better medical treatment. She had lost her job when her employer found out, through a breach of confidentiality on the part of her GP, that she was HIV positive. In London she moved into a bedsit costing approximately £100 a week. It had no heating and was reached by climbing four flights of stairs. She shared the toilet, bathroom and kitchen with 14 other people. She has ARC—AIDS related complex—some of the effects of which are chronic diarrhoea and fatigue. Consequently she found her accommodation more and more difficult to cope with. Eventually her weight dropped to under six stone. She was admitted to hospital and her social worker referred her to a voluntary housing association. This case has a happier ending because accommodation was found. Her weight has increased and there has since been a great general improvement in her health.

My final case involves a horrifying instance of another girl who had been living in the north of England for some time when she found out that she was HIV positive. She returned to London with her boyfriend hoping that she would get support and help from her family and friends. Unfortunately they would have nothing to do with her and she and her boyfriend moved into a squat in Brixton. She then became friendly with a neighbour and confided in him that she was HIV positive. Later on that day he broke into the flat and beat her up and her boyfriend so badly that they both had to be admitted to hospital. On being discharged from hospital they were both too scared to return to the squat. They ended up sleeping in a multi-storey carpark for two weeks until some friends offered to let them sleep on their floor. During this period, not unnaturally, the girl's health deteriorated disastrously. The local authority has not yet been able to house the couple due to lack of vacancies. At present she is moving around, sleeping on various people's floors.

Those are various instances of harassment. I pass to another consideration—drugs. The discovery that they are HIV positive encourages a considerable number of people to give up drug taking. But this means that they may well come under considerable pressure from pushers and other users—their previous companions—to continue the habit. This may drive them, in order to preserve some kind of anonymity, to move to areas where they are not known to the intravenous drug using community.

Another reason for moving from one local authority area to another is the need to be near to hospital services and carers. As noble Lords will know, some hospitals are developing specialist services which draw in people from wide geographical areas. Some people will therefore move to be near what they consider to be their hospital—the place where they are receiving treatment. That is certainly the case with people who are HIV positive. They move specifically in order to be treated at centres of excellence on HIV and AIDS. They do so because the services are perceived to be of high quality, a degree of anonymity is assured and voluntary support groups are available. People with HIV and AIDS also move in order to be close to carers and friends. Some, knowing that they are reaching the end of their lives, naturally move back to their home locality to gain the support of their families. Often the lack of preparedness of local services for such immigrants leads to a panic response rather than a balanced reaction and the necessary support.

The failure of an adequate community response also has a knock-on effect on hospitals, which find themselves having to cope with people who are not currently receiving active treatment or therapy but are unable to find anywhere else to live which would entitle them to social services. That puts increasing pressure on the scarce resources of the NHS.

I think that I have said enough to show that something along the lines of the amendment is required to deal with these cross-boundary movements. It is also possible that savings would be achieved not only for the NHS but also for local authorities if the idea of a portable assessment were accepted and became widespread. This could mean that a new assessment would not need to be made on every occasion but only when the condition of the person in question changed. I think that I have given sufficient background to the amendment. I beg to move.

Lord Carter

My Lords, this is a sensible amendment. Amendment No. 171 will deal with cross-boundary funding. The amendment before us deals with cross-boundary assessment. It is important that the Government should explain how the problems which the noble Lord has described so well will be dealt with. It is not entirely clear when one reads the Bill.

3.45 p.m.

Lord Henley

My Lords, I recognise the concern of the noble Lord, Lord Kilmarnock, regarding HIV and other problems. However, I do not think that the arrangements envisaged by the amendment are practicable.

I agree that it is important that when people receiving community care services move, there should be a continuity of service provision. However, it may not be possible for the existing pattern of service provision to be replicated at the person's new address. For one thing a change of address may well produce a different pattern of care needs if the person moves into a different domestic setting or into a very different type of accommodation. In many instances where day care is being provided, the person would, on a change of address to a different local authority, in any event move too far away from the day centre which he is attending still to be able to get there. The way that we would envisage changes of address being handled would be for someone in receipt of community care services to approach the local authority into whose area he intended to move to make application for community care services there. Ideally this should be done in time for local authorities to carry out an assessment and decide what services should be provided before the change of address takes place. In cases where a person moves to alternative accommodation because of his care needs and possibly with the involvement of the first local authority, it is obvious that there needs to be collaboration between the two authorities to ensure that there is continuity of service provision. Should any particular problems arise in this area we feel that we can address them through our guidance, which, if necessary, could be reinforced by directions. I hope that, in the light of those considerations and the assurance I have given, the noble Lord will feel able to withdraw the amendment.

Lord Kilmarnock

My Lords, I am glad that the noble Lord has recognised the importance of the continuity of care across boundaries. However, I do not think that the rest of his response was quite what I had hoped for. I take his point that a change of circumstances may ultimately not lead to the same assessment because residential accommodation may turn into day care or vice versa. But what worries me is his suggestion that an application should be made in good time for assessment. I do not know how long on average those assessments will take. In an earlier amendment a time limit was suggested, which, so far as I know, has not been accepted.

I tried to illustrate in my remarks that the need to move is often urgent, particularly in cases of harassment. To suggest that people should calmly go to the authority to which they would ideally like to move, wait to be seen and wait for the assessment while they are being harassed by neighbours to leave the accommodation in which they are living is not frightfully helpful. That must be taken into account.

I should have thought that my suggestion of a portable assessment for a limited period was not a bad one. In many cases there would then be the need for reassessment. However, I should have thought that the idea that one could move with one's existing assessment and that its validity would be upheld for an agreed time—a fortnight, a month or some such period—would do a very great deal to end some of these extremely nasty cases.

I shall read carefully what the noble Lord has said. I shall not press the amendment to a Division but I may well come back to it at Third Reading. I hope very much that before the Bill leaves the House the noble Lord will be able to assure me—even if it is through guidance—that the kind of circumstances which I have outlined will be taken into account. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Seebohm moved Amendment No. 168B; Page 52, line 30, at end insert: ("( ) A person who is dissatisfied with an assessment which has been carried out in accordance with subsection (1) above shall have 21 days in which to appeal to the local authority (or a committee thereof) whose decision shall be binding.").

The noble Lord said: My Lords, the amendment is self-explanatory. An appeal procedure is necessary. It has been suggested that people should go to the Secretary of State but I believe that that would be time consuming and would place a quite unreasonable burden on the Secretary of State. I looked through the Marshalled List to see if other amendments about complaints had been tabled. Amendment No. 183A was the only one I could find, but it concerns appeals against the discharge of the duties and not against the assessment. I beg to move.

Lord Carter

My Lords, I think we can all agree that the availability of a right of appeal if a person is dissatisfied with his assessment is essential. However, the House would be interested to know how the Government propose that the problem should be dealt with. Clearly, as the community care packages start to come into operation, there will be people who are dissatisfied with the assessment they have been given. How is it proposed that such people will be able to express their dissatisfaction without a right of appeal being provided for in the Bill?

Lady Kinloss

My Lords, I rise to express my support for the amendment. It is very important for the person concerned to have the right to appeal against such decisions. The Association of Directors of Social Services supports the right of appeal against decisions made on an individual's behalf. The association said: Such considerations are too important for an assessment simply to be delivered, unchallengeable, on tablets of stone". That right of appeal could make the difference between a person staying at home or moving into residential care.

Baroness Masham of Ilion

My Lords, if people have the right to appeal, they are much more likely to accept a decision made on their behalf. Alternatively, it is to be hoped that they will have a say in the matter through the appeal procedure.

Lord Swinfen

My Lords, there are certain conditions which arise whereby the individual has both good and bad days. At the same time, the assessor also has good and bad days. What is the position when the disabled person is having an extremely good day but has to meet with a very grumpy and bad assessor? It is absolutely essential that there should be a right of appeal.

Lord Henley

My Lords, to begin with I should like to clarify the position so that we all know what we are discussing. I take it that we are speaking to Amendment No. 168B and not to Amendment No. 170, which was originally on the grouping list. As I understand it, noble Lords would prefer to take these amendments separately. I propose to do so.

A similar amendment was moved in Committee in another place. My honourable friend the Minister for Health explained that we consider it undesirable to introduce an appeal procedure into community care provision. Although other noble Lords have spoken briefly—and I am grateful for that—I think that it might help the House if I were to set out the reasons for our view.

First, an appeals procedure could very well be an excuse to introduce into community care assessments an unwelcome measure of bureaucracy. If a decision was likely to be appealed against, that would lead to meticulous recording of the information collected at the assessment and the reasons why the decision was reached. Secondly, an appeals procedure would introduce a legalistic overtone into the assessment procedure. Such legalism would not sit well with what is intended to be an interactive social work process. Thirdly, we have to have regard to the costs of such a procedure, which could well divert resources from service provision. Service provision itself might also be skewed by the findings of appeals as, in the terms of the amendment, the decision of the person considering them would be binding on the authority, which would then have to provide the services it was decided to award. Fourthly, there are other means already in existence by which decisions of local authorities can be challenged and it would be open to someone who was deeply dissatisfied by the treatment they had received from the local authority to seek redress in that way.

Finally, as a result of concerns expressed in another place and in this House, we have introduced into the community care arrangements a requirement that local authorities should have a procedure for dealing with complaints and representations. This is embodied in Clause 51 of the Bill. In our guidance associated with this requirement we shall make it clear that local authorities must be able to deal properly with complaints, and, while we are not recommending a separate structure for complaints against assessment, such complaints could be considered by the mechanisms that the local authority would be required to set up. Our guidance also makes it clear that the final stage in the complaints procedure must bring in an independent element on lines similar to that which local authorities will be required to have under the Children Act 1989.

In conclusion, I should mention that we must bear in mind the fact that the social services department will remain accountable to its council and that there is always the form of redress available to anyone of appealing through their elected county councillor, or other councillor, in terms of the accountability of the department to the council. For the reasons I have given, I feel that the requirement to have a complaints and representation procedure is as far as it is appropriate to go in the field of community care. In the light of that explanation, I hope that the noble Lord will feel able to withdraw his amendment.

Lord Seebohm

My Lords, the proposal here was in the nature of a probing amendment. It is very important that there is some form of appeal available. However, I shall read very carefully what the noble Lord said. I must say that I am not completely satisfied with his reply and I may return to the matter at the next stage of the Bill's proceedings. In the meantime, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Baroness Robson of Kiddington moved Amendment No. 168C: Page 52, line 30, at end insert: ("(1A) The Secretary of State shall issue a code of practice with respect to assessments carried out under this section which shall make provision as to the advice which a local authority should seek in making assessments. (1B) Without prejudice to the generality of subsection (1A) above, the code of practice issued under that subsection shall give guidance as to when a local authority should seek medical or nursing advice, and such other advice as may be advised.").

The noble Baroness said: My Lords, this amendment would ensure that there are clear guidelines for local authorities regarding assessment procedures. The White Paper stated that local authorities would need to form their own views about whether a formalised assessment process was necessary. There are many Members of your Lordships' House, as well as members of the Royal College of Nursing, who feel that that is not sufficient and there should be a firmer commitment that assessment will involve a multi-disciplinary approach.

Amendments were moved in another place which would have established a multi-disciplinary team to conduct assessments. However, they were dismissed by the Parliamentary Under-Secretary of State for Wales as being too bureaucratic and rigid. It is for that reason that this amendment has been made much more flexible. It relies upon the Secretary of State to issue a code of practice.

A code of practice would define when a local authority should seek particular forms of advice. It is not a new idea. It follows the precedent within the Education Act 1981 which made similar provision for a code of practice in respect of assessments for children with special needs. If the Government's proposals under the community care Bill are to be successful, one of the most important parts of it will be the assessment process. It has been described as the hinge point where health authority and local authority social service actions interface. Therefore, it is desperately important that this assessment process draws on the full range of knowledge and contributions which can be obtained by making use of all the available professional advice.

I understand that the Welsh Office has issued what is generally considered to be quite an admirable guidance on assessment processes. So far as I know, such guidance has not been forthcoming from the Department of Health. It may have helped us in our considerations if we had seen that guidance document. Of course guidance in itself is not enough; but there is no reason why the Government should resist its incorporation into a code of practice issued by the Secretary of State.

The White Paper Caring for People repeatedly referred to the need for full co-operation. For example, with regard to the organisation of assessment, at paragraph 3.2.7., it says: an essential skill which case co-ordinators will need to deploy will be to manage the involvement, contribution, co-operation and partnership between the local authority … and professions in providing services. The Government expects all those concerned to contribute positively to such arrangements".

However, those expectations are not reflected in the Bill. While I have the utmost admiration and respect for social workers, I still claim that a nurse has a greater knowledge of the services available and a greater capability of diagnosing what could help a patient improve his standard of life. It is for the nurse to decide when to call on a continence adviser, an occupational therapist, a physiotherapist or a speech therapist. It is important that the nurse's view should be part of the assessment process. Nurses should be equal partners in the provision of assessment and care delivery.

I hope that the Government will accept the amendment. It is flexible and would ensure that assessment in the community makes the utmost contribution to the success of the community care proposals. I beg to move.

4 p.m.

Lord Ennals

My Lords, I give the fullest possible support to the amendment which stands also in my name. The noble Baroness is correct. If community care is to become a reality it is vital that the established methods of working together embodied in multi-disciplinary teams should have some formal recognition within the Bill to ensure the best possible and most appropriate services for consumers.

There are many different professionals. The noble Baroness referred to the importance of trained nursing staff, with which I agree. The role of the social worker is also important. I should add—perhaps being prejudiced, as president of the College of Occupational Therapists—the occupational therapists who often have a central role to play in assessment and case management. They have the skills and experience which enable them to bring together those with more precise skills. In a sense, they have a holistic approach to their clients. The concept which we are trying to write into the Bill, by means of a code of practice, is important. It is not for any of us to say that one profession is more important than another. All play a role, as they do in the medical profession.

The code of practice, if properly applied with proper consultation, would underpin the Bill. I should have liked to have seen a similar but more detailed amendment written into the Bill. But, as the noble Baroness said, that was tried in another place and defeated. I guess that if we tried the same here, it would also be defeated. This proposal is the best that we can have. I warmly support the amendment moved by the noble Baroness.

Baroness Blatch

My Lords, the noble Baroness raised an important point. I believe that I can meet almost all her objectives, short of putting the amendment on the face of the Bill.

I can assure your Lordships that we shall be issuing guidance not only on the administrative procedures to be followed, but on the more professional aspect of carrying out assessments. That will cover the points mentioned in the amendment. While I appreciate the feeling behind the amendment and the desire to have that provision placed on the face of the Bill, by virtue of existing legislation, local authorities will have to have regard to the guidance we issue, and, as we have pointed out on several occasions, if necessary we can reinforce that guidance by directions. I can assure the noble Baroness that we shall not hesitate to use the latter power if it appears that local authorities are not seeking proper advice in carrying out their assessments. The requirement in Clause 43 for local authorities to seek the approval of a health authority before arranging nursing home care is designed to ensure that there is a medical and nursing input to those decisions.

The draft guidance on that issue—Draft Guidance for the Assessment and Case Management—is now in the public domain. Paragraphs 28 to 31 are pertinent. Advice on suitable mechanisms to carry out that procedure will follow the draft guidance. All that is being asked for in the amendment is being carried out. It is already in hand, and I hope that the noble Baroness will feel able to withdraw the amendment.

Baroness Robson of Kiddington

My Lords, I thank the Minister for that reply. It was much more helpful than I expected it to be. I shall read the guidelines with great interest. Nevertheless, I am always sad that the answer always is, "We cannot have it on the face of the Bill". I have the utmost confidence that what the Minister says is what she intends to carry out; but the provision will not be on the face of the Bill. We shall not always have the same Ministers or government, but the Bill will remain. That is what worries me about the legislation.

I should like to read the guidelines, and I reserve my right to return on Third Reading if I do not find them satisfactory. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Baroness Masham of Ilton moved Amendment No. 168D: Page 53, line 30, at end insert: ("(1A) A local authority shall have the power to enter into arrangements with voluntary organisations whereby the voluntary organisation shall carry out an assessment under subsection (1a) above of the needs of any person and decide under subsection (1b) above whether his needs call for the provision of services.").

The noble Baroness said: My Lords, the amendment is common sense. The people who run drug and alcohol homes are the experts who have to do assessments before they start rehabilitation. The amendment gives local authorities the power to enter into arrangements for assessments with voluntary organisations. That should save time, duplication, money and a great deal of red tape. As has been said previously, confidentiality also comes into this issue.

If the local authorities have to train and pay extra social workers to do the work, the taxpayers might have something to say because that will be a waste of public money. The Crossroads care attendance scheme gives disabled, ill and elderly people help in their own homes. As a result of the Committee stage, there is a feeling of concern because the ability of organisations such as Crossroads to carry out assessments is at the heart of their independence from the statutory sector. Unless the voluntary sector can maintain its independence and integrity from the statutory sector, there is a real danger that the Government will find that the Bill, far from facilitating service provision by the voluntary sector, will militate against it.

Local Crossroads schemes are worried that they will lose the good will of the voluntary management committee whose commitment is to Crossroads and not necessarily to social services departments. Moreover, the informality and flexibility that Crossroads offers at present will be lost if all its clients' assessments have to be carried out by the local authorities. Voluntary organisations, many of which are professional and expert, feel that they should be included in the legislative requirements in respect of assessments. With a growing elderly population, we must consider seriously the problems that might arise when there are insufficient people willing and able to undertake all the care needed in the community. Voluntary organisations should be treated with all the respect that they deserve.

Will the Government explain how all the assessments needed will be undertaken and by whom, and how long the waiting lists for assessments will be? Will people have to do without help until an assessment has been completed? Will there be an emergency assessment procedure? I beg to move.

Lord Carter

My Lords, I am pleased to add my name to the amendment and to express the support of these Benches. The amendment draws attention to a very important aspect of the whole assessment procedure, which has been exceedingly well described by the noble Baroness. As she said, we have been briefed by Crossroads—who have great anxiety about this matter—and other organisations. They have drawn attention to a problem in the assessment procedure with which the Government must deal.

Will the Minister tell us whether the Bill, as drafted, means that organisations will receive funding only for individual people who have already been assessed by the local authority? If not, will local authorities be able to continue to give block grants to organisations to provide the care attendant service such as Crossroads? Those schemes earned their reputation by being able to decide what services were required and by providing them. Will that continue after the enactment of the Bill, or will local authorities have to carry out assessment on an individual basis?

I was given a scenario by Crossroads, which may be worth repeating and asking the Minister to respond to it. A carer suddenly needs to go away for an afternoon because a relative is seriously ill. At present, the carer goes to Crossroads. They immediately send in a care attendant to relieve the carer for that afternoon. Under the new system, will Crossroads have a budget to cover such eventualities or will the carer need to obtain local authority assessment for her need in order to cover the cost of the service? Will the service be provided by Crossroads, who will then have to ask the authority for reimbursement afterwards, and perhaps not receive it?

The issue is extremely important, and we need to know whether voluntary organisations are to be included in the assessment procedure. If they are not, a very real problem will arise with the gaps which will be caused in providing the assessment; with the waiting time; and with the rejection of the expertise that exists within the voluntary sector.

Baroness Darcy (de Knayth)

My Lords, I also support the amendment. The noble Lord, Lord Carter, and my noble friend Lady Masham covered the ground so well that I do not propose to go into the issue deeply. I particularly hope that the Minister will be able to say something positive regarding the issue of block grants to voluntary organisations such as Crossroads. They were extremely worried by the statement made by the noble Baroness, Lady Hooper, at Committee stage. That is as follows: There can be no question of the local authority writing a blank cheque to them to spend as they see fit on what they decide to be the need of an individual for whom they provide services". —(Official Report, 10/5/90: col. 1570.] I hope the Minister will say that we misinterpreted her words.

Lord Swinfen

My Lords, perhaps I may also briefly support the amendment. Voluntary organisations use a great deal of skill in assessing disabled people. Some of the specialist voluntary organisations by their very nature will know a great deal more about an individual's specialised disability—if I can put it that way—than local authorities who will be dealing with all kinds of disability: physical, mental, sensory, and so forth. It is an eminently sensible amendment.

Lord Mancroft

My Lords, perhaps I may also join in supporting the amendment. I apologise to the noble Baroness, but I was a little late entering the Chamber and I did not hear the beginning of her speech.

It is important that the Government impress upon local health authorities that they recognise the greater level of expertise that currently exists in the voluntary sector. One of the problems that existed in the past was inaccurate and inappropriate assessment by the statutory bodies.

A boring example of that is that in the average year 25,000 alcoholics are assessed and placed in psychiatric wards. Almost 100 years ago Sigmund Freud wrote that alcoholism was not a psychiatric disease. It is a pity that 100 years later we are still making very expensive inaccurate assessments. Those patients fill beds which could be filled by people who need them. It is very expensive to keep patients in those beds; and it is better that alcoholics should be cared for in the community. Voluntary sector organisations do not make those expensive mistakes.

Local authorities are not very keen to form permanent and long-term relationships with voluntary sector organisations. I know from what the Government have already said that they are keen that authorities should form those relationships; but that is where the problem with a framework Bill occurs. What the Government want, and I believe what your Lordships want, does not seem to be getting through. It would be helpful if in some way that could be stamped firmer on the Bill.

4.15 p.m.

Baroness Blatch

My Lords, having listened to the debate, it is clear that we still have a communication problem. On this issue, there are some perceptions which are wrong. One perception is that local authorities will conduct all the assessments themselves. That clearly will not be the case. Without the voluntary sector, local authorities cannot cope with some of the specialised assessments that will need to be carried out.

We recognise—and our guidance on case management and assessment will make this clear—that local authorities may wish to contract out to voluntary bodies some of the more specialised aspects of assessment. That will be particularly appropriate for people suffering from conditions of which local authority staff have little experience and where a great deal of knowledge and understanding of the condition is to be found in a voluntary organisation. We have already heard of such organisations. It is particularly the case with drug and alcohol misusers, but it may also apply to people with other conditions which give rise to special needs. Since we want local authorities to seek the most expert opinion they can in arriving at community care needs, that is something that we would want to encourage in appropriate cases. The legislation as drafted puts no barrier in the way of local authorities taking that action.

For local authorities to be successful providers in the field of special needs, they will have to rely upon the voluntary sector. However, the amendment moved by the noble Baroness goes further and enables local authorities to contract out the making of the decision whether the authority should provide any community care services. I submit that it would be wholly inappropriate for a local authority to contract out such a responsibility. As we have made clear, the decision on what services to provide must be taken by the authority in conjunction with the user and his or her carers, having regard not only to the assessed needs of the person but also to the availability of resources and services to the authority. Ultimate financial responsibility for the provisions of services must rest with the local authority, and that is inseparable from the process of making a decision on what services should be provided to an individual user. Furthermore, the user may have needs for community care services which go beyond what the voluntary organisation carrying out the assessment could provide, and it seems wholly inappropriate for a voluntary body to be able to commandeer services from other providers by reaching decisions about service provision on their behalf.

Again, I refer the noble Baroness to paragraphs 28 and 37 of the draft guidance which is now available for consultation. She will find those helpful. They make the point concerning contractual arrangements between local authorities and the voluntary sector.

The noble Baroness, Lady Darcy (de Knayth), referred to decisions being taken by the voluntary organisations. If an organisation is in the position of assessing people and deciding what services to provide, then the local authority would be abdicating its responsibilities. That is one of the points I made. Once the assessment is made, it will be for the local authority to take that assessment and any other related needs of a person and make a judgment regarding meeting those needs.

