HL Deb 08 May 1990 vol 518 cc1239-306

3.12 p.m.

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

My Lords, I beg to move that the House do now again resolve itself into Committee on this Bill.

Moved, That the House do now again resolve itself into Committee.—(Baroness Hooper.)

On Question, Motion agreed to.

House in Committee accordingly.


[Amendment No. 108AD had been withdrawn from the Marshalled List.]

Lord Allen of Abbeydale moved Amendment No. 108AE: Before Clause 40, insert the following new clause: ("Funding of community care —(1) The Secretary of State shall, with the approval of the Treasury, make grants out of money provided by Parliament towards the expenses of local authorities incurred in connection with the exercise of their community care functions. (2) Grants made in accordance with subsection (1) above shall be used by local authorities solely for the provision of community care for purposes described in plans drawn up in accordance with section 44 below. (3) The Secretary of State shall not later than 30th November in the year preceding any financial year lay before Parliament his estimate of the total amount of grant likely to be disbursed under this section in respect of that financial year, together with a statement of the sums requested by local authorities and the formula for distribution between such authorities, and shall at that time publish forecasts for the following two financial years.").

The noble Lord said: We have now reached the provisions in the Bill relating to community care. The purpose of the amendment is to propose the insertion of a new clause to ensure that the resources made available for that purpose through the revenue support grant are clearly identified and that the grants are used solely for providing community care services. I speak with some diffidence about provisions relating to money in a Bill which has already passed through another place but the issues involved are important and are causing widespread anxiety.

Once upon a time, when I was in the Ministry of Housing and Local Government, as it then was, I thought that I had some dim understanding of local government finance. I make no such claim now, but without an amendment such as this there is a risk that the admirable ambitions set out in the Bill will go sadly wrong. The Government took long enough in all conscience, as the Committee will recall, before they could bring themselves to accept Sir Roy Griffiths' recommendation that community care responsibilities should be entrusted to local authorities. They then stopped short of accepting his accompanying recommendation that there should be specific grants which would in part fund the cost of community care.

The Government are not against specific grants in principle. The Bill indeed provides for such a grant in the context of mental illness, although alas not, incomprehensibly, in respect of mental handicap. The Government said in the White Paper, briefly and without detailed argument, that they had come to the conclusion that a large-scale specific grant was not necessary to secure community care objectives. I wonder.

The Government are committed to transferring to local authorities that part of the social security budget already being used to pay for places in private and voluntary homes. No doubt we shall soon be told what the amount involved will come to. For the rest, as I understand it, the idea is to allocate, through the revenue support grant, an amount based on standard spending assessments, with any necessary extra money having to come from the proceeds of the local poll tax. That mechanism for distributing a nationally determined amount of grant for the personal social services unfortunately falls a little way short of perfection. For one thing, although the allocation for the present year has, I believe, been increased more than for other blocks of expenditure, it is represented to me from all quarters that there is a sizeable gap between the allocation and the real needs.

There is, I fear, a lack of confidence that there will be anything like enough cash to fill the gap and to go on to start providing for the additional cost of the new responsibilities. The allocation is not tailored to the particular needs of individual authorities, which can vary quite a lot. There is no guarantee that the allocation will be devoted wholly to community care.

I believe that so far local authorities have managed pretty well to protect social services spending. Many of them, I am sure, will continue to do so; but there can be no certainty that that policy will continue with all local authorities in the new era of local government finance which we are now approaching.

With the prospect of the Government matching their zeal to promote the principle of local government accountability with their enthusiasm for capping those authorities which they regard as excessively extravagant, it looks as though we may be in for two somewhat undesirable developments. The first is a period of uncertainty about future planning about commitments, given that the criteria for capping are revealed only when the authority has set its poll tax. The second is the prospect of a scramble with other claimants in the queue for an allocation from a local authority's limited resources. Putting it crudely, it is feared that there is not likely to be enough money and that there is no guarantee that what is allocated for community care will necessarily and invariably become available for that purpose.

I have been deluged with representations in support of what the amendment suggests. There is undoubtedly much anxiety. It is not a party political matter. I do not know what assurances the Government can give about there being enough money, not for anything dramatic—not for a Big Bang overnight—but for a worthwhile start on the implementation of these new proposals.

The amendment would at least oblige the Government to state how much money is to be made available through the revenue support grant. It would enable Parliament to debate each year, if need be, the level and adequacy of central funding. It would also ensure that the money intended for society's most vulnerable people would reach its destination. I beg to move.

Lord Carter

From these Benches we are very pleased indeed to support the amendment. It intends that earmarked or ring-fenced central funding should provide some specific estimate within the standard spending assessment for community care, as the noble Lord has said, to allow for parliamentary scrutiny and also to enable a comparison of resources with demographic and community needs.

The only money committed to community care is that part of the social security budget already used to pay for care in private and voluntary homes. I took the trouble to approach the director of social services in my home county of Wiltshire. I asked him for his views on the proposals on community care. I quote briefly from his letter: There will, undoubtedly, be a transfer of resources from the Social Security budget to cover the costs of those people who formerly were admitted to residential care and financed through public funds. The costs of implementing community care, however, will be substantially greater than the funds which may be transferred from Social Security. The reasons are: first, there is a shortfall between the level of benefits provided by Social Security and the cost of the fees. In Wiltshire the shortfall is approximately £30 per week for a residential care home, but substantially more for a nursing home. There will be a statutory assessment of all clients which is not provided for at the present time". We are all aware of the pressures on community care arising from the ageing of the population and the problems of the disabled elderly in particular. The OPCS survey on disability showed that two-thirds—4-2 million out of 6-5 million—of those identified as disabled were over 65.

There is the other effect of the ageing of the population—the growing lack of carers. Governments of all complexions have shamelessly exploited carers for years. The demand for domiciliary services has increased, while the relative supply has fallen. It is estimated that there will be a 20 per cent. increase in severely disabled elderly people between 1986 and the year 2000, from 750,000 to 900,000.

It seems, from reading the White Paper, that the Government feel that market pressures may provide part of the answer. We feel that it is certainly not the answer to apply these to community care. The Griffiths Report specifically called for earmarked or ring-fenced funding for community care. Rejection of the central proposal of the Griffiths Report effectively torpedoes the main recommendation of Griffiths that local authorities should take the lead in the planning and organisation of community care.

If there is no ring fencing, how do the Government propose to ensure that the community care budget is not raided for other purposes? I emphasise that nobody has asked for 100 per cent. central funding, but there must be a specified proportion of central funding that is earmarked for community care. There is the existing gap between funding and demand. In 1988-89, the local authorities planned to spend £190 million more on personal social services than the total government allocation for 1991. There are substantial unmet needs to be catered for before any expansion in services can take place.

The Association of Directors of Social Services, in conjunction with BBC Radio, conducted a national survey of local authority social services departments. It showed that 75 per cent. of local authorities believe that they will have insufficient resources to operate community care under the legislation in 1991. I cannot do better than quote the president of the ADSS, Mr. John Rea Price, who said: This is a worrying picture. Many authorities say they are reducing their existing budget in order to scrape together sufficient cash to fund community care. So, without adequate central government assistance, next year's community care will be paid for by cuts in this year's community care: increased home help charges, the transfer of homes to the independent sector and reduced grants for sheltered housing and other community developments". In all this there is the over-arching problem of the poll tax. It is fundamental to the practice of the poll tax that all expenditure which is not met by central grants, governments grants and the unified business rate must come from the poll tax. There will be tremendous pressure on local authorities to keep the level of poll tax down. As we saw last week, the Government are prepared and ready to make the maximum political capital out of the apparent high-spending authorities. Indeed, it is a political conjunction which almost encourages central government to underfund.

In these circumstances, does anyone really believe that the community care budget will receive the priority it needs if the legislation is to work properly after next April without the protection of ring fencing? The roles of assessor, inspector, the gatekeeper of finances, the purchaser or provider of services will extend the resources of social service departments to their limits. In reality, considerable extra funding and staffing will be required.

We know that the Government are not oppopsed to the principle of ring fencing. We have an example elsewhere in the Bill with grants for mental illness. There was an interesting example of ring fencing in the Budget. The Government proposed that the levy on football pools should be reduced and the amount that was thus saved should be a matter of agreement between the Treasury and the football authorities, but to ring fence it, to spend it on the improvement of football grounds. That seems to me to be an extremely good example of the hypothecation of taxation, which I understand is the Treasury's cardinal sin, and the ring fencing of expenditure. We hope that the Government will not say that they are quite prepared to ring fence the funding of football ground improvements but not to ring fence community care.

For all those reasons it is essential that the central funding of community care is ring fenced and protected. We hope that the Government will see the force of these arguments and accept the amendment.

Lord Hunter of Newington

During the discussion on the part of the Bill dealing with the health service, many anxieties were expressed. On one or two occasions the Government narrowly defeated amendments based on these anxieties. The vote was sufficiently close to convey the real concern felt by doctors and others.

What has emerged was clearly expressed when the Secretary of State talked to the Select Committee on Science and Technology. It was that there might be a rather modest start in certain areas, particularly in relation to contracts. But the Govenment were committed to evolution and a sensitive examination of results, particularly in relation to the first NHS contracts and funded general practices. This chink of light, taken with the awareness of the need for a director of research and development, begins to create the climate of evolution and change in a complex situation.

We have now come to community care and the same concerns will be expressed. There is no machinery at present to carry out the objectives and for that reason the amendment has been put down. The wording may not be right but we hope to hear in the Minister's reply a firm basis here also for evolution. Much is at stake, not least the Government's capacity to work constructively with local government.

Baroness Faithfull

I support the amendment, having been a chief officer in local government and director of social services. I do so for three reasons. First, the expectations of the public on community care have been so raised that if community care is introduced slowly and is set back because of lack of money we shall lose the confidence of the public. Secondly, my noble friend Lady Cox has said for a long time that a number of people in the nursing profession disapprove of social services departments carrying out this work. If it is not properly carried out to start with, people will lose confidence in the whole concept of community care.

Thirdly, when I was a chief officer, I had to prepare my estimates round about September for the following year. If local authorities, and social services departments in particular, do not know exactly how much money they will receive, it will be difficult for them to prepare their estimates. On two occasions when I worked as a director of social services I prepared my estimates, but then some other need arose in the city council and the workload of my department had to be cut back. Unless money is specifically allocated to community care, that process will inevitably occur in some areas. I therefore support the amendment.

3.30 p.m.

Baroness Carnegy of Lour

Many groups which support the notion that there should be earmarked funding or ring fencing of the funding for community care in local authorities do so because they believe it will bring more money to community care. That is their reason for supporting the measure. It is extremely unfortunate that we seem to have arrived at a situation where in addition to those people with that understanding, politicians have been lining up somewhat on party lines. The noble Lord, Lord Carter, indicated that he was speaking for the Benches behind him. It is unfortunate that that has happened because the reality of the situation is that the people who are most vulnerable and who need the money for this purpose are likely to get less rather than more. That worries me. I am speaking not as someone who is a natural supporter of this Government—however, I am such a supporter—but as someone who has spent a long time in local government. I hope that other Members of the Committee sitting opposite who have even greater experience of local government than I have will feel the same way. It is important to realise how the system works.

We are told that the reason for the amendment is that it is the only way to ensure that the money provided by the taxpayer goes to community care. The noble Lord who moved the amendment told us that if the additional functions involved in community care were simply added to local government funding, the money might go elsewhere. The objective of this Committee must be to pass legislation and to set up an arrangement which enables the money that is required to go to community care. The noble Lord, Lord Allen of Abbeydale, said that on the whole local government has been able to protect its social work budget. An examination of local government funding would reveal that local government has done more than that. It has increased spending proportionately through the years. The reason for that is clear. People are concerned about community care. It is an emotive issue. It is as much as a councillor's life is worth not to spend adequately on social work.

I was chairman of an education committee for a number of years and I had the greatest possible difficulty preventing my budget being raided for social work. It was constantly raided for that purpose. I have just received a community charge booklet which tells me what my charge is and other details. The booklet provides an account of how money was spent last year, and how it is anticipated that it will be spent next year. My local authority has just been re-elected at the recent local elections. It increased its community charge last year by only 2.5 per cent. over the previous year. However, it has increased spending on social work by 17 per cent. That is characteristic of what happens through the years. Members of the Committee should not be afraid that the political process in local authorities will result in community care not receiving its fair share of the budget. I do not believe that is a danger.

Normally local authorities dislike earmarked funding and ring fencing very much indeed. When the Government introduced the technical and vocational education initiative, which was a ring-fenced mechanism for funding, local authorities and many Members of this Chamber fought it to the death. They nearly fought it to the death of TVEI. However, eventually that prevailed; and on the whole it has achieved a lot of good. However, that is typical of the dislike of ring fencing of funding which local authorities have always displayed. Local authorities quite rightly want freedom to do the best job that they can for their electorate. I would have defenced that concept to the hilt when I was a councillor. Local authorities want to get the best possible value for money, and they want to save money in one area in order to spend it in another. They want to vire between heads of spending; but they seldom vire away from social work. However, for some reason local authorities now want to abnegate that responsibility. They want to be told what sum they are to receive. They want to spend the money as best they can and, doubtless, complain if they do not have enough money.

Lord Carter

It is clearly understood that no one is asking central government to fund the community care budget 100 per cent. The amount that is allocated for that budget should be protected. However, local authorities are perfectly free to add to that if they wish to do so.

Baroness Carnegy of Lour

I accept that. The noble Lord is. correct. The amendment makes that concept plain, too. However, if the amendment is adopted, the area of local government activity which should be the least politicised and which should be most carefully run on pragmatic grounds in a way that will help vulnerable people who would be frightened by politicians talking politics, will become much more highly politicised. If the amendment is adopted, the beginning of the cycle will occur when Parliament discusses the global sum that will be allocated to community care. There will be a tremendous political discussion about the awful things that will occur if the sum is not larger. That is inevitable. I suppose that those who support the amendment want that. The sum of money will be fixed. Then I suppose there will be a public discussion—perhaps that is what the amendment seeks—on the way the money is allocated between authorities. That formula will have to be public.

At the moment there is a discussion between authorities and the Minister concerned concerning the sum that will be allocated to each council. On the whole that is carried out privately, and the best possible arrangement is arrived at. I have attended many such discussions, as have other Members of the Committee. The year will proceed and we shall begin to hear of all the things that are going wrong in local authorities because there is not enough money. To some extent the situation will be the same as the situation that exists now in the health authorities. The health authority in Lothian, for example, is saying that it is £20 million short, and that it will have to close two of the best hospitals in the region. A 75 year-old friend of mine broke her hip last week. She arrived at a hospital and was told by the surgeon that she had a bad break. However, he told her he could not do anything about it for at least two days because the hospital had run out of money. That is what will happen in community care. I do not know whether or not the surgeon would have dealt with her hip, but that is what he said to somebody who was in a very vulnerable position. That is what will happen to vulnerable people who need the care of local authorities. They will be terrified by hearing discussions about how there will be no more home helps, how this home will close or that home will close because the Government have not provided enough money. Do Members of the Committee really want that? Do Members of the Committee who aspire to government want to be responsible for that? It seems to me to be the most extraordinary idea.

With ring-fencing there is no way in which the Government can decide on the right amount of money. How can they know what is the right sum to provide when local authorities have to draw up the specifications, make arrangements for homes which are cost-effective and try to reduce inefficiency in the private sector as well as in the public sector?

I disagreed with Griffiths. I believe that even the Bill as it stands presents many problems. I should have preferred the health boards to be responsible for the specification and local authorities to be agents. However, that is not what the Government have decided. Nevertheless, they have gone part of the way. I believe that Griffiths was quite wrong to suggest ring fencing. I am very surprised that people who understand the political process in local government and its relationship with central government believe that this is a responsible way to deal with the affairs of vulnerable people. I shall not support the amendment.

Lord Ennals

Before the noble Baroness sits down perhaps she would answer a question. She said that it was her view that many vulnerable people were likely to receive less assistance rather than more. I wonder why she feels that this is a party political issue. All the local authority associations, of whatever political complexion, are in favour of ring fencing. So far as I know from the massive amount of correspondence that I have had, almost all of the voluntary organisations, most of which are non-political, take the same view. They take that view because they share the concern which the noble Baroness expressed at the beginning of her speech. If the Government can make an assessment of the needs of the National Health Service why can they not also make an assessment of the needs of community care?

Baroness Carnegy of Lour

I said that vulnerable people would receive less rather than more assistance because when councillors allocate budgets a great deal of give and take occurs. A ring-fenced sum will already have been allocated to a particular department and the other departments will not give much. The political effect of ring fencing is always that less money from other sources is allocated to a department.

I do not know whether the noble Lord has experience of the process of sharing out money in local government, but I can assure him that that is what occurs. I am sure that other Members of the Committee will agree with me in their heart of hearts.

On the subject of politics, I made it clear that the groups which favour ring fencing do not do so on party political grounds. They believe that they will receive more money as a result. I said that I was sorry that a number of Members of the Committee seemed to be dealing in a political way with a subject which should be discussed by people who understand local government and who can help others understand the effect of this method of funding.

3.45 p.m.

Lord Kilmarnock

Since my name is attached to the amendment I should like to say a few words to explain why it is supported by my noble friends and myself. However, first I was interested to hear the noble Baroness, Lady Carnegy, mention the recommendation of Sir Roy Griffiths that the funds should be ring fenced. She begged to differ, but nevertheless that recommendation stands on the record.

That was not only Sir Roy's recommendation. It was also a recommendation contained in the 1984-85 report of the Select Committee on Social Services of another place, which is an all-party committee with a Conservative majority. Therefore Sir Roy Griffiths' voice was by no means the only one raised in favour of the proposal.

Turning to the question of the merits or demerits of ring fencing, the argument against it has already been undermined by the fact that the Government are contemplating ring fencing funds for expenditure on the mentally ill. Presumably that would mean that social services departments would be able to draw their funds for that purpose directly from central government. The mentally ill are a very important sector. There have been shortcomings in their treatment when they leave institutions, and some people have talked about them falling into a dark hole. There is just as much danger of other people such as the elderly or the disabled for whom there is also inadequate funding also falling into a dark hole. Therefore the Government cannot possibly argue against ring fencing in principle if they already contemplate it for one section of those treated under community care plans.

There are arguments against ring fencing, but in the initial phase it would be preferable to assist local authorities by making it clear precisely what funding will be available from central government for this purpose. That is specified in subsection (3) of the amendment. Therefore, although the noble Baroness, Lady Carnegy, suggested that local government might not be keen on ring fencing, I believe that there is considerable reason why central government should wish to ensure that the money which is provided for that purpose is spent for that purpose.

