Lords Sitting of 10 May 1990

Preamble
The House met at three of the clock [Prayers having been read earlier at the Judicial Sitting by the Lord Bishop of St. Albans): The LORD CHANCELLOR on the Woolsack.
The Lord Chancellor: Leave of Absence
The Lord Chancellor (Lord Mackay of Clashfern): My Lords, before the commencement of business, I take the opportunity to inform the House that I am to vist the judges and staff at Birmingham County Court and the Crown Court on Friday, 18th May. Accordingly, I trust that the House will agree to grant me leave of absence for Friday, 18th May.

European Commission: UK Staff
3.1 p.m.
Lord Campbell of Croy Lord Campbell of Croy asked Her Majesty's Government:
Whether the number of senior officials employed by the European Commission from the United Kingdom is comparable with that of officials from other member states such as France, Germany and Italy; and, if not, what steps are being taken to rectify the imbalance.
Lord Reay: My Lords, the proportion of European Commission officials from the United Kingdom is generally lower than those for Germany, France and Italy, although at senior levels there is a broad national balance. While staff appointments are a matter for the Commission, my honourable friend the Minister of State for Foreign and Commonwealth Affairs met the Commissioner responsible on 17th April and agreed measures to increase the United Kingdom's representation. We are also acting to encourage more United Kingdom candidates to apply for employment in the Community institutions. We and the Commission will continue to work closely together to remedy the present situation.
Lord Campbell of Croy: My Lords, I am grateful to my noble friend for that Answer, from which I conclude that a conscious attempt is being made to reach parity with similar countries. Why is there a shortage of applicants from the United Kingdom when the remuneration should be rewarding enough with the tax benefits?
Lord Reay: My Lords, the remuneration has not been rewarding enough to attract a sufficiency of United Kingdom candidates, which has been the main reason why the situation exists.
Lord Cledwyn of Penrhos: My Lords, to what extent is our under-representation due to our candidates' lack of language skills? Are the Government supporting the Community Lingua
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scheme? Will the noble Lord be good enough to have a word about this matter with his right honourable friend the Secretary of State for Education and Science? The evidence points to our poor record on language as being at least partially responsible for our performance on applications.
Lord Reay: My Lords, I am sure the noble Lord the Leader of the Opposition is right in saying that, traditionally, languages have been an impediment to recruitment. However, one of the measures that the Government are now introducing is the development of a European stream within administration grade recruitment to the Civil Service. This will increase the number of good quality officials fitted for work in the European Community institutions. Language training will be provided.
Lord Jenkins of Hillhead: My Lords, does the noble Lord agree that the problem, which is to some extent a real problem, does not exist at the most senior level? It hardly could as Britain has had one out of the only two Secretaries General of the Commission, and two out of the last three Directors General of.DG1, the external affairs directorate. The problem exists much more at A3 level and below, which is the rough equivalent of the assistant secretary or under-secretary level in our terms. In order to meet this need one has to have people anxious to make a career in the service of the Commission. The position is not greatly helped if the Commission is constantly represented, sometimes by Her Majesty's Government themselves, as being an inflated group of interfering busy-bodies.
Lord Reay: My Lords, I entirely agree with the noble Lord that at the very senior levels —at grades A1 and A2—there is a broad national balance. Overall, the United Kingdom has approximately 12 per cent. of A-grade posts, which is well below our broad geographical share of 15 per cent. On the other hand, in grades A7 and A8 the proportion of United Kingdom nationals is only some 8 per cent.
Lord Boyd-Carpenter: My Lords, my noble friend referred to the tax position of United Kingdom officials serving in Brussels. Can he say whether by that he meant that they were liable or not liable to United Kingdom income tax or any income tax?
Lord Reay: My Lords, I made no deliberate reference to taxation matters. I have no information, but I shall look into the matter and let my noble friend know.
Lord Molloy: My Lords, can the noble Lord explain in a little more detail how the Government will encourage British recruitment to the Commission? How will people know how and where to apply in order to be considered?
Lord Reay: My Lords, in addition to the creation of a European stream which I mentioned, it is the Government's intention to increase the number of secondments to the Commission and also to establish a special unit in the Cabinet Office to

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co-ordinate the British recruitment effort and to take up individual issues with the Commission. This package of measures will, we hope, address the problem
Lord Nugent of Guildford: My Lords, is my noble friend aware that the timescale for making an appointment to the Commission is unduly long? Can anything be done to reduce it?
Lord Reay: My Lords, in addition to what the Government intend to do, the European Commission also intends to introduce procedures which should assist with the problem. One of those is to bring forward from the reserve list more United Kingdom nationals awaiting jobs, where those were successful in competitions.
Lord Campbell of Croy: My Lords, can the Government make it clear that career prospects in the British public service will not be impaired by a period of service with the Commission?
Lord Reay: Yes, my Lords. The Select Committee of your Lordships' House which reported in 1988 made a point of this complaint. However, it has now become increasingly accepted that a spell in Brussels benefits the United Kingdom as well as the Commission. Individual career prospects should therefore become enhanced as a result, and such postings are now seen much more as an integral part of career planning.

Cyprus
3.7 p.m.
Lord Stallard Lord Stallard asked Her Majesty's Government:
What steps they are taking to secure a negotiated settlement of the problems of Cyprus.
Lord Reay: My Lords, we shall continue to give active support to the United Nations Secretary General's efforts to promote a comprehensive, just and lasting settlement of the Cyprus problem.
Lord Stallard: My Lords, I thank the noble Lord for that Answer. I appreciate the Government's hand in this, as I appreciated and welcomed the Minister's recent statement in another place that their policy was to continue to refuse to recognise the proclaimed so-called Republic of Northern Cyprus. He said that it was illegally declared and that the Government would not recognise it. That statement was very much welcomed and appreciated so far as it went.
My Question asks what steps the Government are taking to secure a negotiated settlement of a dispute that has now lasted for 16 years. As it is now clear that the Turkish Cypriot President of the Turkish Republic of Northern Cyprus, which the Government do not recognise, wants only a recognition of the status quo, should we not now be seeking the support of those Turkish Cypriot community leaders who are prepared to negotiate honestly with the Cypriot Government under the auspices of the United Nations?
Lord Reay: My Lords, through continuous diplomatic contact with all parties concerned, including the fellow guarantor powers, Turkey and Greece, we have made strenuous efforts to help the United Nations find a way forward. The United Nations Secretary General has publicly acknowledged that no country does more to help him than we do.
Lord Cledwyn of Penrhos: My Lords, does the noble Lord agree that the Turkish Government's close relations with Mr. Denktash would help to achieve a negotiated settlement if the Turkish Prime Minister and his colleagues felt that that was necessary? Further, can he say whether the Prime Minister, during her recent visit to that country, discussed such matters with the Prime Minister of Turkey and his colleagues?
Lord Reay: Yes, my Lords. The Turkish President made clear to my right honourable friend the Prime Minister in Gallipoli on 25th April that the Turkish Government continue to support the United Nations Secretary General's Cyprus mission. President Ozal said that he supported the principle of a bi-zonal, bi-commual federation in Cyprus with equal political rights for the two communities.
Lord Monson: My Lords, is it not time that we abandoned the illusion that we can control the complex affairs of nations which are situated several hundred or several thousand miles away from our own country? Will the Minister agree that realistically, the best help we can give is, come what may, to maintain those oases of security and stability, the British Sovereign bases and in particular Dhekelia, which is the one part of the island where Turkish and Greek Cypriots can meet on equal terms?
Lord Reay: My Lords, we are one of the guarantor powers and we have longstanding ties with Cyprus. Under the 1960 Treaty of Establishment we retained indefinitely two Sovereign base areas in Cyprus. We have no intention of giving up those bases; nor have the Government of Cyprus ever asked us to do so.
Lord Stallard: My Lords, I must press the noble Lord for some further examples of what he considers to be the next step forward in this process of finding a settlement. Will he say what he considers to be the next step, rather than just simply saying that we shall continue to support the United Nations? In what way can we take the next step forward?
Lord Reay: My Lords, although the last round of inter-communal talks failed to make progress—and we regret that fact—nevertheless, the Secretary General of the United Nations remains committed to searching for a solution, and his initiative is still in being. The way forward is mapped out clearly in Security Council Resolution 649 which was unanimously adopted on 12th March. A member of the United Nations Secretariat has just arrived in Cyprus for consultations with both sides to prepare the ground for the resumption of talks.