The noble Baroness, Lady Masham, raised an important point regarding emergencies. Amendment No. 169A, which will be moved shortly, will be helpful in that respect. Another amendment—I am unable to recall the number—was passed on Thursday; that too will be helpful. Clearly on occasions there needs to be the facility and mechanism for making emergency assessments.

In the light of that explanation, I hope that the noble Baroness will feel able to withdraw her amendment.

Lord Carter

My Lords, before the noble Baroness sits down, perhaps I may ask for two points of information. First, she referred to the draft guidance referred to last Thursday and published last Friday. Is it intended that we should receive a copy of the draft guidance? It has been referred to a number of times and it will be helpful to all of us.

Secondly, if a local authority does not use the voluntary organisation as it should, or as the voluntary organisation thinks it should, to carry out the assessments, will the voluntary organisation be able to use the complaints procedure under Clause 51(7B) in order to bring the local authority to account?

Baroness Blatch

My Lords, with the leave of the House, I hope to receive the answer to the second part of the question before I finish speaking. On the first part, I am only just in receipt of the draft guidance that went out on Friday. I understand that it will be in the Library of the House and it is available to noble Lords now. I am reluctant to quote from the draft guidance because it is up for consultation. It is in draft form and therefore any comments that noble Lords may wish to make will be welcomed by the department. I promise to write to the noble Lord on access to the complaints procedure.

Baroness Darcy (de Knayth)

My Lords, before the noble Baroness sits down, and with the leave of the House, l asked about block grants. She spoke very fast. I may have been stupid in not picking it up, but I do not believe that she answered my point. The mater has given concern to the voluntary organisations. Will the local authority be able to give organisations a block grant or will it only be for the individual person assessed? I was worried by the statement of the noble Baroness, Lady Hooper, at Committee stage.

Baroness Blatch

My Lords, again with the leave of the House, my understanding is that in terms of finance the local authorities will contract with voluntary organisations for a general service. In other words, they will be involved in general assessment work and funds will be made available for that. There will also be flexibility to engage in contracting for individuals. If I am misleading the noble Baroness in that reply, I shall put it right in correspondence with her. I believe that the whole essence of the contractual arrangements between the local authority and the voluntary body is to have flexibility so that all the agencies are brought into play in serving needs. Clearly the application of resources will be important.

I was probably misleading about the complaints procedure and perhaps sounded too negative. It is not the organisation that can make the complaint but the individual. If an individual has been badly served, a complaint can be made on his behalf rather than on behalf of the organisation.

Baroness Masham of Ilton

My Lords, I thank noble Lords who have spoken and the Minister for trying to explain the provisions. This is a complicated matter. The Government have put down Amendment No. 169A, and as the voluntary organisations are extremely worried about the matter the best thing to do at this stage is to take the amendment away and consider it. Many noble Lords have amendments on assessment so perhaps we could get together before the Third Reading and see whether some more satisfactory wording can be found. It is important to be clear. At the moment voluntary organisations are not clear about the position, nor are local authorities. The noble Baroness spoke about communication problems. Perhaps some exist, and that is the reason we want a provision written into the Bill to clarify the position. Therefore at this stage I shall withdraw the amendment and perhaps bring it back later.

Amendment, by leave, withdrawn.

Lord Ennals moved Amendment No. 168E: Page 52, line 30, at end insert: ("( ) In carrying out duties under subsection (1)(a) above a local authority shall periodically review the assessments made at intervals to be specified by the Secretary of State.").

The noble Lord said: My Lords, this amendment stands in the names of the noble Baroness, Lady Cox, and myself. She has asked me to say that she is chairing an important meeting this afternoon and is sorry that, although she may be present for some amendments, she will not be here for this one. Therefore I move it on behalf of both of us.

The amendment would make provision for individuals' assessments to be reviewed and updated to take account of changing needs. It follows on naturally from the case made by the noble Baroness, Lady Robson, on an earlier amendment. We are concerned about what it seems are the limitations which have been put upon assessments. Bearing in mind what the noble Baroness said a moment or two ago, Caring for People states in paragraph 3.2.1: Local authorities will need to form their own views about when a formalised assessment process becomes necessary".

I suppose that that should now be, "Local authorities and, when delegated, voluntary organisations acting on their behalf', or similar wording. It is not surprising that we received the impression that it would be local authorities.

We fear that this may lead to individual clients receiving rather infrequent assessments or even one-off assessments without provision being built in for any review of their needs. We believe that the framework for the assessment process should be more tightly regulated. After all, many people's needs change over a period of time. Elderly people especially have a wide range of complex health and social care needs which should be constantly reassessed. Individuals could then receive the most effective care at the time when they need it. Care plans will need to be amended according to whether the condition of individuals has improved or deteriorated so that the clients are able to fulfil their full potential. I am sure that the noble Baroness will see the significance of the point. I look forward to her reply. I beg to move.

Lord Swinfen

My Lords, the amendment is sensible. I wonder whether the best way of dealing with it is the following. When an assessment is originally made, there should be a recommendation as to when there should be a reassessment. Obviously some people may not need an assessment for a number of years. Others whose condition changes rapidly may need further assessment after only a matter of months. The best way of dealing with the point might be for it to be tied into the assessment.

Lord Henley

My Lords, I hope that the noble Lord, Lord Ennals, can face being answered by me instead of the noble Baroness! Obviously I accept the concern behind the amendment that assessment of community care needs should be regularly reviewed. However, as we have said on other occasions, we do not feel able to accept that this should be on the face of the Bill.

Our draft guidance on assessment which was published on Friday provides that assessments should state the time at which a review should take place. Clearly, the timing of such a review—as my noble friend Lord Swinfen suggested—depends upon the condition of the person being assessed and the type of needs revealed. Someone who is in a very stable condition will obviously need a review less frequently than someone whose condition is still rapidly changing. This is particularly the case where the person is receiving some form of rehabilitation. For all these reasons, I feel that it would be impracticable for the Secretary of State to prescribe the intervals at which reviews are to take place.

As I have said, our draft guidance, which we can reinforce with directions, makes it clear—I refer noble Lords to paragraph 39 of the draft guidance on assessment and case management—that reviews should take place. I feel that that is as far as it is practicable to go. I hope that in the light of these assurances and considerations the noble Lord will feel able to withdraw the amendment.

Lord Ennals

My Lords, I am grateful to the Minister. It would have been a great advanatage to have the draft guidance in front of us so that we could try to speak with the same authority as the Minister. However, he is obviously very much seized of the problem and I am glad that he accepted that there needs to be a review, depending on the nature of the condition of the person. As the noble Lord, Lord Swinfen, said, the condition of people varies. The condition of some people will be stable while that of others will change, particularly as they age.

I am happy about the Minister's response and I look forward to seeing the guidance. If I have time, I shall rush off to the Library and collect a copy. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Baroness Seear had given notice of her intention to move Amendment No. 169: Page 52, line 39, at end insert: ("( ) In carrying out an assessment under this section, a local authority shall have regard to the abilities and views of any carer of the person being assessed, and in particular, shall not assume that the carer will continue to provide care to the person where the carer is unwilling to do so. ( ) In this section, "carer" means a person providing a substantial amount of care on a regular basis, who is not a person employed to provide such care by any body in the exercise of its functions under any enactment, to another person who is living at home.").

The noble Baroness said: My Lords, I spoke to this amendment with Amendment No. 168. We received an unsatisfactory reply and then lost the vote. In the circumstances, since this is a similar amendment, there is no point in moving it. I shall have to contrive a way to bring something similar back at Third Reading.

[Amendment No. 169 not moved.]

Lord Henley moved Amendment No. 169A:

Page 53, line 16, at end insert: ("(4A) Nothing in this section shall prevent a local authority from temporarily providing or arranging for the provision of community care services for any person without carrying out a prior assessment of his needs in accordance with the preceding provisions of this section if, in the opinion of the authority, the condition of that person is such that he requires those services as a matter of urgency. (4B) If, by virtue of subsection (4A) above, community care services have been provided temporarily for any person as a matter of urgency, then, as soon as practicable thereafter, an assessment of his needs shall be made in accordance with the preceding provisions of this section.").

The noble Lord said: My Lords, this amendment was spoken to with Amendments Nos. 145ZA and 145B. I beg to move.

On Question, amendment agreed to.

4.30 p.m.

Baroness Darcy (de Knayth) moved Amendment No. 170: Page 53, line 18, at end insert: ("( ) Section 3 of the Disabled Persons (Services, Consultation and Representation) Act 1986 (which deals with the assessment by local authorities of the needs of disabled persons) shall come into force on the same day as this section.").

The noble Baroness said: My Lords, when moving this amendment in Committee my noble friend Lord Henderson of Brompton said: it is central to this part of the Bill that Section 3 of the 1986 Act should be implemented"[Offical Report, 10/5/90; col. 1583.]

He withdrew the amendment—it was 11.15 p.m.—on the understanding that we would return to the matter I am therefore returning to ask the Minister a few questions. I shall be reasonably brief, although probably not as brief as he would wish, but I want to know the latest state of the Government's thinking on Section 3.

Section 3 gives disabled people three rights with regard to assessment. We have heard from the noble Baroness, Lady Robson, how crucial the whole assessment process is. The rights are: first, to make representations about their needs; secondly, to have a written statement on the outcome of the assessment; and thirdly, to have a review. This would be quite informal and unbureaucratic; not an appeals procedure.

Section 3 is fundamental to good community care. It was drafted only after full consultations, and it was agreed by the Government, the local authorities and the disability organisations to be the best way of proceeding. In fact, I understand that the department actually wrote Section 3.

Can the Minister say whether the Government have changed their minds? Would he agree that Section 3 should be implemented if we are to ensure that local authorities provide a uniform standard of assessment? What is the Government's response to the Social Services Select Committee report Community Care: Choice for Service Users, which was published on 14th June and which recommends that Sections 1 to 3 of the 1986 Act be brought into force a3 soon as possible?

Section 3(6) provides that where the disabled person or his representative is unable to communicate orally or in writing, the local authorities shall provide any necessary services—for example, a sign language interpreter—for the assessment procedure. Deaf people have sometimes been wrongly assessed because of communication problems. Does not the Minister agree that the provision is vital if profoundly deaf and deaf blind people are to be involved in their assessment? Does he not agree that it is actually more likely to be cost-effective if the assessment is right first time round?

This is a very important provision and I do not think it comes into legislation anywhere except in the disabled persons Act. I hope the Minister will be able to say something about this.

When the three local authorities conducted a pilot study of the implementation of Section 3 there were no appeals, presumably because they got the assessment right in the first place as the disabled persons were directly involved. Two out of the three local authorities found that written statements were so useful that they continued the practice after the study was completed. The assessment procedure was simple and unbureaucratic: the disabled persons were asked how they felt their needs could best be met; a letter was then sent to them about the services agreed, and then they were invited to challenge the letter.

I hope the Minister will take this opportunity to say, first, whether the Government still believe they got it right when they, along with the local authorities and the disabled organisations, agreed that Section 3 was the best way of going about assessments. Secondly, does the Minister agree that getting the assessment right in the first place is cost-effective, at any rate in the long term? Thirdly, given that new Section 7B in Clause 51 provides a mechanism for a complaints procedure, is it not logical to include a mechanism for getting the assessment right? I beg to move.

Lord Renton

My Lords, I wish to support most warmly the noble Baroness on this matter for the reasons which she has given. That provision of the 1986 Act was so important that it is surprising that after four years it has not been implemented; and as we are considering the matter afresh and in depth it does not seem to be right for us to lose this opportunity of insisting that is should be implemented as soon as possible. Of course we realise that the whole of the Bill is going to be enacted anyway only on an appointed day or goodness knows how many appointed days, but it would seem to be sheer nonsense to have Clause 48 implemented on an appointed day and still have Section 3 of the disabled persons Act not implemented.

Lord Swinfen

My Lords, I should like to support the amendment as I have added my name to it. In particular, I support the point raised by the noble Baroness, Lady Darcy (de Knayth), concerning representatives of disabled people, especially of those who have communication difficulties. Only in Section 3 of the Disabled Persons (Services, Consultation and Representation) Act 1986 is the authorised representative of a disabled person taken into consideration. As I understand the Bill we are discussing, there is no procedure for that at all.

Baroness Masham of Ilton

My Lords, this provision was accepted by both Houses of Parliament in 1986. If the assessment had been implemented, we should not be so concerned now. There is also concern about the type of assessment. As has been illustrated by the noble Baroness, Lady Seear, many people think the Government are taking a backward step in the present legislation in trying to involve carers. If at all possible the person who is being assessed needs to be able to put his or her own views forward; otherwise we shall be taking a backward step.

Lord Carter

My Lords, I too was pleased to add my name to the amendment and I support it from these Benches. We have been round this course before over the past four years. The Minister will know that there was a meeting last week between the noble Baronesses Lady Hooper, Lady Darcy (de Knayth), Lady Masham, and myself which did not take us much further. It is clear that the Government are going through the consultation procedure. They have sent a letter to local authorities which virtually invites a negative response by suggesting that they might like to wait until after the community care reforms are implemented, whenever that may be.

Those of us interested in this subject on all sides of the House, and indeed in other places, cannot understand the Government's reasons for refusing to implement Section 3. I hope that if the Minister's answer is unsatisfactory the noble Baroness who moved the amendment will decide to press it to a Division in order to give the House a chance to express a view, because the Government have to come up with a better answer than they have given in the past.

Lord Henley

My Lords, as the noble Baroness has said, we considered this matter at an earlier stage in our deliberations. I think it was my noble friend who explained on that occasion that no decision could be made about the implementation of this section and the remaining sections of the 1986 Act not yet in force until we had received cost estimates from the local authority and discussed them with them. We have still to receive those cost estimates. But I can tell the noble Lord, Lord Carter, who mentioned the fact that we had written to the Association of County Councils, that on 12th June, six days ago, we received an interim reply from one of the associations, the Association of County Councils, indicating that it and the Association of Metropolitan Authorities are currently engaged in drawing up, suggested procedures for operation of the outstanding sections and costing these". I give an assurance that we shall be pursuing the matter vigorously.

During the last debate on this issue we incurred some criticism from the noble Lord, Lord Allen—and that criticism has been repeated by my noble friend Lord Renton—about the length of time which has elapsed since the passing of the 1986 Act and our consideration of this section, together with Sections 1 and 2. I should like to take the opportunity to set this issue in context. I can confirm to the noble Baroness, Lady Darcy (de Knayth), that Section 3 was redrafted by the Government. From the outset the Government made it clear that implementation of the Act was subject to the availability of the necessary resources. That has not been an excuse for inaction. On the contrary, as my noble friend said on a previous occasion, key sections of the Act, which convey considerable benefits to disabled people, have been brought into force. From 1st April 1987, on the implementation of Sections 4, 8(1), 9 and 10, local authorities have been required to assess need on request, to have regard to the abilities of carers, to provide additional information for disabled people and to consult organisations of disabled people when making appointments. Since 1st February 1988 young people with disabilities have benefited from the implementation of Sections 5 and 6 which lay a duty on local authorities to identify school leavers with a disability and assess their needs for services. Further progress was made at the end of last year when Section 11 was brought into force with the laying of a report on community care for mentally ill and mentally handicapped people.

Priorities for implementation were agreed with the local authority associations, and at each stage agreement has been reached with them on the resource implications of the relevant sections. These have been taken into consideration in the appropriate public expenditure round. My noble friend mentioned on a previous occasion that the figure taken into account this year for the implemented sections of the Act was the substantial sum of £31 million. I make no apology for repeating what my noble friend said to demonstrate to the House that the Government have not been idle in their approach to the Act. We have, from the outset, stipulated that progress on the Act should not jeopardise high priority social services policy such as the Bill before us today. In my view we could not reasonably do otherwise, and I am sure that noble Lords will accept that as a necessary, indeed vital, proviso.

I recall a suggestion mooted at Committee stage by the noble Lord, Lord Henderson, that the implementation of Section 3 of the 1986 Act would not increase the demand on government funds. I understand that that conclusion was drawn from the results of a pilot study initiated by a consortium of voluntary groups and conducted in just three local authorities. We still do not know which those authorities were. I am rather doubtful about such a conclusion, as the same study showed that assessments carried out under the terms of Section 3 took around 30 per cent. longer than assessments in a control group which did not observe the strict terms of that section. I also find the suggestion surprising in the light of past intimations by the local authority associations during the preliminary consultations a few years ago that they believed the resource implications of this section would be considerable.

It is not the Government who have been saying that there are resource implications but the local authority associations who are the experts. It would be quite irresponsible of us to ignore their earlier view, and even more so not to await the considered and up-to-date estimates which we have been told are now in preparation—and I quoted from the letter of 12th June—and to take a decision tonight which would effectively say, "Despite the evidence to the contrary, and despite anything you were about to tell us in response to our consultation letter, we don't think this will cost anything, so why not get on with it.

In conclusion, I should like to assure the House that we shall proceed with the consultation exercise on Section 3 with all possible speed. In the meantime I hope that the movers of the amendment will accept that the Government are committed to ensuring maximum choice and independence for everyone who is in need of care in the community. I hope therefore that the noble Baroness will feel able to withdraw her amendment.

Lord Renton

My Lords, before my noble friend sits down, I wonder whether he realises that he has not dealt with the point that the amendment makes. The amendment merely suggests that Section 3 of the 1986 Act should be the subject of the same appointed day order and be brought into force at the same time as Clause 48 of the Bill which deals with assessments of need for community care services. The two are closely interlinked. Will my noble friend deal with that point? It is a matter of timing.

Lord Henley

My Lords, the noble Lord is trying to impose a timetable on the Government. I tried to make clear that we shall continue our consultation with Ideal authorities but that we wanted to know more from the authorities, who are the experts, about the cost implications. Until the consultation is complete we cannot take the matter further.

4.45 p.m.

Baroness Darcy (de Knayth)

My Lords, I should like to thank the Minister for replying at such length and so carefully. I appreciate that. However, I cannot say that I am anything but disappointed with his reply. That will not surprise him.

I was very careful not to say that there would be no resource implications in the amendment. I said several times that I believe that it will be cost effective in the long run to carry out the assessment process properly, to get it right so that people are satisfied and do not appeal, and to supply what is needed at the outset.

The noble Lord said that he did not know who participated in the pilot study. I can tell him the names of two local authorities which do not mind being named and which have decided to continue with written assessments. Those authorities are Cleveland and Oldham. I am afraid that I do not not know the name of the local authority which did not continue with the scheme. The other two authorities found the written assessment so useful that they continued with it after the pilot study was completed.

The noble Lord did not say anything about communication provision for the deaf and interpreters. If this section is not implemented I believe that it will be necessary to provide somebody to interpret during the assessment procedures.

The Minister will have noticed the support for the amendment from all sides of the House. I am disappointed by his response. However, the noble Lord says that he will pursue the matter vigorously and with all possible speed. We have managed to get one interim letter since the Committee stage. I hope that he can speed up matters and that we may learn more t y Third Reading. I should like the noble Lord to come back with some very good news at Third Reading. Although I hate returning again and again to the same amendment, as no doubt does the noble Lord, I reserve the right to come back and pursue the matter further at Third Reading if we do not make progress. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Allen of Abbeydale moved Amendment No. 171: After Clause 48, insert the following new clause:

("Grants for community care services

.—(1) The Secretary of State shall make a scheme whereby he shall, with the approval of the Treasury, out of moneys provided by Parliament, make grants to voluntary organisations providing community care services for the provision of those services where—

1. (a) the users of those services are persons who are not ordinarily resident in the area of any single local authority; or
2. (b) the numbers of users of those services who are ordinarily resident in the area of any single local authority is likely to be so small that the Secretary of State is satisfied that no single local authority is likely to provide moneys for the establishment of those services, or
3. (c) the users of those services are persons ordinarily resident in the areas of so many local authorities, that the Secretary of State is satisfied that it would be impractical for that voluntary organisation to enter into arrangements with each of those local authorities separately;

and where it would otherwise be impractical to secure funding for the voluntary organisation to provide such services.

(2) Prior to making a scheme under subsection (1) above, the Secretary of State shall consult those persons who appear to him to be representative of voluntary organisations providing community care services, of the users of community care services and their informal carers, and of local authorities.").

The noble Lord said: My noble Lords, the amendment refers back to a discussion that we had in Committee when the proposal became mixed up with some other amendments which were not quite in line with it. In that discussion the Government accepted that there was a serious problem but then propounded solutions which suggested—and I say this with great diffidence—that they did not appreciate just how grave it was.

The amendment seeks to provide for the setting up of a scheme for the support of those agencies which work with people coming from a number of authority areas where the problems of securing funding may well prove insuperable as the Bill now stands. There are many schemes run by voluntary organisations which have a local catchment area. Examples of the agencies that I have in mind are those which work with clients who come from a number of areas within which these are people with an AIDS-related condition—of whom there will be too few in any one local government area to justify provision for them alone—drug dependency units, drawing their clientele from a wide area, and projects working with single homeless people. Those are areas, and there are others, where innovatory projects have been started and are being run by voluntary organisations and where there is a need which seems not to be met by the statutory body. For many it will be impossible to say in any given year where their clients are likely to come from. They may come from prison, from psychiatric units, from under the arches at Hungerford Bridge, from Ireland or elsewhere.

I have had an opportunity to look at the draft guidance which has now made its appearance and shall be happy to offer my help in improving its grammar. I am afraid that I cannot find anything approaching a solution to the problem in all the words of the documents.

The Government's line has been that responsibility for paying will fall to the authority in whose area the person is ordinarily resident. There is reference to a person being ordinarily resident in premises in Clause 44, but that is not relevant in the present context. For our immediate purposes, we are presumably referred back to the National Assistance Act 1948, but there is no definition in that Act of what ordinary local residence means. Although the noble Baroness, Lady Blatch, was good enough to give us an interesting account in Committee of what it all meant, I have no idea on what authority that exposition was based. Once again, I cannot feel complete confidence that the Government's views will always prevail over the desire of a local authority to take a more restricted view of its responsibilities under the law.

I gather that, in the brave new world into which we are entering—we had some discussion on this matter a few minutes ago—the emphasis will be on block contracts which may well be all right where there is just a local catchment area. However, if it is impracticable for the voluntary organisation to negotiate a block contract and it has to go for individual contracts to the authority where the person is ordinarily resident—whatever that may mean—the problems could be horrendous.

The individual will first present himself to the voluntary organisation which will have to try to find out where he comes from and then attempt to obtain funding from that authority—if it is an authority in this country—with which the individual may well have had no previous contact of any kind. The individual may stay only for a short time and may well have gone long before the wrangling with the local authority has finished. The imagination boggles at the thought of a voluntary body, with its resources already stretched to the limit, having to cope with 40 or 50 local authorities in that way.

I have received a great many representations from bodies which see their future at risk. In view of the pressure on us with regard to time, I shall mention only the Alcohol Recovery Project, which has worked out that it might be involved in links with about 55 authorities, some of them in Scotland and Ireland, and the Hungerford Drug Project, which, on last year's experience, thinks that it would be involved with between 35 and 40 authorities and that it would have about 190 clients for whom no local authority could be identified.

If this part of the Bill is to succeed, it is legitimate to turn to government to do something to secure the preservation of those socially highly desirable activities on the part of voluntary organisations which meet a need of increasing importance. I am well aware of the difficulties—I have been too long in government not to appreciate them—but the Government should be prepared to find some way of funding desirable projects which reach beyond the boundaries of the responsibilities of individual local authorities, or perhaps to provide some scheme whereby the local authorities could collectively provide funds for such projects. That will not happen unless there is some additional provision in the Bill. I am not wedded to the particular formula that I suggest in the amendment and, if the principle is accepted—namely, that something must be done—the Government may want to do it in some other way. However, there is precious little time and there is no doubt that something needs to be done.