The Government have taken the plunge and awarded community care funds to local authorities. I believe that that is quite correct since there is nowhere else for the money to go. That is a decision on which we congratulate the Government. However, having taken that decision the Government cannot want the scheme to get off to a bad start. It is my submission to the Committee that if some arrangement along these lines, perhaps not necessarily in the words of the amendment, is not made the scheme is likely to get off to a very bad start.

Lord Butterfield

Perhaps I may ask the noble Lord, Lord Kilmarnock, to clarify one aspect of the very interesting amendment before the Committee. Each local authority will have to make a social diagnosis of the burden that it is likely to face. As I read the amendment, and having listened to the debate, we appear to be concentrating on the resources available to deal with an unknown problem. The amendment states that the Secretary of State shall: make grants out of money provided by Parliament towards the expenses of local authorities incurred in connection with the exercise of their community care functions". Can the noble Lord assure me that local authorities would not be debarred from carrying out surveys to establish what problem they face in order to exercise their community care functions sensibly, wisely and fairly across the spectrum? I am not clear whether that would be prevented by the wording that is used.

That is the question of an ingénue, but it bothers me that under Clause 45 we shall debate the assessments of the needs of persons. Essentially I am trying to discover whether those moneys could be involved in the assessment of the needs of persons or whether they would simply involve community care facilities.

Lord Kilmarnock

The noble Lord, Lord Butterfield, addresses the question to me, but I am not the best person to answer it. Perhaps he should have addressed it to the noble Lord, Lord Allen of Abbeydale, who is much more authoritative in these matters than me.

However, on reading subsection (1) of the new clause, my simple answer is that the exercise contemplated by the noble Lord would be covered because it would be part of the additional expenses that authorities will incur in making the scheme work. Obviously, they will have to make the assessment that the noble Lord suggests. They will also have to make individual assessments of all the people who are potential candidates for community care. Those are all additional requirements over and above the current responsibilities of social services departments. Therefore I am not sure that the noble Baroness, Lady Carnegy of Lour, was entirely right in suggesting that they were already managing well. She did not take into account the additional expenses that will be incurred in that exercise.

Baroness Faithfull

Perhaps I may tell the noble Lord, Lord Butterfield, that all directors of social services in this country are at the moment doing a survey in their areas of the need for facilities and the needs of the people who would use those facilities.

Lord Allen of Abbeydale

As my name is first to the amendment, perhaps I may add that the answer is certainly that local authorities will be able to do that. As the noble Lord, Lord Carter, pointed out, there is no question of suggesting that the grants from central government should be 100 per cent. It will be for each local authority to decide what additional burden it should bear from its own resources and to take whatever steps it thinks appropriate to assess what that burden should be.

Baroness Young

We have all listened with great interest to the debate on this important issue of principle which has arisen. I fully recognise that the recommendation of Sir Roy Griffiths was that there should be some such proposal for finance. As we all know, having received many letters from them, the issue has been raised by voluntary organisations and others which would like to see something like that happen.

As someone who was in local government for 15 years, albeit some time ago, I am bound to say that I am somewhat surprised that local authorities should be as keen on the proposal as they appear to be. I went into local government in 1957 and, if my memory serves me aright, in those days there were specific grants. There was certainly one for education. The great objective of local government in those days was to get rid of specific grants and to have a general grant on the grounds that that made for much greater responsibility in local government. You had the money; it was up to the elected councillors to determine how it should be spent.

I am therefore surprised at the enthusiasm for the proposal that there appears to be in local government. I wonder whether local authorities have thought through what it would mean. It is difficult to argue on the one hand for specific grants and on the other for increased responsibility because the more specific the grants, the more the local authority becomes in effect an agency for central government.

Under Clause 47(7D) on page 53 of the Bill, there appears to be a proposal that there will be grants to local authorities in respect of social services for the mentally ill. I accept that, but I am not sure that I think it is a particularly good idea and I shall listen carefully to what is said on the matter. However, one feature which distinguishes it from the proposals before us is that it is a much narrower issue—like the TVEI; again, I understood the arguments which were put against that—than funding a large part of education by specific grant from the Government. I do not think that it is quite the same case.

As I understand it, we are discussing the duties under Clause 44 as they relate to the amendment. It would therefore be a specific grant. However, as I understand it, under subsection (3) of the new clause the Secretary of State would lay before Parliament his estimate of the total amount of grant likely to be disbursed and at the same time the local authorities would put to Parliament what they thought they required. It does not take much political understanding to realise that those two sums of money are most unlikely to be equal. In those circumstances, there would be every incentive for local authorities—naturally enough arguing that they were only doing what was in the best interests of their communities—to put up the largest amount of money that they thought they could reasonably get away with. It is unlikely that the Government would match it.

We therefore have an absolutely classic recipe for a major clash between the government, of whatever complexion, and local authorities, of whatever complexion. As my noble friend Lady Carnegy quite properly pointed out, we should then find throughout the year a constant series of examples of homes which should be open but are closed and of people who should be helped but are not being helped. If, at the end of the day, Parliament dealt with it, those people who most need to be helped would suffer the most.

That is not a good way of proceeding. I do not support the amendment. I hope that, when he answers the debate, my noble friend Lord Henley will perhaps give us some indication of where the money for the proposals will come from. I should like to know whether my understanding of the Bill is correct. If not, perhaps he will correct me.

It has already been indicated that there will be some transfer of resources from the social security department to local authorities for the new service. Obviously, there will be some money in the revenue support grant which will come each year. Because the voluntary sector is involved, there will presumably be some money which local authorities will have to see as a benefit to a local authority, at least via the voluntary sector. I am not clear whether there is any other source of income. I should have thought it unlikely. It will be helpful to know in as much detail as possible how my noble friend sees the money for the service being provided.

The other point that I should like to make is that, if one reads the amendment in relation to the next amendment that we shall debate, one sees that one enters into difficult discussions about what is called adequate money. "Adequate" is a difficult word to define in legislation. One person's idea of adequate is not another's. I fear that, if we support Amendment No. 108AE, we shall find ourselves drawn into the next amendment which, as far as I can see, is almost a recipe for asking for a blank cheque. That will not help social services departments, nor will it in the end help those most in need.

I hope that, having listened to the debate, the noble Lord, Lord Allen of Abbeydale, will feel able to withdraw the amendment. Despite all that has been said by the organisations, I do not believe that the proposal is in the best interests of those in greatest need. My noble friend Lady Carnegy set out the arguments well. If we go down this path, we shall put local government on a slippery slope.

The Lord Bishop of Manchester

I was glad to discover that the amendment had been tabled because it attempts to meet the widespread concern in social services departments throughout the country. Certainly, in the area from which I come I have heard the concern expressed again and again that only one part of the Griffiths Report is being implemented. Was it not Churchill who said, Give us the tools, and we will finish the job"? The job of community care is never finished.

As has been well said, to put major responsibilities on local authorities without adequate and guaranteed additional central government funding, while at the same time conducting a campaign to keep the poll tax as low as possible, seems to be a recipe for a bad start.

If the Minister is not to respond favourably to this amendment, I hope that at least he will give a very clear indication where the funds are to come from. It seems to me to be totally unjust to lay major responsibilities on local authorities without answering very clearly that kind of question.

I should like to comment on one or two points that came up in the debate. First, it has been said that the social services have been remarkably successful up and down the country in defending their budgets. My impression is that that is only partially true. What they have been able to do is immensely to their credit but my impression of morale within the social services at a time of acute financial constraint is not one that would encourage such optimism. I believe that it would be unfortunate for this Chamber to send out a complacent signal to indicate that all was well on that side.

With regard to arguments and conflict between central government and the local authorities, frankly the situation could not be much worse than it is at the present time. I shall not make any comment, at any rate at this moment, on where the responsibility for that lies. It seems to me that the point made by the noble Baroness, Lady Young, does not stand up. I cannot see that ring-fenced grants of this kind would improve the argument. When it comes to matters which impinge on local communities, such as the closure of old people's homes or whatever, inevitably the levels of both the poll tax and central government grant would be in question whether or not there are ring-fenced grants.

I hope very much that the Committee will look with favour on this amendment, that the noble Lord, Lord Allen, will not withdraw it and that the Minister will be able to comment sympathetically on the ideas that lie behind it.

4 p.m.

Lord Rochester

It would be wrong for discussion on this important amendment to be concluded without some contribution, however brief, from these Benches. I have no experience of local government nor of health administration. Nevertheless, I have listened to the debate and, taking into account the difficulties raised by the noble Baroness, Lady Young, in particular, I find myself wholly in sympathy with the principle of ring fencing for the funding of community care which underlies this amendment.

Lord Jenkin of Roding

I must begin with an apology to the noble Lord, Lord Allen of Abbeydale, because I was not in my place to hear him move the amendment. However, I have sought to inform myself of the burden of the case that he made, which, I have to say, is not one that is unfamiliar. On a number of occasions one has heard it advanced by several particular interests who, as my noble friend Lady Young said, manage to convince themselves that somehow they would do better if they had an earmarked grant than if they had to argue their case with the other spending departments in local authorities.

During my time as Social Services Secretary—and in this I do not think I followed a policy that was any different from that of my predecessor, the noble Lord, Lord Ennals—I, like him, faced pressures from Treasury colleagues to seek to curb local government spending. It was not a Conservative Minister who coined the phrase "The party is over"; it was the late Anthony Crosland. I am sure that, in addressing our social services audiences—both, as it were, the lay and voluntary audiences, but in this context more importantly the chairmen of social services committees and their directors—we sought to argue that within an overall constrained budget we would encourage them to do the best that they could for their clients.

I say with some diffidence that we have to take issue with the right reverend Prelate who spoke a moment or two ago. If one studies the figures in the Government's White Paper which preceded this part of the Bill it seems that the expansion that has taken place in both residential and non-residential care (in the provision of home helps and a whole range of other services) is ample testimony to the point made by my noble friend Lady Young that social services committees and their departments have succeeded in obtaining a very fair share of the cake when it comes to dividing the resources of a local authority between the various claims upon it.

In a very interesting intervention the noble Lord, Lord Carter, seemed to say, "Well, what is the difficulty? The National Health Service has funds distributed from the centre. Why shouldn't the same apply to community care?" I am sorry; it was not the noble Lord, Lord Carter, but the noble Lord, Lord Ennals, who said that. I apologise to both noble Lords.

To follow the logic of that argument, does one want the community care service to become like the National Health Service with appointed committees? That would be the logic of it. It seems to me that one cannot transfer the whole or a large part of the cost of a substantial government department to the Exchequer—to the central government—without the central government having a great deal more say in how the money is disbursed and ultimately a say in how people should be appointed. It seems to me that the one follows from the other. It is a fanciful idea that somehow one could transfer the cost to the centre while still leaving local authorities entirely free to decide what to do with the money. That is not the way that it works. It is not the way that it works in the National Health Service and I should not want it to be the way that it works in local authority community care services.

The other day my attention was drawn to a very interesting booklet put out by the Association of County Councils. It sought to describe half a dozen entirely different local government initiatives—county council initiatives—in the sphere of community care. I shall not weary the Committee with the details. I am sure that most Members will have seen the publication. Each of the examples represented imaginative innovation in the provision of services—decisions to allocate particular funds to a specific purpose which had been identified in the locality. The councils did not have to seek the consent of the Department of Health or the Department of Social Security. They did not have to seek Treasury approval. The budget was their own.

That is the way in which improvement in the quality and delivery of care—innovations in the provision of different kinds of services—can happen. It happens because local authorities currently have complete discretion on how they disburse their funds If there were an earmarked grant, does any Member of the Committee seriously imagine that such innovations would be possible without having to go to the central government department and say, "This is how we propose to spend your grant. Is that all right by you"? I suspect that that would be fanciful. Of course they would have to seek what might be a deviation from the standard norms laid down by the Department of Health for the provision of services.

As the right reverend Prelate said, there is much unhappiness currently in local government for a variety of reasons. In this hugely important area of local government provision of services (and, so far as I can see, everybody has welcomed the main thrust of the reform, which is to put the duties firmly on local authorities and to augment their general finances to be able to perform them), if one were to add that new tension and constant necessity for argument and counter-argument, does anyone seriously imagine that the relations between government and local authorities would improve? That would not be my experience.

I hope very much that the noble Lord, Lord Allen, in the light of that argument—we have not yet heard it all as we have not heard from my noble friend on the Front Bench—may prefer to withdraw his amendment. If he does not, I most strongly urge the Committee to vote against it.

Lord Ennals

Before the noble Lord sits down, perhaps I may say this. One of the troubles with former Secretaries of State, or any former head of department, is that they are inclined to stand still and not to move with the times. The noble Lord may think the same of me as I think of him.

There are three factors that seem important. First, we need to have, as we have learnt, a continuity of service for health and community care. Secondly, the pattern of community care across the country varies far more than the pattern of health care because of the different method of funding. Thirdly, the Government, who make funds available to local authorities, need some assurance that part of that money will be used for the purpose for which it is intended. When the noble Lord says that the provision will make life more difficult and conflicts greater, he must know that the vast majority of local authorities want exactly what is written in the amendment.

Lord Jenkin of Roding

Since the noble Lord intervened when I thought that I had already sat down, perhaps I may respond briefly. I share one hundred per cent. the view expressed a moment ago by the noble Baroness, Lady Young, about the extraordinary ambivalence of local authorities when they are faced with the question of general or specific grants. When they have a specific grant they argue passionately for a general grant—the revenue support grant as it is now called. When they wish for something particular to happen or some service to have priority, they argue passionately for a specific grant. I suspect that if we were to go down the road of making this a specific grant, as sure as eggs are eggs within a few years the local authorities would be back saying, "It is tying our hands. It is destroying our initative. It is removing our incentive to innovate and develop our services. Can it not now be returned to a general grant?"

I am a very strong supporter of the concept of the general grant. One looks at deviations from it with great care. With regard to the mentally ill it is a very interesting deviation. We shall no doubt come to that, as has already been indicated. It has been a Cinderella service, as no one knows better than the noble Lord, Lord Ennals. He tried to do a great deal to support it and I hope that I followed his policy in that regard. It is not a popular service. Relatively small numbers of people need some very specific services. I believe that to earmark a very small part of the budget for such a group is acceptable. To earmark a large part of a large budget—it is certainly a large part of the budgets of the main social services authorities—would be going entirely in the wrong direction.

4.15 p.m.

Lord Henley

We have had a very interesting debate. Perhaps I may start by saying how grateful I am for the support of those Members of the Committee with local authority background as members of authorities.

As the Committee knows, the only way that the amendment could be effected would be through a large specific grant, ring fenced or earmarked, as the noble Lord, Lord Carter, put it. The underlying intention of the amendment is clearly to protect community care funds. There is concern that they would otherwise be vulnerable to attack from what might be seen by local authorities as more compelling, or more "sexy", as one might put it, interests. I am obviously now well aware of the body of feeling within the Committee that there might be a strong case for ring fencing funds for community care.

I should like to turn to one point that came out of an exchange between the noble Lords, Lord Carter and Lord Ennals, and my noble friend Lady Carnegy. As the noble Lord, Lord Carter, said, quite obviously the amendment merely specifies a minimum. It would then be up to a local authority, if it wished, to go above that minimum. However, the very argument that noble Lords have been putting forward for ring fencing applies to that position also. If there is a specific grant, members of the authority representing other committees and services could very well say—as I believe the noble Baroness, Lady Carnegy, pointed out—"Yes, you have your money. You will not receive any more. As members representing other committees we shall use the money that you raised from the community charge payer for other services such as education, libraries highways, or whatever".

As has been pointed out this afternoon, Sir Roy Griffiths recommended specific ring fenced, earmarked (or whatever one wishes to call them) grants. As the Committee knows, the Government decided after careful consideration of all the arguments—and I accept as did the noble Lord, Lord Kilmarnock, that there must be a balance of arguments—that central support for community care expenditure by local authorities, as with other important local authority functions, is best provided through the revenue support grant. Community care forms such a large proportion of local authority expenditure on personal social services that the provision of a large specific grant would be akin to drawing the service into central administration. That would be wholly inconsistent with the local decision making and accountability that is at the root of our proposals.

Many of the arguments for ring fencing local authority community care funds could be applied equally well to local authority child care services or any other local authority programme. I am sure that the noble Lord, Lord Carter, or other Members of the Committee, would not wish, for example, to ring-fence expenditure on aspects of education, highways, or other services. The Government are not seeking to take over local authority responsibility for community care. They are seeking to support and encourage them by providing the right legislative and financial framework and helping to develop good managerial and professional practice.

Neither do the Government wish to substitute their view for that of local government in the allocation of resources between community care and other local authority services. Recent trends in expenditure show no reason to fear that local authorities will give low priority to social services. The unprecedented expansion in expenditure by local authorities on social services over the past decade (37 per cent. in real terms) has taken place without specific grant or the high profile now being given to community care through both the White Paper and the Bill.

The right reverend Prelate the Bishop of Manchester accused us of complacency in this matter. If that is complacency, then I ask: can it be complacency to say that you trust the local authorities to spend?

The Lord Bishop of Manchester

If the Minister will give way, perhaps I may say this. The same point will apply to the remarks of the noble Lord, Lord Jenkin. Surely the number of elderly has been increasing very rapidly. Of course there is more expenditure in that field.

Lord Henley

I accept, as I accepted before, the demographic trend of an increasing number of elderly. There is also a 37 per cent. increase in real terms which more than covers any increase over the eight or 10 years about which I have been talking of expenditure by local authorities. One cannot describe an action which imposes trust in local authorities as being complacent.

The Government do not underestimate the scale of the challenge facing local authorities. The natural worries that such an enterprise is bound to evoke are understandable. We have no doubt about the need for investment to reap the benefits of our proposals, but it must be the right kind of investment.

We intend to play our part in ensuring that the right framework and resources are available in order to promote and encourage progress. The financial framework outlined in the White Paper was designed with those principles in mind. Inevitably, we have had to address the question of balancing local freedom with the need for central intervention. But we believe that we have the balance right.

The noble Lord, Lord Allen, asked for assurances that there would be enough money available. We have given a very clear commitment to provide adequate resources, taking into account both demographic pressure and the new responsibilities. Such a commitment outside the public expenditure survey is most unusual and reflects the importance that we attach to the community care programme. Work on ensuring the right level of funding is well in hand. The transfer of resources will allow for the projected growth in the number of people needing support, taking account of demographic factors. Local authorities will be able to make more effective use of the transferred resources than income support through assessment and case management, and thus will be able to make more efficient use of resources and ensure that they are directed to where they are most needed.