Bank of England: Status
3.12 p.m.
Lord Ezra Lord Ezra asked Her Majesty's Government:
Whether they consider that the Reserve Bank of New Zealand Act (1989), which provides for a central bank with greater independence consistent with the determination of economic priorities by the elected government, could act as a useful precedent in Britain.
The Paymaster General (The Earl of Caithness): My Lords, our position has been made clear both in this House and in another place. The Government have no plans to change the status of the Bank of England.
Lord Ezra: My Lords, can the noble Earl indicate whether he is aware that under Section 8 of the New Zealand Act to which I have referred, and a copy of which I have with me, the primary function of the Reserve Bank is laid down as being to determine monetary policy which will lead to the stability of prices in line with Government policies? Is he further aware that the policy agreed between the Government of New Zealand and the Reserve Bank is that by the end of 1992 inflation should be running at a rate of 0.2 per cent.? Does he not agree that those procedures and that objective might be highly desirable in the United Kingdom?
The Earl of Caithness: Yes, my Lords; I am aware of the contents of the Act. However, with regard to the noble Lord's second question, it is the Government's duty to bring down inflation.
Lord Bruce of Donington: My Lords, does the noble Earl agree that the Bank of England already has a very considerable amount of independence in practice as exemplified by the Johnson Matthey rescue operation which was carried out without reference even being made to the Treasury? Is he aware that all the powers which are contained by inference in the Question addressed to him by the noble Lord, Lord Ezra, are already quite adequately dealt with under Section 4 of the Bank of England Act 1946 and that there is no necessity for change?
The Earl of Caithness: My Lords, I agree with the noble Lord, Lord Bruce of Donington, that there is no need for change.
Lord Jenkins of Hillhead: My Lords, is the noble Earl aware that the conservatism of the Labour Party never fails to astonish me? Will he agree that there is a substantial distinction between the operations of the Bank of England as a regulator of the City, to which the noble Lord, Lord Bruce, referred, and the functions of the Bank as regards inflation and dealing with monetary policy?
There are certainly arguments on both sides of the question. However, will the noble Earl further agree that with inflation mounting almost certainly to double figures —possibly 11 per cent. —a little humility on the part of the Government might not be misplaced?
The Earl of Caithness: My Lords, we are actually talking about the role of central banks. As the noble Lord will be aware, that varies from country to country whether one takes the example of America or Japan. Over the past five years Japan's inflation rate has been the lowest in G7, although the Bank of Japan is one of the least independent central banks.
Lord Peston: My Lords, I should like to indicate my conservatism by saying how much I agree with the noble Earl that the Government must take full responsibility for monetary policy. Equally, if monetary policy goes wrong and the inflation rate rises, does he not agree that the Government must also take full responsibility for that situation?
The Earl of Caithness: My Lords, that is another question.
Lord Ezra: My Lords, is it not a fact that in many countries now central banks are beginning to play a more independent role to buttress the efforts of their governments? Is the noble Earl aware that in a recent ballot among such bodies as the Association of Corporate Treasurers, there was an 80 per cent. response in favour of a more independent central bank? Should not such opinion be taken more account of in the formulation of government policy?
The Earl of Caithness: My Lords, we are always delighted to receive opinion from all sources. As the noble Lord knows, we study such opinion with great care.
Lord Nugent of Guildford: My Lords, is my noble friend aware that the Bundesbank did not maintain its independence for very long in the face of Chancellor Kohl's decision on one-for-one exchange rates between East and West Germany?
The Earl of Caithness: My Lords, that is a most fascinating question. However, I think that it is slightly wide of the Question on the Order Paper.

European Court of Auditors
3.17 p.m.
Baroness Robson of Kiddington Baroness Robson of Kiddington asked Her Majesty's Government:
What particular proposals they have to strengthen the European Court of Auditors.
The Earl of Caithness: My Lords, there are no proposals at the moment. The court's role is clearly defined in the treaty and any significant strengthening would require a change to the treaty. At the Dublin summit on 28th April it was agreed that Foreign Ministers would consider the question of institutional change. They will report back at the summit planned for 25th-26th June, and decisions will then be taken on whether to call a second inter-governmental conference to consider institutional issues. In the context of such an IGC, the UK would need to consider whether to pursue its long standing desire of improving financial

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control and accountability. The role of the court would clearly be relevant to any such consideration.
Baroness Robson of Kiddington: My Lords, I thank the noble Earl for that reply. I am delighted that it has changed somewhat from the Answer he gave me on 30th April and that it is more in line with the Prime Minister's reply in another place. However, is he aware that the Commission's anti-fraud programme includes additional annual expenditure of 70 million ecus on anti-fraud measures? That is exactly double the annual cost of the budget to the Court of Auditors. It is rather like closing the stable door when the horse has bolted. Would not the right way forward be to make it mandatory for the Council of Ministers to take note of and act upon the Court of Auditor's reports and to give the court greater finance?
The Earl of Caithness: My Lords, the noble Baroness's Question on 30th April concerned fraud. I stand by the Answer I gave on that occasion. We do not think that the Court of Auditors is the appropriate body to produce an annual report on progress in the fight against fraud.
Baroness Robson of Kiddington: My Lords, with due respect to the noble Earl, I did not ask that the Court of Auditors should produce a report; I asked for the court to be given greater powers.
The Earl of Caithness: My Lords, I was clarifying the context in which the noble Baroness phrased her question. She indicated that I had changed my ground from that of 30th April. I have not. The subject of the powers of the Court of Auditors is one on which your Lordships commented some years ago and which might be a matter into which we could look if there is a second IGC.
Lord Bruce of Donington: My Lords, is the noble Earl aware that there are a number of ways in which the Court of Auditors can be strengthened without amendment of the treaty? Is he further aware that it lies within the power of Her Majesty's Government to propose at council level agreement to the increased staffing of the Court of Auditors? At the moment it is significantly understaffed by any professional standards.
Is he also aware that the other way in which the Court of Auditors may be strengthened is to amend the financial regulations so that the report of the court is published immediately after it has been concluded, on the year-end accounts? That would be better than having to wait for months and months to incorporate the Commission's replies to that report. Is the Minister aware that it would be far better and would draw more public attention to the report of the court if it were published promptly, without this interminable time for the Commission to consider replies which the report might incorporate?
The Earl of Caithness: My Lords, I take note of the points that the noble Lord has put to me. He will
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be aware that soon after your Lordships reported, if my memory serves me right, a new A1 post was added to enhance the administration of the court. That is a point which your Lordships picked up. Noble Lords will be pleased that two changes have been made, largely at the instigation of the United Kingdom, to improve the process for consideration of the court's report. First, since 1985 annual reports have been discussed in the Economic and Finance Council as part of budget discharge procedure. Secondly, the Economic and Finance Council makes specific provisions for handling the court's special reports.
Lord Campbell of Alloway: My Lords, is my noble friend aware that my right honourable friend the Prime Minister has been at the forefront of the fight for at least 18 months, to seek to come to grips with fraud in the Community? The suggestions made by the noble Lord, Lord Bruce, are entirely well founded. Although all efforts have been made by this country, does my noble friend agree that we have been frustrated at Community level? In the course of future negotiations will the noble Earl take on board the suggestions that we have made?
The Earl of Caithness: My Lords, fraud is a separate question from the one on the Order Paper. We dealt with it in the Question asked by the noble Baroness on 30th April.

Business
Viscount Davidson: My Lords, it may be for the convenience of the House if I announce that the Committee stage of the National Health Service and Community Care Bill will be adjourned at about 7 p.m. for about one hour, and that during this adjournment the Report stage of the European Parliament Electoral Reform Bill will be taken.

Procedure of the House: Select Committee Report
3.22 p.m.
The Chairman of Committees (Lord Aberdare): My Lords, I beg to move the Motion standing in my name on the Order Paper.
Perhaps I may draw your Lordships' special attention to the first item on declaration of interest. This was a matter which concerned the committee in its last two meetings. Members had no wish significantly to alter the present practice of the House but it was thought that the existing wording in the Companion was not sufficiently clear. Therefore the committee recommends to the House the new guidance which is contained in paragraph 5 of the report.
Perhaps I may make three short points. First, as has always been the case, a decision whether or not to speak or vote on a matter in which one of your Lordships has a personal interest rests with himself or herself. Secondly—and this was the most important point in the committee's view—any

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interest, financial or not, which might influence the views being expressed should be declared in order that the House could make a balanced judgment of the arguments. Thirdly, a noble Lord should not speak or vote if he is acting or has acted personally in the matter under consideration for a specific fee or reward.
The main emphasis that the committee wishes to make is that the revised guidance depends on the importance of declaring any significant interest. I beg to move.
Moved, That the second report from the Select Committee be agreed to.—(The Chairman of Committees.)
Following is the report:
ORDERED TO REPORT—
DECLARATION OF PECUNIARY INTEREST
1. The Committee have concluded their annual review of procedural difficulties in the preceding session to which the attention of the House should be called, by considering at two meetings the issue of Declaration of Pecuniary Interest.
2. Rule (xiv) of the Rules of Debate in the Companion (p.44) is as follows:
It is a long-standing custom of the House that Lords speak always on their personal honour. It follows from this that if a Lord decides that it is proper for him to take part in a debate on a subject in which he has a direct pecuniary interest, he should declare it.
Subject to this, and to the guidance to members or employees of public Boards (the Addison Rules) set out below, there is no reason why a Lord with an interest to declare should not take part in debate. It is however considered undesirable for a Lord to advocate, promote or oppose in the House any Bill or subordinate legislation, in or for which he is or has been acting or concerned for any pecuniary fee or reward.
3. A series of incidents last session suggested that the last sentence of this guidance is widely misunderstood (H.L. Deb. 3rd April 1989 cols. 964 and 972, H.L. Deb. 2nd May 1989 cols. 58 and 61, H.L. Deb. 11th October 1989 cols. 403-406). The point at issue in each case was the meaning of "acting or concerned for any pecuniary fee or reward" and whether it applies to a general salary or retainer or only to a specific pecuniary fee or reward in a particular case, and whether "concerned" is to be construed broadly or narrowly. From an examination of the history of the matter, it appears that the rule was orginally aimed at two potential abuses, namely a Lord gaining pecuniary advantage from his membership of Parliament or using it to further his professional career, and a person outside Parliament gaining unfair advantage through a fortuitous connection with a member of the House. It was not intended to prohibit professionally qualified Lords from speaking on matters connected with their profession, which would deprive the House of the views of members with a direct knowledge of the subjects under discussion.
4. In the light of these recent experiences, the Committee consider that the rule as currently phrased fails to express the original intentions of the House, and accordingly they have agreed a new form of guidance which they hope will express the conventions of the House more clearly,
5. The Committee recommend the following new guidance on the Declaration of Interest, for eventual inclusion in the Companion:
"It is a long-standing custom of the House that Lords speak always on their personal honour. The decision whether it is proper to take part in a debate or a vote in which a Lord has a personal interest therefore rests with the Lord himself; but it is considered undesirable for a Lord to advocate, promote or oppose in the House any Bill or subordinate legislation if he is acting or has acted personally in direct connection with it for a specific fee or reward, or to vote on a Private Bill in which he has a direct pecuniary interest. Subject to these
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exceptions and to the guidance to Members or Employees of Public Boards (the "Addison Rules") a Lord is free to take part in a debate or a vote in which he has a personal interest.
If a Lord has a direct pecuniary interest in a subject on which he speaks, he should declare it, and he should also declare any kind of interest of which his audience should be aware in order to form a balanced judgement of his argument. Such interests may be indirect or non-pecuniary, for example the interest of a relation or friend, hospitality or gifts received, trusteeship, or unpaid membership of an interested organisation, and they may include past and future interests. This rule also applies where a Lord is using his influence as a member of the House in communication with a Minister, Government Department, local authority or other public body outside the House. If a Lord wishes to vote on a subject in which he has an interest that is direct, pecuniary and shared by few others, it is better that he should have spoken in the debate so that his interest may be openly declared.
On certain occasions such as Starred Questions and the various stages of a bill following Second Reading, it may be for the convenience of the House that Lords should not take up time by repeating declarations of interest but a Lord should make a declaration whenever he is in doubt. The Clerks at the Table are available to advise on the interpretation of this guidance in a case of uncertainty."
QUESTIONS ON NATIONALISED INDUSTRIES
6. The guidance given in the Companion on the scope of questions which may be asked on the nationalised industries is as follows:
"The tabling of Questions on nationalised industries is considered undesirable save for those asking for statistical information on a national basis or raising matters of urgent public importance." (p. 79)
The guidance was incorporated in the Companion on the Committee's recommendation of December 1978 (1st Report, 1977-78, H.L. 126). The principle behind the guidance is that governments should be expected to answer only on matters for which they exercise some direct responsibility.
7. Theoretically, Ministers have an arm's length relationship with the nationalised industries and their powers to intervene directly in their operations are limited. However, through their powers to give directions and to appoint and dismiss Chairmen of boards, and through their practice of giving general directives to boards and exercising the power of the purse, it has always been recognised that Ministers do in fact have a considerable measure of control over the operations of these industries.
8. For some years past the framing of questions and subsequent exchanges in the House have taken account of this position and have in practice ignored the Companion's guidance. Questions on nationalised industries often excite considerable interest in the House and criticisms of their content are rare. Government spokesmen show a willingness to answer them.
9. The Committee recommend that the Companion guidance should be modified to follow that recently agreed to on the subject of privatised industries (Procedure Committee 2nd Report 1987-88, H.L. 51), that in future questions should be restricted to matters where there is, in practice, Government responsibility, and that the tabling of questions on nationalised industries and privatised industries should be governed by the following single paragraph:
"The tabling of Questions on nationalised industries and privatised industries is restricted to those matters for which the Government are in practice responsible. In the case of the nationalised industries this includes broad issues of general policy and matters of overall financial control, questions on matters which raise issues of urgent public importance or requests for statistical information on a national basis. In the case of privatised industries, Ministers may retain power, for instance, to give directions either directly or indirectly through a regulatory body or to exercise rights conferred by a special share-holding. Questions on matters of the day-to-day administration of nationalised and privatised concerns which do not fall within the Government responsibility are undesirable."
On Question, Motion agreed to.