Perhaps I may therefore end by posing three simple questions to the Government. Where shall we find the definition of "ordinarily resident" in the area of a local authority for the purposes of Section 29 of the 1948 Act on which the noble Baroness based her remarks at col. 63 of Hansard on 14th May? When she referred to the difficulty of avoiding the closure of those voluntary organisations, she said that she hoped it could be overcome with sensible local organisation. Could we perhaps be told a little more about what that sensible local organisation might be? Could we also be informed why, so far as I can see, the draft guidance is completely silent on what might be done in those circumstances; or would the Government just prefer that those voluntary agencies should be closed down? I beg to move.

Lord Kilmarnock

My Lords, the previous debate to which the noble Lord, Lord Allen of Abbeydale, referred hung on an amendment which I had tabled at that stage and, as he said, it was rather muddled up with a batch of other amendments which were not strictly germane to it. I am therefore glad that the noble Lord has put down a separate amendment this time and we can discuss it fully and without other complications.

My concern is with day care and drop-in services—in other words, those that are not residential—which for the most part cover far more than the area of any one local authority. When I raised the point in the previous debate on 14th May, the noble Baroness, Lady Blatch, said: I readily acknowledge the difficulties in coping with that situation". However, she then went on to say that the Government believed that it was extremely important not to break: the important principle that local services should normally be locally funded". —[Official Report, 14/5/90; col. 62.] She then criticised my amendment on the grounds that it broke that principle.

However, the point is that the services that we are discussing are by definition not local. No satisfactory mechanism exists for funding them. At present, the only mechanism whereby local authorities can collectively fund voluntary sector services across their boundaries is through Section 48 collective grant-giving schemes in the former metropolitan county areas. There is only a handful of such schemes, most of which have limited resources and cannot expect to expand their funding programmes for many years ahead. Many projects funded by them have not even received inflation allowances.

I understand that the guidance to which the noble Baroness referred last time has been published, but I am afraid that I have not had the advantage of looking at it as the noble Lord, Lord Allen of Abbeydale has had. However, it is clear from his remarks that it does not address itself to that problem. Exactly the same view has been expressed to me by someone else who has read the guidance.

One of the problems of moving from grant-based funding of voluntary bodies operating across a number of local authority areas to a contractual system with individual authorities is that it imposes a great deal of difficulty on the voluntary bodies concerned. Knowing my interest, the noble Baroness will not be surprised if I refer to the Terrence Higgins Trust which last year received 42 per cent. of its total income from one application to central government. This year it has had to engage an additional member of staff in order to make 69 separate funding applications to the 33 London boroughs and to a large number of regional and district authorities. This organisation is a national organisation in the sense that 22 of its 30 services are supplied nationally and the other eight services are simply London-wide. Last year it received £450,000 from the Department of Health. This year from 69 applications it has received only £102,000.

The Terrence Higgins Trust is a relatively large and efficiently run voluntary organisation. Obviously, smaller organisations are in even greater difficulty. One which has been drawn to my notice is called Black HIV/AIDS. It employs only four people and has up to 50 volunteers. Bodies of that sort are put under immense strain. When they have to make applications on that scale the effect is that they have to cut back on their front-line activities. The organisation of which I speak has not even had the time or resources to find out the right procedures for applying in various different areas. So that gives some idea, taking a relatively large and a relatively small organisation, of the kind of problems that they run up against.

It seems to me to follow quite naturally that national voluntary organisations should be funded nationally. If the Government want the voluntary sector to act as a partner—they desperately need it to act as a partner—over the whole field of community care, they should treat it on an equal basis.

Finally, I associate myself with the questions put by the noble Lord, Lord Allen. The noble Baroness referred to sensible local organisations. What exactly does that mean? Will there be any guidance on that point? Apparently at the moment there is none. Do the Government agree that there is a need for services of this type to be grant-aided rather than case by case contract funded? The question is: do they agree or not that there is a need for such cross-boundary national organisations in the voluntary movement in this field?

5 p.m.

Lord Mottistone

My Lords, I should very much like to support this amendment in principle. I do not know so much about the details. It would be extremely helpful to the National Schizophrenia Fellowship if we were to have some legislation of this nature. As noble Lords are aware, schizophrenics are particularly difficult people to handle. There is a pressing need in all the big—and not so big—city centres to have day centres to which people from the surrounding countryside from other boroughs, districts within a county or even adjacent counties can attend. It does not seem to me that the Bill as presently drafted addresses itself to that need. That is why I believe that this amendment is necessary.

There is another factor to take into account. Voluntary bodies are largely dependent on raising funds from trusts, their own members and the like. They find it very difficult to raise the kind of sums that are necessary for the day centres that I have just described. It needs some positive pump-priming such as Amendment No. 171 would provide.

I hope that the Government will feel able to respond to this amendment. However, if they do not like it they can always return with another at Third Reading. I hope that they will not say that it is all in the guidelines. I have not read the guidelines, although other noble Lords may have done so. I only just made it to this place because the traffic was bad and it is raining in the south.

I am in a better mood tonight. I must say that last week I was very upset. It is the first time that I have heard any government say to those moving amendments in your Lordships' House that they will not agree because of some circular or guideline, whether published or not does not matter, produced by the department. In the past we have grumbled because the Government have said that there will be secondary legislation. It is a well known argument to which your Lordships are accustomed. However, at least we get a look at secondary legislation. It may be difficult to handle because we cannot amend it but at least it has to go through Parliament in one form or another. Departmental circulars are a fall-back position that strikes me as being incredibly weak. I commend to my noble friends that neither they nor any other government Ministers produce such an argument in the future.

The trouble with departmental circulars is that we do not have any control over their implementation. They do not have any bite from the point of view of local authorities which get so many thick great piles of direction and guidance. One can see them in any local authority. With the best will in the world, they cannot get through them. There is therefore a permanent excuse for not properly putting them into effect and no one can say to them that they are not doing what is written in the Act of Parliament.

I am sorry to spend time on this matter but I wanted to continue what I was saying last week when I was in a bad temper and could not say it properly. I hope that when my noble friends come back to this matter they will take up this amendment as something that needs to be in the Bill in some form or another. I hope very much that they will accept it.

Baroness Faithfull

My Lords, I want to support this amendment from the point of view of a director of social services to whom someone may come and request a service—for example, a person who is blind may want to have a special book. It would be quite impossible to run such a service in one's own local authority because it would be completely uneconomic when there are perhaps only a dozen such people to take into account. However, those people's needs are very great. Therefore one must have recourse to an office in London.

I cite that example because it is quite an outstanding service that enables blind people to be able to order and receive a book that has been prepared in London. That organisation has the most oustanding set of volunteers who translate books for the blind. There are many other examples of services which it would be quite uneconomic to set up in one's own area, even if it were possible to do so.

Secondly, from the point of view of local authority finance one cannot give money to a national organisation. Therefore, although the local authority makes use of such organisations, it cannot give them a grant from the local authority's coffers. There are many different organisations in that position. Therefore, I hope that the Minister will be able to accept this amendment.

Lord Swinfen

My Lords, I should like to associate myself with the remarks on guidance made by my noble friend Lord Mottistone, as I believe will most others who have taken part in various debates on this Bill. I approve of the general principles behind this amendment although I do not know whether the wording in detail is the best possible. I wonder what would be the position of an EC national working in this country, which will increasingly be the case after 1992, who will not be the direct responsibility of any local authority. Where will the money come from? Such people are just as likely to require community care as anyone else.

From my experience with John Groom's I know that when working in the area of one local authority it is difficult to obtain funds from other local authorities. In Edgware we have a home where we deal with about 30 individuals from that number of different local authorities. They have agreed to carry out negotiations with the local authority in whose area the home is situated. However, none of the authorities will receive a penny until the agreement has been reached. I would hope that a government organisation operating the system on a central basis would be a great deal more efficient and quicker.

Lord Milverton

My Lords, I am happy to support the amendment, which appears to be practical and reasonable. The Government should be able to accept it or, if it does not meet their wishes, find a way of accepting it in principle and putting it into practice.

Lord Peston

My Lords, in speaking to the amendment I had intended to concentrate entirely on general principles. However, I was most struck by the comments of the noble Lord, Lord Kilmarnock, about the experience of the Terrence Higgins Trust. One of the great anxieties in relation to such cases is that although the Government rightly say that they wish to safeguard taxpayers' funds and ensure that resources are used efficiently, they end up with a bureaucracy so complex that one wastes vast amounts of money on form filling. That is undoubtedly to the detriment of the service in which one is interested. The noble Lord's point is well taken.

As regards the general principles, the noble Lords, Lord Mottistone and Lord Swinfen, are right to worry about guidance and the problem of debating that. In this case we are perhaps more fortunate. Although it arrived in our hands only during the past half an hour, we have xerox copies of the draft guidance. Therefore, at least one or two of us have had a chance to look at it. Some of the draft guidance is sensible but that which corresponds to the subject that we are now discussing is, to say the least, unattractive. If noble Lords will bear with me I shall read out the exact wording in Caring for People; Implementation Documents, Draft Guidance; Assessment and Case Management. Paragraph 30 states: Where a user's needs appear to fall entirely outside the responsibility of the local authority it will usually be sufficient to refer the person to the appropriate agency and to notify that agency accordingly". That is a great collection of weasel words. The guidance says "appear to fall" rather than "fall". It uses the word "entirely" although it is difficult to define the kind of needs which will fall entirely in one place rather than another. It uses the words "it will usually be sufficient" rather than "it will be sufficient", and so forth. In terms of guidance the document is, to say the least, somewhat blurred. It reminds me most of the old Elizabethan poor law—if you can possibly persuade yourself that it is nothing to do with you, you can send the person somewhere else. That is not a principle upon which one would wish to base community care.

That leads to a logical question which concerns incentives. I see nothing in the community care section of the Bill or in the draft guidance which will make a local authority actually seek to do the job. All the incentives are the other way because if it seeks to do the job it will incur costs but no benefits. It has been pointed out to me that there is a logical contrast between the community care side of the Bill and the health side. On the health side of the Bill at least the money follows the patient. Therefore, if one has the patient one has the resources that go with him. However, on the community care side the money definitely does not follow the patient; only the problem follows the patient. The Government appear to have no degree of consistency in that regard.

It is a moderate amendment and one which either in this or a rewritten form the Government could accept. I have hurriedly searched the draft guidance document and, like the noble Lord, Lord Allen of Abbeydale, can find no definition of "ordinarily resident". The definition of the term is not obvious. Quite the contrary; it is obscure to say the least. From the way in which the Government are proceeding we shall end up without the effective use of resources. We shall certainly end up with potential litigation, which, as legislators, we should try to avoid. However, what finally matters are the people who are looking for community care. The one aspect that we do not appear to be achieving is effective community care. We could achieve that either with the amendment tabled by the noble Lord, Lord Allen, or, as the Government claim always to be more expert at drafting amendments, with an appropriate government amendment.

5.15 p.m.

Baroness Blatch

My Lords, I welcome references to the draft guidance, although we appear to be entering into criticism of it early in the day. The department will welcome any comments which noble Lords may make during the course of the document's circulation for consultation.

I understand the concern behind the amendment. As the noble Lord explained, they relate to voluntary organisations providing specialised services which draw their users from a wide area including some who are homeless. I agree that such voluntary organisations will be faced with a new situation when the new community care arrangements come into effect and will have to take steps to cope with it. I understand that the amendment is intended to help them but I do not believe that it will do so because it cuts across the way the new community care arrangements will work.

It may help if I explain that in more detail. First, everyone is ordinarily resident in the area of some local authority. If a person has no fixed abode he is reckoned to be ordinarily resident in the place where he happens to be when the need for services arises.

A number of fairly pointed questions were raised by the noble Lords, Lord Allen of Abbeydale and Lord Peston. In this context the place of an individual's ordinary residence is defined thus. In a House of Lords' case, Shah v. Barnet London Borough Council, 1983 (1 All England Law Reports 226), the noble and learned Lord, Lord Scarman, said (at page 235): 'ordinarily resident' refers to a man's abode … which he has adopted voluntarily … for the time being, whether of short or long duration". Therefore, even a short stay in a particular area can qualify as a place of ordinary residence.

If a person has no fixed abode he is reckoned to be ordinarily resident in the place where he happens to be when the need for services arises. Under the new community care arrangements the local authority where a person is ordinarily resident, and as I have explained there always will be such an authority, will be responsible for assessing and arranging community care services. This will entail the local authority entering into agreements with the providers of appropriate facilities. Thus it does not matter how few users the local authority has in any particular care category; it will still have to make arrangements to meet their care needs in the most appropriate way. This means that voluntarily organisations will have to deal with the local authorities which place people with them. If they wish to admit a user who will need local authority support to remain in the facility they must contact the local authority in whose area the user is ordinarily resident. In the case of a homeless person who arrives and applies for admission that could well be the authority within whose area the facility is situated.

I accept that that means voluntary bodies must adapt to a new situation. As with any area of change, there are bound to be some hiccups but I am confident that once the situation has settled down the advantages of the new arrangements for voluntary organisations and users alike will become evident.

Voluntary organisations and local authorities will have to evolve mutally acceptable ways of working. We discussed that in more detail in Committee in connection with services for people dependent on drugs or alcohol. However, I do not accept that in any of the cases instanced it will be impracticable for a voluntary organisation to secure appropriate funding for its services. Therefore, the amendment will have no effect.

At present I understand many voluntary organisations rely on income support payments. People who reside in various facilities will still be able to claim income support and housing benefit and, where care needs are not great, payments may cover the bulk of the cost. Thus, the need for additional funding from local authority sources may not be very great in every case.

As regards emergency admissions, voluntary organisations may be able to agree with local authorities that one authority should act on behalf of all of them. That brings me to my final point. The local social services must be locally financed. Grants made to voluntary organisations from central sources are usually restricted to the central administrative expenses of national organisations. Thus, the problem which the new clause seeks to address must be resolved locally. It would be quite impractical to administer centrally grants of the type envisaged. Accordingly, I do not believe that the new clause is compatible with our community care arrangements. Nor does it provide a practical solution to the problems of voluntary organisations which are best addressed through our proposed community care arrangements.

On voluntary organisation funding, I appreciate the difficulties which may arise when voluntary organisations seek funding, for example, for posts. Under our new arrangements the emphasis will be on providing care for people. The voluntary organisations will contract with the local authorities to provide services. Their staffing will follow the number of places which they are contracted to provide. I feel that in time that will prove to be a more straightforward way of proceeding.

The noble Lord, Lord Allen of Abbeydale, criticised my use of the word "sensible". What I intended was reference to the sensible organisation of voluntary bodies rather than sensible organisations.

Lord Allen of Abbeydale

My Lords, I was not criticising the use of the word "sensible". I was trying to find out what are the sensible arrangements.

Baroness Blatch

My Lords, I shall try to elucidate. Voluntary bodies will need to ensure that local authorities are aware of their services and the expertise which they can offer. There will be opportunities for them to do so as part of the planning process. As I have said, that will be mentioned when drawing up specifications for services. And there the voluntary organisations will play a role.

The noble Lord, Lord Allen of Abbeydale, was anxious about the closure of organisations. The aim is not that organisations should close. Our guidance makes it extremely clear that they will play a vital part in the future organisation of community care and, in particular, in ensuring that local authorities are aware of services and standards of care which they can provide in purchasing services. Indeed, I understand that local authorities will be very relieved to have organisations offering that sort of provision for what is very often a difficult client group.

The noble Lord, Lord Allen of Abbeydale, mentioned block contracts. Again, the emphasis is not on block contracts. The local authorities will need to select the appropriate form of contract for the services which they wish to purchase and in doing so they should consider the need for consumer choice, quality of service and value for money.

That the needs of those client groups should be met is very important. The fact that somebody is either sleeping under a bridge or wandering the streets is very much a matter for the local authority where that person is at the time.

Lord Peston

My Lords, what the noble Baroness said is terribly important. To clarify her statement on the Government's position, is she saying that "ordinarily resident" means exactly where you are at the moment? You do not have to establish any local connection other than that. Is she saying that that is what was said earlier and that that is what it means? Is she saying that all the other worries about establishing a local connection in other legislation will not apply to community care from now on?

Baroness Blatch

My Lords, yes. Where the person is ordinarily resident and is walking the streets of Lambeth, Blackpool or Manchester, the place where they are when the need arises is their place of residence. That local authority will have the responsibility of meeting the needs of that person. I hope that with that explanation, the amendment will be withdrawn.

Lord Carter

My Lords, let us take the example of a schizophrenic referred to by the noble Lord, Lord Mottistone. Let us assume that he is registered with one authority for the community charge but happens to be found in need of help in another authority. Will it be the duty of the second local authority to provide that help?

Baroness Blatch

My Lords, that is my understanding. A schizophrenic may well be suffering from amnesia and not know his identity or why he is in that place. If he has a particular need to be met, the authority in whose area he is is found must meet that need.

Lord Mottistone

My Lords, can my noble friend clarify further? I gave an example of an organisation which wishes to have a day centre. It is providing that service because, for all sorts of reasons, the local authority is not making provision. However, the people drawn into the centre come from many adjacent authority areas. Therefore, from the definition which we have been given, the people who attend the centre are resident in the area in which they live but are visiting a day centre in another local authority area. That situation does not seem to be answered by the definition of the noble and learned Lord, Lord Scarman. Therefore, it would be helpful if the noble Baroness could clarify the position.

Baroness Blatch

My Lords, I believe that we are speaking of two categories of people. There are those who are possibly vagrants and happen to be in a particular place because they have no other place to reside and therefore are nomadic and wandering about the countryside. There is another group of people for whom a local authority may buy in the services of a drop-in centre. Those people have a place of residence and are known in a particular area but their needs are best met by the local authority which will contract with the day centre or a particular provider of the services. In that case, money will change hands between the purchasing and providing authorities. We are talking about two categories of people: genuinely homeless, nomadic people in a particular place who have a particular need; and those who are properly registered, who have a home address but whose need is met by the local authority purchasing services across county boundaries.

Lord Swinfen

My Lords, before my noble friend sits down and purely for clarification, she said that if an individual is paying a community charge in one area and is found in need of community care in another local authority's area, the second authority would become responsible for paying. Surely if the person is paying the community charge in the first local authority, he must be resident there in order to be liable for that community charge. Therefore, the first local authority would be responsible for that individual. I believe that the noble Baroness was rather muddled.

Baroness Blatch

My Lords, I am not sure that I am muddled. We are confusing different categories of people. We began by discussing vagrants or schizophrenics who, at a particular moment, may not have a place of residence. In that case wherever they happen to be will be their place of residence. I believe that we are now talking also about people who pay charges, who have a home in another part of the country but who happen to fall ill or have a particular need while en route to somewhere else.

Perhaps your Lordships will accept that my answers refer to the first category of client. However, I must write to the noble Lord as regards a person who happens to be travelling but pays taxes and community charge and has a bona fide residence elsewhere, in order to confirm what is the position in that case.

The noble Lord, Lord Peston, pressed me on ordinary residence. He asked whether that was necessarily the last place of abode. I understand that in the case of an itinerant there would be no obligation on any authority which he may have visited previously. It is a fact, as regards an itinerant person, that wherever that person is when a need arises, the local authority will be obliged to meet the needs of that person.

Lord Peston

My Lords, perhaps I could assist the noble Barones by clarifying further what I said. A nomadic person was not what I had in mind. I had in mind someone who said, "I lived there but now live here. I do not want to be sent back there; I want to be dealt with here because this is where I am". I understood the noble Baroness to say that all that person had to do was to say, "I now live here and this local authority must take care of my needs". I am amazed to discover that the law is as she stated. I am no expert, and if she says that that is the law, I cannot argue. I just want to make sure that she knows what she is saying.

Lord Kilmarnock

My Lords, before the noble Baroness finally sits down perhaps she will explain how money can change hands if confidentiality is of the essence and the person seeking advice is not prepared to divulge his or her place of residence. That is the essence of walk-in services. What incentive is there for the local authority to provide such services in that case?

Baroness Blatch

My Lords, I am not sure that I can provide an answer to that question off the cuff. I can say, for example, that where a person has registered for and paid the community charge is not necessarily relevant. It will depend on where the person has decided to live when the need for the service arises.

If a person happens to go into a walk-in centre for the kind of confidential service and advice referred to by the noble Lord, my understanding is that there will be a requirement for confidentiality to be observed in that case. The service will therefore be met because the authority in which that person has chosen to be at that time will be under an obligation to meet those needs. If the service they are receiving is one where confidentiality is important, my understanding is that confidentiality must be observed.

Baroness Masham of Ilton

My Lords, before the noble Baroness sits down, can she say whether that situation is the exact opposite from the situation that will exist in the health service? Will that not cause great confusion?

Baroness Faithfull

My Lords, perhaps I may ask my noble friend whether the situation has changed. When I was a director of social services and there was a crisis involving a person, the authority where the crisis happened dealt with that person. If that person did not pay rates in that area, the authority was still bound to help that person but could claim from the authority where the rates were paid. That was always the method we adopted. Has it changed?

Baroness Blatch

My Lords, I have given a large number of answers with the leave of the House. The questions are coming thick and fast and we are making no progress on the Bill. Perhaps the noble Lords will be patient and allow me to answer their specific questions in writing.

Lord Allen of Abbeydale

My Lords, I am grateful to noble Lords from all sides of the House who have spoken in support of the amendment. I am also grateful for the fact that on this occasion we have not been told that it is all being dealt with in guidance. I said that there was nothing in the guidance. I have seen the paragraph to which the noble Lord, Lord Peston, referred, but did not understand it and it did not seem to me to be relevant to the topics we are discussing. It is certainly no solution.

I do not want to sound patronising. The noble Baroness has done her best, but the questions being fired at her and the difficulties being discussed demonstrate that there is no accepted definition of "local residents" for these purposes consistent with the definitions adopted for other purposes. The noble Baroness referred to the judgment of the noble and learned Lord, Lord Scarman. I suspect that if we proceed on our present path there will be many more court judgments that she will be able to quote in the coming years.

There are difficulties in the response of the noble Baroness. She spoke of involvement in planning. How can a London-based organisation become involved in planning with an authority in Newcastle? Will new clients be eligible for grant? They will come to the voluntary organisations; they will not be referred by local authority. They might come from Scotland, Ireland or, as has been pointed out, from Europe.

I can only interpret the answer of the noble Baroness as meaning that the Bill does not meet the problems clearly explained by others, if not by me. If the amendment or something like it—I am not wedded to the form—is not introduced, we shall be passing a sentence of death on a number of worthwhile voluntary organisations. If we are to pass a sentence of death, we had better do it in a formal way. I so move.

5.35 p.m.

On Question, Whether the said amendment (No. 171) shall be agreed to?

Their Lordships divided: Contents, 94; Not-Contents, 101.

DIVISION NO. 2
CONTENTS
Addington, L.	Davies of Penrhys, L.
Ailesbury, M.	Dean of Beswick, L.
Airedale, L.	Dormand of Easington, L.
Allen of Abbeydale, L. [Teller]	Ennals, L.
	Erroll, E.
Ardwick, L.	Ewart-Biggs, B.
Auckland, L.	Faithfull, B.
Aylestone, L.	Falkland, V.
Birk, B.	Fisher of Rednal, B.
Broadbridge, L.	Foot, L.
Brooks of Tremorfa, L.	Gallacher, L.
Bruce of Donington, L.	Galpern, L.
Carmichael of Kelvingrove, L.	Gladwyn, L.
	Graham of Edmonton, L. [Teller]
Carr of Hadley, L.
Carter, L.	Greenway, L.
Cledwyn of Penrhos, L.	Grey, E.
Clinton-Davis, L.	Halsbury, E.
Cocks of Hartcliffe, L.	Hampton, L.
Crook, L.	Hanworth, V.
Darcy (de Knayth), B.	Hatch of Lusby, L.
David, B.	Hirshfield, L.