The cost to local authorities of the new policy will be considered in this year's public expenditure survey. The amount of the transfer will be announced as soon as possible and this will feed into the personal social services standard spending assessment on a £for £basis. Specific grants would only act to weaken the local accountability that we have already achieved.

The Government will make clear their view of what local authorities need to spend in order to provide a standard level of service without restricting local authorities' freedom to decide their own priorities, but they will be accountable for those decisions.

My noble friend Lady Young wanted to know where the Government expected the money to come from. Government support for the new community care responsibilites will be distributed through the standard spending assessment for personal social services. Account will be taken of a range of need indicators, including the authorities' increasing responsibility for clients who would previously have been funded through social security payments. The formula is currently being reconsidered in the light of the new policy and discussions with the local authority associations.

In deciding that local authorities should have responsibility for the new budget we recognised that they already had responsibility for the full range of social care services and had developed a great deal of expertise. We also had confidence that local authorities would be willing and able to deliver the policies without the need for us to erode local discretion on the use of large slices of their resources. Alongside that responsibility must come accountability. We have provided for the means to monitor local authority performance on community care and for intervention through extended powers of direction where this becomes necessary. Clause 47 strengthens the Secretary of State's ability to take effective action if local authorities fail to discharge their duties to plan for and provide social services.

As I have said, recent trends in expenditure show no reason to fear that local authorities will give low priority to social services. While we recognise that development has been uneven we believe that this can be addressed by encouraging the spread of good practice.

To this end we are seeking to support and encourage local authorities by providing the right legislative and financial framework and helping to develop good managerial and professional practice. We see our proper role as one of working in co-operation with the service providers and enablers to evolve a strategy for implementation. To this end we have set up a number of project teams and working groups involving people from local authorities, the NHS and the voluntary and private sectors, and most importantly we are also looking to involve represenatives of carers and service users.

The noble Lord, Lord Carter, and other noble Lords mentioned the survey of all social services directors. It showed that in 1990-91 funding for some 70 per cent. of local authority social services departments had increased. That indicates that personal social services expenditure tends to do better in a non-ring-fenced environment than when funding is artificially constrained. As I said earlier, expenditure increased by some 37 per cent. in real terms between 1978–79 and 1989–90 on personal social services.

We have considered very carefully the arguments in favour of ring fencing or linking resources allocation to planning but remain convinced that the widely shared objectives of the White Paper can be achieved without such constraining measures and that the disadvantages firmly outweigh the advantages. Proper local decision-making and local accountability are paramount if local authorities are going to make the most of this opportunity, and we do not want to inhibit that. We are consulting the local authority associations on all financial aspects of the proposals.

The noble Lords, Lord Allen and Lord Kilmarnock, rightly said that we are not against the use of specific grants. The noble Lord, Lord Carter, also mentioned the Budget and football pools, though I am not sure that that is analogous.

Lord Carter

It is absolutely analogous.

Lord Henley

I do not accept that it is. We accept the case for specific grants on some occasions and we do not underestimate the usefulness of targeted specific grants in a context which can be clearly defined (for example, training needs); nor of central funds for special initiatives as in the case of the successful care in the community demonstration programme. We believe that the proposed specific grant for mental illness is the right kind of vehicle for ring-fenced funds. Here there is a definable need to move quickly from the very low baseline of current services to the position where local authorities are taking the primary responsibility for the social care of those people in the community who have a mental illness.

There is also a need to ensure that such service developments are fully co-ordinated with NHS developments; hence our concern to ensure that the grant is paid through the RHAs. It would not be possible to channel the money this way without ring-fencing it. But the need to foster rapid co-ordinated development is not so acute for other client groups or community care generally.

The specific grant for the support of services to mentally ill people is being introduced in response to the particular needs of that situation. Social care for mentally ill people has been largely health authority based in the past and the decision to give primary responsibility to the local authorities for this service necessitates their building rapidly upon their existing low baseline. We believe that it is right to target resources to this service but to give freedom to the social service authorities to decide the pattern of response appropriate to their local needs. We do not consider that other client groups have such a compelling case for such treatment.

We have also considered proposals for specific grants in relation to other groups and conclude that mental illness represents a special case which does not apply to other groups. We are of course anxious that all client groups should receive all the care that they need. But there is generally not the need for such rapid expansion from such a low base. We see a particular need for local authorities to rapidly improve and expand the services they provide for the mentally ill. Furthermore, the social care needs of this group are often met by the NHS at present, which is clearly inappropriate and not conducive to their welfare.

Having explained that specific grants for the mentally ill are a different matter from the total grant for community care, I hope that the noble Lord will feel able to withdraw the amendment and consider that we can leave local authorities to decide how to spend the money as they think best.

Lord Carter

We have had a good debate on this first amendment. Before the noble Lord, Lord Allen, decides what to do I wish to respond to a few of the points that have been made.

The crucial point is that, with ring fencing, the local authorities will know that they will receive at least the amount that has been ring fenced for community care. Farmers and landowners in the Committee will not need to be told that ring fencing is by far the best protection of property available. It has been pointed out that in the past local authorities disliked ring fencing. Of course they did, but the reason for their change of mind illustrates their concern at the implications of the requirements of community care which are to be placed upon them. That is why they have asked for ring fencing. I have already said that they will still have the freedom to add to ring fenced funds. It is by no means a constriction but they will be sure of receiving at least that amount.

The noble Baronesses, Lady Carnegy and Lady Young, appeared to be curiously reluctant to have a public debate about the allocation of community care. Personally, I cannot see what is wrong with that. One looks with interest to see whether Members of the Committee who opposed ring fencing as a matter of principle will oppose the specific grants for mental illness which come later in the Bill.

It has not been mentioned that under the new system, there will be 140,000 new applicants for community care. That is the size of the new demand on resources. There is a whole new system of planning and responsibility for community care.

Cynics may claim that having legislated for the ends, central government are anxious not to be held responsible for the lack of means. We have heard a lot as to how the sums are to be decided. The Minister made it clear that the Government have to do the sums now. They have to make their estimates and forecasts. Those sums have to be done now. One is merely asking that the sums provided as part of that are ring fenced and protected. The figures are not just pulled out of the air by the Government. They have to be worked out now.

The Minister said that resources will be adequate. He should have a word with his noble friend Lady Young who said that she was worried about the use of the word "adequate" in the next amendment which we shall consider. Ring fencing does not restrict the local authorities. They can add the sums that they wish. As I pointed out when I first spoke, they will have to do that through the poll tax. That is the accountability which the Government want.

Despite the extra resources to which the Minister was entitled to refer, there is still a gap of unmet need in the order of £200 million. That has to be met first before all the new responsibilities of community care are able to be met by the local authorities.

The Minister did not say why it is that everybody is asking for this provision. All the local authority associations and voluntary organisations have asked for the protection of ring fencing. The Government have handed it down from on high that they do not believe that that is a good idea and, therefore, that that is the end of the argument. I hope that the noble Lord, Lord Allen of Abbeydale, will pick up the other points which have been made and then consider whether he should ask the opinion of the Committee on this amendment. 4.30 p.m.

Lord Henley

The noble Lord does not seem to trust the local authorities. He asked what local authorities have said about this. We have not heard much from them. However, it is interesting that the only two Members of the Committee who spoke with local authority experience as elected members both said that they did not want this, and that local authorities would prefer not to have their money ring fenced.

The noble Lord quite rightly said that the amount which was ring fenced was a minimum and the local authorities could top up that amount. If the noble Lord lacks faith in local authorities, does he not believe that perhaps they would not go further than that minimum but merely stick to it?

Lord Carter

All the organisations which represent local authorities have asked for ring fencing. We have been inundated with briefing which requests and sets out the arguments for ring fencing.

Baroness Carnegy of Lour

Perhaps the noble Lord, Lord Allen of Abbeydale, can make clear whether he envisages in the amendment that everything which a local authority spends on community care—including what is allocated at present through normal government grants for their existing social services functions—is to be ring fenced. Will the local authorities lose their discretion as to how they spend existing money? The noble Lord, Lord Carter, spoke about money coming from the poll tax. However, there is an enormous social services budget at present for local authorities. Is that to be ring fenced or does that merely apply to the extra amount?

Lord Allen of Abbeydale

We have had an interesting debate; but to my mind it has been slightly disappointing. I thought that the arguments for not accepting the recommendations of Griffiths and the Select Committee might be rather stronger than have emerged so far from the discussions.

To deal with the point which has been raised, the amendment is quite clear that it relates to community care functions. As the Bill proceeds, I hope that we may discover what are those functions. However, that is a point to be considered later.

I tried very hard to avoid raising this matter as a party political issue, and I am pleased that not all the voices from the other side of the Committee were against the proposal. Incidentally, I tried to avoid using the words "ring fencing".

On the specific grant aspect, although I have listened with great care to the noble Baroness and to the noble Lord, Lord Jenkin of Roding, who know more about local government than I, it seems that there is a misunderstanding. I realise that the Home Office is a black sheep in the field of specific grants. I believe that it still clings to the police grant as a separate specific grant. However, this amendment does not propose a specific grant of that sort—that is a fixed percentage of approved expenditure. As the noble Lord, Lord Carter, explained, this is a grant to which local authorities are free to add according to their needs and desires. The amendment suggests that the Government should be under an obligation to tell the world how much money they will provide.

I take the point made by the noble Baroness, Lady Young, about subsection (3) including the provision that that statement to Parliament should include an explanation of what the local authorities have asked for, and the possibility that that would give rise to a great deal of political argument. I can see that that part of subsection (3) should go without any tears.

I still believe that what is proposed here is wanted by the local authorities who do not look upon it as a specific fixed percentage grant. In the new world in which we are moving—and I believe that there is a danger in devoting too much importance to what has happened hitherto—there can be a risk that the most vulnerable members of society will not receive the money which has been intended for them. There is not even a guarantee that the money transferred from the social security budget will find its way to helping on community care. That risk is not universal, but it exists.

The noble Baroness, Lady Carnegy, said that it would be very difficult to work out the amount of grant. It is very difficult to work out the amount of the spending assessment; and, as my noble friend Lord Hunter of Newington said, we are in an evolutionary processs and we shall not achieve perfection on the first day.

The noble Baroness, Lady Young, raised the specific question that if the amendment were not accepted, perhaps the Government could make it clear from where the money is coming. I do not know if the reply she received from the Government satisfied her on that. It did not satisfy me. I am still left in doubt, and I must take the view of the Committee on this amendment.

4.39 p.m.

On Question, Whether the said amendment (No. 108AE) shall be agreed to?

Their Lordships divided: Contents, 127; Not-Contents, 119.

Addington, L. Craigavon, V.
Airedale, L. Crook, L.
Allen of Abbeydale, L. [Teller.] Darcy (de Knayth), B.
David, B.
Alport, L. Dean of Beswick, L.
Ampthill, L. Diamond, L.
Ardwick, L. Donaldson of Kingsbridge, L.
Aylestone, L. Dormand of Easington, L.
Birk, B. Ennals, L.
Blease L. Erroll, E.
Bonham-Carter, L. Ewart-Biggs, B.
Boston of Faversham, L. Ezra, L.
Bottomley, L. Faithfull, B.
Brightman, L. Falkender, B.
Broadbridge, L. Falkland, V.
Bruce of Donington, L. Fisher of Rednal, B.
Butterfield, L. Foot, L.
Callaghan of Cardiff, L. Gallacher, L.
Campbell of Eskan, L. Galpern, L.
Carmichael of Kelvingrove, L. Gibson, L.
Gladwyn, L.
Carter L. Graham of Edmonton, L. [Teller.]
Cledwyn of Penrhos, L.
Clinton-Davis, L. Greenhill of Harrow, L.
Cocks of Hartcliffe, L. Gregson, L.
Grey, E. Nicol, B.
Grimond, L. Ogmore, L.
Hampton, L. Oram, L.
Hanworth, V. Parry, L.
Harris of Greenwich, L. Perry of Walton, L.
Hatch of Lusby, L. Peston, L.
Hayter, L. Phillips, B.
Henderson of Brompton, L. Pitt of Hampstead, L.
Hirshfield, L. Ponsonby of Shulbrede, L.
Houghton of Sowerby, L. Porritt, L.
Hunt, L. Prys-Davies, L.
Hunter of Newington, L. Rea, L.
Hylton-Foster, B. Ritchie of Dundee, L.
Jay, L. Rochester, L.
Jeger, B. Russell, E.
Jenkins of Putney, L. Sainsbury, L.
John-Mackie, L. Saltoun of Abernethy, Ly.
Kearton, L. Scanlon, L.
Kilmarnock, L. Seebohm, L.
Kinloss, Ly. Serota, B.
Kirkwood, L. Shackleton, L.
Leatherland, L. Shannon, E.
Llewelyn-Davies of Hastoe, B. Smith, L.
Somers, L.
Lloyd of Hampstead, L. Stallard, L.
Lloyd of Kilgerran, L. Stedman, B.
Lockwood, B. Stoddart of Swindon, L.
Longford, E. Strabolgi, L.
Lovell-Davis, L. Taylor of Blackburn, L.
McFarlane of Llandaff, B. Taylor of Gryfe, L.
Mcintosh of Haringey, L. Thomson of Monifieth, L.
McNair, L. Thurlow, L.
Mais, L. Tordoff, L.
Manchester, Bp. Underhill, L.
Marsh, L. Wallace of Coslany, L.
Masham of Ilton, B. Walston, L.
Mason of Barnsley, L. Wedderburn of Charlton, L.
Milner of Leeds, L. Williams of Elvel, L.
Molloy, L. Winchilsea and Nottingham, E.
Mulley, L.
Murray of Epping Forest, L. Winstanley, L.
Airey of Abingdon, B. Elliot of Harwood, B.
Alexander of Tunis, E. Fortescue, E.
Allerton, L. Fraser of Carmyllie, L.
Annaly, L. Gainford, L.
Arran, E. Gisborough, L.
Auckland, L. Gray of Contin, L.
Balfour, E. Gridley, L.
Belhaven and Stenton, L. Hailsham of Marylebone, L.
Beloff, L. Harmar-Nicholls, L.
Belstead, L. Havers, L.
Bessborough, E. Henley, L.
Bethell, L. Hesketh, L.
Blatch, B. Hives, L.
Blyth, L. Home of the Hirsel, L.
Boardman, L. Hooper, B.
Boyd-Carpenter, L. Ingrow, L.
Brabazon of Tara, L. Jenkin of Roding, L.
Bridgeman, V. Johnston of Rockport, L.
Brookeborough, V. Joseph, L.
Brougham and Vaux, L. Kaberry of Adel, L.
Butterworth, L. Kinnaird, L.
Caithness, E. Kitchener, E.
Campbell of Alloway, L. Lauderdale, E.
Campbell of Croy, L. Layton, L.
Carnegy of Lour, B. Lindsey and Abingdon, E.
Carnock, L. Long, V.
Cawley, L. Luke, L.
Clanwilliam, E. Lyell, L.
Colnbrook, L. McColl of Dulwich, L.
Cork and Orrery, E. Mackay of Clashfern, L.
Cottesloe, L. Malmesbury, E.
Cranbrook, E. Mancroft, L.
Cross, V. Margadale, L.
Davidson, V. [Teller.] Merrivale, L.
Denham, L. Mersey, V.
Dilhorne, V. Milverton, L.
Ellenborough, L. Monk Bretton, L.
Elles, B. Mottistone, L.
Mountevans, L. Sempill, Ly.
Mowbray and Stourton, L. Sharples, B.
Munster, E. Skelmersdale, L.
Nelson, E. Stodart of Leaston, L.
Nelson of Stafford, L. Strathclyde, L.
Norfolk, D. Strathmore and Kinghorne, E.
Norrie, L.
Nugent of Guildford, L. Strathspey, L.
Oppenheim-Barnes, B. Swansea, L.
Orkney, E. Swinton, E.
Pender, L. Terrington, L.
Penrhyn, L. Teviot, L.
Perth, E. Thomas of Gwydir, L.
Peyton of Yeovil, L. Thorneycroft, L.
Pym, L. Tranmire, L.
Rankeillour, L. Trefgarne, L.
Reay, L. Trumpington, B.
Renton, L. Ullswater, V. [Teller.]
Romney, E. Vaux of Harrowden, L.
St. Davids, V. Westbury, L.
Sanderson of Bowden, L. Wise, L.
Savile, L. Young, B.

Resolved in the affirmative, and amendment agreed to accordingly.

4.47 p.m.

[Amendment No. 108AD had been withdrawn from the Marshalled List.]

Lord Carter moved Amendment No. 108AEA: Before Clause 40, insert the following new clause: ("Implementation of Part III Timetable for implementation —(1) This Part, other than this section and section 44 below, shall have effect subject to the making of an Order of Orders by the Secretary of State after consultation with such organisations representative of local authorities, users and carers as appear to him to be concerned. (2) Section 44 below shall have effect from the date of Royal Assent. (3) No Order shall be made in respect of any other provision of this Part under section 63(2) below except where the Secretary of State is satisfied that the resources available to local authorities are adequate to secure the proper carrying out of their duties in a manner conducive to the interests and welfare of any person for whom community care services may be provided or arranged. (4) For the purposes of subsection (3) above, no Order shall be made unless the Secretary of State is satisfied that resources sufficient to the requirements of subsection (3) above are available in respect of the implementation by authorities of the functions subject to the Order in the first financial year in which they apply and that such resources are likely to be sufficient in the succeeding four financial years based on his estimate of the likely cost of those functions over those years.").

The noble Lord said: In moving this amendment I speak also to Amendment No. 108AEB. These amendments follow on naturally from our victory on the previous amendment. They are intended to ensure that community care is brought in on a proper timetable to match the resources available and that the necessary start-up costs are properly funded.

As we know, from April of next year financial responsibility for residential care will be transferred from social security to local authorities, together with the introduction of assessment, a case management system and the proposed arm's length inspectorate.

The local government information unit has produced a very useful table listing the new or increased functions that are proposed in the Bill. They are: to produce and publish a community care plan and to revise it regularly; to publish criteria for undertaking individual assessments; to carry out individual assessments; the assessment and collection of individual contributions towards the cost of services; to create monitoring and inspection units; to set up complaints procedures; to create purchasing and budgeting systems; and to set up systems for case management. For all those functions no additional funding is proposed.

All that will involve heavy expenditure on information technology, recruitment, training and, of course, the associated infrastructure costs. One estimate suggests that information systems alone could cost £140 million to £200 million over an 18-month period. There is also the problem of bringing local authority residential homes up to the new standards required, and that could cost another £200 million or more.