National Health Service and Community Care Bill
3.25 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.
[The CHAIRMAN OF COMMITTEES in the Chair.]
Lord Carter Lord Carter moved Amendment No. 113AH:
Before Clause 44, insert the following new clause:
("Assessment in the planning process of charges for accommodation
—(1) Each local authority shall, in taking steps to prepare its first plan of the provision of community care services in their area under section 44(1) below and annually thereafter specify acceptable standards of care and accommodation for placements for people in their area in residential care homes and nursing homes and shall specify those standards for each category of personal or nursing care required depending on an individual's level of dependency.
(2) Each local authority shall be required to supply the Secretary of State with a schedule setting out the range of charges which it considers reasonable and would be prepared to pay to meet the standards specified in subsection (1) above in respect of each of the categories of personal care set out in paragraphs 6 and 7 of Schedule 4 to the Income Support (General) Regulations 1987 in respect of the forthcoming financial year by such date as the Secretary of State may direct.
(3) Subject to subsection (4) below, the Secretary of State shall, after receipt of the information specified in subsection (2) above and following consultation with the local authority associations and other bodies he considers relevant, satisfy himself that the appropriate amount of income support (if it were in payment) would be adequate to meet such range of charges as has been specified for each of the categories of personal are as specified in subsection (2) above in relation to the forthcoming financial year.
(4) In respect of the first financial year for which community care services are provided under this Part, the Secretary of State shall certify that he is satisfied, after the consultation specified in subsection (3) above, that the equivalent resources have been made available to local authorities to meet the range of charge, notified to him under subsection (2) above.
(5) This section shall come into effect at Royal Assent.
(6) In this section, "appropriate amount of income support" has the same meaning as in paragraphs 5, 6 and 7 of Schedule 4 to the Income Support (General) Regulations 1987.").
The noble Lord said: In moving Amendment No. 113AH, with the leave of the Committee I shall speak to Amendments Nos. 113AJ and 113AL. The group of amendments deals with a real and urgent problem: namely, the current shortfall in income support levels in meeting the full weekly cost of residential and nursing care. We know that local authorities will inherit this shortfall next year. Residents at present in care and those who enter residential care between now and spring 1991 will be trapped in the shortfall.
I received a letter from the director of social services of Wiltshire County Council, who stated:
"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".
Other surveys have shown a shortfall of £40 to £60 per week. All this is before we take into account the effects of higher interest rates on residential home costs in the private sector.
To their credit, the Government have decided to collect information on the level of costs and fees in residential care, but as we understand it this information will not be available when the social security budget is transferred to local authorities in April next year. Perhaps the Minister will confirm this when he comes to reply.
The pressure already affects the quality of care. As we all know, there is great pressure on relatives to make up the difference. In my own family, in attempting to find residential care for an elderly member of my wife's family, I experienced the subtle and insistent attempts by the social services departments to persuade the relatives to pick up the bill if they possibly could. We are told that in some areas of the country there are no homes with charges below income support levels. Obviously this raises tremendous problems for elderly, poor people and their relatives.
Those who will need residential care after the Bill comes into force will be able to claim from the local authority which will pay the full cost and recover a contribution from the resident towards the cost. However, anyone who is already resident in care now or goes into care before next year will have to rely on income support. There are approximately 150,000 residents on income support today and government figures confirm that over 40 per cent. are in homes where the charge is above the income support level.
I wish to ask the Minister to say in his reply what happens when people's savings run out. What happens when the relatives are no longer prepared to make up the difference? What happens if fees increase still further and the gap widens? I am sure he will emphasise in his reply the increase proposed in the levels of benefit for August. That is between £5 and £15 per week against a shortfall of £30 to £60 per week. All that the so-called preserved rights to income support achieve for those in residential or nursing care or entering before next spring is to preserve the right to uncertainty and deep concern.
I also wish to ask the Minister the Government's view about the comparison between residents in the same home after next spring. There will be some who have the preserved insecurity and others who will benefit from the Government's proposals if they enter after that date.
These amendments are designed to overcome this problem. Amendment No. 113AH places two new duties on local authorities to specify acceptable standards for residential placements and to incorporate these standards into the community care plan; and to supply the Secretary of State for Social Security with a schedule which sets out what it considers to be a reasonable range of weekly charges to provide an acceptable standard of care.
The schedule would correspond to the current categories of care used by the Secretary of State to set the national limits for income support. The first duty would require the authorities to list and publish

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the standards which must be met in homes which they will be using for residential care. The amendment seeks to avoid perpetuating the present two-tier system whereby residents who rely on public funds often receive poorer quality care. Adequate standards should include proper safeguards on privacy and should ensure that residents have their own clothing and appropriate diets. There should be adequate staffing and staff training and the care provided should encourage independence and include rehabilitation, where appropriate.
The second duty would provide a mechanism whereby the size of the income support shortfall in the area could be measured. At present there are 13 income support limits depending on the type of care needed; for example, ordinary residential care for the elderly, nursing care for someone under pension age, or treatment for alcohol or drug dependency. The schedule would allow comparison between the income support level and the rate which the local authority considered reasonable and was willing to pay. There would be an incentive for local authorities to set reasonable rates because these are the rates which they will have to pay from April next year when buying places in residential care.
Amendment No. 113AJ seeks to provide some limited protection for people who are in residential care homes or nursing homes now or who need to be in care but cannot find a home willing to accept them. There would also be continuing protection after April next year if income support limits failed to keep pace with homes' fees. The amendment gives the Secretary of State for Social Security the power to make a discretionary topping-up payment from the social security budget. An individual who needed care in a home with charges above the statutory limits would have the right to apply to the Secretary of State for an additional payment of income support. In considering the application and reaching a decision, the Secretary of State would have to take into account information supplied by local authorities and health authorities on the range of charges at homes registered in the area. There would also be a duty to take account of the rates which the local authority believed reasonable and was prepared to pay for an adequate standard of care.
The Independent Healthcare Association points out that the maximum levels of income support are inadequate to meet the average charges for nursing or residential care for the elderly. Most people are obliged to obtain top-ups either from relatives or from a charity. Fees for shared rooms are closest to the income support levels. Ironically, however, local authorities are insisting on a lower proportion of residents—often as few as 20 per cent.—occupying shared rooms. The association claims that a home which has a majority of patients receiving income support is only viable if the owner is able to provide 24-hour cover at a rate lower than the local authority would pay someone else, where capital costs have been paid and no reserves are kept in anticipation of future expenditure, where staff are paid significantly less than the rates proposed by the Whitley Council and where expenditure on repairs, maintenance, renewals, newspapers and other things is kept to a
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minimum level. However, that impinges on residents' quality of life.
We have all had massive briefing on this problem. We have heard from the Association of Metropolitan Authorities, the National Federation of Housing Associations, the NCVO, the Community Care Alliance, the Local Government Information Office, the Spastics Society, the National Association of Citizens Advice Bureaux and many others. Those organisations are in the front line of the problem. They cannot all be wrong. I urge the Government to deal most sympathetically with a situation where frail, elderly and frightened old people and their relatives are looking to the Government to provide a solution. I beg to move.
3.30 p.m.
Baroness Cox: I support the amendment, moved so well by the noble Lord, Lord Carter, which contains many important provisions. The essence of the amendment has been expressed comprehensively and in general terms. Therefore, I do not wish to repeat the arguments. I wish simply to illustrate the need for the amendment. I shall do so by referring to a true case study which could be multiplied many hundreds of times over.
An elderly patient was discharged from hospital where he had been treated, having suffered from a cerebrovascular accident or stroke. By the time he left hospital he had recovered reasonably well but had some problems with mobility as a result of paralysis caused by the stroke and some problems with incontinence. He needed the support and advice of an incontinence adviser; he needed assistance to enable him to visit the lavatory regularly. However, he was sent to the kind of care home where that kind of specialist, skilled help was not available. Consequently, he suffered from incontinence, and that led to soreness and pressure areas. Those areas became infected and the patient's physical condition deteriorated. The patient naturally and understandably became depressed, demoralised and withdrawn.
A very unhappy syndrome of physical and psychological problems could so easily have been avoided if only there had been a proper assessment of the patient's needs and proper planning in terms of his social and health needs. The situation could further have been avoided if he had been sent to an appropriate place of care, and if he had received the care appropriate to his needs even if it was rather more expensive.
The noble Lord, Lord Carter, has highlighted the inadequacy of the provision of so much of the care that is currently available. We must ensure that all people in the community, particularly the frail elderly whose numbers will increase so dramatically over the coming years, are given the quality of care which they deserve and need. The example I have given illustrates the general purpose of the amendment. I shall reiterate the purpose: it is that such problems should not recur under the new dispensation.
The amendment would allow for the abolition of the suffering associated with the kind of situation I