Hollis of Heigham, B.	Oram, L.
Houghton of Sowerby, L.	Peston, L.
Hughes, L.	Phillips, B.
Hunter of Newington, L.	Pitt of Hampstead, L.
Hylton-Foster, L.	Prys-Davies, L.
Jeger, B.	Robson of Kiddington, B.
Jenkins of Hillhead, L.	Russell of Liverpool, L.
Jenkins of Putney, L.	St. John of Bletso, L.
John-Mackie, L.	Saltoun of Abernethy, Ly.
Kilmarnock, L.	Seear, B.
Kinloss, Ly.	Seebohm, L.
Kirkhill, L.	Stedman, B.
Lawrence, L.	Stoddart of Swindon, L.
Lloyd of Kilgerran, L.	Strabolgi, L.
Lockwood, B.	Swinfen, L.
Longford, E.	Taylor of Blackburn, L.
McFarlane of Llandaff, B.	Thomson of Monifieth, L.
McNair, L.	Thurlow, L.
Masham of Ilton, B.	Tordoff, L.
Mason of Barnsley, L.	Turner of Camden, B.
Milner of Leeds, L.	Walston, L.
Milverton, L.	White, B.
Molloy, L.	Williams of Elvel, L.
Morris of Castle Morris, L.	Wilson of Langside, L.
Mottistone, L.	Winstanley, L.
Northfield, L.	Young of Dartington, L.
Ogmore, L.

NOT-CONTENTS
Aldington, L.	Layton, L.
Alexander of Tunis, E.	Long, V.
Allenby of Megiddo, V.	Lyell, L.
Allerton, L	McColl of Dulwich, L.
Arran, E.	Mackay of Clashfern, L.
Balfour, E	Macleod of Borve, B.
Belhaven and Stenton, L.	Margadale, L.
Beloff, L.	Merrivale, L.
Belstead, L.	Mersey, V.
Bessborough, E.	Montagu of Beaulieu, L.
Blatch, B.	Montgomery of Alamein, V.
Blyth, L	Murton of Lindisfarne, L.
Borthwick, L.	Nelson, E.
Boyd-Carpenter, L.	Newall, L.
Brigstocke, B.	Norrie, L.
Brougham and Vaux, L.	Nugent of Guildford, L.
Butterworth, L.	Orkney, E.
Caithness, E.	Orr-Ewing, L.
Campbell of Alloway, L.	Oxfuird, V.
Carnegy of Lour, B.	Pender, L.
Carnock, L.	Penrhyn, L.
Cavendish of Furness, L.	Peyton of Yeovil, L.
Cawley, L.	Plummer of St. Marylebone, L.
Clanwilliam, E.
Coleraine, L.	Prior, L.
Colwyn, L.	Quinton, L.
Cottesloe, L.	Rankeillour, L.
Craigmyle, L.	Rees, L.
Crathorne, L.	Rodney, L.
Crickhowell, L.	Rodney, L.
Cullen of Asbourne, L.	Romney, E.
Davidson, V. [Teller]	Sanderson of Bowden, L.
Denham, L. [Teller]	Savile, L.
Eccles of Moulton, B.	Skelmersdale, L.
Eden of Winton, L.	Strange, B.
Elles, B.	Strathclyde, L.
Elliot of Harwood, B.	Strathcona and Mount Royal, L.
Fanshawe of Richmond, L.
Foley, L.	Strathmore and Kinghorne, E.
Fraser of Carmyllie, L.
Fraser of Kilmorack, L.	Swinton, E.
Gridley, L.	Terrington, L.
Hanson, L.	Thomas of Gwydir, L.
Harmar-Nicholls, L.	Thomas of Swynnerton, L.
Henley, L.	Trefgarne, L.
Hesketh, L.	Trumpington, B.
Hives, L.	Ullswater, V.
Hood, V.	Vaux of Harrowden, L.
Hooper, B.	Vinson, L.
Inchcape, E.	Wedgwood, L.
Johnston of Rockport, L.	Whitelaw, V.
Lauderdale, E.	Young, B.

Resolved in the negative, and amendment disagreed to accordingly.

5.44 p.m.

[Amendment No. 172 not moved.]

Lord Carter moved Amendment No. 173: After Clause 48, insert the following new clause:

("Local authority assessment of needs of disabled persons

.—(1) When requested to do so by—

1. (a) a disabled person,
2. (b) his authorised representative, or
3. (c) any person who provides care for him in the circumstances mentioned in section 8 of the Disabled Persons (Services, Consultation and Representation) Act 1986,

a local authority shall decide whether the needs of the disabled person call for the provision by the authority of any services in accordance with section 21 of the National Assistance Act 1948.

(2) Where a local authority are satisfied that in order to meet the needs of a disabled person it is necessary for that authority to make arrangements for any services referred to in subsection (1) above, it shall be the duty of that authority, with the consent of the said person, to make those arrangements.

(3) In this section— disabled person" and "authorised representative" have the same meanings as in the Disabled Persons (Services, Consultation and Representation) Act 1986. local authority" has the same meaning as in section 43 above.").

The noble Lord said: My Lords, this amendment was discussed in Committee and then withdrawn, but my noble friend Lord Ennals made it clear that we were not satisfied with the Government's response and would certainly wish to return to the matter on Report.

The purpose of the amendment is this. Currently, disabled people, or their representatives or carers, have a right to ask for an assessment of their need and for domiciliary services under Section 4 of the Disabled Persons (Services, Consultation and Representation) Act 1986. The local authority then has a duty to meet that assessed need. This new clause would give disabled people a right to ask for an assessment of their need for residential care and respite care and would therefore place a duty on local authorities to meet that assessed need. That is particularly important in view of the fact that the Bill passes to local authorities all responsibility for the arrangements for residential care.

We believe that without such a duty a two-tier system will be created with statutory rights for assessment to meet assessed need existing for some services—that is, the domiciliary services—but not for other services; that is, residential care and respite care. The amendment clearly states that the local authority, with the consent of the said person",

shall make the necessary arrangements. Therefore, it clearly establishes that people would not go into residential care against their wishes.

When we discussed this matter in Committee the noble Baroness, Lady Blatch, implied that the amendment would undermine the position of day care services by putting residential care and respite care on the same basis as day domiciliary services and that in some ways that would devalue the residential care and the domiciliary services. We cannot understand that argument. We strongly agree that community care is preferable to residential care, but this amendment simply gives people a right to ask for an assessment of their needs for residential or respite care if they want it. It is also vital that people have access to short-term residential or respite care in order that they may remain in the community.

We have already referred to the excellent report from the Social Services Committee in another place, Community Care; Carers. In the committee's conclusions and recommendations, paragraph 10 on page 27 of the report states: We recommend that in all areas there should be available the following, types of 'respite services'". It refers, among other services to: in-patient accommodation for longer periods and respite care for the most disabled people … hospice care for terminally ill patients; residential care and nursing home places near to the patient's home, with community health service support; placement with an alternative family and other types of placement schemes such as supported lodgings; overnight respite care".

Those are all areas where we feel a duty should be placed on local authorities to secure this form of assessment and meet this need.

The report continues: We believe that the Government should demonstrate its stated commitment to supporting carers by allocating additional sums to local authorities to enable new respite services to be developed where necessary".

As I said, we feel it is essential that it should be a duty on local authorities that residential and respite care, which are essential parts of the community care packages, are placed on the same basis as domiciliary services. I beg to move.

Lord Swinfen

My Lords, I very much support this amendment. With a disabled person living at home the strain on a family can be appalling. When someone needs to be taken to the lavatory more than once every single night, or perhaps has to be turned so that he or she does not develop pressure sores, or is generally disruptive to the rest of the family, particularly when there are children, there can be a danger of a breakdown in health of those who are caring and indeed a breakdown of the family itself.

Care in the community is, I understand, the cheapest method of caring for a disabled person. Full-time residential care is a great deal more expensive. Respite care, in particular, will often prevent a disabled person being forced into full-time residential care because it gives the family a much needed break.

I know from my own experience that at present many local authorities are extremely reluctant to pay for respite care. It appears to me the authorities would far rather see the family break down and the individual be forced into full-time residential care because they are not prepared to pay £1 now to save £10 later. That is ridiculous and pure short-sightedness. I strongly support the amendment.

Lady Kinloss

My Lords, I support this amendment. The majority of adults with mental handicap live with their parents, many of whom are frail and elderly themselves, and very much pressure can be put on them. Therefore, respite care is essential, but it is thin on the ground. MENCAP has found that of 475 adults with mental handicap and living at home, only 134 had any respite care. It is also necessary that a range of residential care is available for adults with mental handicap.

It is a relief for ageing parents to know that their son or daughter is safely and happily settled before a crisis point is reached. At this point some mentally handicapped sons or daughters may find that they lose both their parents and their home at the same time. Therefore, residential care should be a positive option and not a last resort.

Baroness Masham of Ilton

My Lords, I also support this very important amendment. The choice of the kind of respite care is very important. The problem of the AIDS tragedy has shown the need for respite care. In fact, some of the services now provided for AIDS patients are better than those available for people with many other types of disability.

Baroness Blatch

My Lords, this is an amendment that we discussed in some detail in Committee. The noble Lord and others have expressed the view that the purpose behind the amendment is to ensure that respite care would be available if this seemed the best way of meeting a user's need. One of the great hopes of the new system as opposed to the old one is that, where a local authority feels that it makes economic sense—a point made by my noble friend Lord Swinfen—it will be forced to consider respite care more seriously as a provision.

I recognise that respite care can play an important part not only in helping someone to remain in the community most of the time but also in giving his or her carer a much needed break. I agree that it should be available when needed. But I do not think that this amendment is required to secure that. The outcome of the needs-based assessment should be the provision of services which best meet those needs. The statutory requirement to provide day and domiciliary care is enhanced to reinforce this and not to restrict the range of care offered by authorities. I can assure your Lordships that we shall see that this point is brought out in our guidance to authorities.

The amendment we are debating goes a lot further than respite care and embraces all forms of residential provision. As I have said, that may not be helpful. I hold to the view expressed at Committee stage that this amendment is not necessary and places the emphasis on people being admitted into residential accommodation rather than exploring the alternatives. In the light of that explanation I hope that the amendment can be withdrawn.

Lord Carter

My Lords, that was the answer I expected and it is extremely disappointing. The noble Baroness said that she believed that local authorities would be forced to consider the matter. How can a local authority be forced to consider a particular issue if there is no statutory duty to do so? That is the whole point of the amendment; namely, that this measure should be placed on the face of the Bill so that the local authority has a legal obligation.

The noble Baroness appears to welcome the fact that a local authority will be forced to consider the matter, but she refuses to accept that without the amendment there is no element of force to make a local authority consider the issue. There will still be no statutory duty to assess and provide residential and respite care. The noble Baroness glossed over the matter by saying that the question was larger than the provision of respite care.

As we all know, the provision of respite care is essential to the success of community care. The noble Baroness said that the amendment was not helpful but she did not say why. Is it because the Government are concerned about the cost which might fall on local authorities? If that is it, they should say so.

I believe that the noble Baroness said that the amendment would mean that people could be forced into residential care. But it states that it will be the duty of the local authority, with the consent of the said person". In other words, nobody would be forced into residential or respite care if the amendment were accepted because the person would have to agree. All we are asking is that there should be the same duty on the authority as now exists in connection with the provision of domiciliary services and home services to assess and provide residential and respite care.

The answer was very unsatisfactory. Since Committee stage the Government have shown no movement at all on this matter or signs of even beginning to understand the problems. Therefore, I ask for the opinion of the House.

5.55 p.m.

On Question, Whether the said amendment (No. 173) shall be agreed to?

^*Their Lordships divided: Contents, 81; Not-Contents, 97.

DIVISION NO. 3
CONTENTS
Addington, L.	Dean of Beswick, L.
Airedale, L.	Dormand of Easington, L.
Allen of Abbeydale, L.	Ennals, L.
Ardwick, L.	Erroll, E.
Birk, B.	Ewart-Biggs, B.
Bonham-Carter, L.	Falkland, V.
Broadbridge, L.	Fisher of Rednal, B.
Brooks of Tremorfa, L.	Foot, L.
Carmichael of Kelvingrove, L.	Gallacher, L.
	Galpern, L.
Carter, L. [Teller.]	Gladwyn, L.
Cledwyn of Penrhos, L.	Graham of Edmonton, L. [Teller.]
Clinton-Davis, L. [Teller.]
Cocks of Hartcliffe, L.	Greenway, L.
Crook, L.	Grey, E.
Darcy (de Knayth), B.	Halsbury, E.
David, B.	Hampton, L.
Davies of Penrhys, L.	Hanworth, V.

Harris of Greenwich, L.	Phillips, B.
Hatch of Lusby, L.	Pitt of Hampstead, L.
Hirshfield, L.	Prys-Davies, L.
Hollis of Heigham, B.	Rea, L.
Hughes, L.	Robson of Kiddington, B.
Hylton-Foster, L.	Russell of Liverpool, L.
Jeger, B.	Saltoun of Abernethy, Ly.
Jenkins of Hillhead, L.	Seear, B.
Jenkins of Putney, L.	Seebohm, L.
John-Mackie, L.	Stedman, B.
Kilmarnock, L.	Stoddart of Swindon, L.
Kinloss, Ly.	Strabolgi, L.
Kirkhill, L.	Swinfen, L.
Lockwood, B.	Taylor of Blackburn, L.
Longford, E.	Thomson of Monifieth, L.
McFarlane of Llandaff, B.	Thurlow, L.
McNair, L.	Tordoff, L.
Masham of Ilton, B.	Turner of Camden, B.
Mason of Barnsley, L.	Walston, L.
Milner of Leeds, L.	White, B.
Morris of Castle Morris, L.	Williams of Elvel, L.
Ogmore, L.	Winstanley, L.
Oram, L.	Young of Dartington, L.
Peston, L.

NOT-CONTENTS
Aldington, L.	Lucas of Chilworth, L.
Allenby of Megiddo, V.	Lyell, L.
Allerton, L.	McColl of Dulwich, L.
Arran, E.	Mackay of Clashfern, L.
Balfour, E.	Macleod of Borve, B.
Belhaven and Stenton, L.	Malmesbury, E.
Beloff, L.	Mancroft, L.
Belstead, L.	Margadale, L.
Bessborough, E.	Merrivale, L.
Blatch, B.	Mersey, V.
Blyth, L.	Montgomery of Alamein, V.
Borthwick, L.	Moran, L.
Boyd-Carpenter, L.	Murton of Lindisfarne, L.
Brigstocke, B.	Nelson, E.
Brougham and Vaux, L.	Norrie, L.
Butterworth, L.	Nugent of Guildford, L.
Caithness, E.	Orkney, E.
Campbell of Alloway, L.	Orr-Ewing, L.
Carnegy of Lour, B.	Oxfuird, V.
Carnock, L.	Pender, L.
Cavendish of Furness, L.	Penrhyn, L.
Cawley, L.	Peyton of Yeovil, L.
Clanwilliam, E.	Plummer of St. Marylebone, L.
Coleraine, L.
Colwyn, L.	Prior, L.
Craigavon, V.	Quinton, L.
Craigmyle, L.	Rankeillour, L.
Crathorne, L.	Reay, L.
Crickhowell, L.	Rees, L.
Davidson, V. [Teller.]	Rodney, L.
Denham, L. [Teller.]	Sanderson of Bowden, L.
Eccles of Moulton, B.	Savile, L.
Eden of Winton, L.	Skelmersdale, L.
Elles, B.	Strange, B.
Elliot of Harwood, B.	Strathclyde, L.
Fanshawe of Richmond, L.	Strathcona and Mount Royal, L.
Fraser of Carmyllie, L.
Fraser of Kilmorack, L.	Strathmore and Kinghorne, E.
Gridley, L.
Hanson, L.	Swansea, L.
Harmar-Nicholls, L.	Swinton, E.
Henley, L.	Thomas of Gwydir, L.
Hesketh, L.	Thomas of Swynnerton, L.
Hives, L.	Trefgarne, L.
Hooper, B.	Trumpington, B.
Hunter of Newington, L.	Ullswater, V.
Johnston of Rockport, L.	Vaux of Harrowden, L.
Lauderdale, E.	Vinson, L.
Layton, L.	Wedgwood, L.
Lewin, L.	Whitelaw, V.
Long, V.

On Question, amendment agreed to.

[^*The Tellers for the Not-Contents reported 97 names. The Clerks recorded 98 names.]

6.2 p m.

Loud Allen of Abbeydale moved Amendment No. 174: After Clause 48, insert the following new clause:

("Authorised representatives

. Sections 1 and 2 of the Disabled Persons (Services, Consultation and Representation) Act 1986 shall come into force on the same day as section 48 above.").

The noble Lord said: My Lords, we have already discussed Section 3 of the 1986 Act. On this occasion it was the unhappy lot of the noble Lord, Lord Henley, to persuade us that the Government have been briskly active over a period of four years in implementing some parts of the 1986 Act. The Act received the Royal Assent on my birthday. That annual reminder of the passing years is always tinged with melancholy at the thought that yet another year has gone by without the Act being fully enforced.

Sections 1 and 2 raise a point quite different from that in Section 3, although there are consequentials. In Committee we had, rather late in the evening, what I fear was a not very satisfactory discussion on the amendment. Section 1 of the 1986 Act gives a right to a disabled person to have an authorised representative. Section 2 lays down the rights of those representatives. They will be unpaid. The local authority can, if need by, make arrangements for the appointment of a volunteer, probably by arrangement with a voluntary organisation. Without a right to representation the plain fact is that some of the disabled will be unable to have any say in how to live their lives. My noble friend Lord Henderson of Brompton and I tried to argue that this right is essential if Part III of the Bill is to be properly implemented. The persons we are talking about are those vulnerable disabled people—for example, the deaf blind—who have no relatives or carers to speak for them and are not really capable of speaking for themselves.

In Committee the noble Baroness, Lady Hooper, made what I thought was the rather surprising statement that these two sections, with Section 3, are the most complex and potentially the most expensive of all the provisions of the 1986 Act. I simply do not agree with her. Some administrative expenses would be involved in implementing Sections 1 and 2 but what those sections are essentially concerned with is the provision of unpaid voluntary representatives. MENCAP, for example, would be happy to arrange for a pool of such volunteers to be made available.

Reference was made in the earlier discussion to the rather leisurely approach made by the Government to the local authorities. That approach carried the suggestion that these sections, having waited for four years, might wait even longer, until the Bill and the Children Act had been put into force and had had time to settle down. I very much hope that, whatever the local authorities may say, the Government will think again. I was encouraged to note that this view was shared by the Select Committee on Social Services of another place. The Government's approach overlooks the fact that if there is representation the chances are greatly improved of achieving assessments which are more likely to be satisfactory to the individual and to the community and to be cost-effective into the bargain. That seems to fall exactly in line with what the White Paper and this part of the Bill aim to achieve.

I must not take up too much time but I should like to give an example. It concerns Mr. James—that is not his real name—who is in his early seventies and is partially sighted. His wife is in her late fifties and is deaf. Their daughter, who has a mental handicap, is in her late twenties and since leaving school has seldom been out of the house. She receives no benefits of any kind. Years ago the parents approached the social services for help but were so terrified when there was a suggestion by the mental health officer that their daughter should be taken away and put into an institution that they have had no further contact with social services and since that time have had no help whatsoever.

The daughter's continuing isolation has naturally increased her disabilities. In order to communicate with Mr. and Mrs. James one must first speak to Mr. James, who as I say is partially sighted, and his wife in turn, will lip-read what he says. They desperately need and want the support of an authorised representative who will deal with social services on their behalf and on behalf of their daughter. Without Sections 1 and 2 of the 1986 Act it is not clear that there are any arrangements for them to be represented.

We happen to know about the James family but one wonders how many families there are in a similar plight about whom we do not know. About 10 years ago the Government published a document entitled Mental Handicap: Progress, Problems and Priorities. It included this statement: The most important factor in safeguarding the position of vulnerable patients and ensuring their rights are upheld is personal contact between the patient and someone whose job it is to explain the position from the patient's point of view".

That is exactly what the amendment is aimed at achieving. If I may remind the House of a point made by the noble Lord, Lord Renton, on the earlier occasion, it is not an amendment to provide that these sections should immediately come into force; it is an amendment proposing that they should come into force on the same day as Clause 48 of the Bill. I beg to move.

Lord Carter

My Lords, I was very pleased to be able to add my name to the amendment. As usual the noble Lord, Lord Allen of Abbeydale, has explained the situation admirably. The amendment proposes that people with disabilities should be given a right to advocacy thus enabling any individual, regardless of his communication difficulties, to have a public voice. That is what Sections 1 and 2 deal with. We can all agree that the right to freedom of individual expression is fundamental. Most people take it for granted; but some people may not be able to exercise the right because of mental, sensory or physical disabilities. As the noble Lord said, without the right of representation some disabled people will be unable to have a say in how they live their lives.

The noble Lord mentioned the case of Mr. James and his family. We are all familiar with the tragic case of Beverley Lewis; so there is no need to go into detail. She received no education from the age of nine and simply starved to death at home because her mother neglected to feed her properly. The health authority, the social services department and the education department knew about Beverley's case; yet they failed to prevent her death. It was not until several weeks after her death that her mother was diagnosed as suffering from severe schizophrenia. There is just a chance that, if Sections 1 and 2 of the Act had been in force, the local authority could have appointed authorised representatives for Beverley and her mother. If the Minister refers to cost, I shall have to weigh up the considerations of cost against the other Beverley Lewises of this world and similar cases about which we simply do not know.

Lord Swinfen

My Lords, I rise to express my support for the amendment. If my noble friend of the Front Bench is proposing to reject the amendment on the grounds of cost, will he please advise the House just what the cost is: first, in financial terms; and, secondly, in terms of the cost to disabled people as regards their physical and mental welfare? I can see neither a logical nor a moral reason for rejecting the amendment.

Lord Ennals

My Lords, I can condense what I have to say into one sentence. In my view, it is utterly deplorable that here we are, four years after the Bill was enacted, having to ask that its provisions be implemented. That is terrible.

Lord Boyd-Carpenter

My Lords, I hope first that my noble friend will carry out the suggestion made by my noble friend. If he plans to reject the amendment—which I hope he will not—on the grounds of cost, he should state fully what the cost will be. Secondly, perhaps he will offer some answer to the rather difficult question of why, four years after Parliament enacted the measure, it has still not been put into force. If it was right four years ago—after all, it was carried by the same Government—can he explain why it is not right now?

Lord Henley

My Lords, I am not sure that I can take the House much further as regards Section 3 than I did when it was discussed on a previous amendment. As I explained in connection with that amendment, which was designed to bring Section 3 into force at the same time as Clause 48, it would be irresponsible for us to proceed to further implementation of the Act before our consultations with the local authority associations are complete. I said that we were pursuing the matter with all possible speed. I think I can also say that it was agreed with the local authority associations at an early stage that Sections 1, 2 and 3 should be considered together for implementation.

I have mentioned the letter which we received from the Association of County Councils on 12th June of this year in which it replied also on behalf of the AMA. The association stated that it is drawing up procedures for the operation of the outstanding sections and costing them accordingly. The association stressed that it would be happy to discuss such matters in time. I honestly do not think that I can take the matter further at present. With that consideration in mind, I hope that the noble Lord will feel able to withdraw his amendment.