Therefore, the purpose of this clause is to make it a duty for local authorities to draw up their community care plans for 1991, when the Bill has received Royal Assent, laying a requirement on the Secretary of State to assure himself that sufficient funding is available to meet the needs detailed in the plans. As more people are moved out of long-stay hospitals in pursuit of the community care ideal, initial funding will be required to ensure that supported housing schemes are available.

We fear that the alternative is perhaps a rise in homelessness, particularly among those with a history of mental illness or mental handicap. The clause will enable the Secretary of State to make a specific grant to cover the capital and revenue cost of starting up the new services which are necessary. As I have just said, the amendments require that the Secretary of State shall satisfy himself, according to subsection (3), that: No order shall be made … except where the Secretary of State is satisfied that the resources available to local authorities are adequate to secure the proper carrying out of their duties in a manner conducive to the interests and welfare of any person for whom community care services may be provided or arranged".

Presumably, no responsible Secretary of State would wish to do other than as set out in that subsection. Therefore, we are confident that the Government will accept this amendment. I beg to move.

Lord Seebohm

The noble Lord, Lord Carter, has put the matter very fairly. I wish to make a few comments as general points quite apart from this particular amendment. None of the amendments that carry my name and practically none of those in the names of other Members of the Committee is intended to knock the Bill. This Bill represents probably the finest and biggest move forward for social care that we have seen in all the 40 years during which I have been involved with social problems. Therefore, it is absolutely vital that these provisions are carried out.

Perhaps I may give an example: very shortly, local authorities will be making their assessments of needs for care in their areas. They will provide a package for clients. A client will be perfectly reasonable and understand that one cannot immediately cure a large shortage of speech therapists or physiotherapists and so on. What is even more important, he will understand that the necessary housing and special accommodation to meet the needs of the disabled cannot be produced immediately.

However, he will not understand that the one matter that can be cured overnight—namely, the provision of money—is the one issue which is spoiling the whole exercise. If that issue stopped the exercise it would be criminal folly. These amendments are quite moderate. We have to be very careful that the financial resources are available before the measures are put into effect.

Lord Jenkin of Roding

Is this not a case of putting the best before the good? Is it really suggested that local authorities should not be free to implement this very important part of the Bill? I acknowledge the commendation which the noble Lord, Lord Seebohm, has just given. I share his view in saying that this is an extremely important part of the Bill. As I read the clause, is it seriously suggested that there has to be a kind of tripwire in that no local authority can go ahead and implement these plans until all local authorities have satisfied the Government that their resources are adequate? Presumably, it would be only then that the Secretary of State would be able to make his commencement order.

Let us consider for a moment what the effects will be. Let us suppose that, for perfectly honourable reasons—there may be other reasons which have a more political slant—there are local authorities which are determined to go on proving to the Government that in their view their resources are inadequate. Let us suppose that the Government go on seeking to negotiate by argument and by making their case and that those arguments drag on month after month. In those circumstances, is it seriously suggested that the Secretary of State will have to delay his commencement order so that nobody can go ahead with these arrangements? That is the effect of this amendment.

I am open to correction by the noble Lord, Lord Carter, or any other Member of the Committee, if that is not what the amendment means. If the amendment means what I think it does, then it is a classic example of willing the end without willing the means. If this amendment provides such a valuable advance then its provisions should be allowed to go ahead as quickly as possible. I find the arguments put forward on this matter slightly awry.

This Bill has consisted of two arguments. The first is that the Government are rushing ahead and implementing it far too quickly and everything is a great rush. The second is advanced by people who say how terrible it is that the Government are dragging their feet; that they have had the report for years and they have not done anything about it. We have to decide the direction in which we are going and what we want to do. There should be a measured pace which involves having a report, reaching a decision and then pressing ahead, making sure that we can implement the measures even if, right at the beginning, it is obvious that they will not be perfect.

We had that situation as regards the last part of the Bill in connection with the health service. Agreements are not going to spring fully armed like the goddess Athena out of the breast of Zeus—or perhaps I have got my mythology wrong. The agreements are going to evolve in the same way that local authority community care will evolve. I suspect that community care will evolve more rapidly through experience and by working forward rather than by seeking to have everyone coming to the starting line and being asked whether they are properly mounted and ready to go, following which the Secretary of State makes a commencement order and off everybody goes.

With the greatest respect to Members of the Committee opposite who appear to be making that case, I do not believe that that approach adds up. There must be consultation. There has always been continuing dialogue between central and local government, both with individual authorities and with local authority associations, and that must continue. I believe that the Government would wish to implement this part of the Bill as quickly as possible and so begin to secure the advantages which the noble Lord, Lord Seebohm, and I and many others hope will flow from it.

I hope that my noble friend on the Front Bench will not be seduced by the arguments put forward by Members of the Committee opposite and advise the Committee to accept this amendment, because I shall not. I believe that that would be quite wrong.

Lord Seebohm

I do not believe that the noble Lord, Lord Jenkin of Roding, understands how this scheme will work. The Secretary of State made a statement quite recently to the effect that the first task of every local authority will be to make a review of all the existing services in its area. The plan then has to include what extra services are required. That will involve a fairly straightforward assessment of the additional costs that have to be met. After talking to local authorities, the Secretary of State's answer will be, "The state is behind you in meeting this additional finance". That is all that is involved. Unless the Secretary of State gives that kind of answer no responsible local authority will begin putting these packages into effect.

5 p.m.

Baroness Hooper

Much of the discussion about financial implications which took place in connection with the last amendment applies also to these amendments. However, asking the Government for an unlimited commitment is a very different kettle of fish in terms of the substance of the amendment. In the whole area of community care our policy is designed to put the clear lead responsibility with local authorities building on the vital lead role that they have had for social care provision over the past 40 years.

The principles behind our community care White Paper have met with widespread support, as has been said. I am grateful to the noble Lord, Lord Seebohm, for again confirming that point this afternoon. For years governments, whatever their party, have wanted to improve and enhance care in the community. Nevertheless, there has never been so great a need for us to grasp the nettle and to enable services to be improved through giving a clear lead and accountability to local authorities working at all times in close collaboration with other statutory, voluntary and independent agencies. I hope that such accountability is not interfered with as a result of the Committee's acceptance of the previous amendment.

The new clause contained in Amendment No. 108AEA refers to the timetable for implementation of the proposals. We propose that the main social security benefit changes to bring our proposals into effect should be made on 1st April next year. At that time, therefore, local authorities will need to have in place sufficient arrangements to cater for those people who would otherwise have looked to the social security system for their public support. We are also expecting at that time that initial community care plans will have been developed. I note that the amendment supports that planned implementation approach.

However, the proposed new clause goes on to require consultation with a number of representative organisations before the Secretary of State can make an order. It requires him to be satisfied about the availability of resources. As my noble friend Lord Jenkin said, an enormous amount of consultation is already quite properly going on with local authority associations, with directors of social services, with the voluntary sector, with users' and carers' organisations, with the independent sector and with other statutory agencies, particularly housing authorities, health authorities and family practitioner committees. Inevitably the pace of consultation is stepping up all the time and will very soon include consultation on drafts of the guidance material promised in the White Paper on, for example, care plans, assessment, complaints procedures, inspection units and contracting. Therefore consultation in a very full way is due to take place prior to the implementation of our proposals. I again agree with my noble friend Lord Jenkin that the effect of the amendment would be to provide a recipe for delay and bureaucratic procedures.

I recognise the difficulty in deciding what funding is adequate. It is nearly as difficult as defining what is reasonable. Nevertheless, our courts succeed in doing something on those lines almost every day. Both here and in another place we have consistently said that resources to fund the new proposals will be adequate. My noble friend Lord Henley restated that point in regard to the previous amendment. Negotiations over funding are taking place in the present expenditure round in the normal way. Very detailed discussions are taking place with the local authority associations in order to inform these negotiations.

We are not expecting everything to happen at once on 1st April 1991 in the community care field any more than on the National Health Service side. I have indicated where the priorities lie for ensuring that facilities are available to deal properly with people who would otherwise have looked to the social security system for support. We are well aware that it will take some time after a particular implementation date to ensure that all the changes that may be required by the new policy are fully operational and running. We shall have to learn and build on experience. Therefore, all the considerations which the new clause would require to be taken into account are already on board in the consultation and negotiation processes which are currently taking place. Those negotiations can, of course, include taking account of any representations which are made about start-up costs, to which Amendment No. 108AEB refers.

For all those reasons I urge that the amendments be withdrawn and certainly that they should not have the support of the Committee.

Lord Carter

I am grateful to the Minister for that reply. However, I think she is overlooking the fact that the amendments are important as we are now in the whole new world of ring-fenced funds. The noble Lord, Lord Jenkin, referred to the need for a measured pace. He is absolutely right. The amendments are intended to achieve a timetable of implementation which proceeds at a pace with which the Secretary of State is satisfied. The timetable for implementation must satisfy the Secretary of State alongside the protection of the sums allocated.

The Minister said that the amendment requires an unlimited commitment from the Government. I cannot help feeling that her brief was prepared on the expectation that the previous amendment would not be accepted. She referred to start-up costs. She knows that there is considerable concern on this point among all local authorities. I referred earlier to information technology, which could cost £140 million to £200 million. In previous Acts allowances for start-up costs in a number of areas have been allowed for. They have not been allowed for in the community care aspects of the Bill. For those reasons, it is extremely important to test the opinion of the Committee.

5.5 p.m.

On Question, Whether the said Amendment (No. 108AEA) shall be agreed to:

Their Lordships divided: Contents, 114; Not-Contents, 113.

Addington, L. Clinton-Davis, L.
Airedale, L. Cocks of Hartcliffe, L.
Allen of Abbeydale, L. Craigavon, V.
Alport, L. Crook, L.
Ardwick, L. David, B.
Aylestone, L. Davies of Penrhys, L.
Birk, B. Diamond, L.
Blease, L. Donaldson of Kingsbridge, L.
Bonham-Carter, L. Ennals, L.
Boston of Faversham, L. Erroll, E.
Bottomley, L. Ewart-Biggs, B.
Broadbridge, L. Ezra, L.
Bruce of Donington, L. Faithfull, B.
Campbell of Eskan, L. Falkender, B.
Carmichael of Kelvingrove, L. Falkland, V.
Fisher of Rednal, B.
Carter, L. Foot, L.
Cledwyn of Penrhos, L. Gallacher, L.
Galpern, L. Molloy, L.
Gladwyn, L. Mulley, L.
Graham of Edmonton, L. [Teller.] Murray of Epping Forest, L.
Ogmore, L.
Greenhill of Harrow, L. Oram, L.
Greenway, L. Parry, L.
Gregson, L. Perry of Walton, L.
Grey, E. Peston, L.
Hampton, L. Phillips, B.
Hanworth, V. Pitt of Hampstead, L.
Harris of Greenwich, L. Ponsonby of Shulbrede, L.
Hatch of Lusby, L. Porritt, L.
Hirshfield, L. Prys-Davies, L.
Howie of Troon, L. Rea, L.
Hughes, L. Ritchie of Dundee, L.
Hunt, L. Robson of Kiddington, B.
Hunter of Newington, L. Rochester, L.
Hylton-Foster, B. Russell, E.
Irvine of Lairg, L. Sainsbury, L.
Jay, L. Saltoun of Abernethy, Ly.
Jeger, B. Seebohm, L. [Teller.]
Jenkins of Putney, L. Serota, B.
John-Mackie, L. Shackleton, L.
Kearton, L. Shepherd, L.
Kilmarnock, L. Smith, L.
Kinloss, Ly. Stedman, B.
Kirkwood, L. Stoddart of Swindon, L.
Leatherland, L. Strabolgi, L.
Llewelyn-Davies of Hastoe, B. Taylor of Blackburn, L.
Taylor of Gryfe, L.
Lockwood B. Thomson of Monifieth, L.
Longford, E. Thurlow, L.
Lovell-Davis, L. Tordoff, L.
McCarthy, L. Underhill, L.
McFarlane of Llandaff, B. Wallace of Coslany, L.
Mcintosh of Haringey, L. Walston, L.
McNair, L Wedderburn of Charlton, L.
Mais, L. Williams of Elvel, L.
Masham of Ilton, B. Winchilsea and Nottingham, E.
Mason of Barnsley, L.
Milner of Leeds, L. Winstanley, L.
Airey of Abingdon, B. Fraser of Carmyllie, L.
Alexander of Tunis, E. Gisborough, L.
Allerton, L. Gray of Contin, L.
Arran, E. Gridley, L.
Balfour, E Hailsham of Saint
Belhaven and Stenton, L. Marylebone, L.
Beloff, L. Harvington, L.
Belstead, L. Henley, L.
Bessborough, E. Hesketh, L.
Birdwood, L. Hives, L.
Blatch, B. Home of the Hirsel, L.
Blyth, L. Hooper, B.
Boardman, L. Howe, E.
Boyd-Carpenter, L. Ingrow, L.
Brookeborough, V. Jenkin of Roding, L.
Brougham and Vaux, L. Johnston of Rockport, L.
Butterworth, L. Joseph, L.
Caithness, E. Kaberry of Adel, L.
Campbell of Alloway, L. Killearn, L.
Campbell of Croy, L. Kitchener, E.
Carnegy of Lour, B. Lauderdale, E.
Carnock, L. Layton, L.
Carr of Hadley, L. Lindsey and Abingdon, E
Clanwilliam, E. Lloyd of Hampstead, L.
Coleraine, L. Long, V. [Teller.]
Colnbrook, L. Lucas of Chilworth, L.
Cork and Orrery, E. Luke, L.
Cottesloe, L. Lyell, L.
Cranbrook, E. McColl of Dulwich, L.
Cross, V. Mackay of Clashfern, L.
Cullen of Ashbourne, L. Malmesbury, E.
Davidson, V. [Teller.] Mancroft, L.
Denham, L. Margadale, L.
Dilhorne, V. Merrivale, L.
Elles, B. Mersey, V.
Elliot of Harwood, B. Milverton, L.
Ferrers, E. Monk Bretton, L.
Fortescue, E. Mottistone, L.
Mountevans, L. Sempill, Ly.
Mowbray and Stourton, L. Sharples, B.
Munster, E. Somerset, D.
Nelson, E. Stodart of Leaston, L.
Nelson of Stafford, L. Strathclyde, L.
Norfolk, D. Strathmore and Kinghorne, E.
Norrie, L.
Nugent of Guildford, L. Swansea, L.
Oppenheim-Barnes, B. Swinfen, L.
Orkney, E. Swinton, E.
Pender, L. Terrington, L.
Penrhyn, L. Thomas of Gwydir, L.
Pym, L. Tranmire, L.
Rankeillour, L. Trefgarne, L.
Reay, L. Trumpington, B.
Renton, L. Ullswater, V.
Romney, E. Vaux of Harrowden, L.
St. Davids, V. Westbury, L.
Sanderson of Bowden, L. Young, B.
Savile, L.

Resolved in the affirmative, and amendment agreed to accordingly.

5.14 p.m.

Lord Carter moved Amendment No. 108AEB: Before Clause 40, insert the following new clause: ("Start-up costs —(1) The Secretary of State may, for up to five years from the date of any Order under this section, in relation to the functions covered by that Order and with the approval of the Treasury make grants out of money provided by Parliament towards any expenses incurred by local authorities in connection with the establishing of functions and activities arising under this Part, and in making any determination as to the adequacy or otherwise of resources under subsection (4) above the Secretary of State shall have regard to the desirability of making grants under this subsection. (2) A grant made under subsection (5) above may be for capital or revenue expenditure.").

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

On Question, amendment agreed to.

Clause 40 [Provision of accommodation and welfare services: agency arrangements]:

Lord Allen of Abbeydale moved Amendment No. 108AF: Page 46, line 9, after ("disability"), insert ("mental disorder, dependency on drugs or alcohol or being substantially handicapped by any deformity or disability").

The noble Lord said: The amendment is aimed in a very friendly way at discovering which people will be covered by the enlarged powers of local authorities to find accommodation for those in need. Under the provisions of Clause 40(1)(a), the relevant section of the National Assistance Act 1948 would be amended so as to provide that it was the duty of a local authority, subject to the approval of the Secretary of State, to provide residential accommodation for persons aged over 18 who by reason of age, illness, disability "or other circumstances" are in need of care and attention which is not otherwise available to them.

If one turns to Clause 53 of the Bill, a Scottish clause, it will be seen that this adds a new section to the Social Work (Scotland) Act 1968. It deals with the provision of suitable residential accommodation where nursing is provided. The persons eligible are those, who appear to them to be in need of such accommodation by reason of infirmity, age, illness or mental disorder, dependency on drugs or alcohol or being substantially handicapped by any deformity or disability".

I appreciate that there is an amendment on the Marshalled List under the aegis of the Scottish Law Society which proposes drafting amendments to that provision. However, that does not affect the point I am trying to make.

The fact that in the Scottish clause it is necessary to spell out that the provisions apply to those suffering from mental disorder or those who are dependent on drugs or alcohol or handicapped by a deformity presumably means that such groups are not covered by the amendment in the Bill to the English legislation. However, is that in fact correct? Does the word "illness" in Clause 40(I)(a) include mental illness? Can the Government tell us rather more about the words which they have selected and what they actually mean? Why is the Scottish provision, which is, admittedly, about accommodation with nursing care, so much more detailed?

I am aware of the drafting defect in the amendment in that if it were adopted the word "disability" in line 9 of the Bill would have to go. However, that is a minor point. I beg to move.

Baroness Faithfull

I rise to express my support for the noble Lord, Lord Allen of Abbeydale. It is most important that it should be made absolutely specific to whom the community care provision is applicable. It is not, except in a certain part of the Bill, written anywhere specifically. It is only right and proper that those who have to administer the provisions of the Bill should know exactly to whom "community care" refers.

Lord Ennals

I too support the amendment. It may be that when the Minister replies she will have an explanation. However, on the face of it, it is a strange situation where, as the noble Lord, Lord Allen of Abbeydale, said, Clause 53, which deals with the Scottish responsibility, takes in precisely the words: infirmity, age, illness or mental disorder, dependency on drugs or alcohol or being substantially handicapped by any deformity or disability". That is a very good explanation. One could perhaps argue that it does not include everyone; but the clause with which we are now dealing is so very limited. That creates immediate concern among each of the headings. For example, if we look at mental disorder, there are many aspects which necessarily require treatment. No one is arguing that such residential accommodation is necessary or that medical or nursing treatment is required. But it seems to me to be most unwise to exclude those categories from the definition. It would also create a great deal of confusion.

Similarly, there are times when those suffering from senile dementia will need treatment. There are some schizophrenics and drug dependency cases which will inevitably need treatment. I am looking at paragraph 7.8 of the Government's policy document Tackling Drug Misuse. It is a summary of the Government's strategy which states that, as the incidence of drug taking has increased, so primary health teams, including general practitioners, have become increasingly involved in treatment and support. Treatment in many cases consists of assessment, counselling, general medical care and social support.