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have described. It would also eliminate the fears that many people have that they will not be able to obtain or continue to have the high quality care which they need. That is an important point. The amendment is designed to meet in personal terms the needs of anyone entering community care and to meet in general terms the policy associated with planning provision and financial support for that care. I hope that the proposal will be accepted so that we avoid unnecessary suffering and provide for people according to their own unique, distinctive and individual needs. I support the amendment.
Baroness Seear: I, too, wish to support the amendment to which I have added my name. The noble Lord, Lord Carter, referred to the situation where, for financial or other reasons, patients are forced out of institutions where they receive proper care, or at least something approaching proper care. In some cases there is nowhere for them to go, but in many cases families will attempt to do something for thern out of a sense of family responsibility. However, in many cases those families are inadequately equipped to provide the kind of care that is required. As a result the patient suffers and the burden that falls on people trying to provide care becomes intolerable. I wish to underline that point in particular. We cannot overburden carers. We shall kill off carers in the attempt to maintain cheaply people who should be in institutions.
Baroness Carnegy of Lour: My Lords—
The Parliamentary Under-Secretary of State, Department of Social Security (Lord Henley): If my noble friend will give way, it may be convenient if I intervene at this moment to put the Government's case. I hope to speak again at the end of the debate and reply to many of the points that Members of the Committee have made. Before I begin I should emphasise that Amendments Nos. 113AH and 113AJ are separate amendments and are grouped with Amendment No. 113AL. We are obviously speaking to the two together but it would not necessarily follow that if the first one were agreed to, the second one goes with it. They require separate decisions.
We have now come to one of the most important components of our proposals for care in the community—the drawing up of community care plans for the provision of services to local communities. These plans are a cornerstone of our policy. They are designed to enable local authorities to set out and publish the needs of the community they serve, their objectives for the arrangement of services to meet those needs within the resources available to them, and to set out targets which they are setting themselves to develop and improve the services available in their areas. We shall also require local authorities in drawing up their care plans to consult local statutory, voluntary and other agencies to ensure that the approach to community care becomes much more user driven rather than fitting clients into existing services.
I do not believe that the new clause proposed in Amendment No. 113AH will help in the planning of services in the way that I have just outlined. First,
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the clause appears to be designed to require local authorities to specify in their first plan, and annually thereafter, the standards of care and accommodation for placements for people in their areas in residential and nursing care for each category of personal or nursing care. Naturally the objective of all authorities will be to provide the best possible quality of care in residential settings for all clients whom they may assess as in need of such care.
It may well be that as authorities develop their plans over time they may wish publicly to state the standards and specifications which they may require from service providers, including their own directly-managed provision. I should certainly not wish to prevent authorities from doing so if they felt that it was the best way to secure the provision which they required locally. At the same time I do not wish to impose such a bureaucratic requirement upon them, particularly in the early rounds of planning when they will have a great deal of work to do in identifying all the resources which may be available locally and determining the way in which they wish to specify contracts and enter into agreements for that provision.
As I understand it, the second part of the clause is intended to require authorities to tell the Secretary of State what range of charges they consider reasonable and are willing to pay to meet the standards they have specified. It would also require the Secretary of State to satisfy himself that income support, were it paid, would have been inadequate to meet such charges and to certify what resources equivalent to the income support that would have been paid has been made available to local authorities.
That is a receipe for chaos and bureaucracy. It takes away all the local flexibility that we wish to give local authorities to enable them to enter into the contracts which are most beneficial in meeting the needs of those in their area requiring different forms of residential care. What is reasonable to one man can be outrageous or unrealistic to another man. Not least, there are clients with very differing needs, some of whom may be supported in residential care where fees can justly be comparatively low and made even more competitive through the purchasing power of the local authority. In other cases, people with very high and specialist dependency may require much more intensive and expensive support which the authority also feels is justified in the individual circumstances. Under our proposals local authorities have the flexibility to enter into either or both kinds of arrangements according to the priorities they determine. The clause before us does nothing to assist them in this; indeed, it could have precisely the opposite effect.
In turning to Amendment No. 113AJ I should like to commend the movers for their concern about this issue. I should like to emphasise at the outset that the Government recognise the importance of protecting the position of those who—for good and sound reasons—will not be covered by the new community care arrangements. We recognise the very real need to give as much reassurance as possible to those who are currently residents of homes and receiving benefit. I have to tell the Committee, however, that

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I believe that this new clause is both unnecessary and impractical.
In addressing the new clause and the concerns expressed by the movers of the amendment, I ought first to remind the Committee why the Government have decided to continue the income support system for people who are resident in homes at the point of change to the new arrangements next year. We recognise that the present system is not perfect and is something of a blunt instrument. However, we also consider that it is important to avoid any unnecessary disruption to the arrangements made for the many frail and elderly residents of these homes and their families. It is also extremely important to enable local authorities to concentrate on their primary task after April 1991; namely providing an effective service for those turning to them for help for the first time under the new arrangements.
The Committee will recall that the whole issue of the current income support system for people in homes was extensively debated in another place both during the passsage of this Bill and during the passage of the Social Security Bill. There are three separate themes in the Government's response and I believe that that response renders this new clause unnecessary.
The Government fully recognise the importance of the current levels of the income support limits. Last month we increased the weekly benefit for virtually all existing claimants in homes by £10 a week. I remind the Committee that that represents an additional cost of £100 million on top of existing expenditure of £1,100 million. Following representations made in another place we are also introducing a second stage to the increase in the limits in 1990-91. In addition to the changes already made, from 13th August there will be further targeted increases to all the income support limits of £5, £10 and £15 to help maintain their value during the coming year. More than 200,000 people will benefit. That amounts to £45 million more this year and £70 million in a full year.
My right honourable friend the Secretary of State has also been considering how he should carry out future upratings of the income support limits. He has undertaken to make a thorough assessment of the position and to look carefully at the levels and structure of the income support limits as they would apply from 1991. He also expects to approve the commissioning of the necessary research in the near future.
Thirdly—and this thought also lies at the heart of the new clause we are debating now —my right honourable friend wants to be able to use the information that will become available as a result of practical decisions and negotiations by local authorities after 1991. The Social Security Bill, which we shall debate in 11 or 12 days, already contains a new provision (Clause 9) which confirms his powers to do just that —to set local limits for income support taking into account evidence supplied to him by local authorities about the charges they will be negotiating and meeting for residents in homes under the new arrangements.
3.45 p.m.
Lord Carter: Will the noble Lord allow me to intervene? Can he answer the question which I put to him and tell the Committee when the information which the Secretary of State proposes to collect in order to make those decisions will be available?
Lord Henley: Obviously it will take some time for that information to become available. It will not be available immediately the arrangements come into effect next April. We require information from the local authorities after they have negotiated fees for the homes. There is no point at the moment asking local authorities what fees are being charged in their areas because those are not necessarily the true fees. We need to know what the fees or charges will be after negotiation by the local authority. That is the evidence that we require. The information that the noble Lord seeks from local authorities at the moment has little value.
We shall not be able to use this new source of information immediately from April 1991 but we shall want to start to use it in reviewing and setting the limits as soon as enough robust information is available. Officials will be talking to the local authority associations about how local authorities can help in that process and how soon they can begin to help.
That brings me to the new clause in detail. The clause would require the Secretary of State to request from local authorities schedules of fees charged by homes in their area. It would also require him to deal with requests for review of the income support payable for an individual in a home where the amount paid is less than the fees charged and in doing so to take into account the schedules of fees supplied by local authorities, statements made by the local authority concerned about the range of charges in its area which it would be prepared itself to cover and any other information he wishes. The clause would come into effect on Royal Assent and hence be operative before April 1991. That is the point that I made to the noble Lord earlier. It is very different evidence from that which we would acquire after local authorities started negotiating their own fees.
In summary, the difference between this approach and that of the Government is that the proposers of the amendment wish individual local offices to reach individual judgments in individual cases and want the system to start now. The Government consider it crucial, on the grounds of simplicity and equity and on the grounds that there must be firm controls in that area to avoid a blank cheque being signed on the taxpayer, that there should continue to be a regulated system of limits applying, albeit one that is sharper than our current blunt instrument and as sensitive as we can make it. They also consider that it will be essential to reach a judgment, after consultation with the local authorities, about the precise information that would be most helpful and about how soon enough information would be available to provide the robust evidence that I mentioned earlier.
The proposed new clause imposes a completely unrealistic timescale and would place grave