Lord Boyd-Carpenter

My Lords, before my noble friend sits down, can he tell the House when the consultations which are not yet completed actually began?

Lord Henley

My Lords, I am afraid that I cannot answer that question. However, I can repeat the assurance I gave to the House as regards Amendment No. 170, which was moved by the noble Baroness, Lady Darcy (de Knayth). We will pursue these consultations with all possible speed. We have received a reply from the Association of County Councils, but we do not think that it would be responsible to continue at present until we have had further discussions with the associations.

Lord Ennals

My Lords, four years have elapsed since the enactment of the Bill. Therefore, how can the Minister say that the Government will proceed "with all possible speed"? I know that they have an agreement to take the implementation of all three sections together, but if they had wanted to implement them they would have been able to do so. I am sure that the local authorities would have been prepared to go along with them rather than see a four-year delay. The situation is really quite intolerable.

6.15 p.m.

Lord Henley

My Lords, as I said, we have already implemented considerable parts of the Act. The noble Lord will know that when the legislation was enacted, on the birthday of the noble Lord, Lord Allen of Abbeydale, we said that we would implement the sections when we could. However, we stressed at the time that there were financial implications. I shall continue to stress that point. We shall continue to discuss the matter. I have given the assurance that we will make all possible speed and that we will continue to discuss these matters with the Association of County Councils and the AMA. After that has been done, and at an appropriate stage, these sections can be implemented. I must stress again that we agreed that they would be taken together.

Lord Carter

My Lords, can the noble Lord confirm that the letter which was sent to local authorities was dated February or March of this year? In any event, that is three and half years after the Bill was enacted.

Lord Henley

My Lords, consultations began on 19th February. However, perhaps I may repeat what I said to the noble Lord. We have already implemented large parts of the Act. We always stressed that there were financial implications and we continue to say so. As I said, continued discussions are necessary with the local authority associations.

Lord Allen of Abbeydale

My Lords, perhaps I may begin by asking the noble Lord a question. I am sure that the leave of the House will be readily forthcoming to enable him to answer. He said that the Government will proceed with all possible speed in the matter. Does that mean that they have abandoned the idea of a postponement until this Bill and t le Children Act are operating and have settled down, as suggested by the letter sent earlier this year?

Lord Henley

My Lords, with the leave of the House I can only give the answer I gave earlier: we shall continue to pursue the matter with all possible speed. I hope that the noble Lord will accept my assurance on that point.

Lord Allen of Abbeydale

My Lords, I think that an assurance on those terms is not worth very much. I do not understand why we cannot have a simple statement from the Government that when the consultations are completed and the cost, which I accept is relevant, assessed, although the amount, I submit, would be very small, taking into account the savings referred to by the noble Lord, Lord Swinfen, this section will be brought into force. The lives of many people in this country continue to be miserable because of the absence of such powers.

I do not wish to divide the House yet again, but I should warn the Government that if these sections are not implemented soon there will be further parliamentary problems for them. Having said that, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 175 had been withdrawn from the Marshalled List.]

Baroness Darcy (de Knayth) moved Amendment No. 176: After Clause 48, insert the following new clause:

("Direct payments by local authorities for welfare services to disabled persons.

. Notwithstanding the provisions of section 29(6) of the National Assistance Act 1948, a local authority, having regard to any guidance issued by the Secretary of State, may make payments to a disabled person for the purchase of care or personal assistance services.").

The noble Baroness said: My Lords, this amendment would enable local authorities to make payments directly to disabled people so that they can make their own care arrangements and thus have a greater control over their lives. My noble friend Lady Masham moved this amendment in Committee to discover what progress the Government had made following an undertaking in another place by the Minister for Health to consider the proposal.

In his reply on that occasion the noble Lord, Lord Henley, said that consideration was still in progress and that if it was at all possible a government amendment would be brought forward at a later stage. I am moving this amendment again to try to elicit the latest state of play and also to ask the Minister a few questions.

I have a sense of déjàvu;. Does the Minister agree that the current situation is unsatisfactory? Despite the lack of legal clarity, several local authorities make payments to disabled people directly or via a third party. Disabled people also receive direct payments through the Independent Living Fund. Those arrangements work well, and there appear to be no undue complications.

A further question: the Spinal Injuries Association suggested in a letter of 8th March to the department that it could give details of successful schemes used by its members. Will the Minister ensure that there is a meeting between voluntary organisations, such as the SIA, and the department to try to resolve any difficulties? Thirdly, will the Minister clarify that it is at present lawful for a local authority to make payments to a disabled person via a third party, because there seems to be some confusion over the present state of the law?

Will the Minister say what is meant by a "third party"? If it is possible to allow payments through a third party, is there any reason why local authorities cannot allow payments to be made directly to the disabled person, who should surely be treated as being as responsible and accountable as the third party? The issue is one about which disabled people have strong views.

A direct payment scheme does not suit everyone as it requires an ability to deal with everything related to employing people; but it should be a possible option so that those who are agreeable and capable and who want to do so can take charge of their own lives. That is something that the able-bodied adult takes for granted.

One local authority that has made payments directly to individuals for more than 18 months said in a letter to my noble friend Lady Masham that there was clear evidence to show that making direct payments to disabled people to enable them to make their own care arrangements could work, and enhanced the quality of life afforded to them.

I hope that the Minister can clarify the existing legal position. If she has no positive news about a government amendment will she take a long, hard look at the matter before Third Reading. I beg to move.

Lord Ennals

My Lords, I strongly support the amendment. It is important that as many disabled people as possible, and as many as can cope, should have the independence to negotiate and be involved in their own packages. By "packages" we mean life enhancement. There is a great deal of support for that policy. It is a pity that the Government have not brought forward an amendment to deal with the issue.

I have looked at the views expressed by some of the organisations which have experience of this matter. The British Association of Social Workers recommends that all money for individual care programmes be paid directly to the individual to purchase the care that he or she needs. The Audit Commission report, Making a Reality of Community Care, published in December 1986, says that disabled people construct their own care packages and employ their own staff in a highly autonomous fashion. They effectively do their own joint planning. The Prince of Wales Advisory Committee on Disability and Living Options states: Client-directed services offer severely disabled people the greatest degree of control over the personal, domestic and social care support that they receive". It is extremely important that that provision should be facilitated. The Government have not tabled an amendment, and I therefore hope that they will accept this amendment.

Lord Swinfen

My Lords, I strongly support the amendment. Perhaps I may give two instances. One is of a man who is unfortunately now dead. He was paralysed from the neck downwards, but he was able to run his own life, hire and fire his own helpers and use his own social security benefits to that end, and manage his finances. He lived at home. He said that doing that considerably enhanced the quality of his life.

The other instance is of a young married couple who are both spastics. The wife is severely disabled. She needs about eight hours' care a day. The husband has considerable involuntary movement but can run his life with the aid of a computer, which he operates with his feet. They cannot obtain from their local authority a grant to help them live independently. However, they have a council house which was converted for them. The local authority pays the grant that it would like to pay to that disabled couple to a third party who, acting on their instructions, pays for the help that they need. The disabled couple interview and hire their own help. Without that £200, which is used for them by a rather roundabout and at present illegal route, they would be in a home.

If that couple were in a residential home it would cost the public purse—I am lumping together local authority and central government funds as one public purse—in excess of an extra £200 a week. The amendment would not just benefit physically handicapped and other disabled people, by giving them a greater responsibility for their lives, freedom and enjoyment—we all like making our own mistakes, and we have the freedom to do so, but disabled people are not allowed to risk making mistakes—it would benefit the public purse considerably. I can see no logical reason for the Government to reject the amendment.

Baroness Masham of Ilion

My Lords, this is, again, a commonsense amendment. The matter will be up to the local authorities. If the scheme did not work, they could stop direct payments. As has been said by the noble Lord, Lord Swinfen, the amendment would encourage responsibility, and that surely should be the Government's aim.

Lady Kinloss

My Lords, I support the amendment, which would enable local authorities to make payments directly to disabled people to buy their own care arrangements. As my noble friend Lady Darcy has said, such a scheme would obviously not suit everyone, as it requires an ability not just to deal with everything related to employing people but also to cope with the money. However, it should be an option that is open to everyone, as it would give a feeling of independence.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Hooper)

My Lords, we have always made it clear that the Government have a great deal of sympathy with the purpose behind the amendment. At an earlier stage we agreed to look positively at how and whether the Government could bring forward an amendment to meet that purpose, albeit initially on a limited or experimental basis.

A considerable effort has been made to achieve that purpose but Ministers have reluctantly had to conclude that we are unable to take powers to enable payments to be made directly to clients in that way. The difficulty hinges on the proper control of public expenditure and the need to ensure that the local authority is accountable for the expenditure it makes through having to maintain responsibility for arranging those services that it judges are needed and which it can fund.

There are of course other difficulties with the proposals. My honourable friend the Minister of State outlined them in another place. They included: determining which clients were suitable recipients; the bureaucracy required to run such a dual system; and avoiding abuse of the use of funds. In addition there are the difficulties to which the noble Baroness, Lady Darcy (de Knayth) referred. The sticking point is accountability for public funds.

In answer to the noble Baroness's three questions: first, as I have already said, we have considerable sympathy with the intention behind the amendment. Secondly, as the noble Baroness knows, I am willing to be involved in and to help to arrange a meeting, if that is felt necessary, between the voluntary sector and the department, as she suggested. As to payments via third parties, that is a complex issue. If the noble Baroness is agreeable, I shall write to her on that issue because the reply may have to be at some length.

6.30 p.m.

Lord Ennals

My Lords, before the noble Baroness sits down, does that mean that there could be consultation before Third Reading in the hope of some agreement on an amendment?

Baroness Hooper

My Lords, I am quite willing to have a meeting whenever it is convenient to other noble Lords.

Baroness Masham of Ilton

My Lords, before the noble Baroness sits down, would that mean that local authorities would still be accountable? If the scheme was not working, they could stop it. Surely they would still be accountable for the money.

Lord Swinfen

My Lords, would my noble friend consider putting in an independent individual to monitor such schemes? I am sure that the House will give her leave to answer.

Baroness Hooper

My Lords, I regret that I am not able to add anything to what I have said. It amounts to the fact that I cannot accept the amendment.

Baroness Darcy (de Knayth)

My Lords, I wish to thank all noble Lords who have taken part, and particularly the noble Lord, Lord Ennals, for his helpful intervention at the last minute. I thank the Minister for her reply, I know that she is sympathetic towards the amendment. She will not be surprised to hear me say that I was disappointed that she could not accept it. I appreciate that if she will have a meeting and talks perhaps we can achieve something before Third Reading.

I do not quite understand the worry over accountability. The Independent Living Fund makes payments direct to individuals and it has had no problems. A contract would be drawn up with the individual; care needs would be specified and the local authority would have the right to inspect the books. Perhaps too much is being made of the problem. Contracts will be the order of the day under the Bill and I do not see why one cannot draw up a contract with the individual disabled person, just as one would for the service provider.

Thanks to the intervention of the noble Lord, Lord Ennals, the noble Baroness has agreed to enter into discussions. I understand that that is without any firm commitment. I hope that we can convince her that accountability is not that much of a problem. I was somewhat disappointed that she could not state that it is now legally possible to pay money to a third party. Is that what she said? Perhaps she would write to me about the meaning of "third party". May I press her to say now that it is legal to make payments through a third party? I understand that I cannot do so, that is clear. I pin some hopes on the discussions but, in view of that indication of dissent, I must point out that disabled people feel passionately about this and we may well have to return to it at Third Reading. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 56, [Duty of local authority to make assessment of needs]:

[Amendments Nos. 177 to 179 not moved.]

[Amendment No. 180 had been withdrawn from the Marshalled List.]

The Minister of State, Scottish Office (Lord Sanderson of Bowden) moved Amendment No. 180A:

Page 61, line 22, at end insert: ("(4A) Nothing in this section shall prevent a local authority from providing or arranging for the provision of community care services for any person without carrying out a prior assessment of his needs in accordance with the preceding provisions of this section if, in the opinion of the authority, the condition of that person is such that he requires those services as a matter of urgency. (4B) If, by virtue of subsection (4A) of this section, community care services have been provided for any person as a matter of urgency, then, as soon as practicable thereafter, an assessment of his needs shall be made in accordance with the preceding provisions of this section.").

The noble Lord said: My Lords, this amendment has already been spoken to. I beg to move.

Lord Carmichael of Kelvingrove moved Amendment No. 181: After Clause 56, insert the following new clause:

("Scottish Community Care Inspectorate

.—(1) There shall be constituted a body to be called "the Scottish Community Care Inspectorate."

(2) It shall be the duty of the Scottish Community Care Inspectorate:—

1. (a) to monitor the provision of community care in Scotland; and
2. (b) to advise the Secretary of State on ways to improve the standard of community care in Scotland.

(3) The Secretary of State shall prescribe the constitution of the Scottish Community Care Inspectorate.").

The noble Lord said: My Lords, this new clause is designed to correct a long-standing omission in the framework for community care in Scotland by establishing an inspectorate to monitor the performance of local authorities and to ensure that good examples of community care are recognised and followed.

England has had a social services inspectorate as part of the Department of Health for many years. Throughout the debates on the Bill it has been repeatedly said by the Government that there was no need to write safeguards into the Bill because the social services inspectorate would monitor standards of service and inspection. That is at col. 29 of the Official Report for 14th May.

In Scotland the social work services group plays a limited central role in the Scottish Office but there is no equivalent of the English social services inspectorate. The usefulness of the inspectorate is also demonstrated in other areas. For instance, schools have an inspectorate and long-stay hospitals are monitored by the Scottish Health Advisory Service. It recently strongly criticised the provision for psychiatric patients.

The proposed inspectorate would be much wider in scope than the local authority's arm's length inspection units. Registration can only deal with individual establishments, as they arise. The inspectorate could look at the whole system of the delivery of community care in each local authority. It could examine whether the services offered were relevant to the actual users. It would monitor the effectiveness of the new case managers. It could also look at what services are not being provided. For example, several adult training centres for mentally handicapped adults now designate part of the week as being leisure and do not work with the trainees on these days. The theory is that the trainees will be occupying their time constructively elsewhere, but often the trainees are simply sitting at home. The inspectorate would also consider the adequacy of domiciliary and home care, which is not currently subject to any registration procedures.

The inspectorate would not only monitor services but would play a positive role in seeking out examples of good practice and innovation and ensuring that the principles behind them are made known and implemented throughout the whole of Scotland.

There is also a need to provide impartial guidance to the various statutory bodies: social work departments; health boards; housing authorities, etc., which have generally not worked well together in planning and delivering services. This is demonstrated in the report of the Scottish Working Group on Care in the Community, most aptly called, Stop … Start … Stutter!

There would be less need for this clause if the Scottish Office had taken the positive role adopted by its counterparts in England and especially in Wales. Examination of the Scottish chapter in the White Paper, Caring for People bears out the suspicion that the Scottish office has no clearly articulated policy for community care. In joint planning it has abandoned attempts to make local authorities and health boards work together. In many cases it appears to have abdicated its responsibility to produce guidelines for the registration of services, leaving it up to the Association of Directors of Social Work to produce guidance for residential homes and failing altogether to provide any guidance for day care centres.

If the Government do not accept this clause, they must surely explain why the social services inspectorate is a vital part of community care in England but is not necessary in Scotland. They must explain how they propose to provide in Scotland the strong central strategy that Sir Roy Griffiths rightly identified as being necessary if community care is to be more than merely a slogan. I beg to move.

Baroness Faithfull

My Lords, I support the noble Lord, Lord Carmichael of Kelvingrove, having been an inspector in both the Home Office and the Department of Health. I have also, as a director of social services, been inspected. So I have had the experience of an inspectorate from both points of view.

In England and Wales the inspectorate was abolished in 1970 and was turned into an advisory service and not an inspectorate. It was then found that there was a great gap in maintaining standards throughout the country. The inspectorate was brought back again about three years ago, so in England and Wales the inspectorate was found to be a necessary adjunct to good practice.

The noble Lord, Lord Carmichael, made many points. Perhaps I may reinforce them. First, on the question of spreading good practice throughout the country, when I was an inspector and visited in one area I came across very good practice but when I visited another authority I found that it had not implemented that good practice. Thus one was able to make an exchange of views and ideas and spread good practice throughout the country. Furthermore, through the inspectorate it was possible to have uniform and consistent policies throughout the country and to maintain high standards. A number of my staff used to look forward to the inspections because they felt that every now and then it was psychologically very good to have someone from outside the local authority coming to look at their work.

Another very important factor was that the inspectorate was able to bring into the department ideas it had picked up in the country. The inspectorate was able to act as a bridge between the administrators, who very often did not get out much, and what was going on in the country. It seems to me most extraordinary that although Scotland is ahead of England and Wales in its social and penal policies in this one area it lags behind. Therefore, I strongly support the amendment and hope that the Government will be able to accept it.

Baroness Masham of Ilton

My Lords, my Scottish blood advises me to support the amendment. With so much change and the need for accountability it seems wise and useful to have an inspectorate. An inspectorate can advise and pinpoint needs. It can prevent money being wasted and encourage people when they are doing a good job. I should like to ask why Scotland has not had an inspectorate during all these years.

6.45 p.m.

Lord Sanderson of Bowden

My Lords, I shall be delighted to answer the noble Baroness in due course. I thank the noble Lord for introducing this amendment, which I think should have been reached at an earlier stage. We did not have an opportunity to debate it before.

The new clause seems to be based on the belief that it is necessary for the Secretary of State to set up a new organisation in order to discharge his role in the central monitoring arrangements described in paragraphs 5.25 to 5.27 of the White Paper Caring for People. As the White Paper makes clear, the statements of intent which appear throughout chapters 1 to 8 are related specifically to England but will have a more general application in practice unless there is some specific reason to the contrary. The references to the Social Services Inspectorate in that part of paragraph 5 which I have just mentioned are specifically related to England, as the context makes clear. They could not apply to Scotland because there is no precise equivalent of the Social Services Inspectorate there, as has been said.

What we have in Scotland instead—and I hope to persuade my noble friend that we are not lacking in imagination in how to go about these things—is a central corps of social work advisers who operate as professional staff within the social work services group of the Scottish Education Department. Those officers are responsible for advising the Secretary of State on professional issues relating to the development of the whole range of social work services. They also have informal responsibilities for work with local authorities and voluntary bodies on particular aspects of service development, and carry out specific inquiries and other projects which equate with some of the work now done by the Social Services Inspectorate in England. Like the English inspectorate, our arrangments are non-statutory.

I can assure your Lordships that the lack of any specific reference in chapter 10 of the White Paper to Scottish intentions in regard to the monitoring of community care development should not be seen as having some special significance. As is clearly stated in chapter 10, we also see a need for central monitoring of the community care plans which are to be prepared by local authorities. Paragraph 10.9 is quite specific about the Secretary of State's intentions to call for reports from local authorities in connection with progress in implementing these plans and to examine different aspects of community care.

It will not be a desk exercise. We fully intend that professional and other social work services group staff should pay visits to local authorities for that purpose, and we are giving consideration to the role of existing professional staff which may need to be adapted to meet such needs. Local authorities will be closely involved in the development of the new arrangements.

At this stage we do not think it necessary to form a separate group of advisers dealing with community care questions and to give them a different status from their colleagues who are concerned with other professional social work issues, including matters relating to child care, the staffing of social work departments, or training needs—all of which are concerns for existing social work services group professional staff. The Social Services Inspectorate in England is not divided in that way and, given the smaller scale of operations in Scotland, the case for doing so there would be even more difficult to justify. I understand the noble Lord's wish to proceed as in England. The question of employing existing social work advisory staff within the social work services group to contribute more directly to the objectives of chapter 5 of the White Paper on achieving high standards of care is already being addressed.

I come now to the specific points which have been made in the course of this debate. The noble Lord raised the question of adult training centres not being used to best effect. We have looked closely at the future of adult training centres by funding a major research work. It is certainly not a situation which we simply accept. We are always looking for improvements and new developments. After all, coma unity care is a developing science.

The noble Lord also spoke of joint planning not being effective at present. We have always accepted that the existing system of joint planning was not universally successful, although it had some notable successes. We are moving forward with a new planning system. The local authorities will now have clear lead responsibilities. As to the noble Lord's rather unkind reference to the Scottish Office not having a community care policy, the simple answer to community care policy in Scotland can be found in chapter 10 of the White Paper, just as it can be found for England and Wales in a similar manner.

I hope that, on reflection, the noble Lord will agree that the clause is unnecessary in seeking to create a separate organisation of the kind proposed purely to deal with community care, and that the best approach meanwhile will be to redeploy existing staff in a more limited way along the lines I have suggested.

Baroness Faithfull

My Lords, my noble friend the Minister talked about more informal consultative methods. Does he not agree that such informal consultative methods did not work in England from 1970 to 1977? Does he not think that a more structured inspectorate is going to set a better standard throughout the country?

Lord Sanderson of Bowden

My Lords, the answer is that I do not think so as regards Scotland at this stage. We feel our integrated approach is the best way forward for us. There is a difference between England and Wales and Scotland, as I have tried to make clear. I understand that my noble friend has a great deal of experience in this field. Perhaps I may talk to her afterwards. She may like to come and see how it is done in Scotland, and inform herself as to whether we are doing it as well as we could. There is always room for improvement but we think that the way we are taking it forward is the right way.

Baroness Masham of Ilton

My Lords, before the noble Lord sits down finally, perhaps I may ask him whether the White Paper is going to be a kind of working reference for the future.

Lord Sanderson of Bowden

My Lords, yes indeed. The White Paper Caring for People, and specifically Chapter 10, is a working paper for the future and something on which we shall base our judgments.

Lord Carmichael of Kelvingrove

My Lords, I am grateful for the support for the amendment from the noble Baronesses, Lady Faithfull and Lady Masham, both of whom have a great deal of experience in this field. In particular the noble Baroness, Lady Faithfull, as she put it, has been both an inspector and inspected. That is quite a record.

The Minister, as always, was very helpful. I shall need to read with great care what he said, but he appeared to say "We have all of this but we call it something different".

The amendment was put forward by people who are involved in this work on a daily basis. They do not look at the matter in the same way as the Minister. The SWSG has a job to do and does it, within its limits, extremely well. However, it appears that it is being given a role which is greater than was originally envisaged.

I shall study with great care what the Minister had to say. He genuinely tried to reassure us. I believe that it would be good for the Scottish SWSG if the Minister followed up his suggestion and had a talk with the noble Baroness, Lady Faithfull, on the matter.

Lord Sanderson of Bowden

My Lords, with the leave of the House, before the noble Lord sits down, I should like to assure him that the role of the SWSG will be strengthened in the future.

Lord Carmichael of Kelvingrove

My Lords, that is an important point. Perhaps we shall have an even stronger inspectorate but under a different name. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 49 [Inspection of premises used for provision of community care services]

[Amendment No. 182 not moved.]

Baroness Hooper moved Amendment No. 182A: Page 53, line 31, after ("premises") insert ("and the facilities and services provided therein").

The noble Baroness said: My Lords, the amendment fulfils an undertaking that I gave at Committee. Amendment No. 182A makes it clear that the persons inspecting the premises under Clause 49 can also inspect the facilities and services provided in them. I believe that that entirely meets the proper concerns expressed by your Lordships. I beg to move.

Lord Kilmarnock moved Amendment No. 182B: Page 54, line 12, after ("records") insert ("or other records identifying an individual's medical status").