I received a document only today from Turning Point, the largest national organisation providing advice, care and rehabilitation for people experiencing alcohol and drug-related problems, as well as those with mental health-related difficulties. It is extremely worried that under the new proposals the needs of the client groups that it serves will apparently not receive sufficient priority from individual local authorities. It is concerned to see the amendment accepted. There are many arguments for including the same definition in the English part of the legislation as is found in the Scottish part. The Minister may give us a totally satisfactory explanation. If not, we wait to see.

The Earl of Balfour

The problem is that doctors do not want to know anyone suffering from the effects of drugs or drink. It is a serious problem. We must remember that, except where someone has been held in hospital under a three-day order, a person has a right to discharge himself. The only way that a person who has become seriously mentally deficient through, for example, alcohol can be held in custody is under the Mental Health Acts. At the end of a period of 28 days, the detention requires a court order.

I am not fully familiar with the legal provisions in the Bill, but as I understand it, a person has the right to discharge himself from hospital unless he is held under those special provisions. I believe that the Committee will find that there is nothing to prevent someone from discharging himself. I realise that the amendment provides that the person should be held for a period—somewhere it says 21 days—for treatment. That is a wonderful idea, but I do not believe that the existing legislation covers that point, which is what worries me.

Lord Mancroft

I support the amendment. The noble Lord, Lord Allen of Abbeydale, put the arguments well. Those working in the field, and the sufferers, would be grateful to have a clearer definition of the term, which is what the amendment seeks to provide. The next amendment is probably the one upon which to discuss the problems of alcohol and drug treatment, which is the area in which I am interested in relation to this amendment. A closer definition of "disability" would be helpful and is probably long overdue.

Baroness Blatch

The clause consists of a number of technical amendments to the National Assistance Act 1948. Their general thrust is to make it clear that local authorities can make arrangements for the provision of services with both the private and voluntary sectors. As such they form one of the corner-stones of our new community care policy because they give local authorities the power they need to develop a mixed economy of care. By using their considerable purchasing power skilfully, local authorities should be able to promote the development of a robust market in care provision which will enable them to secure the most cost-effective delivery of services.

Subsection (1) of this clause paves the way for all this by amending Section 21(1) of the 1948 Act, which empowers local authorities to provide or arrange the provision of residential accommodation (including residential accommodation where nursing is provided) for the full range of people who may require it. It was to ensure that that part was fully comprehensive that the Bill amends "infirmity" in the original legislation to "illness [or] disability". That change both brings the terminology up to date and marks a widening of the people covered to include those—this is important—for whom the local authority may arrange nursing home care in accordance with the new subsection (1A) of Section 26 of the 1948 Act set out in subsection (2) of this clause.

Since the aim is to be comprehensive, we have not referred to particular client groups but instead used broad definitions of the qualifying conditions; for example, age, illness, disability or any other circumstances", which provide someone in need of care and attention with facilities not otherwise available to them.

Although I understand the motive behind the amendment, I must question whether it would be wise to press it. Being specific in one direction usually implies some restriction in another. I fear that to mention drug or alcohol dependency or severe handicap, for example, would have the effect of narrowing the wide application that this subsection needs to have. In addition, the terms used have no precise legal definitions and their inclusion might raise doubts not only about other client groups but about whether someone possibly falling within one of those groups mentioned was really qualified.

What is, of course, critically important is that local authorities should make arrangements as appropriate for all those people who may be entitled to public support and in need of social care provision. The noble Lord, Lord Allen of Abbeydale, is concerned that some vulnerable groups may be excluded or not catered for in arrangements for social care. I have explained that Clause 40 is deliberately designed, by adding "illness, disability" to the National Assistance Act 1948, to be wide and comprehensive in its coverage of all clients for whom social care may be necessary.

Lord Peston

Perhaps I may interrupt the noble Baroness. For those of us who are interested in the subject, the point she is making is important. Is she saying that those groups are already included within the meaning of the words "illness" and "disability" and therefore that the words in the amendment are unnecessary and that no problem can possibly arise? The arguments put forward are that the words are necessary and that problems can arise. It is a matter of interpreting the law. Is the noble Baroness saying that there is no difficulty because those groups are definitely included? Can she give an absolute assurance that that is so?

Baroness Blatch

I can give an unequivocal answer. The answer is yes. Whether the person is suffering from an alcohol-related problem, from drug abuse or whatever it may be, if a local authority deems there to be a need for provision, it is the local authority's duty to respond to that need. Those groups are included. It will be for local authorities to determine, first, the need, and, secondly, the provision.

I recognise that those concerned with or representing different vulnerable groups, including but not exclusively those to which the noble Lord, Lord Allen, refers, are concerned that some clients may fall between a gap in provision between health authorities and local authorities. There is that danger now, if any authorities seek to shrug off their proper responsibilities. What our new proposals do is to make responsibilities and accountability clearer and also to make the arrangements made locally more transparent and clear. In other words, at the outset they will have to plan provision for all client groups, which will include those named in the amendment. In their care plans local authorities will have to show what their arrangements are for dealing with all client groups, and that will include agreed plans with health authorities where clients may, as they often will, need both health and social care.

Mention has been made of aligning Clause 40 with the Scottish Clause 53, but that clause deals only with the provision of nursing home accommodation and Clause 40 deals with both residential care and nursing homes. Accordingly, it needs to include a much broader definition of the classes of people who can be helped. That apart, we can see severe difficulties of interpretation with the Scottish clause, as the speaking note explains. That speaking note is my response to the amendment.

My noble friend Lady Faithfull asked, "Whom is community care for?" That was her specific question. Community care is for everyone who needs it. That is why the definition is cast in wide terms. We think that it is more helpful than listing various conditions. Disability, as is made clear in Section 29, means blind, deaf, dumb, mentally disordered—that is ill or handicapped. It would substantially—I am having great difficulty in reading this note—include permanent handicap by illness, injury or congenital deformity. The Secretary of State has power to prescribe further definitions. "Disabled person", for example, means any person to whom Section 29 of the 1948 Act applies. The definition in Clause 40 goes on to include other circumstances. The Scottish definition includes only nursing home provision.

Through the guidance we are preparing for local authorities, we need to ensure that their plans cater for all groups. That is the main point that I am making in my response. I assure the Committee that we shall do that and think further about how best to ensure that this is effective. We should give more thought to what has been said in the debate. I shall therefore return to the issue on Report. In the meantime I hope that the noble Lord will feel able to withdraw his amendment.

5.30 p.m.

Lord Kilmarnock

Before the noble Lord decides what to do in response to that reply, perhaps I may make a few remarks. The noble Baroness made an important point when she reminded us that mental disorder covers both the mentally handicapped and the mentally ill. I read the clause as meaning that the mentally handicapped are excluded from the Bill. If the Government are going to re-examine it, I hope that they will bear that point in mind.

Baroness Blatch

In response to that, we shall look at the point most carefully between now and the Report stage. I can say that if there is deemed to be a need and the problem is one of mental handicap, then the local authority has an obligation to respond.

Lord Ennals

Before the noble Lord decides what to do, perhaps I may say that I am grateful to the noble Baroness for suggesting that she would consider this before the Report stage. A little earlier, she implied—and I may have misunderstood—that the handling of the provision would be in guidance rather than being included in the Bill. I am glad that there will be good guidance but I believe that it needs to be on the face of the Bill.

I was not impressed with the argument used by the noble Baroness as to why the Scottish clause was appropriate but a similar English clause would not be appropriate. When she considers the matter between now and Report stage, I hope that she will conclude, as we do, that there needs to be a clear definition. This is not a great problem; she says that the provision may exclude people. We have dealt with definitions like this under the Mental Health Act and other Acts. I should not have thought it was difficult to produce a definition which would be applicable both to the circumstances in Scotland and those in England.

I was encouraged by the thought that the noble Baroness would consider the matter carefully and read what has taken place in this brief exchange.

Baroness Blatch

I must confirm that there is no intention of excluding any group that is deemed to require community care or nursing provision. I said that we need to think further about how best to ensure that the service is effective. That will probably take the form of guidelines but I wish to return to this at Report stage.

Baroness Masham of Ilton

As the noble Baroness said that she would re-examine the matter, perhaps she will look at the unpopular specialties like alcohol and drugs. It is easy for them to be forgotten. So that nobody is forgotten, can the word "including" be contained in the provision in the Bill so that nothing is omitted?

Baroness Blatch

That will be taken into account. I must emphasise that it will be for local authorities to decide how they plan to make provision for all client groups deemed to be in need in the community care plans. Therefore it would be difficult to name a group. By naming one, we suggest implicitly that the others have been excluded.

Lord Allen of Abbeydale

We all know what Clause 40 is aimed at. However, I am still left in some ambiguity. The noble Baroness argues that it is dangerous to have a specific list. But she has not explained why, in those circumstances, there is a specific list later in the Bill dealing with residential nursing accommodation in Scotland. As she has undertaken to look at the matter again before the Report stage, I have no intention of pursuing it further now. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Mancroft moved Amendment No. 108B: Page 46, line 40, after ("authority") insert ("subject to subsection (1BA) below").

The noble Lord said: With the leave of the Committee, I should like also to speak to Amendment No. 109A. I must first declare an interest in that I am a director of a treatment centre providing care for drug and alcohol users. I am also chairman of the Addiction Recovery Foundation and secretary of the Promise Trust which is another charity providing care for those people. I also speak after extensive meetings with both Turning Point which the noble Lord, Lord Ennals, mentioned earlier and with the Standing Conference on Drug Abuse, the NCVO and Alcohol Concern.

The purpose of the amendment is to examine and draw attention to the problem of emergency admissions into facilities, particularly of alcohol and drugs sufferers. By that we mean the voluntary sector! and private facilities, as they carry most of the burden of this care.

The reason for the figure of 21 days in Amendment No. 109A—I know that the Government are not happy with such a figure—is that most of the treatment centres call these admissions crisis intervention. Drug and alcohol sufferers do not walk down the street and decide to go somewhere for help. They go for help because they are in a state of crisis. That usually means that their use of alcohol and drugs is threatening their health to a dangerous level.

To help someone over that crisis does not happen overnight. It does not take two or three days, nor four or five days. The minimum requirement—and this is a real minimum requirement—is 21 days. The most talked about drug addicts in Britain are heroin addicts. To take an addict safely off heroin to a state where he can be returned to the community without being a serious danger to himself takes 21 days. That is how the figure is arrived at, although it is open to debate.

It is helpful at this stage if we look at the size of the problem. A small part of the Bill is involved and a small area of community care. There are reckoned to be something like 150,000 street addicts in the country, all of whom are in need of treatment. There are approximately 800,000 people with alcohol problems. In its report of June 1989, the Association of Community Health Councils reckoned that there were between 800,000 and 1.65 million people suffering from prescription drug addiction. In many ways the latter is even more difficult to deal with.

It is also important to realise that one is dealing largely with unwilling patients. They do not wish to come forward. It often takes a crisis to persuade them to come for care. If we do not catch them when they come, we shall lose them. They will go back into the community until they surface again in a casualty ward, the magistrates' court or in some other situation which is expensive to the community. There is difficulty in assessing them and I shall give the Committee this example. My right honourable friend David Mellor, in a debate in another place in December 1989, stated that there were 15,000 registered heroin addicts. In the same breath he explained that there were probably 150,000 of them. The reason for the discrepancy in the figures is that people simply will not come forward for assessment. They are frightened to register, frightened of statutory bodies like health authorities and local authorities. They want to keep out of their way.

I shall give the Committee another example. A few months ago I visited a needle exchange centre which is a front line facility being run in the Midlands. It is partly funded by the local authority. The local authority put an assessor into that tiny little facility to help assess the patients coming through the door. However, as soon as it became known in the local community that a nurse from the health authority was carrying out assessments, the number of people walking through the door dried up overnight. I believe, therefore, that it will be difficult for health authorities to make assessments.

Another reason why that is so difficult is that there is a marked lack of expertise. This is, relatively speaking, a new area of health care, but it is a growing and difficult area. Local health authorities will find it difficult to get people who have the expertise to make assessments. That is why my amendment suggests that they delegate the assessments to the voluntary sector and to private facilities which have the expertise.

Reports written last year state that 25,000 people with alcohol problems were admitted to psychiatric wards. However, alcoholism is not a psychiatric disease. That is an inaccurate assessment. However, 25,000 inaccurate assessments a year means there is an awful waste of time and money in this area. Most of those people end up on benzodiazepines. Those are the 800,000 to 1.6 million people mentioned by the Association of Community Health Councils. Those people should never have been put on those drugs in the first place. Those are inaccurate assessments. As a service and as a community we cannot allow 800,000 inaccurate assessments to be made. That is a frightful waste of money.

Who then will make these assessments? We know that GPs do not like dealing with these difficult, expensive and time-consuming patients. Social workers do not have the time or the expertise to deal with these patients and often patients come forward via probation officers. However, probation officers should not be in the business of assessing health needs. That is not their job. They do not want to do that but they are forced to do it and they are being put in the place of expert assessors who do not exist.

The next problem is a logistical problem. The kind of facilities that we are talking about do not exist in every health or local authority. Therefore patients sometimes have to travel far and wide to reach the right facility. They are mobile patients. They were born in one place, educated in another, have worked in another and are resident in a third or fourth place. Yet they turn up for treatment in a fifth place. We are expecting a harassed administrator in a facility to chase around and find out where a patient is registered or resident. He must find the right person in that authority to make the assessment before the patient is admitted.It is just not practical to do that.

The new methods of payments which appeared in the social security legislation are already tripling the workload of administration in these facilities. These facilities do not have much money or time. To prevent them making the assessments which they are expert at making would be a grave mistake. I am engaged in a facility in Nottingham. When we take patients from other authorities and write to their authorities it takes weeks to obtain a reply. We wrote to various health authorities in the first week of April about patients who had been admitted to our facility. We are now in the first week of May but we have not had any reply to those letters. Strictly speaking, the 21-day period is too short.

The Government have said what local authorities and health authorities can do and what they will do. However, in my experience, that is not what is happening. As an example I would mention a treatment centre in Kent of which I am a trustee. Staff at that centre wrote to Kent County Council inquiring about patients entering the facility. I have the reply here, but I shall not quote from it. Kent County Council stated that it did not anticipate having any patients in treatment facilities of that kind because there were quite enough facilities in Kent to deal with them. There are in fact no facilities in Kent for dealing with them.

Broadway Lodge is the oldest voluntary sector facility of its kind in the country and it has now been running for 17 years. It specialises in street drug addiction, as it were. In all that time Avon and Somerset has never given that facility one single penny or paid for one single patient. We have no reason to believe that that will change. In its recent letter the county council outlined the fact that there will be no change.

There is a registered nursing home in Bournemouth called Quinton House which has over the past two months written to 73 local authorities. However, only 27 have bothered to reply and of those eight have definitely stated that they will not fund patients suffering from drug and alcohol abuse in voluntary sector establishments. That does not bode very well for the future. The situation is that the largest purchaser of care is not keen on buying care from the largest provider. That is not quite what the Government have in mind.

It is important to note that the private and voluntary sector establishments support this Bill. They think it contains some necessary and good reforms. They think the theory of the Bill is great but that in practice it will not work. Judging from the evidence that we have, they are right. The Bill will not work in practice. It is not a question of what authorities can do but what they will do. They have been slow to react in the past and with a relaxation of the rules, as is anticipated now, and with the evidence that we have, there is no reason to assume that the inadequate services that are presently available will continue. Many of them will collapse overnight.

Voluntary sector facilities are always short of cash. They are charities and all charities are short of cash. The patients that enter the facilities for a month or perhaps six weeks will find that those facilities have gone out of business if there is as much as a month's hiccup in funding. The expertise that they have gained will be lost and there will be little or no treatment available for this large group of sufferers. It seems a pity that a month after this Government hosted the largest ever conference on drug addiction and drug problems and outlined in detail their policy for what they call drug demand reduction—that involves treatment among many other things—they promote a Bill which may seriously affect the entire policy of drug reduction. I beg to move.

5.45 p.m.

Lord Winstanley

I support this amendment, which has been so admirably moved by the noble Lord, Lord Mancroft. In his speech the noble Lord alerted the Committee to a real and serious problem. I hope that, after listening to his speech, many Members of the Committee who were perhaps marginally aware of this problem will have become a little more acutely aware of what it involves. When this problem arises, it frequently requires urgent attention.

As the noble Lord, Lord Mancroft, has rightly said, it is a problem which general practitioners frequently encounter. As an ex-general practitioner, I should say at once that GPs do not on the whole deal with this kind of situation very effectively. They do their best to deal with it, but often that is not good enough.

The Committee is now aware of the real problem. The problem has existed for a long time, but the Bill as it now stands does not provide a solution to it. A solution must be provided. I hope that as a result of moving this amendment we shall at least receive a clear answer on how this problem can be solved so that the kind of events which the noble Lord described so graphically do not continue to occur and recur in various parts of the country. I support the amendment.

Baroness Masham of Ilton

I also support the amendment. I believe that the amendment standing in my name, Amendment No. 114ZC, which also concerns assessments will come before the Committee on Thursday. The Government have encouraged many voluntary and non-governmental agencies to carry out the difficult work involved in the drug and alcohol fields. Some of the activities of those agencies act as an alternative to prison. That is important as our prisions are far too full. As we know from the incidents at Strangeways, our prisons are causing great problems. The agencies carry out crisis work as well as longer term treatment.

Unless the legislation is improved and an efficient method of assessment and funding is found many agencies will close down, as the noble Lord, Lord Mancroft, said. Therefore, I hope that the Government will consider all of the amendments and try to work something out because the issue is very important.

Lord Carter

I am very glad to support the previous speakers from these Benches. This is a very sensitive and important matter. The noble Lord, Lord Mancroft, speaks with great experience on the subject. As the noble Lord, Lord Winstanley, said, he has drawn the attention of the Committee to what could be a very serious problem.

The amendment is intended to ensure rapid emergency admission and treatment for drug users, especially those who are most at risk from HIV infection. That is a matter which we know causes great concern to a number of voluntary organisations. We have all heard from those organisations on the subject. We hope that the Minister will be able to give an assurance that their fears are unfounded. The amendment also deals with the detoxification of those with alcohol problems where speed is of the essence if a relapse is to be avoided.

All of the organisations concerned with those problems are very worried that the requirement to seek the agreement of a district health authority prior to admission will impede access to emergency care. We cannot believe that that is the Government's intention. We hope very much that the Minister will be able to confirm that the Government understand the problem and have plans to deal with it.