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difficulties on Department of Social Security local offices as individual officers would be required to make extremely difficult judgments in individual cases. Even with the information from local authorities, they will have to reach judgments on what is a reasonable charge for the taxpayer to meet. That might be particularly difficult where no one in the home in question has been placed there by the local authority or no one receives the same level of care, or where there are several different levels of fee applying in the same home. Department of Social Security officers are not accountants. They simply do not have the expertise to sort that out. This is a recipe for delay, bad decision-making and unfair and unequal treatment.
As I said earlier, I clearly understand the motives behind the new clause. However, having said that, I hope that after some debate —and I shall answer as many points as possible at the end of the debate —the noble Lord will withdraw the amendment.
Lord Ennals: Before the noble Lord sits down, perhaps I may ask him two questions. First, in the studies that will be made by the Secretary of State, I presume that the different levels of cost of care homes in different parts of the country will be taken into consideration. I am aware that the cost of care homes in London is on average £66 per week higher than the income support level. I hope that the variations will be considered. Secondly, and perhaps more fundamentally, will the noble Lord give an assurance that none of those people now in care homes, without the resources to pay the fees required, will be evicted between now and the time when the legislation to which he referred comes into effect?
Lord Henley: I thought that I made it clear that my right honourable friend would look at local differences. That is the point of acquiring evidence from various local authorities. I should emphasise that that evidence should concern the cost rather than fees or charges. Those are two different things. That was why I stressed that our present arrangements are very much a blunt instrument. As the noble Lord knows full well, there is always the danger that if one puts up the limit many of the fees would go up.
The noble Lord also asked what will happen to those who are in homes at the moment and whether they might find themselves moved out. I cannot give him the assurance that he requires. He will know full well that the social security system, providing income support here, has never been the provider of last resort. Local authorities have a duty to help people who need residential care which is not otherwise available and health authorities have a duty to help people who need nursing care.
Baroness Seear: Perhaps I may press the noble Lord on that point. We are not trying to be difficult about it. As I see it, the crux of the matter is that it is a short-term problem. What will happen in the interim to those people who may be forced out? Unlike so many other problems, this problem will come to an end because, after 1991, the position will
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be different. However, what will happen to those people who, if they cannot meet the bills, will be out on their ear?
Lord Henley: I accept that there is a short-term problem here. That is why my right honourable friend made a mid-year announcement of an extra £5, £10 and £15, at a cost this year of £45 million and at a full-year cost of £70 million, in addition to the £100 million that he announced would come into effect this April. That is a large sum of money.
Lord Renton: As a past president of MENCAP and having a daughter aged 35 who has had to be in residential care pretty well all her life, I normally support the proposals put forward by the consortium to which the noble Lord referred, but I cannot in all conscience support this group of amendments.
I came to the debate without having thought about the matter very deeply, although I had read the amendments. However, having thought about the matter further—I shall burden the Committee briefly with some of my thoughts on it —and having heard my noble friend Lord Henley explain what the Government are doing and propose to do, I think it would not be reasonable for us to press the amendments. In any event, I hope that those who move them with their usual care and sincerity will consider the matter further in the light of the debate rather than put us into even temporary conflict with another place by pressing the amendments, even perhaps successfully, today.
Perhaps I may now give my reasons which are in addition to those which my noble friend mentioned, although I entirely support his reasons which I find very powerful. The first reason is that in Clause 44 the Government make an important new advance in the provisions—which after all have been on the statute book for many years —for the care of those who require it in various kinds of home, whether they are publicly or privately provided for or, as in the case of my daughter, a bit of each. Clause 44 makes a welcome and important new departure.
I find it strange that the first two amendments which we are discussing have been placed on the Marshalled List to precede Clause 44 because, quite frankly, they should be regarded as an elaboration and extension of it. By putting them first, we are putting the cart before the horse legislatively. In the circumstances, I do not think that it makes sense to do so.
In addition, the first amendment—Amendment No. 113AH —overlaps, as my noble friend said, with existing arrangements to be found in the Social Security Bill and, incidentally, overlaps with the broad power given by Clause 44. When legislating, even when we have to go into some detail, we should try to avoid overlapping if we can.
There is then the question of cost. I am glad to say that we are spending much more than used to be spent on care of the elderly and others with severe handicap of one kind or another. I tried to follow my noble friend, but I am not certain whether he gave any estimate of the cost of our requiring the Government to implement Amendment No. 113AJ. He said that we would give a blank cheque to those

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who were given power to spend. Although the Government have said that it will be a blank cheque, perhaps they have some idea, even at the back of their mind, as to how much might be incurred under that blank cheque.
We all know, and are worried about it, that the economy is not in such a healthy state as it has generally been under this Government in the past 11 years. I must confess to the Committee that the Chancellor of the Exchequer is a friend of mine. He represents my old constituency and achieves much bigger majorities than I ever did. He has not spoken to me about this, but I think that we are doing no service to those who are afflicted in any way by letting inflation run. We all have to be responsible enough to hold inflation. One way in which to do so is to avoid unnecessary expenditure—certainly to avoid blank cheques.
I therefore could not possibly vote in favour of either of these two amendments if they were pressed to a Division. I have much respect for the Members on the Front Benches. They are caring, as I hope that I am, about those who have special needs. However, if they press either amendment to a Division I could not support them.
My noble friend pointed out with some reason that, although we are imposing new administrative arrangements on the local authorities concerned and on the Secretary of State in Clause 44, we do not want the system —which is a good one and should be given a fair run —to be bogged down and perhaps delayed and impeded by over-elaborate administrative arrangements. One hesitates to use the word bureaucracy, but it would be a further extension of bureaucracy. For those reasons, expressed as briefly as I can, I very much hope that there will be second thoughts on the part of those who moved these two amendments.
4 p.m.
Lord Kilmarnock: When the noble Lord, Lord Henley, replies to the debate perhaps he will clear up something for me. He mentioned that there were to be increases in income support in the three bands of £5, £10 and £15 respectively. I believe he said that that would affect 200,000 people and would cost about £45 million. But he also said that the Social Security Bill—which we have not yet discussed—will give the Secretary of State powers to take local conditions into account when setting levels of income support.
My question is simply this. When local authorities have reported, when the necessary information has been garnered, and if wide discrepancies are revealed, what will then be the Government's attitude? What will they do?
The noble Lord, Lord Ennals, has already mentioned that there is a discrepancy of £66 in the London area over and above the limits. I take the point that we need the information. It would be nice to hear what the Government plan to do if very large discrepancies are revealed.
Baroness Carnegy of Lour: This is a very complicated subject which is difficult for us to grasp.
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We have had some very short speeches which have not illuminated it. However, I am deeply disturbed by what some Members of the Committee are saying and what we in Parliament are doing.
The Bill follows the idea in the Education Reform Act that my noble friend Lady Cox supported enthusiastically in most of its parts. We made it possible for decisions to be made near the ground, by the people who will be most involved, who can be sensitive. We did so in the face of a good deal of opposition from a number of noble Lords opposite. There has not yet been time for that measure to be programmed.
In the community care section the Bill follows the same idea. It gives the decision making to local councillors who know the circumstances, and whose constituents are the people for whom care is needed and their relations. The councillors are answerable to them. Most people involved in local authority work are closely linked with somebody who will depend on community care. Anything that we do in this Chamber, or in another place, which militates against that idea will damage the ability of people at ground level to make decisions. Some Members of the Committee may not consider that people at ground level should do so. But if one does so consider it is very important not to damage such ability.
In putting the problem, the noble Lord, Lord Carter, very rightly talked about shortfalls in local authorities: the problems of meeting the costs of such provisions. My noble friend Lady Cox very rightly gave us one case study. I was reminded of discussions I had in my local government days about social services when our hearts went out to the people about whom we were talking. That is why I said the other day that there is not usually much problem in getting local authority voters to fund social services.
However, we must not mix up our concern that that should happen with the system by which it is proposed to bring it about. Of course a system must be found whereby people are not left in the lurch, and the charges must be met. The Bill may be incomplete. However, if we do what is suggested in these amendments, I believe that we take all the benefit away from the Bill as it is drafted. There may be Members on the Cross-Benches and very likely other noble Lords opposite who believe in the principle of the Bill and would not wish to undermine it. If one uses local government in this way, first, one ring fences its budget. That is what we have done as the Bill now stands. Local authorities are told the sum that they have; and that is the sum they they will spend. If one then allows them to say, "That is what we reckon we shall need; this is what we have," and if the Government have to assure them that they will give them the balance, one would remove from councillors their ability to do their job. It is the easisest thing in the world. The charges would be set accordingly. The councillors would not need to do all the negotiating that is at the heart of the Bill. The downward pressure would not be there. The taxpayer would have to stump up.
I am surprised that my noble friend did not say that it was not right for this committee to pass the amendment. It would cost an enormous amount of money because there is no pressure to do other than