The noble Lord said: My Lords, Clause 49 of the Bill as it stands allows: Any person authorised by the Secretary of State", access to: such information as he may request", from any person employed in premises where community care services may be provided. The clause is quite draconian in that respect, but an exception is made in subsection (5), which states that: No person may … exercise the power conferred by subsection (2)(b) above so as to inspect medical records … unless he is a registered medical practitioner". After the words "medical records" the amendment would add the words: or other records identifying an individual's medical status".

This is an issue of confidentiality. As it stands the Bill would appear to allow social services inspectors access to information about clients in community care facilities which could create considerable anxiety among inter alia people with HIV or AIDS. Noble Lords may be aware that unless confidentiality is guaranteed many people with HIV and AIDS may be deterred from seeking local authority services. People with HIV and AIDS needing assistance already contact voluntary organisations in the first instance because they believe that local authorities are lax or careless in maintaining the confidentiality of people with HIV.

It is well known that people with a history of illegal drug use, many of whom may have been unwittingly infected with HIV, are notoriously reluctant to contact statutory services because of anxiety about confidentiality. Women with HIV, especially those with children, are also very concerned to protect themselves and their children from the social hostility and discriminatory behaviour that may ensue if their HIV status becomes known.

In making HIV antibody testing available at GUM clinics, where special measures to protect confidentiality are required by law—and I refer to the National Health Service venereal diseases regulations of 1974—the Government have recognised the principle that confidentiality must be an essential component of HIV and AIDS services if people with or at risk of HIV infection are to be encouraged to come forward for testing, advice and care. It should not be necessary for the purposes of inspection under the provisions of this clause of the Bill for inspectors to know the medical status of named individuals. The purpose of such inspections, as set out in paragraph 5.24 of the White Paper Caring for People, states: The Department of Health proposes to issue further guidance for registration and inspection staff on the conditions to be expected in a good home … It will give a special emphasis to assessing the quality of care provided and the quality of life of residents as well as physical conditions".

Those seem to be perfectly acceptable objects of such inspections. To achieve those objects it seems to me to be quite unnecessary that an inspector should have access to information which may be held not only on medical records, which are excluded by the Bill, but also on social work records and possibly on the records of voluntary organisations. In order to close that loophole I have sought to insert in the Bill the words which appear in the amendment. I beg to move.

Baroness Masham of Ilton

My Lords, I should like to support the amendment. It seems very sensible.

Baroness Hooper

My Lords, I agree that access to medical records should be very tightly controlled to prevent them falling into the wrong hands. That is a very well-established principle in health care management. That is why Clause 49(5) prohibits anyone other than a registered medical practitioner from inspecting medical records during the course of an inspection.

The amendment, however, goes rather further. It would extend the restriction to any record which identifies an individual's medical status. Much as I understand the concern underlying the amendment, it could do more harm than good. We are not talking of the dissemination of detailed medical records; simply of documents which may refer, in broad terms, to the patient's condition. It might often be very important for non-clinical staff carrying out inspections, such as social services inspectors, to know in very general terms a user's medical status. I am concerned that in taking the very important principle of confidentiality to this extent the amendment might in some cases inhibit the proper inspection of services. In the light of that information, I hope that the noble Lord, Lord Kilmarnock, will feel persuaded not to press his amendment.

7 p.m.

Lord Kilmarnock

My Lords, I am not persuaded. We have agreed that medical records per se are exempted from inspection under the Bill because, as I have explained, there are other types of record on which the HIV status of the resident of a home or the receiver of day-care services or whatever it may be can also be held. I refer to social work files and, I dare say, the files of some voluntary organisations. I cannot understand why it should conceivably be necessary for the inspectors to know that in carrying out the type of inspection which is described in the White Paper and to which I referred.

The deterrent effect on people who, rightly or wrongly, fear that their status may be revealed and cause discrimination against them could be considerable, so I do not accept the explanation of the noble Baroness. However, I shall certainly read it just in case I can put some other gloss on it, but if I am unable to do so I shall almost certainly return to the matter on Third Reading. In the meantime, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 50 [Transfer of staff from health service to local authorities]:

Baroness Hooper moved Amendment No. 182C: Page 54, line 43, leave out ("when a person") and insert ("if a person declines an offer of employment made with a view to such a transfer or return as is referred to in subsection (1) or subsection (2) above and then").

The noble Baroness said: My Lords, this technical amendment is necessary to give proper effect to Clause 50. I beg to move.

Clause 51 [Powers of the Secretary of State as respects social services functions of local authorities]:

Lord Allen of Abbeydale move Amendment No. 183:

Page 55, line 20, at end insert: ("(3) Before issuing any direction under this section, the Secretary of State shall consult organisations representative of social services authorities").

The noble Lord said: My Lords, when we reach Clause 51 we depart from community care and, as the noble Baroness, Lady Hooper, made clear, start to deal with the social services functions of local authorities in a wider sense, including, for example, their responsibilities in relation to children and the mentally disordered—all that notwithstanding the Short Title of the Bill.

It seems to me quite wrong that the clause should be in a part of the Act under the heading which noble Lords will find before Clause 47; namely: General provisions concerning community care services".

Whatever Clause 51 may be, it is not a general provision concerning community care services. As my noble friend Lord Henderson of Brompton pointed out in Committee—and he is no mean authority—it raises the question of whether the Long Title is defective. Although in the Long Title power is taken to amend various named Acts, there is no reference to the Local Authority Social Services Act of 1970 which is amended by this clause. There is no doubt some good explanation from the experts, but it would be agreeable to have it on record. I have heard nothing from the Government since those points were raised in Committee, but that is not an experience entirely without precedent.

On the amendment itself, the explanation given by the noble Baroness confirms that this is an important clause, adding as it does extensive new powers of direction from the centre to the provisions which already exist in the 1970 Act about issuing general guidance. It represents a significant change in the relationship between central and local government. When the point was taken that there should be consultation before those new centralised powers were exercised, the noble Baroness said: Before issuing general directions, I have no doubt that the Secretary of State will consult local authority associations and other bodies in the customary way".—[Official Report, 14/5/90; col. 96.]

However, the provisions in the Bill are not limited to general directions. Although the noble Baroness is in no doubt, we think that in view of the significant and far-reaching addition to the powers of central government which this provision embodies it would be right to spell out the requirement for consultation on the face of the Bill. I beg to move.

Lord Peston

My Lords, perhaps I may speak briefly to this amendment which stands in the names of the noble Lords, Lord Allen of Abbeydale and Lord Henderson of Brompton, and of my noble friend Lord Carter.

I cannot follow the noble Lord, Lord Allen, on the esoterica of the Long Title or anything of that kind. I am looking forward to an explanation of those fundamental matters. However, on the substantial amendment, it seems to me very straightforward and the very least exposes the difference between the Government and the rest of us. Any rational Secretary of State would certainly consult organisations representative of social services authorities. That goes without saying. However, one does not write legislation simply on the assumption that the Secretary of State is always rational and sensible. One writes legislation on the basis of what is itself rational and sensible. As this is a straightforward requirement, the obvious way to deal with it is not to worry about guidance, regulations or guidelines but to put it on the face of the Bill. It is with great pleasure that I support the amendment.

Lord Harmar-Nicholls

My Lords, I am always a little disturbed about these kinds of amendments. You either have faith that the Secretary of State, whoever it is, is competent to give the direction that the Bill enables him to give or you have not. It has been suggested that you cannot anticipate him having the good sense. I believe that the noble Lord, Lord Peston, used the word "rational". Surely we must presume that we are passing legislation and that the people who have to operate it will be rational people. You cannot anticipate irrational people holding high offices of state.

Lord Peston

My Lords, with permission, perhaps I may say to the noble Lord that if everyone was rational we would not need any legislation. It would all happen automatically. As I understand it, the point of writing legislation is to make people do the right thing.

Lord Harmar-Nicholls

What a sceptic the noble Lord is. Although everyone is not rational, one presumes that someone who has gone through the sieve of being elected is likely to be as rational as you would want him to be when you gave him the power. I believe that the amendment is unnecessary.

Baroness Hooper

My Lords, we are at Report stage. The Long Title refers clearly to the social services functions of local authorities. The clause is therefore within the Long Title of the Bill and the rules of relevance.

First, general directions will normally be issued as part of a circular. It is well established and usual practice for local authority associations to be consulted before any circulars are issued unless they are of a purely routine nature. I can assure your Lordships that there will be such consultation and that the practice is so well-established that it does not need to be written into legislation.

Secondly, there are specific directions to an individual authority. They will normally be issued where a local authority is failing to deliver its services, often as a preliminary to default action. The issue of such directions is essentially a matter between the Secretary of State and the authority. I do not think that it would help matters—indeed, it could be a positive hindrance—if the Secretary of State had to consult the local authority associations before issuing directions in those circumstances. Finally, it might be necessary on very rare occasions for directions to be issued as a matter of urgency and again a requirement to consult the local authority associations might be an impediment to speedy action.

For those reasons the amendment appears to be either not required or to be positively unhelpful. I hope that on that basis the noble Lord will withdraw it.

Lord Allen of Abbeydale

My Lords, I should just point out to the noble Lord, Lord Harmar-Nicholls, that the statute book is littered with requirements for consultation. There is no novelty about this proposal. I was very disappointed in the reply about the Long Title. At Committee we took the point that the Long Title referred to social services. If that is enough, why does one need to refer to the national health Acts? Why does one not say in the Long Title: "To extend the powers of the Secretary of State over national health"?

I am disappointed that we did not have a rather more technical and professional explanation. It was not a point that I myself took originally. I am sure that we all defer to the great wisdom of the noble Lord, Lord Henderson, in this area. I am sorry that the point which he took in all solemnity has been so light-heartedly brushed aside. Nor has the noble Baroness referred to the point that I made about the subheading in the statute, which, even with all the ingenuity supplied by her civil servants, I think she would find very hard to defend. I understand that under our procedures we are not allowed to tinker with marginal headings but I hope that the point will be borne in mind for the next print of the Bill.

Her reply on the merits of the amendment comes as no surprise. Although I am not satisfied with it, I am not prepared to continue with the matter at this stage of the evening. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

The Deputy Speaker (Lord Grantchester)

My Lords, I must tell the House that, if we agree to Amendment No. 183A, I cannot call Amendments Nos. 184 to 187.

Baroness Hooper moved Amendment No. 183A:

Page 55, line 24, leave out from ("them") to end of line 45 and insert ("by a qualifying individual, or anyone acting on his behalf, in relation to the discharge of, or any failure to discharge, any of their social services functions in respect of that individual.

(2) In relation to a particular local authority, an individual is a qualifying individual for the purposes of subsection (1) above if—

1. (a) the authority have a power or a duty to provide, or to secure the provision of, a service for him: and
2. (b) his need or possible need for such a service has (by whatever means) come to the attention of the authority.").

The noble Baroness said: My Lords, this amendment has already been spoken to. I beg to move.

Lord Seebohm

My Lords, when I brought forward Amendment No. 168A about complaints, we were persuaded by the noble Lord, Lord Henley, that there was sufficient provision for complaints without any additions in the Bill. This amendment drives a horse and cart right through that statement. In the Bill as it now stands, Clause 51, Section 7B states: The Secretary of State may by order require local authorities to establish a procedure for considering any representations (including any complaints) which are made to them with respect to the discharge of their social services functions made by or on behalf of … [inter alia] any person whose request for such a service has been refused by the authority". I cannot see that provision in this amendment. It seems to me that that is now completely abolished. Is it the intention that nobody should ever be able to complain that he has not received service or assessment?

Lord Mottistone

My Lords, I find this discussion very difficult because Amendment No. 183A was grouped with Amendment No. 164B on Thursday and no provision was made by those who made the grouping—they are perhaps the ones to take note—to include at that time Amendments Nos. 184 to 187, which now cannot be called. I shall not be able to make a long speech about my Amendment No. 186, but I should like to say briefly that the section as drafted now, before Amendment No. 183A is considered, will not enable many private carers taking responsibility for those with schizophrenia to make representations to their local authority about the services which they have a power or duty to provide.

I should like to continue speaking but I do not think it is quite right to do so in view of what has happened. All I can say about Amendment No. 183A is that it makes even worse the bad situation which my amendment sought to correct. I plan to write to my noble friend, saying what I would have said if I had not been pre-empted. I hope to get a very coherent reply from her.

Lord Carter

My Lords, I am in exactly the same position as the noble Lord, Lord Mottistone. My amendments, Amendments Nos. 184, 185 and 187, have now been pre-empted. Obviously this is a very unsatisfactory situation. We have a number of anxieties about the revisions which have been made to the complaints procedure. I think it best to discuss this matter after this stage of the Bill to see whether we can do anything at Third Reading or at least have a letter from the Minister to explain and answer our concerns.

Lord Swinfen

My Lords, I hope that my noble friend will be prepared to reconsider her amendment and if necessary come back at Third Reading with other amendments to make certain that we cover people such as schizophrenics as well as others who have disabilities with long periods of remission when they may not need any help but with whom the disease recurs quite suddenly.

Baroness Hooper

My Lords, as my noble friend Lord Sanderson explained when speaking to the original grouping, this amendment is designed to increase the scope for complaints. It does not rule out complaints by or on behalf of clients by carers. Instead, it allows for complaints at any stage of the assess Tent process.

I am assured that this amendment takes into account the various points that were raised earlier at Committee stage. However, I shall be happy to follow up the suggestion to enter into correspondence if that will help my noble friend Lord Mottistone.

On Question, amendment agreed to. [Amendments Nos. 184 to 187 not moved.]

7.15 p.m.

Baroness Masham of Ilton moved Amendment No. 138: Page 56, line 11, after ("held") insert ("upon representation or").

The noble Baroness said: My Lords, I shall speak to Amendments Nos. 188 and 188A. In this case I wish that the Minister had been able to speak first. It might have saved me some time in thanking her. I think that her amendment is perhaps better than mine, although I am just not sure about it. I wish that she had spoken first. However I think that we shall be pleased to accept her amendment. I can then withdraw mine. I beg to move.

Baroness Blatch

My Lords, I am more than happy to oblige the noble Baroness. As I said at Committee stage, we shall take this anxiety away and see whether the wording of the Bill can be amended. I shall be happy to move the amendment standing in my name, which inserts words into the new Section 7(c) of the Local Authority Social Services Act 1970 similar to those at present appearing in Section 32 of the National Assistance Act 1948, which is to be repealed by the Bill. I hope that your Lordships will find that reassuring.

The amendment moved by the noble Baroness, Lady Masham, does not make totally clear that the decision whether or not to hold an inquiry, even if representations are received, must in the end rest with the Secretary of State, although I agree it does not impose an unconditional obligation upon him. In the light of what the noble Baroness said, I believe that she will be happy to accept the government amendment and I hope that she will feel able to withdraw her own amendment.

Baroness Masham of Ilton

My Lords, I am very grateful to the Minister and I accept her amendment. I just wish that the Governement had been able to take a few more of our amendments away and do the same with them. We should then have saved a lot of time and made a lot of people outside this House much more confident and happy.

Lord Ennals

My Lords, having been so critical of the failure of the Government to move, and since my name is on the amendment, I thought I should speak. I am grateful on this particular occasion.

Baroness Masham of Ilton

My Lords, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Baroness Hooper moved Amendment No. 188A: Page 56, line 11, after ("where") insert ("whether on representations made to him or otherwise").

The Viscount of Falkland moved Amendment No. 189: Page 56, line 40, at end insert ("and persons who are presently or recently have been dependent on alcohol or drugs.").

The noble Viscount said: My Lords, as those of your Lordships who were present at previous stages of the Bill will know, this amendment makes it possible for the Secretary of State to make grants for the residential treatment of drug addicts and those who are dependent on alcohol and drugs. The reasons are well rehearsed and I do not propose to go over them again.

I admit that the Government have stated that they are fully aware of the problems of alcohol and drug addicts. They have taken account of that in the Bill and that has been a step forward. However, the fact remains that local authorities throughout the country have an uneven record of acknowledging the need for the treatment of such people. An account in today's Daily Mail states that several industrial companies in the Midlands have decided to institute treatment which they will finance. The courses will run for 30 days at a treatment centre in Birmingham of which I know little. They believe that, because through treatment people can be made productive citizens, it is economically sensible to treat them rather than to dismiss them and go to the expense of engaging new people. In my view and in that of the voluntary agencies, that approach holds good in the country at large.

An undertaking that the Government will step in if local authorities do not fulfil their obligations to alcohol and drug addicts is not good enough. During the interval a number of treatment centres will close, which will create an intolerable situation. I propose to go no further than that. Such a provision in the Bill will deal with the problem. I cannot understand why the Government have not yet acknowledged the seriousness of the situation which demands an amendment of this kind. I beg to move.

Lord Ennals

My Lords, I support the amendment. On the third day of the Report stage I spoke at length about the problems that would be faced in the near future by organisations involved with those abusing drugs and alcohol. Including such people within the clause is one way of dealing with the problem. I believe that the noble Viscount has the provision right and I hope that the Minister will accept it.

Lord Allen of Abbeydale

My Lords, I hope that we never reach the position in which we write onto the statute book the American word "presently" as though it were synonymous with the English phrase "at present".

Baroness Masham of Ilton

My Lords, I too support the amendment. Alcohol and drugs have been linked with mental illness. Responsibility is now being moved to local authorities. As I said previously, unless special safeguards are implemented there will remain considerable misgivings about the move. Therefore, the amendment is most important.

Baroness Hooper

My Lords, I know that there is a strong feeling about the issue. On several occasions we have discussed whether there is a case for ring fencing community care. The Government have carefully considered their position following the Committee's decision to support amendments which bear on the subject. Apart from the important point that ring fencing limits local flexibility and determination, all the evidence thus far shows that expenditure on personal social services does well out of non-ring-fenced funding and has risen substantially in real terms as compared with other lower areas of expenditure. The reason why we must make an exception to that general policy for those who are mentally ill is that this is an area where we know well that resources have been inadequately applied and that in some cases services have been less than we would have wished.

As regards the services for drug addicts and alcoholics, when we debated an identical amendment in Committee the noble Viscount pointed out that he was concerned that, without a specific grant, services would not be provided for such groups. I shall not go over the ground that we then covered about the various services and funds that have been made available by the Government and as a result of government action. However, that should not allow anyone to subscribe to the view that insufficient attention is being given to this.

As I explained when we debated the amendment to Clause 43 tabled by the noble Lord, Lord Allen of Abbeydale, we shall be issuing a guidance to local authorities on the provision of services for this group. It will include approval by the Secretary of State of schemes to provide residential care under Section 21 of the National Assistance Act 1948 and non-residential welfare services under Schedule 8 to the National Health Service Act 1977. This will be the first time that we have issued such comprehensive guidance to local authorities.

Secondly, we shall be directing local authorities to include services for drug addicts and alcoholics in their community care plans and thus they will be required to translate our guidance into specific proposals for their areas. Finally, amendments already made to the Bill require local authorities to consult in drawing up care plans with health authorities, the new family health services authorities, housing authorities and voluntary and other bodies providing services. That is deliberately designed to ensure that services provided by other statutory agencies and by voluntary bodies all mesh together and to improve the scope for developing relevant services to all client groups, including alcohol and drug misusers.

I hope that in the light of that explanation and the assurances that I have given the noble Viscount will feel able to withdraw his amendment.

Baroness Masham of Ilton

My Lords, before the noble Baroness sits down I wish to ask a question. If the money is not specially linked to alcohol and drug problems, how can the Government give the assurance that it will be spent on those problems?

Baroness Hooper

My Lords, with the leave of the House, the whole object of the exercise of requiring local authorities to produce community care plans is to create much greater transparency. First, they must consult in the preparation of those plans; secondly, they must publish the plans. The provisions that they are making will be evident and interested parties will have every opportunity to be involved in the process.

The Viscount of Falkland

My Lords, I am sure that the directions and guidance which are sent to local authorities will be excellent and complete. My anxiety and that of those who are involved in such treatment is about the speed with which the local authorities will react. Local authorities may be aware of the problems but generally their record is not encouraging. We believe that unless a similar amendment is included in the Bill sufferers will find themselves without treatment. During previous stages of the Bill it was said that certain local authorities had not yet fully grasped its implications or the Government's intentions.

At this stage it would not be possible for me fruitfully to divide the House. However, I reserve the right to return to the issue at a later stage. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Mottistone moved Amendment No. 190: Page 56, line 40, at end insert ("and for the purpose of this section the illness may be overt or may have resulted in continuing disability").

The noble Lord said: My Lords, in Committee I moved an amendment to establish whether those people who were substantially handicapped as a result of a previous mental illness would be eligible for services provided by local authorities with the help of a specific grant. That is the subject of this section of the earlier Act. I was reassured by the Government's statement that the term "mental illness" would bear its normal meaning and encompass, all stages of mental illness; not only acute episodes but any continuing or persistent disabilities".

However, on 14th May, the very date on which the statement was made to this House, the Department of Health dispatched its draft circular about the specific grant to the National Schizophrenia Fellowship and, no doubt, to other similar bodies. In that draft circular a distinction is drawn, between: Those among the homeless population suffering from overt mental illness", and others, also homeless, whose mental illness may not bi; obvious but who may nevertheless be just as much in need of social and medical care and for whom services financed by the specific grant are very much needed because of the disabilities resulting from a mental illness.

I have returned to this issue because the reassurance which my noble friend gave in Committee seems less convincing in the light of the draft circular. I beg to move.

7.30 p.m.

Baroness Hooper

My Lords, I can only repeat the assurance, given by my noble friend Lord Henley at the earlier stage, that all mentally ill people, at whatever stage of illness, are covered by the definition in the Bill and that no further explanation or clarification is required.

My noble friend referred to the draft circular. It is in draft form in order that it might be improved. Perhaps we can look at it in the light of my noble friend's comments and see what alterations are possible in order to clarify fully the point because I believe that the assurance given at an earlier stage still holds good.

Lord Mottistone

My Lords, I thank my noble friend for that reaffirmation of the assurance and also for undertaking to look at the draft circular to see whether its wording can be improved. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Seebohm moved Amendment No. 191: After Clause 51, insert the following new clause:

("Role of Director of Social Services

. In section 6 of the Local Authority Social Services Act 1970 (which requires a local authority to appoint a Director of Social Services) the following subsections shall be substituted for subsections (3) to (8)— (3) The Director of Social Services of a local authority shall not, without the approval of the Secretary of State (which may be given either generally or in relation to a particular authority), be employed by that authority in connection with the discharge of any of the authority's functions other than social services functions. (4) A local authority shall secure the provisions of adequate staff to assist the Director of Social Services appointed by them in the discharge of his functions. (5) A local authority shall not, without the approval of the Secretary of State (which may be given either generally or in relation to a particular authority), arrange for the discharge of any of the authority's social services functions by any officer who has not been appointed by, or is not under the direction of, the Director of Social Services for that authority. (6) For the purposes of subsection (4) above, an officer appointed by or under the supervision of a person subordinate to the Director of Social Services shall be deemed to have been appointed by or, as the case may be, to be under the direction of the Director of Social Services." ").

The noble Lord said: My Lords, we had quite a full discussion on this matter in Committee. I did not divide the Committee because the Minister, having indicated that the points were not covered in her brief, said that she would consult the department.

I have made one minor alteration to the original amendment; that is, to leave in Section 6(2) of the 1970 Act authorising two local authorities to combine the appointment of a joint director with the approval of the Secretary of State. That is to cover the only example which I could find dealing with Cornwall and the Scilly Isles: I do not wish to upset that.