Baroness Hooper

This is an important area. I can confirm to the noble Lord, Lord Carter, that the Government understand the problem. I appreciate the desire of my noble friend Lord Mancroft for greater clarity. I also recognise that this is an area of concern not only to Members of the Committee but also to the providers of facilities, many of whom are in the voluntary or private sector.

I recognise that my noble friend's intention is to ensure that where people are in need of urgent admission to residential accommodation in which nursing care is provided such services are available to them on an emergency basis when there is no time initially to undertake a full assessment of their longer term needs for which the local authority may be responsible. There is also the question of which local authority may be responsible.

Nothing in the Bill changes the responsibilities of either health or local authorities where they have statutory duties to provide emergency care. A client, perhaps someone suffering from the effects of drugs or alcohol and in need of emergency or urgent treatment, will have the same access as now to emergency care.

The Bill places responsibilities clearly with those health and local authorities, working with the voluntary and private sectors, to ensure that arrangements are in place to meet the needs of the clients they serve. That will ensure that arrangements for emergency care are in place and will entail meeting, the costs according to the agreements that are made locally for such services. Those arrangements will be set out in community care plans which will be published. There will therefore be considerably more transparency about the provision which is available than exists now. We shall require consultation to take place as to how arrangements for services will be made where more than one providing agency may legitimately be involved.

I understand that it may be said that present emergency or urgent care arrangements are not necessarily ideal and I know that some difficulties can and do arise. I also know that some of the emergency and urgent treatment facilities currently provided are made by the voluntary sector using income support payments to users and that concerns have been expressed that support for those facilities could be withdrawn.

A great deal of work is being undertaken to implement the policy of placing that responsibility on local and health authorities. As part of that work arrangements will have to be made locally by getting together to work through care plans. We shall discuss that in greater detail during our deliberations on Clause 45. Those arrangements must ensure that emergency and urgent care is available for those needing it. It is therefore up to the responsible authority to ensure with other agencies that provision is available on which they can call as necessary.

Of course I agree that where emergency treatment and care are required a full assessment of the client's needs will have to follow after the crisis intervention has taken place. Equally, a client with a long-term problem will already have had his or her needs assessed. Means of coping with potential emergencies needs to be part of the plans for the care of that individual.

I agree that greater clarity is desirable, but I am doubtful that it is necessary to have such clarification on the face of the Bill because there must be local agreements which will be more specific. Nevertheless I should like to consider the matter further in the light of what has been said to see what could be done. I trust that in the meantime my noble friend will feel able to withdraw his amendment.

Baroness Masham of Ilton

Perhaps I may ask the Minister for clarification of something that she said. She referred to the responsible authority. One of the major problems when dealing with alcoholics and certainly with drug addicts is that they have often been turned out of their homes. They have no fixed address, they roam the country and often seek treatment in districts other than their own. They want to get away from their home districts because they are not very popular there and for reasons of confidentiality. Many drug addicts nowadays are HIV positive which makes the problem even more difficult because confidentiality is involved.

Baroness Hooper

The intention is that for everyone, everywhere there will be an authority which is responsible for them. It will be up to the individual to say where his or her normal residence is, whether it is under a bridge or elsewhere. The authority in that area will be obliged to take responsibility for that individual.

Lord Pitt of Hampstead

I am a little disturbed by the complacency which is evident on this matter. The noble Lord, Lord Mancroft, painted a very accurate picture of the situation. I can assure the Committee that when drug addicts are in crisis they are available for treatment. If they have treatment, then one can do something about the problem. If the treatment is not provided there and then one loses them. They go back to Piccadilly or elsewhere, have a fix and are not seen again.

Therefore, this is one of the issues which needs to be tackled. Treatment must be provided as required. I have said before in this Chamber that drug rehabilitation centres should be like VD clinics: one goes in and receives treatment. This problem is even more important because the person who seeks help is usually in crisis. They tend not to come unless they are in crisis. When they are in crisis they are capable of being treated and they respond to treatment if they are treated then. What is lacking in the resources available at the moment is adequate treatment at that moment.

There is anxiety that the Bill introduces the question of responsibility for assessing and paying for the already inadequate emergency treatment which is available. I should be grateful if, in considering the issue, the Minister would bear in mind the urgency of the situation in terms of what is required for the patient at that moment. It is not just a question of which authority is responsible, how it assesses or what assessment is made. It is a question of regarding that as a treatment which you can provide at that moment and which will save you many problems later.

I have said this once before in the Chamber and I say it again: if we set out seriously to treat our drug addicts, we would save a great deal of the money that we spend on enforcement and through other agencies. We are making a mistake in that we do not take seriously enough the way in which, by treating addicts when they are in crisis, we can save ourselves many problems. I realise that I have spoken for longer than I had intended, but I hope that the Minister has taken the point.

6 p.m.

Baroness Hooper

I cannot imagine what was contained in my previous remarks to suggest to the noble Lord, Lord Pitt, that there was any complacency about the situation. We regard it as extremely serious. The intention is that crisis intervention should not only be as good as it is now, but that we should be able to improve upon what now exists.

Lord Mancroft

We have had a useful debate and I am certainly reassured by the knowledge that the Government are more aware than they perhaps were of the extent of the problem. That is a comfort. Certainly, we are all aware that this is a framework Bill. Perhaps that is one of the problems that one has with framework Bills. It is rather like being asked to buy a car which does not have an engine. I would not buy one like that. It is difficult to know how good the framework is if one does not see the regulations within it. I am aware that this area is very much dependent upon the care with which the regulations are drawn up. I know that much care is going into that. I am much heartened by what my noble friend said. She said that she would go away and look further at the matter, and I shall look forward to hearing what she has to say about it. I thank her and beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Seebohm moved Amendment No. 109: Page 46, line 41, leave out ("the consent of the District Health Authority for the area") and insert ("an assessment notified to him in writing and agreed by both the local authority and the District Health Authority.").

The noble Lord said: In moving this amendment, I propose to speak also to Amendment No. 110A and, if the noble Baroness, Lady Faithfull, will allow me, to Amendment No. 109ZB to which my name should have been attached.

People may think that Amendment No. 109 is rather esoteric and pernickety, but it is serious because the relationship between the health authorities and the social services has always been delicate. I do not think that anyone knows more about it than I do. It sometimes leads to quite stormy relationships. One must therefore be careful in the wording of the measure. The Bill states that the consent of the district health authority must be obtained when moving someone into a home where nursing care is required. We propose to say that there should be: an assessment notified to him [the person concerned] in writing and agreed by both the local authority and the District Health Authority".

There must be agreement between the health authority and the social services.

The amendment stands on its own, although Amendment No. 110A deals with what happens if there are disagreements. That amendment simply deals with the question of who pays. If the district health authority insists that someone requires nursing care, and the local authority believes that something less elaborate is required—we know perfectly well that a combination of accommodation and nursing care will be in short supply with the increasing number of old-age people—the district health authority should pay the cost. Similarly, we do not agree that the district health authority should have the right to close a ward in order to move people out and therefore transfer the cost to the local authority.

Those are the main points of the amendment. The amendment of the noble Baroness, Lady Faithfull, is similar in that, if people are moved into accommodation by the district health authority and the local authority has to pay, obviously the latter should be consulted and make an agreement to that effect. That is the essence of the amendment. I beg to move.

The Deputy Chairman of Committees (Lord Alport)

I must advise the Committee that, if Amendment No. 109 is agreed to, I shall not be able to call Amendment No. 109ZA.

Baroness Faithfull

I apologise to the noble Lord, Lord Seebohm. His name should also have been appended to the amendment. Perhaps I may add a little to what he said.

We are seeking a joint assessment of every case because if there is a joint assessment between the district health authorities and the local authorities, there will presumably be agreement at the end of the assessment.

I am a little confused. Perhaps the Minister can explain the situation to me. As I understand it, as the noble Lord, Lord Seebohm, said, it is intended that the local authority will not be asked to pay for the cost of something without knowing what the cost is. If there is a joint assessment followed by a joint agreement, there will be agreement about the cost. As I understand it, the local authority would pay for a nursing home. Where in the Bill does it state that social services departments are responsible for nursing home fees as well as those for other accommodation? Having said that, I should add that I support the amendments.

Lord Ennals

This group of amendments is not at all pernickety. I speak particularly to Amendment No. 110A, but the group hangs together very properly. Unless some adjustment is made, we are building up for ourselves a great deal of ill-feeling between health authorities and social services departments.

As I read it, there is a distinct ambiguity in the Bill about the powers of the district health authorities. On the one hand, the Bill aims to prevent local authorities from placing individuals in nursing homes without the consent of the health authority, as set out in Clause 40(1)(b) on page 46 of the Bill. That is right. On the other hand, there appears to be no restriction on health authorities making placements without the consent of the local authorities. In those circumstances it is unclear who would be expected to pay if the patient required support from public funds. Obviously, the issue of assessment is crucial in this matter.

As the Bill now stands, district health authorities—in future that will cover NHS trusts or provider units—would have every incentive to create nursing homes which could be registered by the health authority without reference to the local authority and to impose the bill on the local authority. They could thus transfer responsibility for expenditure to the local authority apparently without any let or hindrance. Obviously, that would be grossly unsatisfactory and I cannot imagine that that is what the Government intend. The rapid growth of nursing homes is a well-known phenomenon and now outstrips that of residential care homes which was the phenomenon a year or so ago.

Nursing home places are much more costly. Proprietors can and do charge much larger fees for nursing home places. If it is easier for patients to gain access to them rather than to residential care homes, there would be a double incentive for that sector to develop, it would seem, without control.

Let me give an example. In Scotland one health board converted several hundred beds into nursing home beds which will draw money from the social security system. When we turn to the English situation, one private company decided to change a number of homes into nursing homes to the tune of 940 beds—that is in Letchworth, Malvern, Preston, Blackburn, Dudley, Oldham, Warrington and Bolton. Also there is a plan for a home or extension in the course of construction to be converted into nursing home beds. I could continue with much disturbing evidence in that respect.

After April 1991 local authorities will have to pay for new admissions and apparently have no necessary say in the appropriateness of those admissions unless they are by joint assessment, as referred to in Amendment. No. 109. I do not object to the NHS paying for admissions which local authorities believe to be inappropriate or for which the local authority has no funds. It would be inappropriate for the health authority to make a decision which could pre-empt the money available to local authorities for community care, whether or not they are ring fenced.

As I said earlier, I am sure that the Government do not intend that to happen. If so, they must either accept amendments such as this one or make some other change. Otherwise, on the face of the Bill there would be a situation which would be grossly unsatisfactory and which, as I said at the beginning of the debate, could lead to great conflicts between health authorities and local authorities. That is the last thing that we want to do in this Bill.

The Earl of Balfour: I was very interested to hear the expression "joint assessment" used by my noble friend Lady Faithful. That might be a loophole when dealing with some of the complicated cases. If the district or local authority's medical officer of health, a general practitioner and/or a psychiatrist were all to agree that a certain patient should have treatment, that might be a way in which legislation could be tightened up to enable people to be respectfully forced to take treatment. That might be a way forward.

6.15 p.m.

Baroness Hooper

Amendment No. 109 has two parts to it. The first is about the notification of the outcome of an assessment to the person who has been assessed, and we shall be coming on to discuss those issues also when we reach Clause 45. The other part of the amendment seeks that both the local authority and the district health authority should agree that arrangements are necessary before they are made to place someone in residential accommodation where nursing care is provided.

I believe that this part of the amendment is redundant since the requirement in Subsection 1B of the 1948 Act, now contained in Clause 40(2) of the Bill, covers that concern to obtain the consent of the relevant DHA. The local authority, in the circumstances envisaged by this amendment, will already have decided that residential accommodation with nursing care is necessary. This will almost invariably be as a result of a multi-dis-ciplinary assessment involving staff from the DHS and we are providing that the placement should not take place without the consent of the DHA. Therefore the anxiety with which this amendment deals is already met in the wording of the Bill.

Turning to Amendment No. 109ZB, at present there are two ways involving a district health authority in which a person may enter a nursing home. Under the first, the authority advises a hospital in-patient that he is ready for discharge from hospital but will need nursing home care. The patient and his family then arrange such care, and if they require help from public funds to meet the fees the patient claims income support. The second way is for the health authority itself to enter into a contractual arrangement with the nursing home. Under that the hospital is responsible for the full cost of the place in the home. The patient moves into the nursing home but remains a hospital in-patient which means that he cannot be charged for his care or accommodation and that his entitlement to social security benefits is very limited.

When the new community care arrangements come into efect, patients leaving hospital will no longer be able to claim a special rate of income support to meet the fees in nursing homes (unless they have preserved entitlement to income support at the registered homes rate). Thus, if they are unable to meet the fees themselves, such patients will need to seek help from the local authority. The local authority will assess their needs for community care in accordance with Clause 45 of the Bill, and if it decides their care needs call for the provision by the authority of nursing home care, the authority will proceed to arrange that in accordance with the new Section 26(1A) of the National Assistance Act 1948. The local authority will in effect be giving its consent to provision of nursing home care by agreeing to arrange it. It will also need to seek the consent of the health authority before making arrangements, in accordance with the new Subsection IB to Section 26 of the 1948 Act, which we are considering. We expect that normally the health authority will give that consent by taking part in a multi-disciplinary assessment of the patient's community care needs. Thus, provisions already in the Bill mean that a person cannot enter a nursing home for which a local authority will have to pay without that authority being closely involved in the process and consenting to the move.

There still remains the second possibility that I mentioned earlier. A health authority may decide to place a person in a nursing home by making a contractual arrangement with that home. In that case, the health authority pays for the care which means that the patient is receiving support from public funds. However, the local authority will not have to pay for this and it seems quite unnecessary to require the health authority to seek the consent of the local authority before placing a patient in a nursing home in that way.

So the Bill already provides for the local authority to give its consent before a patient for whom it will have to pay is placed in a nursing home. If a health authority attempted to prejudge the outcome of a community care assessment and placed a patient in a nursing home without seeking the consent of the local authority, the local authority would be perfectly entitled to refuse to support the patient unless and until it decided, by carrying out a community care assessment, that this form of care was necessary for him. On the other hand, it does not seem reasonable to require the local authority to give consent to health authority contractual arrangements with nursing homes.

I have considerable sympathy with the intention behind the third amendment in this group, Amendment No. 110A. When the new community care arrangements come into effect, there will be an overlap of responsibility between local authorities and health authorities, both of whom will be able, albeit in different ways, to provide continuing nursing care. It is important therefore that they draw up ways of working together so that both authorities are clear for which people they should be providing. The key to this is in the preparation of community care plans under Clause 44 of the Bill. Local authorities will be advised, in accordance with the White Paper Caring for People, that plans should include planning agreements with district health authorities. One such agreement should cover the need for nursing home places arranged by the local authority and the criteria for admission to them. The assessment and placing of individual patients in these places will then take place in the context of that planning agreement. Given that general scenario, the outcome in each of the three sets of circumstances envisaged in the amendment we are now considering would be as follows.

First, when the local authority does not agree that the person's care needs call for the provision by them of nursing home care, the local authority cannot be required to pay for the care. Indeed I have no doubt that the local authority would refuse to pay for nursing home care and would be quite justified in doing so.

Secondly, when a person leaves hospital as part of a planned change of service provision, I agree that the health authority should make some contribution to the cost. Under our proposals this would be achieved as follows. The number of nursing home places would have been agreed by the authorities, as I have explained. This agreement should take account of any planned hospital closures. Where extra places are required on this account the authority should also agree on the finance that would be transferred from the health authority to the local authority under the joint finance arrangements, in accordance with the Government's care in the community policy, to enable the local authority to provide the required number of places. If arrangements are made on these lines the position of the local authority will be fully safeguarded and I see no need for any further more explicit provisions.

Thirdly, there is the situation when the patient moves to a registered nursing home which offers services other than nursing, which I take it means a private hospital. In accordance with the arrangements set out in the clause that we are now discussing, when a local authority has agreed, following an assessment that a patient's care needs call for the provision by them of nursing home care, they will then negotiate with a registered, or exempt, nursing home for the provision of appropriate care. That is what they will pay for and that is what the patient will be entitled to receive. I do not see that it matters what other services the nursing home provides. If the assessment is properly carried out and the proper agreement drawn up with the nursing home there ought to be no possibility of the local authority finding itself paying for private hospital treatment—something that they have no power to pay for anyway. If a person provided with nursing home care in a home which was also a private hospital needed acute treatment, he would have to enter a National Health Service hospital for that purpose unless the health authority, not the local authority, entered into a contractual arrangement with the nursing home hospital to provide the acute treatment required.

It has been a lengthy and, I have found, a somewhat complicated response to the amendments proposed. However, I hope that I have been able to demonstrate by that lengthy explanation that the three parts of Amendment No. 110A are already provided for. In the light of that explanation, I hope that the movers of these amendments will feel able to withdraw them.

Baroness Faithfull

Before the Minister sits down, perhaps I may say that I find her explanation slightly complicated. The Minister stated in her first statement that Section 40 deals with district health authority consent for local authority placements. However, the amendment which stands in my name and that of the noble Lord, Lord Seebohm, requires local authority consent before the district health authority placement if the local authority is required to pay. It is complementary to Section 40.

What would happen to someone placed by the district authority in a nursing home if the local authority refused to pay? Could the district health authority be forced to pay if the patient had agreed to be transferred?

I do not expect an answer now but perhaps the noble Baroness will write to me. We have had many complications from her and I have added to them. Perhaps I might have a letter on the subject.

Baroness Hooper

I am very happy to comply with my noble friend's request. I shall endeavour to make it a short letter. I shall make it available to other Members of the Committee who may be interested.

Lord Ennals

My questions may be even simpler than those posed by the noble Baroness, Lady Faithfull. It is rather difficult stuff; it is not like poetry. One has to follow every word. I have three simple questions. First, Clause 40(1B) states: No such arrangements as mentioned in subsection (1A) of this section may be made by an authority for the accommodation of any person without the consent of the District Health Authority for the area in which he is ordinarily resident". That makes it quite clear that such arrangements will not happen that way round. I do not quite understand why, even if these amendments are not right, the assurance the other way round cannot be given with the same precision.

Secondly—I am trying to turn into one sentence what the noble Baroness said—is she saying that there can be no circumstances in which a local authority will be charged for nursing home accommodation without having given its consent? That will be a very important statement if she says yes. It might be better if it were written in the same terms as those for the protection for the district health authority.