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to spend. That worries me. We have not heard very much from Members opposite who have local government experience and I do not know whether they will agree with me. About 20 per cent. of local government expenditure will now be ring fenced. Local councillors can only make a decision within the budget. It will be ring fenced.
Lord Carter: We had this debate on Tuesday. The noble Baroness is wrong. In the case of ring-fenced funding. the local authorities will be perfectly free to spend over and above the ring-fenced funds. No one suggests that ring-fenced funds should be 100 per cent. of expenditure. The local authorities would be free to add to that money and then they will be held accountable to their voters for the poll tax.
Baroness Carnegy of Lour: It is true that they will be free to spend more than the amount that is being ring fenced. However, Members of the Committee who have local government experience will know that expenditure on the police, which takes another enormous portion of the budget, is virtually predetermined. Expenditure on the fire service is predetermined to the extent that standards are set and so forth. The one remaining large portion of local government expenditure is on education. At present that accounts for about 50 per cent., 25 per cent. of which is predetermined by salaries.
Parliament is saying that local government will be able to decide how to spend only 25 per cent. of its budget, plus 2 per cent. or 3 per cent. for other services such as rubbish. If in addition we say to local government, "Under an amendment such as this you can have as much as you want in addition because you have said that it is needed", we would wreck local government. I strongly believe in local government. At present it does not go my way in Scotland but I believe in it. It is doing Scotland a great service, although at the moment it is dominated by the Labour Party. It is doing Scotland a great service and we are ruining it—
Lord Ennals: The noble Baroness said that local government in Scotland is dominated by the Labour Party. It is not; is is dominated by the voters. Local government elections are the people expressing their view, whether it happens to be Conservative, Labour or Liberal. There is nothing wrong with that; that is what democracy is about.
Baroness Carnegy of Lour: I know that there is nothing wrong with it. I said that the people have elected councils which are dominated by Labour councillors. That was what they wanted. I believe that they are doing a great job for Scotland. The noble Lord must listen to what I say, although it may be surprising. If we take away that power—and the amendment enhances that —we shall be turning local government into an agent of central government—
Noble Lords: Oh!
Baroness Carnegy of Lour: The amendment turns it into an agent of central government. If the local authority associations are backing the amendment I
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wonder how closely in touch they are with councillors. They have not written to me about the matter, perhaps naturally. If they had I should know more about their views. I shall be very surprised if they are in close touch with the councillors.
The amendments are providing for local government to be able to ask for as much as they say they need for community care. The figure that must be spent on community care is the best that local government councillors can obtain. Of course there must be a mechanism whereby cases about which we know are not left in the lurch. However, I am most alarmed by the general principle. I am shaken by the fact that the Labour Party, which believes so much in local government, is going along with it. I do not like to talk about political parties in this Chamber but I find the matter quite extraordinary. I hope that its members will think hard before pursuing that principle, and I hope that the amendments will not be carried.
Lord Milverton: On previous occasions I have supported Members on the opposite side of the Committee. I have supported the noble Lord, Lord Carter, and my noble friend Lady Cox. I have given the matter some thought. I know a little about what it is like to have a disabled member of the family because my sister has a mongol child. That is minor compared with the disabilities with which many people must contend.
I have listened to the arguments and given the matter a great deal of thought. The remarks of my noble friend Lord Renton helped me to make my decision to vote against the amendment should it come to that. I have decided to support my Front Bench. As far as I am able to understand such complex issues my noble friend Lord Henley gave a satisfactory answer. Although I have supported the noble Lord, Lord Carter, on similar issues, on this occasion I shall support my Front Bench.
4.15 p.m.
Lord Carter: The Minister has already spoken and therefore it may be helpful if I deal with some of the points which have been made since I moved the amendment. The Minister will have an opportunity to reply and we shall then decide what to do with the amendment.
Members of the Committee will have noticed that the Minister did not reply to my questions. I hope that in a moment he will take the opportunity to do so. What happens when those people now in residential care have a shortfall because their savings have run out?
Lord Henley: The noble Lord, Lord Ennals, asked that same question and I answered him.
Lord Carter: No, my noble friend asked what will happen if they face eviction. I ask what will happen if their savings run out. What are they to do if the relatives are no longer prepared to make up the difference? What will happen if the fees increase still further and the gap widens? None of those questions has been answered. The Minister did say what will happen to the residents who face eviction—that

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it will be up to the local authorities to solve the problem.
I could not hide a wry smile when I heard the remarks from the other side of the Committee about the bureacracy involved in our amendments. They come from members of a governing party which has introduced the poll tax, which is a bureaucratic nightmare. The Minister said that bureaucracy is involved because local authorities must discover the range of charges. Is not that exactly what the Government are trying to discover in their consultation process?
The Government believe in competition and the Minister used that word. It is intended to drive down the costs, thereby reducing the shortfall. However, the argument that today's fees should not be used as a regulator is spurious. The Department of Health assumes that local authorities will obtain cut-price care by negotiating the block contracts for care which the Minister mentioned. However, because of their nature, the block contracts will reduce choice. Therefore, the notion that we can have both choice and lower prices is illusory.
The noble Baroness, Lady Carnegy, must take the point that local authorities will have to make up the existing shortfall before they can begin to find the funds to solve the problems which the Minister said they will have to solve; for example, when the residents' savings run out, when the relatives will not make up the difference or when they face eviction. She referred with nostalgia to the old system of local government with which she is familiar. She described what used to happen in local government, but we now live in the age of the poll tax. Local authorities now have the overarching problem that the cost of everything they wish to do over and above the Government's requirements must fall on the poll tax. It must bear the cost of all extra local government expenditure.
Amendment No. 113AJ meets exactly the requirements which the noble Baroness mentioned. If there is a shortfall in individual cases it provides the power for a discretionary top-up to income support from the social security budget. We have been told endlessly that the amendments will wreck local government. Why then have we been briefed by all the associations representing local authorities which wish to see their provisions included in the Bill?
The Minister said that he recognises the importance of the cover required and that the Government wish to give a reassurance. But fine words of reassurance do not help to make up the many shortfalls. There are shortfalls after the recent April top-up. The further top-up in August of £5, £10 or £15 per week must be considered against the shortfalls which will then exist of between £30 and £60 per week.
Whenever we debate issues such as social security and health the Minister always quotes the big figures, and I understand that. We are told that is £45 million here and £100 million there, and that is important. However, that does not attempt to deal with the individual problems of people who now face a
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shortfall even after the expenditure which the Minister quoted. He said that the Secretary of State wishes to look at income support levels and therefore further research is required. We have been down that road before in respect of disability. We had the OPCS surveys but we have not received the comprehensive review of disability benefits which was promised as a result of the research.
The point was made in another place by a number of Members that the information which the Government require is available now. The point was made by my right honourable friend Mr. Merlyn Rees that one need only go to the voluntary organisations which run various homes around the country. They will be entirely prepared to reveal their costs, perhaps unlike the private sector, because, as the Minister said honestly and correctly, it is the costs about which the Government are anxious and not the fees which are charged. They want to know what are the costs which they will have to meet. That information can be obtained from the voluntary sector.
The noble Lord, Lord Renton, referred interestingly in an aside to the fact that, were we to be successful on these amendments, that may result in a temporary conflict with another place. That assumes that another place would wish to overturn our decision. He referred at some length to Clause 44, but that does not help those in shortfall now. Amendment No. 113AJ is intended to deal with that problem.
The noble Lord also referred to the need for care as regards public expenditure. That is so. He mentioned too the state of the economy. To be fair, he might have referred to the 1 per cent. on the RPI which is a direct result of the Government's introduction of the poll tax. That has also affected the state of the economy. When one compares that sort of decision with the individual and human problems that we are now facing, I am surprised that the noble Lord is not able to see the importance of Amendment No. 113AJ in helping all those people who now face that problem. That must be dealt with before the new system is introduced next April.
Lord Boyd-Carpenter: Before the noble Lord sits down, in view of his reference to the possibility of a conflict with another place, has he thought about a major source of conflict which will arise if these amendments are carried and inserted into this Bill in the light of the amendment inserted into the Social Security Bill in another place on 26th March?
I shall quote a few words from the Secretary of State for Social Security in a few moments. But an amendment has been carried dealing with this topic which, whatever the noble Lord may say, is quite inconsistent with the amendments he is now proposing to insert into this Bill. I shall quote because I believe that it is only fair to do so. The Secretary of State for Social Security in introducing this amendment said:
"The power that I am taking in the new clause is designed to help me to set up a system of local limits, if need be. In setting such limits, I want to have regard to both the charges being met by local authorities in homes and also, perhaps, the charges being met by other bodies such as the voluntary sector".—[Official Report, Commons, 28/3/90; col. 590]