I return to the main argument which was the basis of the 1970 Act; namely, that the Director of Social Services, shall not, without the approval of the Secretary of State (which may be given either generally or in relation to a particular authority), be employed by that authority in connection with the discharge of any of the authority's functions other than their social services functions".

If that was considered important in 1970, how much more important is it now that the duties of the director have been so heavily increased by the enactment of the Children Act and the imminent implementation of this Bill and other matters which have arisen in the past 20 years?

Confusion seems to have arisen because of the wording of subsection (1) which states: A local authority shall appoint an officer, to be known as the director of social services, for the purpose of their social service functions".

At least one local authority has apparently argued that that allows it to do what it likes. In one case the director is used only as an adviser. That is a dangerous interpretation and quite contrary to the spirit of the Bill and the Seebohm Report which engendered it.

I understand that some local authorities have already been given permission by the Secretary of State to add responsibility for housing to the functions of the director of social services. I deplore that. Other authorities have acted similarly without the authority of the Secretary of State. I expect that such authority was given before the last two Bills were introduced into Parliament. I firmly believe that the matter must be made abundantly clear by this amendment. If it is not, it will be a severe disappointment to the directors (on whom so much depends) who have to implement Part III of the Bill. They need the line of accountability enshrined in legislation. I know that they will be on tenterhooks to learn what are the Government's views on the matter.

The Association of Directors of Social Services has told me that it considers the amendment a crucial precondition to the successful operation of the community care legislation. I beg to move.

Lord Carter

My Lords, I have been pleased to add my name to the amendment and to support it from these Benches. We all know that the noble Lord, Lord Seebohm, speaks with great authority on these matters. The House will have listened with great care to the anxieties which he expressed.

Directors of social services have greatly enlarged responsibilities under the Bill. It is essential that the role and the responsibilities of directors are clearly spelled out. Clear line management cannot and must not be divorced from legal responsibility. There must be a single officer charged with the strategy. He can and should leave the tactics to others. However, the strategic role of planning and direction must be clear. We support a clear statement on the face of the Bill so that misunderstandings and muddles can be avoided.

Baroness Faithfull

My Lords, I support the amendment. Social workers are in a very difficult position. There have been many cases of children dying or being seriously abused. Social workers need to have a direct line management and need to know exactly who is responsible. When I was running a small department, no abuse case was dealt with without the papers arriving on my desk. That gave social workers a sense of security. I took the blame and the buck stopped there.

If directors of social services are to have wide responsibilities which include housing, they will not be able to give a sense of security and line management to social workers. In the days when social work departments were working mainly with children, I should have welcomed the responsibility of the housing department because the housing situation was so difficult. However, now that there is the Children Act and this Bill, it is beyond the bounds of any one person to take on responsibilities for housing and the additional responsibilities of these two Bills and at the same time have line management giving security to the social workers.

Lord Winstanley

My Lords, I too support the amendment as I did in Committee. I do not wish to repeat the arguments which I advanced then. I merely wish to ask a question. My recollection of the reply which we received on that occasion was that further inquiries had to be made into precisely what was the present situation. I have no doubt that those further inquiries have been made. I should like to know whether, having inquired into the situation, it has been decided in the department that the actions of some local authorities in that regard are ultra vires? If so, are steps being taken?

Baroness Hooper

My Lords, to some extent we are ad idem on this matter. We are all concerned to ensure that directors of social services have, and continue to have, adequate authority to carry out their responsibilities and that they can be effectively held accountable for doing so.

We are all anxious to avoid the addition of inappropriate responsibilities to the director's social services functions, the erosion of his authority or unclear lines of responsibility for he or his staff which undermine his position. Where we differ is over whether we need to add to existing legislation to secure that aim.

Reference has been made to the reorganisations carried out or under consideration by certain authorities involving the management and delivery of services, including housing and other elements besides social services. Such arrangements are not necessarily detrimental to the proper provision of services; indeed, they may have advantages in allowing for co-ordinated and comprehensive response to the needs of an individual or of a family. Much will depend on local circumstances. The Government are anxious that authorities should be free to organise the way in which they carry out their statutory duties with the minimum of restrictions.

The noble Lord, Lord Winstanley, specifically mentioned the case of Tower Hamlets where application has been made for my right honourable friend the Secretary of State to give approval under Section 6(5) of the Local Authority Social Services Act 1970 for its director of social services to take on additional functions, including housing. Approval has not yet been given. The Social Services Inspectorate is currently assisting the authority in the clarification of management arrangements to ensure that the director has the necessary authority and accountability. We shall certainly require to be fully satisfied in that regard.

We believe that the Secretary of State has adequate powers to prevent directors of social services being inappropriately burdened with additional responsibilities. The amendment does not propose any modification to the provision of Sections 6(5) and 6(4). It may be argued—and rightly so—that the power is not comprehensive and local authorities may reorganise their services or otherwise erode the position of their director of social services without necessarily falling foul of Section 6(5) or needing the Secretary of State's agreement under it. However, the clause of the Bill now under consideration includes new general direction-making powers relating to local authorities' social services functions. That power will enable the Secretary of State to issue directions on the manner in which local authorities are to carry out their duties under Section 6 of the Local Authority Social Services Act 1970.

Perhaps I should say a little more with regard to Section 6. We are particularly concerned with two subsections. Section 6(1) requires that a local authority, shall appoint an officer, to be known as the director of social services, for the purposes of their social services functions"— those functions also being specified in the Act. It follows from that that the director so appointed should have the authority necessary for him to carry out those functions effectively and be accountable for them to the social services committee to which they are allocated. Under Section 6(6) of the Act local authorities must provide adequate staff, for assisting him [the director] in the exercise of his functions". Clearly he should be able to direct such staff in the way in which those functions should be carried out.

At the earliest possible opportunity the Government intend to use the powers contained in Clause 51 to ensure that the intention of Section 6 of the 1970 Act is clearly stated and that all authorities abide by it. That would be achieved by issuing suitably worded directions to all authorities dealing particularly with Sections 6(1) and 6(6). The Government already have sufficient powers to ensure the proper exercise of the role of directors of social services and are ready to use them. There is therefore no need further to extend the legislation as proposed by the amendment, and in the light of that explanation I hope that the noble Lord will feel able to withdraw it.

Lord Seebohm

My Lords, this is another instance where these responsibilities could be included on the face of the Bill. Directions are all very well, but clarification of the 1970 Act is necessary because of the concern of the directors. If the position was clear they would not be so concerned.

We must give support to directors of social services to enable them to complete their task. They want this provision and on this occasion, regarding this important role, we must give them what they require. In those circumstances I must press the amendment.

7.45 p.m.

On Question, Whether the said amendment (No. 191) shall be agreed to?

Their Lordships divided: Contents, 43; Not-Contents, 50.

DIVISION NO. 4
CONTENTS
Addington, L.	Houghton of Sowerby, L.
Birk, B.	Hunter of Newington, L.
Brooks, of Tremorfa, L.	Jeger, B.
Carmichael of Kelvingrove, L.	Kilmarnock, L.
	Kinloss, Ly.
Carr of Hadley, L.	Lloyd of Kilgerran, L.
Carter, L.	Lockwood, B.
Clinton-Davis, L.	McNair, L.
Cocks of Hartcliffe, L.	Mason of Barnsley, L.
Darcy (de Knayth), B.	Monkswell, L.
David, B.	Nicol, B.
Dean of Beswick, L.	Pitt of Hampstead, L.
Donoughue, L.	Seear, B.
Dormand of Easington, L.	Seebohm, L. [Teller]
Ennals, L.	Stedman, B.
Faithfull, B.	Stoddart of Swindon, L.
Fisher of Rednal, B.	Swinfen, L.
Graham of Edmonton, L. [Teller.]	Thurlow, L.
	Turner of Camden, B.
Grey, E.	White, B.
Halsbury, E.	Winstanley, L.
Hatch of Lusby, L.	Young of Dartington, L.
Hollis of Heigham, B.
NOT-CONTENTS
Arran, E.	Fraser of Carmyllie, L.
Balfour, E.	Glenarthur, L.
Belhaven and Stenton, L.	Gray of Contin, L.
Belstead, L.	Gridley, L.
Borthwick, L.	Harmar-Nicholls, L.
Brigstocke, B.	Henley, L.
Brougham and Vaux, L.	Hesketh, L.
Butterworth, L.	Hives, L.
Caithness, E.	Hooper, B.
Carnegy of Lour, B.	Lauderdale, E.
Carnock, L.	Lindsey and Abingdon, E.
Cox, B.	Long, V. [Teller.]
Craigmyle, L.	Lucas of Chilworth, L.
Crickhowell, L.	McColl of Dulwich, L.
Davidson, V. [Teller.]	Mackay of Clashfern, L.
Eccles of Moulton, B.	Merrivale, L.
Falmouth, V.	Mersey, V.

Mottistone, L.	Swinton, E.
Murton of Lindisfarne, L.	Thomas of Gwydir, L.
Norrie, L.	Trefgarne, L.
Orkney, E.	Trumpington, B.
Pender, L.	Ullswater, V.
Sanderson of Bowden, L.	Vinson, L.
Skelmersdale, L.	Wise, L.
Strathclyde, L.
Strathmore and Kinghorne, E.

Resolved in the negative, and amendment disagreed to accordingly.

7.53 p.m.

The Lord Chancellor

My Lords, in calling Amendment No. 191A I should inform your Lordships that, if it is agreed to, I cannot call Amendments Nos. 192 to 194A.

Lord Carmichael of Kelvingrove moved Amendment No. 191A:

Page 57, leave out 1 to 6 and insert: ("(1A) Without prejudice to subsection (1) above, a local authority shall exercise its community care functions under this Act in accordance with any general directions issued by the Secretary of State and shall take account of any general guidance issued by him.").

The noble Lord said: My Lords, I had understood that these amendments were grouped together. The purpose of Amendment No. 191A is to seek to ensure that the Secretary of State may issue general directions only in relation to a local authority's community care functions. The amendment also brings the provision more closely into line with the Social Security Act 1986, and that, after all, is what the Government say is their intention.

Section 33(10) of the Social Security Act 1986 states: An officer shall determine any question under this section in accordance with any general directions issued by the Secretary of State and … shall take account of any general guidance issued by him".

I am sorry to note that the noble Lord, Lord Harmar-Nicholls, is not in the Chamber, because this applies to some extent to what he said earlier. It is interesting to note that in the case of R. v. The Secretary of State for Social Services Ex-parte Stitt (21st February 1990) the Secretary of State had purported to direct social security officers to reach a decision with regard to, inter alia, their budgets. The result was that an officer could not make a social security payment which would result in the budget being exceeded.

That was ruled to be an improper use of the direction and therefore this is a fundamental amendment which I hope the Minister has had examined with the same view as is taken by those who have advised me. I beg to move.

Lord Sanderson of Bowden

My Lords, I agree that Amendments Nos. 191A, 192, 193, and 194A have been grouped together. These amendments give a menu of different ways of curtailing the Secretary of State's power under Clause 52 to issue directions to local authorities on matters relating to their social work functions. Our community care proposals will mean major changes in the way in which people's needs for health and social work services are assessed and delivered. Local authorities are being given important new responsibilities and, while I have no doubt that these tasks will be carried out with the utmost care and professionalism, there is always a risk that unforeseen circumstances may arise or other difficulties emerge. It is in anticipation of that risk that we have drafted Clause 52.

Amendments Nos. 191A, 192 and 193 have a common factor: they would restrict the Secretary of State's powers of direction under that clause to those matters concerned with community care. There is no doubt that the Clause 52 direction-making powers will be highly relevant to community care in particular, because of local authorities' new duties to carry out assessments and to prepare and publish community care plans. However, it would not be possible to restrict that direction-making power entirely to the community care field. The Secretary of State's existing powers to issue general guidance and make regulations extend to the whole spectrum of local authority duties under the 1968 Act and other relevant enactments. It would not be consistent with this to limit the direction-making power to the community care field. Nor, I am reliably informed, is there any reason why the present Bill should not contain provisions which in some cases extend beyond the community care context to the wider social work field. I believe that is what the noble Lord asked for.

Amendment No. 191A would also restrict directions to those of a general, rather than a specific, nature. That could, I am afraid, crucially weaken the ability of Clause 52 to achieve its aim. The noble Lord, Lord Carmichael, tabled in Committee an amendment which would have replaced the power to issue directions with one to issue general guidance. I said then, and I repeat now, that an important advantage of directions is that they can be tailor-made to individual circumstances. Thus, they allow the Secretary of State to step in when an individual authority seems to be falling down on very specific aspects of its duties. In short, directions can, and might, be used as a fine tool but this amendment would reduce them to a blunt instrument.

Finally, I turn to Amendment No. 194A, which would remove the requirement for local authorities to comply with directions under Clause 52. This sits oddly with the noble Lord's other amendments, which, while limiting the power to make directions, do not remove it. I therefore assume that he accepts the need in principle for a power of direction, which seems to me to be paramount. He will also surely accept that to be meaningful it must be more than just a paper power. It must have teeth. That is not to say that the Clause 52 power should be seen as a new tough measure to control local authorities. On the contrary, we see community care as an area where there is a large degree of agreement and consent with common objectives. Clause 52 provides a reserve power which I do not expect will be used very often, but one which clearly needs to be binding on local authorities if it is to be effective.

I hope that that explanation shows why the Government believe that Clause 52 as it stands is necessary.

Lord Carmichael of Kelvingrove

My Lords, in his reply the Minister said that he was advised on certain matters and possibly because he is in the same position as myself we are getting into fairly deep water. For example—he did not refer to this—I wonder whether the court decision which I cited had been taken into account in the framing of Clause 52.

It seems to me that if there were a budget it would take away the requirement for the Secretary of State's social work functions. He could say that he had spent his budget, and the budget could be reduced ad infinitum until theoretically, there was no money for any social work. That seems dangerous. I shall not press the amendment, but I hope that the Minister will look at the point, which has a certain relevance. In the meantime, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 192 to 194 not moved.]

Clause 59 [Power of Secretary of State to make grants]:

[Amendments Nos. 195 and 196 had been withdrawn from the Marshalled List.]

8 p.m.

Lord Carmichael of Kelvingrove moved Amendment No. 197: Page 63, line 14, after ("Parliament") insert ("in addition to that made available under the Revenue Support Grant").

The noble Lord said: My Lords, unlike Chapter 4.25 in the English White Paper, the contribution of resources transferred from the health boards to the local authorities receives no mention in the Scottish chapter yet it remains fundamental to the achievement of this aspect of community care. The National Health Service changes proposed in the Bill may ensure that greater pressure is put on the resources released from long-stay hospitals and for them to be retained and diverted elsewhere within the health boards. There is no legal obstacle to the English equivalent of dowries in Scotland. Without the transfer of resources, the burden of paying for care will have to be shouldered by local authorities and communities. Long-stay hospital discharge programmes should not be subsidised out of the care element except on a bridging basis.

There is concern that the specific grant for mental health will be top sliced from existing local authority expenditure. It will be project led and, unlike England, it will be applicable in cases of hospital discharge but without contribution from the National Health Service. I hope that the Minister will see the point that I am trying to make and that he will consider this amendment favourably. I beg to move.

Lord Sanderson of Bowden

My Lords, I admit that I did not expect to see this amendment on the Marshalled List. We had a long discussion on it at the last stage of the Bill. I have some sympathy with the noble Lord's wish to return to the issue of whether the specific grant should be new money—that is what we are talking about—or diverted from existing resources, which is the noble Lord's fear. In Committee, I gave a very lengthy explanation of why this amendment is not desirable or necessary. Perhaps I went on too long so I shall try a shorter version.

The key point is that it is not appropriate to deal with this kind of issue in primary legislation. Indeed, I am aware of no precedent for doing such a thing. In particular, the amendment does not take into account the actual mechanism for supporting local authorities. Local authorities now work within a total level of support from the Government, known as aggregate external finance, which includes revenue support grant, non-domestic rate income and any specific grants such as that provided for in Clause 59. What is crucially important is not so much the relative size of these three elements but the total amount of aggregate external finance. We are currently in consultation with CoSLA and others about those factors that need to be taken into account in setting the level of aggregate external finance for the next financial year.

Clearly we shall be paying particular attention to local authorities' new responsibilities under the Bill in deciding on the total size of the settlement. It is worth noting that revenue support grant already supports local authority spending on services for mentally ill people.

The noble Lord asked about the resources aspects not referred to in the Scottish chapter of the White Paper. Dowry payments, with which Chapter 4.25 of the White Paper is concerned, can be made by Scottish health boards when patients are discharged from hospital, as in England. In a nutshell, what the noble Lord wishes me to say is along the following lines. He knows as well as I do how difficult public expenditure discussions can be. The key point is that grants will be new money for mental illness, betokening the importance that we attach to that area. It will be used not to allow local authorities to reduce the money they already spend but rather to support improvements. The noble Lord and I could dispute for the rest of the evening whether the total envelope of local authority external finance is high enough or higher than it would have been without that grant.

The key point in debating community care this evening is that the grant will represent new money for mentally ill people. I insist that that is the situation as we see it. However, I cannot commit the Government to what the totality of the envelope might be in any one year.

Lord Carmichael of Kelvingrove

My Lords, that is part of the worry. There may be more money but it may not be new money. However, the noble Lord said that we could discuss this matter for the rest of the evening, but realising what lies ahead there is not much of the evening left. I shall take advice on the complicated reply that the Minister has given. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Baroness Hooper moved amendment No. 198: After Clause 62, insert the following new clause:

Clinical Standards Advisory Group

(".—(1) There shall be established in accordance with this section a Clinical Standards Advisory Group (in this section Vol. 520 referred to as "the Advisory Group") which shall have the following functions:—

1. (a) in accordance with a request made by the Health Ministers or any one of them, to provide advice on the standards of clinical care for, and the access to and availability of services to, national health service patients and, in this connection, to carry out such investigations into such matters (if any) and to make such reports in relation thereto as the Health Ministers may require;
2. (b) in accordance with a request made by one or more health service bodies, to provide advice on, to carry out investigations into and to report on the standards of clinical care for, and the access to and availability of services to, national health service patients for whom services are or are to be provided by or on behalf of the body or bodies concerned; and
3. (c) such other functions as may be prescribed by regulations.

(2) The Advisory Group shall consist of a chairman and other members appointed by the Health Ministers and regulations may—

1. (a) require that one or more members of the Advisory Group shall be appointed from persons nominated by such body or bodies as may be specified in the regulations; and
2. (b) provide that one or more of the members who are not appointed from persons so nominated must fulfil such conditions or hold such posts as may be so specified.

(3) Regulations may make provision as to—

1. (a) the appointment, tenure and vacation of office of the chairman and members of the Advisory Group;
2. (b) the appointment of and the exercise of functions by committees and sub-committees of the Advisory Group (including committees and sub-committees consisting wholly or partly of persons who are not members of the Advisory Group);
3. (c) the procedure of the Advisory Group and any committees or sub-committees thereof; and
4. (d) the attendance at meetings of the Advisory Group or any committee or sub-committee thereof of persons appointed by the Health Ministers and the extent of their participation in such meetings.

(4) Proceedings of the Advisory Group, or of any committee or sub-committee of the Advisory Group, shall not be invalidated by any vacancy in membership or by any defect in a member's appointment or qualifications.

(5) The Health Ministers—

1. (a) may pay to the chairman and members of the Advisory Group, or of any committee or sub-committee of the Advisory Group or any persons appointed as mentioned in subsection (3)(d) above, such sums by way of remuneration and travelling and other allowances as the Health Ministers, with the consent of the Treasury, may determine;
2. (b) shall make available to the Advisory Group and to any committee or sub-committee thereof such staff and other services or facilities as are necessary to enable them to carry out their functions; and
3. (c) shall defray such expenditure as is reasonably incurred by the Advisory Group in carrying out their functions.

(6) Where the Advisory Group carry out an investigation or make a report in accordance with a request made by a health service body, that body shall reimburse, in such manner as the Health Ministers may determine, so much of the expenditure incurred by them under paragraphs (a) and (c) of subsection (5) above as they certify as being attributable to the carrying out of that investigation or the making of that report.

(7) In this section— clinical care" means any action which is taken in connection with the diagnosis of illness or the care or treatment of a patient, and which is taken solely in consequence of the exercise of clinical judgment; the Health Ministers" means the Secretaries of State respectively concerned with health in England, in Wales and in Scotland; health service body" means—

1. (i) a health authority, within the meaning of the National Health Service Act 1977,
2. (ii) a Health Board or Special Health Board constituted under section 2 of the National Health Service (Scotland) Act 1978,
3. (iii) a State Hospital Management Committee constituted under section 91 of the Mental Health (Scotland) Act 1984,
4. (iv) the Common Services Agency for the Scottish Health Service,
5. (v) a National Health Service trust constituted under Part I of this Act or under the National Health Service (Scotland) Act 1978, and
6. (vi) a Family Health Services Authority;

national health service patient" means any person for whom any services are or are to be provided by or on behalf of a health service body; regulations" means regulations made by the Health Ministers and any such regulations may make different provision for different cases or descriptions of case, including different provision for different areas; and "services" means services provided—

1. (a) in England and Wales, by virtue of directions under section 13 or section 14 of the National Health Service Act 1977 or section 5 of this Act; or
2. (b) in Scotland, by a health services body under Part I or Part III of the National Health Service (Scotland) Act 1978;
3. (c) pursuant to an NHS contract, as defined in section 4(1) of this Act or section 17A of the National Health Service (Scotland) Act 1978.").

The noble Baroness said: My Lords, this amendment has been spoken to. I beg to move.

Lord Mottistone moved, as an amendment to Amendment No. 198, Amendment No. 198A: Line 7, after first ("to") insert ("continuity").

The noble Lord said: My Lords, in moving this amendment I shall speak to Amendments Nos. 199B and 199C. I shall not be moving Amendment No. 204A. I spoke to these amendments when we dealt with this subject at an earlier stage. Amendments Nos. 198A and 199C seek that when the advisory group carries out investigations and gives advice on standards and the availability of services to NHS patients it should give it on continuity as well.

Amendment No. 199B asks that voluntary organisations be given authority under subsection (1)(b) to request investigation by the advisory group. I spelled that out at some length on the earlier occasion. My noble friend the Minister has written me a splendid letter explaining why these amendments are unnecessary. It will be helpful for the record if the matter can be explained to your Lordships as well. I beg to move.

Lord Ennals

My Lords, perhaps I may make some comment on Amendment No. 198 as well as on other amendments. At Committee stage, in congratulating the Minister on tabling the amendment concerning the Clinical Standards Advisory Group, I said that there were issues which concerned many of us. Some of those concerns were reflected in amendments, though most of them have been subsequently withdrawn. However, they will reappear in one form or another at Third Reading.

The first issue concerns the degree of independence of the CSAG. In the Official Report on 12th June at col. 246 I asked the Minister whether the group would be able to act on its own or whether it could only do so on request. She replied that there would be, nothing to prevent the group initiating activity, though we would largely expect it to respond to requests". Later, at col. 247, she said that the programme of work is, intended to be settled between it and the health Ministers". There is a great deal of room for misunderstanding here. What would happen if the group wished to initiate an inquiry to which the Minister was opposed? That is a fundamental question. The issue might well be one in which the Minister was involved. The original amendment stated that the group would, provide advice on … the access to and availability of services to, national health service patients". That might concern the allocation of resources or the consequence of a management board decision—a matter about which the noble Lord, Lord Hunter, had much to say. It is essential that the amendment and the face of the Bill in its final form should not leave that kind of room for misunderstanding. The purpose of legislation is to prevent misunderstanding.