Thirdly—and if the Minister cannot reply now, so be it—can she explain the massive growth in nursing homes to which I made reference? There is obviously a campaign afoot, mainly in the private sector, to turn one type of accommodation into another. Usually if someone does that there is a motive behind it. I suspect that there is some profit motive behind it. Why should that be going on if there is nothing to worry about?

Baroness Hooper

I believe I said at the beginning of my lengthy oration that there are provisions in the Bill which mean that a person cannot enter a nursing home for which a local authority will have to pay without that authority being both closely involved and consenting to the move. That is an answer that I can clearly give at this stage. Perhaps I may read the record and include any other answers to questions raised by the noble Lord in my reply to my noble friend.

Lord Seebohm

The noble Baroness has not answered my first point on Amendment No. 109. It was a question about the relationship between the health and social services. It is a very dicey issue. Amendment No. 109 stands entirely on its own, quite apart from who will pay and who goes where. Has the noble Baroness given that thought?

Baroness Hooper

I may not have given it sufficient thought. I should like to do so before responding to the noble Lord.

Lord Seebohm

In that case, before I take counsel's advice on the long statement, I beg leave to withdraw my amendment.

Amendment, by leave, withdrawn.

Baroness Blatch moved Amendment No. 109ZA: Page 46 line 41, leave out from ("of) to end of line 42 and insert ("such District Health Authority as may be determined in accordance with regulations").

The noble Baroness said: The amendment stands in the name of my noble friend Lady Hooper.

Our intention is that in England and Wales no one should enter a nursing home at the public expense until the health authority which continues to have responsibility for providing continuing nursing care to that person has given its consent. The health authority will normally give its consent through a process of multi-disciplinary assessment. The Bill as it probably stands refers to the consent being required of the district health authority in which the person is normally resident. The concept of ordinary residence in relation to a district health authority, is however, inappropriate in this Bill. In future district health authorities will have primary functions. Clause 3(1) defines their primary functions as being functions exercisable by directions under Sections 13 and 14 of the National Health Service Act 1977.

These directions given in regulations will set out those for whom district health authorities are responsible. The regulations have not yet been drafted and the precise terminology has therefore not been agreed. However, the policy is that district health authorities will be responsible for providing health services to, among others specified in regulations, people living within their districts. It is important that the new subsection (1B) of Section 126 of the National Assistance Act 1948 should correspond with the regulations made under Clause 3(1) so that the consent of the right district health authority can be obtained. It is for that reason that the reference to "ordinarily resident" is being replaced by a power to make regulations which will set out which district health authority is to give consent. Such a provision is needed to cope with the overlapping responsibilities of health and local authorities. I beg to move.

On Question, amendment agreed to.

[Amendments Nos. 109ZB and 109A not moved.]

[Amendment No. 110 had been withdrawn from the Marshalled List.]

[Amendment No. 110A not moved.]

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

6.30 p.m.

Lord Allen of Abbeydale moved Amendment No. 110BA: Page 46, line 48, at end insert: ("(1D) Before arrangements are made by virtue of this section with any person, that person shall disclose to the local authority making the arrangements any relevant criminal convictions. (1E) On request by a local authority, a police officer shall disclose to the authority any relevant criminal convictions of any person with whom it is proposed to make arrangements by virtue of this section. (1F) Relevant criminal convictions for the purposes of subsections (1D) and (1E) above shall be specified in regulations made by the Secretary of State. (1G) Any person in respect of whom a disclosure is made under subsection (1E) above shall be informed of the disclosure.").

The noble Lord said: The amendment is grouped with Amendment No. 113ZA to which I do not propose to speak. There are separate arguments and I wish that they had not been grouped together.

As regards the amendment tabled in my name, I appreciate that I am stepping into an area where, like Agag, it is necessary to tread delicately. However, as I spent a substantial part of my career dealing with the police, I venture to press the Government a little about the problem. I have not overlooked the relevant exchanges which took place in our debates on the Children Bill; nor have I overlooked the report in today's Times about the excessive demands made on the police for access to their records.

The aim of the amendment is obvious—how to ensure that information comes to light about the relevant criminal record of anyone seeking to run a residential home. I know that the Government are aware of the problem. On 1st May in another place (col. 881) the Minister for Health said that registering authorities should ask an applicant to provide details of any previous criminal convictions and that it was planned to require such disclosure when the regulations under the Registered Homes Act 1984 were next revised.

I imagine that the regulation-making power in the 1984 Act is wide enough for the purpose. I have a slight doubt but I am not a lawyer. Incidentally, I hope that Mrs. Bottomley did not mean what she said when talking about getting an applicant to provide details of any previous criminal conviction. We require the particulars of relevant criminal convictions, and the offences could be listed. It would not be of great consequence to know that an applicant had been convicted of exceeding the speed limit.

Be that as it may, the problem would not be solved unless there was access to police records. If an applicant knew that there was no such check he might take the risk of not disclosing a conviction. If it were known that there would be a check—and that procedure could be explained on the application form—the risk of an applicant taking such a chance would be much less. In practice little extra burden would fall on the police.

For some years I was chairman of the Gaming Board for Great Britain. Any applicant for a certificate to act as, say, a croupier in a casino had to declare any convictions and his record was checked against police records. I cannot help wondering whether it is not as important to protect the elderly and infirm from being entrusted to the care of someone who has a conviction for cruelty or blackmail as it is to protect a gambler from handing his bet to a croupier who has a conviction for dishonesty. I beg to move.

Baroness Faithfull

I support the amendment but having read and thought about it again over the weekend, I am a little worried about one point mentioned by the noble Lord. Under the Children Act one always asks anyone, first, whether he or she has a conviction and, secondly, whether one has his or her permission to go to the police. I always believe it right to ask for that permission. If a person has a conviction of the type enumerated, one usually receives a letter the next morning stating that they have another job and will be moving to another part of the country. Therefore, one is saved the trouble of worrying the police for a reference. I support the amendment but I now wish that a provision had been included to the effect that the applicant would be informed at the beginning that the police would be contacted and that his or her permission would be obtained.

Lord Seebohm

I wish to speak to Amendment No. 113ZA, which is grouped with that standing in the name of my noble friend Lord Allen. I am at a great disadvantage because I have never been a Permanent Secretary at the Home Office or chairman of the Gaming Board for Great Britain.

The provision contained in my noble friend's amendment is merely an extension to the voluntary bodies. I am reminded of an amendment which is no longer on the Marshalled List; it is that relating to the control of small homes. I am worried about the matter but cannot think of a suitable amendment to put forward. I do not know whether I am out of order in asking the Minister to comment. There appears to be a danger in unregistered and unlicensed homes which are run on commercial lines and I hope that something can be done about that.

I agree with my noble friend that if applicants are told that their names will be passed on to the police, who will check whether they have convictions, that will stop many people from putting their names forward. Therefore, it will not cause a great deal of trouble for the police.

Baroness Oppenheim-Barnes

I had not intended to intervene but I must oppose Amendment No. 109. From what has been said it would appear that the floodgates would open as soon as anyone applied to operate a residential home. Ex-convicts from all over the country could apply and nobody would know unless the police were consulted. To my certain knowledge the police are disturbed about the fact that they do not receive from hospitals, doctors and others vital information that would prevent crimes.

I have the greatest sympathy with the point made about elderly people who are vulnerable and in the care of those running commercial homes. It is important that those who are responsible for them should be of impeccable character. Nevertheless, they are not the only people at risk. Often people in local authority homes have cause for complaint and when they are being mistreated it is extremely difficult for them to lodge any complaint whatever.

I fear that if this amendment were to be accepted, it would open the floodgates. It would be highly undesirable from the point of view of the public, civil liberties and so on if that sort of information became freely available. A person having a grudge against another who wants to open a residential home may seek to place information against that person. That has happened and could happen in the future.

There are many other areas in which one would like to think that access to information from the police was possible. For example, I recall when I represented the city of Gloucester that an ex-prisoner from one of the special units in the prison was teaching in one of the local primary schools. The prison warder's child was being taught by that ex-prisoner. However, it would not have helped if the police had been able to give information about the ex-prisoner because he had applied for the iob under an assumed name.

I know that that is not likely to happen in the case of a person opening a residential home. However, I believe that that is a very dangerous precedent and that other ways should be found of ensuring that people who are granted permission should be thoroughly vetted and approved. However, that should stop short of consultation with the police.

Lord Peston

I thought that this amendment was completely non-controversial until the intervention of the noble Baroness. I am now obliged to be a trifle controversial which, as she knows, is not my habit. I was going to begin by saying that the matters before us are entirely non-political. If one looks at the Committee stage of this matter in another place, anxieties on this were raised by honourable Members of all parties. I still believe that there is no political content: in the amendments.

I also add that as I read the Committee discussions in the other place, the key problem about which the Minister was anxious was to do with bureaucracy rather than civil liberties and matters of that sort. I thought that the noble Lord, Lord Allen of Abbeydale, dealt with the bureaucratic side of the matter very well. The provision will act to reduce rather than increase the number of cases likely to be taken up. Therefore, I was somewhat surprised because it looked as if the Committee stage in the other place would lead the Minister to table amendments, but that did not happen. That is why the matter is now before this Committee, not having been dealt with in another place.

I am speaking to both amendments because I believe that the points of principle are the same in both cases. However, the case is overwhelming. There should be no doubt that people carrying out this sort of function should be fit and proper. If they have a criminal conviction or, to use the precise words, "any relevant conviction", it seems to me that one should pause especially, as I understand it—and I am not an expert in the field—if similar considerations already arise in the case of child care. Therefore, I fail to see the logic of arguments that that consideration should not arise in the case of the elderly.

As regards the remarks of the noble Baroness, Lady Oppenheim-Barnes, I stand second to none in my anxieties on civil liberties, but I do not regard this as a civil liberties issue at all. I am surprised that that question arises. This is purely a matter of the relevant information that should be before those who are taking the decisions in this sphere. I take the point of the noble Baroness, Lady Faithfull, on the wording, but that is not fundamental at this stage. However, I hope that these amendments can be accepted or that the Government will say that they will come back with amendments of their own to deal with this matter.

I have listened as an interested but inexpert person to the contributions made and I find it very hard to conceive of any argument to reject the line which the two amendments take.

6.45 p.m.

Baroness Masham of Ilton

When we were working on our young people, alcohol and crime report, we looked at this matter in relation to publicans. We felt that anybody with a criminal record should not run a public house. However, the Rehabilitation of Offenders Act covers that. I was interested when the noble Baroness, Lady Faithfull, spoke about the Children Act because children are covered by this legislation and it does not seem to have opened many floodgates, as the other noble Baroness said it may do.

We are dealing with people in residential care who are very frail and elderly, and the disabled people in such care will be very disabled or very mentally ill or handicapped. Therefore, they need protection. They would be very vulnerable if a thief tried to steal from them.

Also, in future nurses will be able to prescribe, which could be very dangerous if such a nurse had a criminal record. Therefore, this matter needs careful consideration and should be looked into. I should like to hear from the noble Baroness, Lady Faithfull, as to whether the floodgates were opened when children became protected by this legislation.

Baroness Hooper

As is generally recognised, the thrust of the Government's community care proposals is to give the individual in need of care or support the highest possible quality of life. This means providing the services and support which people who are affected by problems of ageing, mental illness, physical handicap and other disabilities need to be able to live as independently as possible in their own homes or in homely settings in the community.

We are all too aware of how vulnerable these people can be. I therefore sympathise with the objective underlying these two amendments. It is clearly important that sensible precautions and safeguards should be built into local arrangements. However, we believe that in negotiating contracts, there will be adequate scope for authorities to satisfy themselves as to the fitness of the people supplying the services. Our guidance on contracting will advise authorities on the factors they should take into account. Clearly, this will be one of them.

In addition, the Registered Homes Act 1984 requires authorities to satisfy themselves that proprietors and managers who run residential care homes and nursing homes are fit to do so. In saying that, I recognise that, as the noble Lord, Lord Seebohm, said, small homes catering for four or fewer people are not included in that. Nevertheless, applicants for registration are therefore very carefully vetted and our standing advice to authorities is that they should require people wanting to set up a home to disclose any previous criminal convictions including convictions which, under the Rehabilitation of Offenders Act 1974, are treated as spent. In saying that, I recognise the point made by my noble friend Lady Oppenheim-Barnes that a person may operate under an assumed name and be unwilling to disclose any previous convictions. That is an enormous problem.

This requirement, not at present found in the schedule, is included in regulations made under the 1984 Act which spell out what information applicants for registration must supply to the registration authority. Proposals to amend the regulations to correct this omission will be made as soon as a suitable opportunity arises.

That brings me to the question of access to police records raised by Amendment No. 113ZA. As my noble friend Lady Faithfull said, there are already arrangements in place for checking on people involved in the care of children. Since 1986 the police have given priority to implementing new arrangements for checking the background of people whose work in schools, the health service and in social services brings them into regular contact with children. Together with the Home Office we are presently exploring, through three pilot schemes, the feasibility of extending these arrangements to those who work with children in the voluntary sector. If the pilot schemes are successful and extension of these child protection arrangements to the voluntary sector is agreed, there will be a substantial addition to the workload of the police. I think that that goes some way towards answering the point raised by the noble Baroness, Lady Masham.

Nevertheless, I can report that officials from the Department of Health and the Home Office have opened up discussions on the specific issue of access to criminal records in respect of residential care home and nursing home proprietors. I have nothing to report as yet, but this is an important development and we must await its outcome before seeking to make further demands on the police.

Against that background, I have to say that the purpose these amendments seek to achieve is not best served by introducing primary legislation. Therefore, I trust that the movers of the amendment will not wish to press it.

Lord Allen of Abbeydale

I do not propose to press my amendment at this stage but before Report stage we should all like to know a little more about what is in prospect and what is possible. I confess that I was a little surprised by the speech of the noble Baroness, Lady Oppenheim-Barnes. Far from opening the floodgates, it seems to me that we would be closing them. There have been too many instances where people running homes have turned out to have unsatisfactory characters and convictions. A factual check on their records could only be helpful.

Lord Peston

Perhaps I may intervene because I do not want my noble friend to withdraw his amendment before I ask the noble Baroness a question. I said earlier that it looked as though the Minister of State in the other place was at one stage going to introduce government amendments. The noble Baroness referred to discussions between officials. Is there still some possibility of government amendments? Was the noble Baroness trying to convey that to the Committee?

Baroness Hooper

No. I believe my conclusion was that we do not feel that the inclusion of this in primary legislation is the way forward.

Baroness Faithfull

Is it therefore intended to put it in regulations?

Baroness Hooper

I am not in a position to say at the moment.

Lord Allen of Abbeydale

It is precisely on that point that we require more information before we decide whether to pursue the matter on Report. Certainly I should like to keep the position open.

Perhaps I may add that this is a modest amendment. It is not suggested that individuals should be exempt from the rehabilitation of offenders legislation, which I am afraid does apply to my casino croupier. We are not proposing to extend such legislation to employees but only that it should apply to owners and managers of homes. I am blessed if I know how dealing with this matter by a contract and by the local authority satisfying itself that the persons are of good character can possibly meet the difficulty if the local authority has no means of checking on a possible criminal record.

I do not believe that this will place a greater burden on the police for the reasons that I have explained. I emphasise, following up the point made by the noble Baroness, Lady Faithfull, that it is a crucial feature of the scheme that the applicant should be told on the application form that information is liable to be checked with the police.

I have wrestled with this kind of problem for many years and I am conscious of the fact that there are many members of society, many institutions and many bodies who would dearly like to be able to go to the police. I think that in some respects the police have tended to go too far. I am not at all surprised at the fuss that is blowing up about the possibility of criminal records and their disclosure being put into the hands of a non-police body. I have some sympathy with the feelings. Before I withdraw the amendment I see that the noble Lord, Lord Ennals, wishes to intervene.

Lord Ennals

I felt that the noble Lord was about to withdraw his amendment. Before coming back on Report perhaps he will bear this point in mind. Obviously a number of Members of the Committee have been involved in the care and rehabilitation of offenders. We are not suggesting—at least I do not think the noble Lord is suggesting—that all those who may have committed an offence are necessarily to be excluded. As I understand him, he is saying that we need to know. There are some offences the nature of which would make such people entirely unsuitable for coping with those who need help and understanding and also very frail people. There are some types of one-off offence which would make a person totally unsuitable to be in charge of a home but which might not preclude other types of employment. However, we must know.

Lord Allen of Abbeydale

I support that entirely. One hopes that a list of offences could be drawn up. For example, a conviction for murder, manslaughter, blackmail, physical cruelty or various types of sexual offences would debar an applicant. However, a person caught driving without car insurance perhaps would not be excluded, but it would be nice to know. It is possible that a person with a long string of convictions which are not themselves of great moment would cause one to pause and consider whether he is a suitable person.

The great problem is defining the categories of people for whom the police should provide a service. I submit that looking after the elderly and infirm is one such category. There are others who would like to obtain help from the police of whom that is not true in my view.

Having said all that, we await with interest to see whether anything emerges before Report stage so that we can consider what to do then. In the meantime, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Carter moved Amendment No. 110C: Page 47 line 7, at end insert: ("(3A) At the end of subsection (2) of that section (under which the arrangements must provide for the local authority to make payments in respect of accommodation provided) there shall be inserted "if the organisation providing accommodation is a registered housing association within the meaning of the Housing Associations Act 1985, any arrangements for payments towards the costs of any individual resident shall not meet the whole costs of the placement but will cover that element of the weekly charges attributable to the provision of personal or nursing care and any services or other charges that are ineligible for housing benefit."").

The noble Lord said: This amendment is intended to deal with a complicated but, I am sure, unintended problem arising from the drafting of the Bill. Where local authorities place disabled people in residential care the authority will meet the full cost of that placement and recover a contribution from the resident, including any income support and housing benefit. That takes no account of the way in which housing associations which provide housing for community care projects are required to collect rents in order to qualify for housing corporation finance.

This amendment seeks to make housing associations a special case to ensure their continued funding through the Housing Corporation, which is extremely important for them. The residents in such homes, would have the care element paid for by social services but would pay the rent element direct to the housing association. The residents would then be eligible to claim housing benefit on the rent in the usual way. The amendment ensures that there would not be a gap between the rent element and the other services that the local authorities pay for.

As the proposals are currently framed, the local authorities place an individual in residential care and pay the full cost of the placements to the organisation or proprietor running the scheme. The authority will then carry out a means test on the individual and recover a proportion of the cost. Such an assessment will take into account the resident's income support and housing benefit.

The Department of Health proposes that the housing benefit is calculated on a notional basis by taking the average cost of one and two-bedded properties in an area and averaging it out. That notional element will be taken to be the housing benefit entitlement for the resident and will be taken into account in turn when the means test of resources is carried out.