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That amendment has gone into the Social Security Bill, which we shall shortly be considering in Committee. It is quite plain that that is not consistent with this amendment.
What will happen if these amendments are carried? Logically, the amendments to the Social Security Bill must be rejected or the law will be left in a state of chaos. That is unfair not only to the local authorities, which have to administer this, but even more so to the people whom it is supposed to benefit.
Perhaps the Committee will consider for a moment that, as some of my noble friends have said, we are dealing with a large volume of public expenditure. In those circumstances there must be a strong argument for adopting a solution of another place as to how that expenditure should be authorised and carried out. For this Chamber to carry a proposition such as we did the other day, which was rejected and which involved substantial expenditure, leaves the whole matter very uncertain. If we were, as in logic we should do as part of the same process, to throw out the amendments put in another place to the Social Security Bill, we should end up by doing no good to anybody.
I fully understand—and I have listened to this debate with great care—the strong feelings of Members on both sides of the Committee. I am sure that we were all very moved by what my noble friend Lord Renton said. However, if one wishes to be practical and to secure that as soon as possible the position of the very unfortunate people with whom we are concerned is rectified and put on a firm foundation, I suggest that the inevitable conclusion is that these amendments should be withdrawn. Thereafter, when we come, as we do in a few days' time, to consideration of the Social Security Bill in Committee, we should support the clause put in by another place, which is now safe from any alteration by that Chamber.
In that way we shall be able to go ahead knowing that, although we may not have achieved in exact detail what the Committee wants, we shall have secured that this important benefit is safe and secure for a great many people whose interests we have at heart. If we become involved in a conflict with another place by introducing clashing amendments, we risk throwing the whole matter into confusion and we shall inevitably incur delay.
Lord Ennals: I am not quite certain why the noble Lord is so worried. This Committee is entitled, as we did on Tuesday, to pass an amendment to a Bill which has come from another place. The other place must then decide what to do with it. When we come to consideration in Committee of the Social Security Bill, we are equally entitled to pass amendments if we believe that it is right to do so. Again, another place must then decide what is the best course to take.
The reason that the issue is before us today is that there is a conviction —and I believe it is shared by Members of the Committee on both sides—that some of those people who are in care accommodation today and who could conceivably be evicted are not
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covered by the steps taken by the Secretary of State for Social Security which we have welcomed. It is because we are worried about that particular group of people in the time until the new Act comes into operation that these amendments are before us.
Lord Boyd-Carpenter: The noble Lord is absolutely right in saying that we can amend and that another place can amend. However, I ask him to consider whether that makes good sense. We are trying to help a very unfortunate section of our population. With the full approval of another place there is a provision which will go a great way towards achieving that. Because some of us may prefer in certain detail our own ideas, it surely does not make good sense and certainly does not make good social sense to involve ourselves in a long and complicated conflict with another place which will delay the remedial measures that we all wish to see. If the noble Lord really wishes these people to be helped quickly, he will withdraw his amendments.
4.30 p.m.
Lord Henley: The noble Lord, Lord Carter, spoke of shortfalls in the levels of income support and cited cases. There will always be shortfalls whatever may be the limit for the level for income support. The noble Lord knows full well that if we raised the limit to £300, there would still be shortfalls in some parts of the country. It is important to bear in mind that there are still homes below the limits as they are set although I appreciate that there are problems in some areas. However, I believe that we can find homes in all areas which are below the limits. The other point which the noble Lord should consider is that if we keep on increasing income support levels, as I said before, the fees are pushed up. That does not help those who are paying their own fees and who are not on income support.
The noble Lord asked about the position of those who are paying their own fees should their savings run out. It does not matter; they can still go on income support. They will still have their preserved rights. It is the residents who are in a residential or nursing home at April 1991 who are relevant, not whether they are in receipt of income support on that date.
The noble Lord quoted his right honourable friend in another place, Merlyn Rees, and said that there was already evidence of the costs. He quite rightly said that it was costs that we should look at and not fees and charges. He cited the evidence from voluntary organisations. It may be that voluntary organisations can provide some evidence, but merely because an organisation is voluntary does not necessarily mean that the fees it is charging are the cheapest or are the base line. An economist would probably be able to advise the noble Lord on this, but no doubt there are profit-making bodies providing a perfectly good service who charge lesser fees than some voluntary organisations.
My noble friend Lord Renton quite rightly asked about my estimate of the cost of Amendments Nos. 113AH and 113AJ. As my noble friend quite rightly said, I referred to a blank cheque. I do not think I can go beyond that. The amounts would be impossible to

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predict, and Amendment No. 113AH appears to be an open-ended cheque. Local authorities no longer need to negotiate; they simply set out what they consider the local charges to be and ask the Secretary of State to pay up. Amendment No. 113AJ is equally open ended. The Secretary of State has to respond to the fees charged and there will be no incentive for the local authority to negotiate the best fees. They would know that in the end my right honourable friend the Secretary of State would pay out.
As my other noble friends mentioned, Clause 9 in the new Social Security Bill deals with that problem. The noble Lord, Lord Kilmarnock, rightly asked what would be the attitude of my right honourable friend to local discrepancies under Clause 9 of the Bill. That will be debated in greater detail in 11 or 12 days' time; but perhaps I can read out part of the first section of Clause 9, which states:
"the Secretary of State shall take into account information provided by local authorities or other prescribed bodies or persons with respect to the amounts which they have agreed to pay for the provision of accommodation".
I assure the noble Lord that my right honourable friend will take into account local variations, and we shall be very interested in the local variations that appear throughout the country.
The noble Lord, Lord Carter, in justifying Amendment No. 113AJ, said that it would help people who have a shortfall now. That may be the intention, but it cannot help people now. Reliable local authority information will not be available until after April 1991. Research is to be commissioned shortly by my right honourable friend, and that will help us in forming decisions on the next uprating of limits.
I shall repeat the upratings that we announced. There is an extra £100 million; that is, £10 a week on nearly all the income support levels this April; an extra £45 million on an interim uprating in August—a full year cost of £70 million. That is on top of the £1,100 million we already spend in a full year. Those upratings, together with the new clause in the Bill, constitute a substantial and proper response to the concerns expressed both here and in another place.
I remind the Committee that the Secretary of State for Social Security has given a commitment to review the level and structure of limits as they will apply to preserved cases. Finally, local authorities and health authorities will continue to retain their current ability to help individuals.
The Government's approach is the best way forward. The new clauses are unnecessary and impractical. If the noble Lord insists on pressing the amendment, I hope that the Committee will reject it.
Lord Carter: I do not intend to detain the Committee much longer. We received no reassurance from the Minister regarding the problems that we brought to the attention of the Committee. Perhaps I may deal briefly with the point made by the noble Lord, Lord Renton, regarding the conflict in the other place. It was intended to be a little tease about his use of the words "temporary
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conflict", which assumed that the amendment would be automatically overturned in another place.
Lord Renton: Perhaps the noble Lord will allow me. That is the right assumption, bearing in mind that this matter was twice debated in another place, and at Report stage the conclusion was reached that an amendment on the lines now proposed was not acceptable. The other place, to a far greater extent than this Chamber, has a responsibility under our constitution which we strictly do not have for having the last word in government expenditure.
Lord Carter: I understand that entirely. The advice that I received was that these amendments do not clash with the Social Security Bill. This is not the time to go into the constitution of debate. As I read the amendments, I do not think that they clash with the Social Security Bill, as the noble Lord, Lord Boyd-Carpenter, said.
Lord Boyd-Carpenter: If the noble Lord will allow me to intervene. Is the noble Lord saying that both the amendments to the Social Security Bill to which I referred and these amendments could co-exist in our law without utter confusion? Is he really saying that?
Lord Carter: As I am advised and understand the position, yes. Noble Lords may laugh out loud. They are entitled to their views. I am only repeating the advice that I received.
The Minister said that these provisions will push up the fees. Surely the plans of the Government's own research, the plans to impose local limits, will stop that. That information will all be made available to local authorities. If the Minister wants evidence regarding the costs in the voluntary sector, it is a pity that the noble Baroness, Lady Ryder of Warsaw, is not here because I am sure that she would be able to tell him about the substantial problems that are now faced in the homes with which she is involved.
We have had an excellent debate. I understand that it is a complicated matter. Noble Lords who support the amendment have not received the assurances required from the Minister, and I therefore feel I must ask the opinion of the Committee.
4.37 p.m.
On Question, Whether the said amendment (No. 113AH) shall be agreed to?
Their Lordships divided: Contents, 90; Not-Contents, 112.

Division No. 1

CONTENTS

Acton, L.

Boston of Faversham, L.

Airedale, L.

Bottomley, L.

Allen of Abbeydale, L.

Broadbridge, L.

Aylestone, L.

Bruce of Donington, L.

Bancroft, L.

Campbell of Eskan, L.

Birk, B.

Carmichael of Kelvingrove L.

Blease, L.

Bonham-Carter, L.

Carter, L.

1493

Cledwyn of Penrhos, L.

Lockwood, B.

Clinton-Davis, L.

Longford, E.

Cocks of Hartcliffe, L.

Lovell-Davis, L.

Darcy (de Knayth), B.

Macaulay of Bragar, L.

David, B.

McIntosh of Haringey, L.

Dean of Beswick, L.

McNair, L.

Diamond, L.

Milner of Leeds, L.

Donaldson of Kingsbridge, L.

Morris of Castle Morris, L.

Dormand of Easington, L.

Mulley, L.

Ennals, L.

Nicol, B.

Ewart-Biggs, B.

Northfield, L.

Ezra, L.

Ogmore, L.

Falkland, V.

Oram, L.

Fisher of Rednal, B.

Peston, L.

Fitt, L.

Pitt of Hampstead, L.

Foot, L

Prys-Davies, L.

Gallacher, L.

Rea, L.

Gladwyn, L.

Ritchie of Dundee, L.

Graham of Edmonton, L. [Teller.]

Robson of Kiddington, B.

Rochester, L.

Hampton, L.

Russell, E.

Hatch of Lusby, L.

Sainsbury, L.

Hirshfield, L.

Seear, B. [Teller.]

Houghton of Sowerby, L.

Shackleton, L.

Hughes L.

Somers, L.

Hunt, L.

Stallard, L.

Jacques, L.

Stedman, B.

Jay, L.

Stoddart of Swindon, L.

Jeger, B.

Strabolgi, L.

Jenkins of Putney, L.

Thurso, V.

John-Mackie, L.

Tordoff, L.

Kilbracken, L.

Underhill, L.

Kilmarnock, L.

Wallace of Coslany, L.

Kirkhill, L.

Wedderburn of Charlton, L.

Leatherland, L.

White, B.

Listowel, E.

Williams of Elvel, L.

Llewelyn-Davies of Hastoe, B.

Winchilsea and Nottingham, E.

Lloyd of Kilgerran, L.

Winstanley, L.

NOT-CONTENTS

Alexander of Tunis, E.

Faithfull, B.

Allenby of Megiddo, V.

Fraser of Kilmorack, L.

Arran, E.

Gisborough, L.

Auckland, L.

Hailsham of Saint Marylebone, L.

Balfour, E.

Balfour of Inchrye, L.

Henley, L.

Belhaven and Stenton, L.

Hesketh, L.

Beloff, L.

Hives, L.

Belstead, L.

Home of the Hirsel, L.

Bessborough, E.

Hood, V.

Blatch, B.

Hooper, B.

Blyth, L.

Hylton-Foster, B.

Boyd-Carpenter, L.

Joseph, L.

Bridgeman, V.

Killearn, L.

Brightman, L.

Kinnaird, L.

Brougham and Vaux, L.

Lauderdale, E.

Butterworth, L.

Layton, L.

Buxton of Alsa. L.

Limerick, E.

Caithness, E.

Lloyd of Hampstead, L.

Campbell of Alloway, L.

Long, V.