The question of the group's independence was raised not only by me but also by the noble Baroness, Lady Seear, at col. 248 of the Official Report of 12th June. It was also raised by the noble Baroness, Lady Cox, in her contribution. We cannot legislate in a way that could lead to major doubts about the interpretation of the law. We must clarify the matter and therefore discussions should be held very quickly between those who seek to make amendments and the Minister, so that amendments clarifying the issues can be tabled for Third Reading.

A number of issues are involved, including the question of who can nominate members. The amendment states that the advisory group may: require that one or more members of the Advisory Group shall be appointed from persons nominated by such body or bodies as may be specified in the regulations; and provide that one or more of the members who are not appointed from persons so nominated must fulfil such conditions or hold such posts as may be so specified". The Minister made some suggestions. She said that the group will consist of members appointed on the nomination of medical, dental and nursing Royal Colleges and the chairmen of the standing medical, dental and nursing advisory committees. That is very good. My specific question would be: what about the College of Occcupational Therapists and other professions allied to medicine? What about the representatives of community health councils or the representatives of other community bodies?

This matter cannot be left to a ministerial explanation in your Lordships' House. These issues must be on the face of the Bill or there will from the start be disagreements between the advisory group and the Minister. That would be grossly unsatisfactory. The Minister said (at col. 258 of the Official Report of 12th June) that the voluntary organisations might be a source of suggestions.

The question of the annual report must also be considered. The Minister implied that it was likely that reports would be published. It is essential that this matter should be on the face of the Bill. I do not want to go any further, but several issues are involved. There is the question of preventive services. The noble Lord, Lord Walton, raised the question of whether clinical care should be interpreted to include continuing care. There are still many unanswered questions. I hope that it will be possible to have a friendly meeting very quickly so that at Third Reading an amended amendment can be brought forward to remove any uncertainties that could be counter-productive.

8.15 p.m.

Lord Kilmarnock

My Lords, in introducing the amendment, the noble Baroness has evidently not want to discuss it again today. I want to make my position clear, particularly as I have withdrawn a number of amendments which I had originally tabled to the government amendment. When we last debated this matter on 12th June I put to the Government a list of matters which I hoped would come within the purview of clinical standards. They included control of infection, investigations of deaths, investigations of accidents, readmission rates, the use of blood, peri-operative deaths, waiting lists, medical audits, and hygiene, food and so on. On that occasion I was glad to get an encouraging response from the noble Baroness, who said: The noble Lord, Lord Kilmarnock, quoted nine key areas. I assure him that, with the single exception of catering and hygiene standards, all the areas he has mentioned will fall fairly and squarely on the remit of the group as defined in the Government's Amendment No. 198". —[Official Report' 12/6/90, col. 259.] That was as good news. The variant that we were advancing at that time—to call it a Clinical and General Standards Board—would no longer have been necessary if all those matters were covered.

In response to the noble Lord, Lord Ennals, on that day, the noble Baroness also offered (at col. 257 of the Official Report) a meeting to discuss any remaining outstanding points. Because we seemed to be getting very close, and in order to improve the climate for discussion, the amendments to which I referrec—in the names of the noble Lord, Lord Ennals, the noble Baroness, Lady Cox, and myself—were taken off the list and so are not down for discussion today. In fact the noble Lord, Lord Ennals, still has one amendment left—Amendment No. 201A—on the right to initiate. In addition we shall later discuss Amendment No. 204AA, in the names of the noble Lords, Lord Hunter of Newington, Lord Carr of Hadley and Lord Ennals, which I shall be happy to support as an additional safeguard on non-clinical matters. The so-called "soft" issues are also important—customer relations, courtesy, the physical conditions of clinics, and so on.

As the noble Lord, Lord Ennals, said, one or two important points are still outstanding, although I am glad to say that we are moving closer. He was quite right to say that the right to initiate inquiries is crucial to the credibility of this body. The noble Baroness was not wholly clear in response to a query of mine (at col. 260 of the Official Report of 12th June) about the position on that point. In her reply she seemed to be slightly frightened of upsetting the Royal Colleges. I remind the House that the Royal Colleges are not gods—they may be demigods—and I cannot imagine that they would object to this additional power for the group which they have agreed to join. I regard that point as crucial.

The group can expect to command extremely little respect unless it has a certain freedom of manoeuvre. That is not, so far as I can see, in the Bill. I remind the Government that analogous foreign bodies in Canada, Australia and the United States are entirely dependent of central government. We have had an arm's length tradition and that is the road we are going down on this occasion. I am all for following our own traditions and practices. But I have absolutely no doubt that the body concerned would command very much more respect if it had this additional power and was not confined to being switched on by the Secretary of State or called in as a consultant by a health unit.

The noble Lord, Lord Ennals, also mentioned the importance of an annual report to Parliament. I support him on that point. Although we are closer together, these matters are still outstanding. It will therefore be interesting to hear what the noble Baroness says when she comes to reply. I would be happy if a meeting could be arranged to discuss these outstanding points. If nothing came out of it we should want to return to these points at the final stage of the Bill.

Lord Carr of Hadley

My Lords, I support this government amendment. It is a most important development. I know that it was not easy to arrive at and I congratulate both the Minister and those involved on bringing it forward. I do not want to propose anything that would upset that. I pay attention to the need for the body to have the right initiative. I also believe that it should report regularly. However, I do not quite understand why that should not be set out in the amendment. I am perfectly content with the quite clear assertions from the Front Bench that the group will have the power of initiative and that it will report. Nevertheless, I should prefer to see this provision in writing, although I shall not press the point provided the Minister can assure us that there is no doubt that the body does have the right to take such initiatives and that it will report.

Lord Ennals

My Lords, I welcome the noble Lord's remarks. I hope he will agree that when we come to legislate on such issues, we are not legislating for a particular government or for a particular Secretary of State; we must legislate for whatever government is in power and for whichever secretary of state is involved. In my view, clarity is absolutely essential. I have served, as has the noble Lord, Lord Carr, as a Secretary of State. The worst thing we can have is legislation which is not clear and which leaves room for argument.

Baroness Hooper

My Lords, we had some discussion on this amendment last week. I should like to point out again—although it means repeating what I said on that occasion—that the Government amendment represents the results of negotiations with representatives of the Royal Colleges and other representatives of the medical professions. The result is most important because it is one which will receive the support of those bodies, which is one of the most important ways of making such measures effective.

I explained last week that the proposed group's programme of work would be arranged between it and the Health Ministers and that it would be an open process. I also said that proposals from all persons and bodies including, for example, the Royal Colleges and the voluntary and consumer organisations, will be considered in order to produce a suitable and manageable programme. However, the noble Lord, Lord Ennals, has again said that the group should have a right to initiate studies on the grounds that if it does not have complete independence of action it will be a paper tiger. I believe that that view reflects a misunderstanding of the way in which the group is intended to function and the purpose for which it was set up with the support of the Royal Colleges and other bodies.

The group will be independent and authoritative. I do not doubt that a body consisting of distinguished nominees of the medical, dental and nursing Royal Colleges, together with the chairmen of the standing advisory committees, would play an influential role in the determination of its workload: equally, I am sure that it will be forthright in giving praise and, where appropriate, making suggestions for improvements in standards of clinical care.

The group's remit will enable it to provide advice on all aspects of clinical care standards. The word, "standards" certainly embraces the concept of quality. I am advised that nothing would be gained by writing the word "quality" upon the face of the Bill, not least because this is not a statutory concept and may therefore be one which provokes difficulties of interpretation. Nor, indeed, is it necessary to include explicit references to the prevention of illness or continuity of care, as both aspects are covered by the present wording.

As regards the question of continuity raised by my noble friend Lord Mottistone, subsection (1)(a) and (b) gives the group powers to advise on standards of clinical care, access to services and, in addition, availability of services. A break in continuity which adversely affected the quality of treatment of a patient would certainly fall within the scope of an investigation into standards of clinical care. Moreover, a discontinuity in treatment could well be the result of restricted access to, or, alternatively, availability of a service. Either way, I believe that my noble friend's legitimate concern about continuity of services is fully covered by the existing provision.

I turn now to deal with the question of an annual report. It is the Secretary of State and the Ministers who are accountable to Parliament for the provision of an efficient and effective National Health Service. As noble Lords will know, that accountability takes a number of forms; for example, it may be through debates, parliamentary Questions or responses to and appearances before Select Committees. Reports to Parliament of the Clinical Standards Advisory Group can therefore be provided through any of those channels. Therefore, requiring the group to provide an annual report direct to Parliament, as provided for by Amendment 201A, would only disturb these well-established accountability procedures. I see no reason why the Clinical Standards Advisory Group should be an exception to that rule.

The noble Lord, Lord Ennals, also referred to the membership of the group. This will closely follow the agreement to which I have already referred between the Secretary of State and the Royal Colleges. Members drawn from the medical, dental and nursing Royal Colleges, and the standing advisory councils, will be best placed to advise on the rather specialised area of standards of clinical care. The group cannot be all things to all men. A very widely based membership, as advocated by the noble Lord, might only reduce the authority of the group's advice on clinical care issues. With that explanation, I trust that I have responded, or at least touched upon, all the points that have been raised.

Lord Carr of Hadley

My Lords, before my noble friend sits down, perhaps she will make the issue as regards reporting a little clearer. I have served as Secretary of State in more than one department. I recollect that there were various bodies associated with the departments of which I was Secretary of State which made annual reports. I cannot remember there being any way in which they stood between me and my accountability to Parliament.

I honestly do not understand the point my noble friend is making. It may well be that the reports were not made to Parliament but made to the Secretary of State concerned. I do not think that any of us who want such reports to be made would quibble about that point. We would not want to do anything to weaken the Secretary of State's accountability to Parliament. However, I think that there are plenty of precedents concerning bodies, committees or inspectorates which make annual reports as required by statute and yet the Secretaries of State involved are still directly responsible to Parliament. As I said, I do not understand the point that my noble friend is making.

Lord Ennals

My Lords, I wish to make exactly the same point. On the last occasion when we discussed the matter, the Minister said: I expect that it will become normal practice for the reports to be published and made widely available on most cases, certainly as regards national issues. However, that matter must be decided between the group and the Minister or body commissioning a study".—[Official Report, 12/6/90; col. 259.] I think that that provision weakens the powers of the group. I am sorry that an amendment tabled in my name and that of the noble Baroness, Lady Cox, refers to, an annual report to Parliament". I do not think that it should be to Parliament. In fact, I thought that that particular amendment had been withdrawn from the Marshalled List. It appears that a mistake has been made in that connection. Moreover, to leave it to the discretion of the Minister as to whether this body makes a report is grossly unsatisfactory: equally, to leave it to the discretion of the Minister as to whether this body should introduce an inquiry of its own is also unsatisfactory. I should have thought that the Minister would have agreed that those two points must be clarified in the legislation.

Lord Kilmarnock

My Lords, as other noble Lords have been asking questions of the Minister before she finally retakes her seat, I trust that I may ask her one further question. My question is but a brief one. None of us wishes to unpick the agreement which has been painstakingly stitched together with the Royal Colleges. If the Government were to refer back to the Royal Colleges before Third Reading and convey the strongly felt view of this House that this body should have power to initiate inquiries, is the noble Baroness saying that they would be seriously likely to reject outright a proposal which would actually strengthen their hand and that the whole structure would fall apart as a result.? I find that conclusion extremely hard to accept.

8.30 p.m.

Baroness Hooper

My Lords, I do not believe that I can add anything to what I said today and last week.

Lord Mottistone

My Lords, unlike other noble Lords, I am happy with my noble friend's explanation. I beg leave to withdraw the amendment.

Amendment No. 198A, as an amendment to Amendment No. 198, by leave, withdrawn.

[Amendment No. 199 had been withdrawn from the Marshalled List.]

[Amendments Nos. 199A to 199C, as amendments to Amendment No. 198, not moved.]

[Amendments Nos. 200 and 201, as amendments to Amendment No. 198, had been withdrawn from the Marshalleld List.]

[Amendment No. 201A, as an amendment to Amendment No. 198, not moved.]

[Amendments Nos. 202 to 204 as amendments to Amendment No. 198, had been withdrawn from the Marshalled List.]

[Amendment No. 204A, as an amendment to Amendment No. 198, not moved.]

On Question, Amendment No. 198 agreed to.

Lord Hunter of Newington moved Amendment No. 204AA: After Clause 62, insert the following new clause:

("Advice on standards other than those provided for in section (Clinical Standards Advisory Group)

There shall be established an independent group which shall have the function of providing advice to the Management Executive in the discharge of its responsibilities for setting and achieving all standards in the National Health Service other than those provided for in section (Clinical Standards Advisory Group) above.".

The noble Lord said: My Lords, in recent weeks I have been studying intensively the role of the management executive. I find that the management board was superseded by the management executive in January 1989. Of course, in March 1990, as the House is aware, the director of research and development, whom the Government proposed in response to a recommendation from this House, was made a member of the management executive. I say that merely to show that the Government have been flexible and concerned to evolve the best possible system.

In March this year the Secretary of State, in addressing the Select Committee on Science and Technology, said the evolution was an essential part of the new proposals, all of which could not be introduced in the spring of 1991. He and the noble Baroness, Lady Hooper, suggested that in the first instance it was likely that a limited number of NHS trusts and fund-holding practices would be established. It is my understanding that an undertaking was given that the results would be carefully monitored and the outcome of those experiments made widely known.

In the interim, Duncan Nichol, the chief of the management executive, has not been idle and has made vigorous contacts with local management within the health service. One thing that has been done, for example, is the allocation of regional quality funds to a total of some £7.5 million.

In response to an amendment tabled by me that the director of research and development should have an advisory committee, I finally accepted the argument that the person appointed could determine the need and the kind of advice that he might require depending upon the circumstances at the time. I therefore withdrew the amendment.

I return to the central issue which the Government agreed is the responsibility of the management executive; that is, the detailed assessment and systematic monitoring of standards. The need for evolution and the undertaking given by the Government that first steps should be carefully monitored justify the setting up of an independent group, as I have suggested. It is as well to remember that a substantial number of managers have recently been appointed and they are only now beginning to learn their role and develop the delicate and complicated business of working with the clinicians who are responsible for the diagnosis and treatment of patients. We must also remember that the study of the United States Medicare programme in relation to audit showed there to be a great range of difficulties which may arise here and may have to be overcome.

Policy proposals have been suggested which will require attention. The intensive monitoring of changes, especially the radical new proposals for trusts and the purchasing of facilities and services, require to be carefully examined in the first instance. It is the kind of role that one could have imagined Sir Roy Griffiths, who is now vice-chairman of the policy board, discharging extremely well.

An independent committee of the kind proposed would fulfil a number of roles. It would reassure the public that enormous care was being taken to try to achieve as smooth a transition as possible. It would reassure the medical profession and provide a body with which the clinical standards advisory group could discuss matters of mutual interest. Perhaps as important, it would reassure everyone that the Government were truly concerned about the quality of the health service and the effect of possible changes on the welfare of the people. Setting up such a committee during the evolutionary period even for three years, with a six-monthly report would be enormously helpful. I beg to move.

Lord Carr of Hadley

My Lords, I support the amendment which I joined the noble Lord, Lord Hunter of Newington, in tabling. As your Lordships will be aware, in various debates on the Bill I, like other noble Lords, have made clear the great importance that I attach to the assurance of quality. The maintenance of quality is, above all, the responsibility of the management of the NHS, as it is of any organisation. Unless the management is almost obsessively dedicated to putting quality at the top of its list of priorities, no independent outside body will achieve that aim.

Even when there is that commitment to quality, some outside supervision, advice and comment is of value. It is of value to the service itself, and in something as delicate and personal to people as the health service, in which we propose to make radical changes which will inevitably create certain fears and doubts—whether ill-founded or well-founded; and noble Lords will know that I support the principle of the changes that the Bill introduces—there is an added need for some degree of independence to oversee the setting and achieving of standards.

The government amendment No. 198, which was accepted, dealt with that matter, if not perfectly at least satisfactorily. In that case clinical standards only are dealt with, in my view properly. Although the quality of the health service depends first and foremost upon the quality of clinical standards, it does not depend entirely upon clinical standards. That is why I, like the noble lord, Lord Hunter, and, I suspect, others feel that some further independent body should be involved in the setting and achieving of standards, other than clinical standards, in the health service. I commend the amendment to the Government. I hope that they will take it seriously. As I have said, it is good for its own sake and it is also an important element in winning that degree of support of all staff in the health service and the public, which will be important if not vital to making the changes proposed in the Bill successful in practice and to the contentment of the people of this country.

Baroness Hooper

My Lords, the amendment makes it clear that the responsibility for standards of clinical care should rest with the clinical standards advisory group which Amendment No. 198 establishes, and not with the NHS management executive. That is not the way I see the respective functions of those two very different bodies.

The NHS management executive is responsible to the Secretary of State for the quality of services in the NHS generally. That includes all aspects of quality from portering services and the food that patients receive right through to standards of clinical care. The different aspects of quality are naturally the responsibility of different management executive directors. Clinical standards, for example, are an important part of the remit of the medical and nursing directors; but they all combine to influence the overall quality of service that the patient receives. It would surely be wrong to separate the clinical side of quality and place it in the hands of a different body.

The clinical standards advisory group will play a key role in guaranteeing and improving standards of clinical care. However, as I said earlier, its role will be to provide forthright and independent advice on clinical standards to the Secretary of State and the NHS management executive. It will not be accountable to him for those standards. To give the group formal responsibility for any area of National Health Service operations would only distort existing effective accountability arrangements and hinder the group's important advisory work.

At the highest level the National Health Service policy board supervises the work of the management executive under the chairmanship of the Secretary of State. It includes members with a wealth of experience both of the health service and of the management of other large organisations who provide valuable advice at both strategic and working levels on all aspects of its work, including quality improvement.

The management executive itself has a membership with in-depth experience of the National Health Service as well as members drawn from outside the pubic sector. As your Lordships know and as the noble Lord, Lord Hunter, mentioned, we are in the process of making an appointment to the new post of director of research and development. That post has been widely advertised to enable us to recruit the person of the right calibre, whether from government, the National Health Service or elsewhere.

My noble friend Lord Carr said that independent advice is needed. The management executive already has a large range of independent advisers to consult in its everyday work. Directors are in regular contact with regional chairmen and general managers, both informally and through the established review procedures. It is a reflection of the importance of quality in these contacts that it features on the agenda of all the reviews of regional health authorities' performance undertaken by the management executive last year. That pattern looks set to continue this year.

Equally important, the management executive has established effective working relationships with independent bodies. These can provide a valuable source of advice and support in specific areas of work, including quality. A good example is medical audit, where the management executive has allocated funds to a number of bodies, including the Royal College of General Practitioners and the College of Anaesthetists' quality of care unit to help in the development of a nationwide audit system. Substantial funds have also been awarded to the King's Fund for the purpose of establishing an information and data exchange.

I hope that these examples show that the National Health Service management executive is by no means closed to independent advice and assistance in its work on improving quality, nor indeed on any other matter. On the contrary, they demonstrate an effective commitment to an open approach to its work. They show that partnership, whether with experienced individuals, health service bodies or independent organisations, is the management executive's chosen means of pursuing its goal of improving the delivery of high quality health care in the National Health Service. I hope that they show too that the important principle of independent advice embodied in the amendment is already a reality in the work of the management executive today. In the light of this, perhaps the noble Lord, Lord Hunter, will feel able to withdraw the amendment.

Lord Hunter of Newington

My Lords, the Minister has given a clear and broad account of the activities of the management board and its connections with the King's Fund as well as of many other matters. If one looks closely at the matter, the same kinds of contacts existed previously in the medical world. I feel sad that the noble Baroness has drawn a distinction because one could argue—although I do not do so—that there is no need for the clinical advisory group. That seems to me a disastrous conclusion arising from what the Minister said.

I shall have to consider the matter because the suggest ion that the executive does not require any advice and that it can choose its advisers except in the medical field is one I find difficult to digest at this time of night. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Schedule 9 [Minor and Consequential Amendments]:

Baroness Hooper moved Amendment No. 204B:

Page 106, line 29, leave out from beginning to end of line 30 and insert

("(b) for the entry relating to section 6 of the Local Authority Social Services Act 1970 there shall be substituted—

Sections 6 and 7B of this Act

Appointment of director of Act social services, etc; provision and conduct of complaints procedure." ").

On Question, amendment agreed to.

Lord Sanderson of Bowden moved Amendment No. 205:

Page 109, line 36, at end insert: (" ( ) For paragraph (b) of subsection (2) of section 25 of that Act (arrangements for provision of general dental services) there shall be substituted the following paragraph— (b) For conferring a right, subject to— (1) subsection (2A);

1. (ii) the provisions of this Part relating to the disqualification of persons providing services; and
2. (iii) section 8 (persons over retiring age) of the Health and Medicines Act 1988 and regulations made under that section,

on any dental practitioner who wishes to be included in any such list to be so included;".").

The noble Lord said: My Lords, I beg to move Amendment No. 205 and speak to Amendment No. 209. These amendments take the opportunity afforded by the Bill to remedy a minor drafting infelicity in the National Health Service (Scotland) Act 1978 caused as a result of an amendment to Section 25(2)(b) of that Act by paragraph 11 of Schedule 2 to the Health and Medicines Act 1988.

Amendment No. 205 provides a new wording for the 1978 Act and Amendment No. 209 repeals the wording in the 1988 Act. I beg to move.

On Question, amendment agreed to.

Lord Sanderson of Bowden moved Amendment No. 206: Page 110, line 48, at end insert: (") In section 79 of that Act (purchase of land and moveable property)—

1. (a) in subsection (1), after the word "Act" where it first appears there shall be inserted the words "and may take any such property or land on lease,"; and
2. (b) in subsection (2), after the word "(1)," there shall be inserted the words "other than on lease".").

The noble Lord said: My Lords, this amendment corrects an anomaly by giving the Secretary of State specific powers to take on lease property or land for National Health Service use. That new power would then be delegated to health boards, subject to a financial ceiling. I beg to move.

On Question, amendment agreed to.

Lord Sanderson of Bowden moved Amendment No. 207: Page 112, leave out lines 6 to 10.

The noble Lord said: My Lords, this amendment has already been spoken to. I beg to move.

On Question, amendment agreed to.

Baroness Hooper moved Amendment No. 208: Page 113, line 7, at end insert:

"The Acquisition of Land Act 1981

21 A. In the Acquisition of Land Act 1981, in section 17 (local authority and statutory undertakers' land). in subsection (4), in the definition of "statutory undertakers" after paragraph (a) there shall be inserted— (aa) a National Health Service trust established under Part I of the National Health Service and Community Care Act 1990, and".").

On Question, amendment agreed to.

Schedule 10 [Enactments Repealed]:

Lord Sanderson of Bowden moved Amendment No. 209: Page 121, line 60, at end insert:

("1988 c. 49. The Health and Medicines Act 1988. In Schedule 2, paragraph 11.")

The noble Lord said: My Lords, this amendment has already been spoken to. I beg to move.

On Question, amendment agreed to.

Clause 67 [Short title, commencement and extent]:

Lord Sanderson of Bowden moved Amendment No. 209A: Page 67, line 45, after ("(3)") insert ("and (34)").

The noble Lord said: My Lords, I have already spoken to this amendment. I beg to move.

On Question, amendment agreed to.

Lord Sanderson of Bowden moved Amendment No. 210: Page 67, line 45, after ("(1)") insert ("and (3)").

The noble Lord said: My Lords, this is a technical amendment to remove the application of Clause 43(2) to Scotland. Section 22(1) of the National Assistance Act 1948, which Clause 43(2) amends, was repealed for Scotland by the 1968 Act. I beg to move.

On Question, amendment agreed to.