However, that system has a number of faults. What is important for this amendment is that it ignores the fact that the housing associations receive their funding from the Housing Corporation. They need to be able to show that the landlord-tenant relationship exists so that the scheme can be counted as a housing scheme. In addition, because of new requirements by the Housing Corporation it is necessary to show a reasonable market return on the capital invested in the scheme.

We are sure that it is not the Government's intention to discourage housing associations from funding community care schemes; for example, where a housing association fulfils housing needs, other agencies contract for the care element and the case manager brings the whole system together. The National Federation of Housing Associations has made it clear that the proposed new arrangements are incompatible with the housing associations and the funding system as operated by the Housing Corporation.

This morning I received a letter from Sense, in the Midlands. We all know of the remarkably good work done by the National Deaf-Blind and Rubella Association for some of the most severely handicapped people in society. In referring to residential accommodation and the continuing education that it provides to deaf-blind students, Sense states: Of necessity, time in an educational establishment must be limited and Sense has therefore entered into partnership arrangements with a number of housing associations to develop permanent homes for students who are ready to move on from the further education centres. Twenty-four such places will become available in the next financial year and further provision is planned across the country.

The costs of developing accommodation for adults with dual sensory impairments are very high because of the special needs of the client group, and Sense would not be able to contemplate development of further places without the financial support available from the Housing Corporation through Housing Associations".

Unless that anomaly is dealt with that situation will arise. As I said, we hope that all these matters have led to an unintended result in the way in which the Bill is drafted. The wording of the amendment may not be perfect and we shall be quite prepared to withdraw it if the Minister can assure us that the Government recognise the problem and have specific plans to deal with it. I beg to move.

7 p.m.

Lord Swinfen

I strongly support this amendment. There is a growing tendency for housing associations, particularly with physically disabled people as their residents, to work in conjunction with other voluntary organisations for physically disabled people and where the other organisations provide the nursing care element. It is essential that that is paid for by the local authorities.

Baroness Llewelyn-Davies of Hastoe

I wish to take up the point raised by my noble friend Lord Carter. I think that in making these arrangements the Government may have affected the basic funding policy of the housing associations unintentionally. I believe that that may be unintentional because I know that noble Lords in all parts of the Committee understand and appreciate the vital role that the housing associations play in this area. Over the years they have been encouraged to do so by successive governments.

As the Committee knows, housing associations are now expected to finance new schemes under these arrangements partly by raising the money through private loans. That is only possible if residents can claim housing benefits on the normal basis and the associations can continue funding through the Housing Corporation, as my noble friend has pointed out. That is a key point and I do not apologise for emphasising it.

The amendment would make the community funding arrangements and the housing associations' policy compatible. Therefore I hope that the Government can take it seriously. The amendment would also preserve the direct landlord-tenant relationship, which is of great importance. Otherwise residents will lose control of their own finances and they will be unable to handle their own money, and it will undermine the principle of choice and independence which is basic to the housing associations philosophy in this regard. I cannot believe that the Government wish to do that.

As the noble Baroness said, the whole question is highly complicated. Indeed, this whole Bill is highly complicated. I shall not go into any further detail at this point. As the Bill stands the most serious consequences will follow. I hope that the noble Lord will be able to reassure us. I fully support the amendment moved by my noble friend.

Lord Henley

As the noble Baroness has just said and as her noble friend Lord Carter said earlier, this is a very complicated matter. I hope that I can assist the Committee. The provisions of Sections 21 and 26 of the National Assistance Act 1948, as amended by the clause we are now considering, and of Section 22 of the same Act, as amended by Clause 42 of the Bill, have the effect that a local authority which arranges residential or nursing home care for someone must charge that person the full amount he is assessed as being able to pay in accordance with regulations the Secretary of State will be making under Section 22(5) of the 1948 Act. The effect of this will be to leave the person with an amount, also to be prescribed in regulations, for personal expenses.

The financial assessment provisions will be prescribed in regulations and will be legally binding on local authorities, with the aim of securing equality of treatment for people in residential care and nursing homes across the country and obliging local authorities to collect the full amount legally payable by such people. That will be fair both to people in homes and to charge payers. I assume that these arrangements will commend themselves to all Members of the Committee. As the noble Lord has explained, the purpose of the amendment is to relax the mechanism by which payment will have to be made. Under Section 26 of the National Assistance Act 1948 this has to be as follows: the local authority negotiates a charge for the place in the home representing the full cost of providing accommodation, care and services. It then charges and collects from the resident the amount he can afford to pay, taking into account any income support or housing benefit to which he is entitled. That explains the difficulties that are created both for housing associations, which stand to lose valuable support from the Housing Corporation, and for users, who may be being encouraged to take more responsibility for their own affairs, including paying their rent, to prepare them for life back in the community.

I agree that there seems to be a problem here. Indeed that is already under investigation by officials of the departments concerned. I would not like to speculate today what the outcome will be or whether this amendment is the answer. However, I am grateful to the noble Lord for raising the issue. I hope that we shall come back at a later stage with further proposals if, when our officials have finished considering the matter, there seems to be a need for them. With that assurance I hope that the noble Lord will feel able to withdraw the amendment.

Lord Carter

I am extremely grateful to the Minister. I do not wish to be pedantic, but he said that he hopes to come back with another suggestion. I hope that he will return at the next stage of the Bill with some proposals.

Lord Henley

It was an assurance without commitment. I said that when our officials had finished considering the matter, if there seemed to be a need for an amendment, we should return with other suggestions.

Lord Carter

I am extremely grateful to the Minister. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn. [Amendments Nos. 111 to 113 had been withdrawn from the Marshalled List.]

Lord Seebohm had given notice of his intention to move Amendment No. 113ZA: Page 47, line 26, at end insert: ("(7) Any voluntary organisation or other person making arrangements with a local authority under subsections (5) and (6) above shall ensure that each person employed in the provision of services discloses any relevant criminal conviction. (8) On request from the local authority, police must disclose relevant convictions of any person employed in the provision of services under subsections (5) and (6) above. For the purposes of this section, "relevant criminal convictions" shall be set out in regulations made by the Secretary of State and laid before both Houses of Parliament.").

The noble Lord said: I am not letting this matter drop by any means. We shall bring it back at Report stage. For the time being I withdraw this amendment.

[Amendment No. 113ZA not moved.]

Lord Ennals moved Amendment No. 113ZB: Page 47, line 26, at end insert: ("(7) In placing any contract with a voluntary organisation or person for the purposes of the provision of community care under section 26 of that Act as amended by this Part, a local authority may, where it considers it conducive to the maintenance or improvement of the type, quality or range of care, or of the continuity of such care, include in any contract with such an organisation or person any of the following matters—

  1. (a) the hours of work, or rate of remuneration, of workers employed by the organisation or other person;
  2. (b) any arrangements for training given by or on behalf of the organisation or person to workers before or during their employment;
  3. (c) the use of volunteers;
  4. 1301
  5. (d) the composition of the workforce of the organisation or person in respect of sex, race or disability, in relation to the type, quality or range of care available to persons under the contract.").

The noble Lord said: This is an important amendment. There is no doubt that some local authorities and some health authorities have had disappointing experiences in the field of private contracts for work that has been put out to tender. Part II of the Local Government Act 1988 prevents local authorities from imposing what it calls non-commercial considerations when awarding contracts. That legislation applies to all contracts.

The Government's community care proposals seek to encourage local authorities to stimulate the provision of care services by the voluntary and private sectors. This will mean that local authorities will increasingly enter into contractual arrangements with the voluntary and private sectors. It is of great concern that the quality of service to consumers should not suffer as a result of that trend. This matter is very much in the minds of the local authority associations and, in particular, of the Association of Metropolitan Authorities.

The real danger with the White Paper proposals is that the introduction of the tendering principle to social care services and the emphasis on stimulating competition will encourage service providers to cut costs. Traditionally, workers engaged in caring or domestic duties have had little status and have been open to exploitation. The easiest way for non-unionised employers to reduce overheads and provide a competitive unit cost is to employ staff on a casual basis, at low hourly rates of pay and with no training given. Workers who are undertrained, poorly paid and overworked will not provide service users with high quality care delivered with sensitivity or warmth.

The experience from contracted out local government services other than community care sometimes gives cause for concern. There have been some disturbing experiences and sometimes contracts have been ended for that reason. For example, where private contractors have taken over contracts for the provision of welfare catering they have usually been able to submit a competitive bid by imposing significant reductions in the terms and conditions of employment. As a result, too often staff turnover has become a major problem—400 per cent. per annum in one recorded welfare catering contract. There have also been some very unsatisfactory results from cleaning contracts, both with local authorities and with health authorities.

A separate but related issue is the use of volunteers in the provision of social care services. While I recognise and support the valuable contribution which volunteers make—being involved with voluntary organisations, I emphasise this point very much—sometimes there must be concern about the way in which their voluntary effort might influence the ability of voluntary organisations to submit tenders which to all intents and purposes represent unfair competition. Volunteers should be used as a supplement to and not a substitute for properly paid labour. Local authorities must therefore be able to stipulate this in their contract specifications.

Social service departments will be arranging contracts for the provision of care services for some of the most vulnerable members of the community.

I am thinking of elderly people, people with mental handicaps and so on—frail people. All those currently involved in the provision of care services to such groups, including government bodies such as the Social Services Inspectorate, are agreed about the need for adequate training of staff to ensure good quality care. Stipulations with regard to the training of staff are also deemed to be non-commercial considerations under the terms of Part II. It is increasingly acknowledged that social care services can be effective only where those providing the services reflect the cultural experiences of those in receipt of them. Where this is not the case research shows that services will suffer from low take-up and that those who use such services are likely to suffer from insensitive approaches to meeting their needs. We are thinking in terms of race, of gender or of disability, and stipulations about the cultural experience of those involved are considered to be non-commerical considerations under Part II.

All the above considerations are disallowed in contract specifications under the provisions of Part II of the Local Government Act. It is those that we are challenging. The amendment seeks to reverse the situation to ensure that considerations which are essential to the provision of good quality social services are allowed to be stipulated in the specification of contracts arising from community care legislation. The purpose is to allow local authorities to make these provisions locally; and only in situations which are appropriate and not across local authority services as a whole. The purpose of the amendment therefore is to influence only those contracts that are involved with the work of social service departments.

Additionally, the spirit of previous legislation—of the Disabled Persons (Services, Consultation and Representation) Act 1986 in particular—places an emphasis on user involvement and satisfaction. This amendment would be in pursuance of those aims, aims for which all noble Lords fought long and hard during the passage of the Disabled Persons (Services, Consultation and Representation) Act 1986. It is encumbent on government to honour that legislation by acknowledging the value of this amendment. I beg to move.

7.15 p.m.

Baroness Blatch

As we have discussed in going through Clause 40, the clause covers the provision of accommodation and welfare services enabling local authorities to make arrangements for the provision of care in private and voluntary homes for people assessed as needing that form of care. It enables authorities to employ as their agents in the provision of welfare services individuals and organisations as well as voluntary organisations. Noble Lords will be aware that the purpose behind making these provisions is to encourage local authorities and enable them to select from the full range of available provision that which best meets the needs they have identified for their local community. It will therefore be for the local authority to make, via contractual arrangements, the most apropriate agreements that they can with those providing the services.

Authorities will need to give a good deal of thought to the kinds of contracts they wish to enter into and the skills that they will need to set up and negotiate these contracts. It is for each authority to determine the most apropriate form of contract it will enter into, and contracts may range from block arrangements for quite a large number of residential places with a single provider to one-off purchases of specialist facilities. Different forms of agreement may be appropriate in those different circumstances. The amendment before us proposes certain requirements which local authorities may make of those with whom they contract.

We should not determine from the centre the most appropriate features to be taken into account in drawing up a contract. This will depend upon the kind of arrangements the local authority wishes to make and the facilities which the individual or organisation providing the service has at its disposal. The important factor is to secure the right quality of care for those who will be using the facilities at a cost to the authority which is reasonable. The features of the contract which this amendment describes may be regarded as desirable or essential in some cases and by some authorities; others may have different priorities for contract arrangements which they will use to secure the best outcomes for their clients. This is clearly a matter for local discretion and for local determination. The Department of Health is in the process of preparing draft guidance on purchasing and contracting to help local authorities develop their own approach. We do not propose to prescribe particular features of the contract in the way this amendment seeks to do. I therefore hope that the noble Lord will feel able to withdraw the amendment.

Lord Pitt of Hampstead

Before the noble Lord decides what he will do with the amendment, I should like to ask the Minister a specific question. Paragraph (d) of the amendment is quite important in terms of the people who are employed. I say that because if we are to take into account the needs of individuals in specific areas, we must also take into account their race, religion and other such matters.

If the Minister is saying that under the proposed guidelines local authorities will be encouraged to take such matters into consideration, then I am quite happy. However, I did not gain that impresssion from what the noble Baroness said. I should like her to confirm whether she was suggesting that that would be so.

Baroness Blatch

There are two responses. First, it is my understanding that all employers are bound by the race discrimination laws and those regarding discrimination against people with disabilities. Therefore, all employers would be bound in any event by the law as it stands. Equally, it would be open to any local authority when making contractual arrangements to determine their own parts of the contract which would relate to paragraphs (a), (b), (c) or (d).

Lord Pitt of Hampstead

I do not wish to prolong the debate, but I was not suggesting that the authority would be discriminating; I was suggesting that the authority should positively concern itself with such factors. I was trying to elicit from the Minister whether she agrees with me that the authorities would be encouraged under the regulations to act in the way that I suggested.

Baroness Blatch

The authorities would be entirely free to concern themselves with such factors.

Lord Ennals

The Minister has been most helpful. However, I hope that she will give some thought to the point made by my noble friend about guidelines. We want to ensure that local authorities can specify that the workers employed in non-statutory agencies are properly trained and have appropriate working conditions and rates of pay. They should also ensure that service providers are equal opportunity employers, and that they are able to deliver services which meet the religious or cultural needs of the client groups.

When we come to consider quality of service, which is perhaps the most important issue because it affects clients, it is hard to monitor whether clients are receiving the appropriate quality of service. How do you build into a contract for home helps the stipulation that such workers must be kind and friendly as well as being good at keeping the home clean?

Leaving aside the issue of whether this provision finally finds its place in the legislation, I should be much less inclined to press the matter on Report if I thought, as my noble friend said, that there would be guidelines to local authorities about these very sensitive issues affecting people who need very sensitive care and treatment. If the Minister can say something now or later—and I am not trying to press her on the matter—I should be most grateful.

Baroness Blatch

So far as I am aware, there will be guidelines. However, if I have misled Members of the Committee in any way, I shall put the matter right at a later stage.

Lord Ennals

I know that the noble Baroness would never intentionally mislead the Chamber. I shall not press the amendment to a Division. However, I shall study carefully what has been said and consider whether I shall return to the issue on Report. In the circumstances, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 40, as amended, agreed to.

Clause 53 [Residential accommodation with nursing]:

Lord Carmichael of Kelvingrove moved Amendment No. 113A: Page 56, line 27, leave out ("substantially handicapped by any deformity or") and insert ("handicapped by any deformity or physical or mental").

The noble Lord said: Clause 53 inserts a new section, Section 13A, into the Social Work (Scotland) Act 1968. It requires a local authority to make provision for residential accommodation with nursing facilities available for persons in need of such accommodation by reason of, infirmity, age, illness or mental disorder, dependency on drugs or alcohol or being substantially handicapped by any deformity or disability".

This concerns one of the complications of the Bill to which I referred on Second Reading. We should have had a separate Bill dealing with Scotland. I say that because we are dealing not with a new Bill; we are dealing with amendments to other Scottish legislation. When I point out to the Committee that this is an amendment to the 1968, albeit rather seminal, Act—namely, the Social Work (Scotland) Act 1968—it will be realised just how ill-fitting are these clauses in a UK Bill.

There is also the question as to whether this new section is even inserted in the correct place in the 1968 Act. Section 13, after which this section will be inserted, relates to the provision of assistance by local authorities in finding suitable work for "persons in need" who are able to work and for "disposing of the produce of their work". The new section bears no relation whatever to that section.

Additionally, the legislation refers to Section 12 of the Act which sets out the "general social welfare services" which local authorities must provide. We believe that this section would be more appropriately inserted after Section 12 and new Section 12A as new Section 12B. I commend the amendment to the Minister who will reply. Perhaps he will at least take that part of the proposal away and concede that issue, if nothing else.

There is also anxiety regarding the definition of those who must be provided with residential accommodation with nursing facilities if necessary. What constitutes a substantial handicap? Why under the terms of the new section will accommodation with nursing be provided only for those who are, substantially handicapped by any deformity or disability"?

Those specific definitions could lead to very serious difficulties of interpretation. I beg to move.

The Minister of State, Scottish Office (Lord Sanderson of Bowden)

The noble Lord can be assured that I shall look to see whether this particular section is in the correct place in the Bill. However, we believe that the attempt to clarify, for the purposes of local authority powers to provide residential nursing care, the term "disabled" as extending to both physical and mental disablement is unnecessary.

In practice local authorities in Scotland have exercised their social work functions over the past 21 years or so on the basis of a definition of a "person in need" as contained in the Social Work (Scotland) Act 1968, to which the noble Lord referred. It refers to disability without any distinction. As regards the description of the level of handicap, the term "substantially handicapped" is already used in the definition of a "person in need" as contained in Section 94 of the 1968 Act. That governs the recipients of certain services under the Act. In any event, persons with less than a substantial handicap would be unlikely on that account to have need of nursing care under this section. I am sure that the noble Lord recalls the passing of that Act.

Accordingly, I urge Members of the Committee to reject the amendment as it is unnecessary for the purpose about which we are quite clear: residential nursing care should be reserved for persons who cannot be expected to sustain normal living in the community and who have needs which make ordinary residential care inappropriate for them. In other words, the present wording in this section does not cut off anyone in need.

Lord Taylor of Gryfe

I shall welcome the Minister's statement if the provision covers all disabilities including mental disability. If that assurance is given, I shall be happy with the statement.

Lord Sanderson of Bowden

Yes, I can give that assurance.

Lord Carmichael of Kelvingrove

The Minister always tries to be as helpful as his powers allow. I look forward to hearing his reply as to whether the provision is in the appropriate place in the Bill. Again, like my noble friend Lord Taylor of Gryfe, I am pleased that the Minister included all disabilities. The Minister made a complicated reply for which I am grateful. I look forward to hearing his comments when we return at a later stage. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Baroness Blatch

I beg to move that the House do now resume. In so doing, perhaps I may suggest that the Committee meet again not before 8.30 p.m.

Moved accordingly, and, on Question, Motion agreed to.

House resumed.