Campbell of Croy, L.

Luke, L.

Carnegy of Lour, B.

Lyell, L.

Carnock, L.

McColl of Dulwich, L.

Carr of Hadley, L.

Mackay of Clashfern, L.

Clanwilliam, E.

Macleod of Borve, B.

Coleraine, L.

Mancroft, L.

Constantine of Stanmore, L.

Massereene and Ferrard, V.

Cork and Orrery, E.

Merrivale, L.

Cornwallis, L.

Mersey, V.

Cottesloe, L.

Milverton, L.

Cranbrook, E.

Monk Bretton, L.

Dacre of Glanton, L.

Mottistone, L.

Davidson, V. [Teller.]

Mountevans, L.

De Freyne, L.

Mowbray and Stourton, L.

Denham, L. [Teller.]

Munster, E.

Dilhorne, V.

Murton of Lindisfarne, L.

Ellenborough, L.

Nelson, E.

Elles, B.

Nelson of Stafford, L.

Elliot of Harwood, B.

Nugent of Guildford, L.

Erroll, E

Orkney, E.

1494

Oxfuird, V.

Shannon, E.

Peel, E.

Strathclyde, L.

Pender, L.

Strathmore and Kinghorne E.

Platt of Writtle, B.

Porritt, L.

Swansea, L.

Pym, L.

Swinfen, L.

Rankeillour, L.

Swinton, E.

Reay, L.

Terrington, L.

Rees, L.

Teviot, L.

Renton, L.

Thomas of Gwydir, L.

Roskill, L.

Thurlow, L.

St. Davids, V.

Trefgarne, L.

St. John of Bletso, L.

Trumpington, B.

Saltoun of Abernethy, Ly.

Ullswater, V.

Sanderson of Bowden, L.

Vaux of Harrowden, L.

Sandys, L.

Whitelaw, V.

Sempill, Ly.

Wolfson, L.

Resolved in the negative, and amendment disagreed to accordingly.
4.46 p.m.
[Amendment No. 113AJ not moved.]
Clause 44 [Local authority plans for community care services]:
Baroness Faithfull Baroness Faithfull moved Amendment No. 113AK:
Page 50, line 4, after ("may") insert ("after taking into acount the views of the appropriate local authority associations").
The noble Baroness said: This is a simple amendment with no resource implications. I should point out that I speak as a vice-president of the County Councils Association. Clause 44(1)(a) states that each local authority,
"shall, within such period after the day appointed for the coming into force of this section as the Secretary of State may direct, prepare and publish a plan for the provision of community care services in their area".
The amendment merely inserts, after the word "may",
"after taking into account the views of appropriate local authority associations".
As I said, I speak as a vice-president of the County Councils Association. All that we ask has nothing to do with policy or money; we seek merely to ensure that the local authority associations, which have an overall picture of the needs throughout the country, shall be consulted. I beg to move.
Lord Renton: I should have thought that the local authority associations are so well organised and so powerful that there is no chance whatever of their views being ignored. Therefore, my noble friend's amendment, essential though it may be considered, is unnecessary. That is because the local authority associations are doing their job so well.
Baroness Faithfull: Perhaps I may respond to my noble friend Lord Renton. The effect is the other way round —to enable the Government to have the views of the local authority associations that my noble friend thinks so good.
Lord Renton: The same argument applies, if I may say so.
Lord Ennals: I certainly support the amendment. Consultation is absolutely essential. As the noble

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Baroness, Lady Faithfull, said, this is an important clause. It sets out not only that a compete plan must be published showing how a local authority fulfils its community care responsibilities but also that the plan must be reviewed. And there are powers to order it to bring forward a new plan. That will be an important, ongoing, operation if it is to be effectively carried out.
Of course, as the noble Lord, Lord Henley, said on an earlier amendment, there will be consultation with statutory bodies and voluntary organisations. However, sometimes it does not happen that the local authority associations are consulted. Whether we are referring to the AMA, the CCA, the ADC or even the ADSS makes no difference. All those organisations have an important contribution to make. And since this amendment cannot be considered controversial there is no way in which the Minister can reply that the Government do not believe in consulting the local authority associations. It seems to me that the amendment can be easily accepted.
Lord Renton: In fairness to my noble friend I should point out that I read her amendment as meaning that the local authority should take account of the views of local authority associations, and bearing in mind the comma after the word "direct" I am still of that view. But if she means that the Secretary of State should do so, perhaps a little further thought might be given to the drafting and then there would be no ambiguity. Whichever way it is, I still maintain that the local authority associations are so well organised that nobody has a chance of failing to take account of their views.
Lord Seebohm: I should like to support this amendment. I must confess that I am vice-president of the Association of County Councils, which is doing an enormous amount of work in co-ordinating the views of the various local authorities. It has a wealth of information which I think should be tapped.
Baroness Hooper: I believe that I can reassure the movers of this amendment, and the noble Lord, Lord Ennals, also, because there is, and has been, regular consultation with the local authority associations about the implementation of our community care policies. This consultation takes place at both ministerial and, regularly, official level. The views of the local authority associations are therefore well known and are being taken into account.
I am sure that the Committee will agree that the Secretary of State should be the person to determine the period and time by which all local authorities must prepare their plans, albeit that each authority does it individually. Since these plans are an important cornerstone of the new policy it is vital that they are produced at a time which coincides with the other changes that have to be made legislatively in order to implement our policies.
We expect to have them prepared by 1st April 1991, and I refer the Members of the Committee to
1496
paragraph 5.9 of the White Paper, which refers to this particular point. This is when benefit changes are made, and transfers of funds from social security resources are made to local authorities. This approach to timing has always been perfectly clear to the local authority associations and the many other interested statutory, voluntary and independent organisations, and has been accepted by them.
I believe that this amendment is therefore unnecessary, because consultation is an ongoing process. It is also even unhelpful because it is the proper role of the Secretary of State to determine the time at which implementation of the changes which effect our policy come into force. I believe that it could be a recipe for delay and again for further build-up of bureacratic procedures. I therefore urge the Committee to oppose this amendment.
Lord Ennals: The noble Baroness says that it is a recipe for delay. Does that mean that there is a possibility that they would not be consulted?
Baroness Hooper: I made it clear that they have been, and are being, consulted. Therefore, it is unnecessary to repeat the process and duplicate the procedure.
Lord Ennals: Here we are dealing with this quite new clause. It is a new responsibility placed on local authorities. It is not something about which they have been consulted up to now. It is about the plans and the nature of the plans presented to the Secretary of State and revisions of them as the years go by, and whether the Secretary of State should seek the advice of the local authority associations. The fact that they have been consulted up to now is not the point of the amendment.
Baroness Hooper: Perhaps I can help the noble Lord further by referring to the sort of timing that we have in mind. After all, we must await Royal Assent before we can move into the further detailed preparation of plans. Local authorities will then be directed to prepare plans, and quite probably that will be towards the end of September after we have had feedback on guidance, which is due to go out fairly soon.
However, many have already started making preparations for these plans. Furthermore, after the first year, which we all appreciate is likely to be the most difficult one, there will be opportunity for annual review based on the experience of previous years. There will be ample opportunity for adequate consultation with the local authority associations. My reference to what has been, and is, going on is simply to reassure Members of the Committee that it will be a continuing process.
Baroness Faithfull: I thank the Minister for her reply. I just say that the local authority associations often act as a bridge between the ministries and their plans and the people in the areas who put forth those plans. I recognise that there is consultation between the ministries and the local authority associations. I should like to read what the Minister has said, and

1497
if necessary bring it forward at the next stage of the Bill. Meanwhile, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendment No. 113AL not moved.]
Baroness Seear Baroness Seear moved Amendment No. 113AM:
Page 50, line 9, leave out ("and").
The noble Baroness said: With amendment No. 113AM, which is a paving amendment, I should like to take Amendment No. 113AN. There are two major concerns behind these amendments. It probably would not have been necessary to put down these amendments but for the fact that the Bill is extremely thin on any indication as to what the standards are to be in the application of community care. Of course standards are what it is all about. Community care not related to any idea of the level of care and what is involved in care is really a meaningless phrase.
In the Second Reading debate I asked the Minister what was the policy for quality of care; what researches had been done to find out how much resources were going to be needed in order to achieve minimum standards of quality of community care. Frankly, I got no reply. It is for this reason that we need to put down an amendment of this kind. The assurance of quality is essential if community care is to be anything other than a pious farce.
The second reason is that there is a grave danger that a local authority, hard pressed for resources, will skimp on community care in order to meet from its budget, its limited resources, the many other demands made on local authorities. I was delighted to learn that, in my reprehensible absence this week, the community care budget is to be ring fenced. If the Government would now give us a commitment that that decision taken earlier this week will not at any stage be reversed, to a large extent the need for this amendment would fall. I only keep it here because experience of what has happened to amendments of this kind in this Chamber does not give me the greatest encouragement to think that that amendment is necessarily absolutely safe. Although it would make a great deal of difference, I do not propose at this time to withdraw my amendment.
The point of these amendments is to make clear that every local authority should say what it thinks it needs to do, then what it thinks it is going to be able to do, and to explain the reasons for the difference. It is an attempt to establish standards of quality. I am sure that the Committee will be aware that we are here in a dangerous situation. We are bringing people out of institutions, putting them into the care of the community, and we have not any adequate estimate whatsoever as to what the costs are going to be. If we get it wrong, the price is going to be paid by those members of our community who are in the least strong position to pay it —the people coming out of the institutions, the people who, as the years go on, need special care, and above all the people on to whom that responsibility is going to be thrust if the organisations and the local authorities are inadequate in meeting those needs. It is the
1498
families of the people who will have to shoulder the burden. A great many of them will shoulder that burden as well as they can, but often it will be done inadequately at an enormous human cost. I beg to move.
5 p.m.
Lord Carter: I am pleased to be able to add my name to the amendments and to support them from these Benches. When the noble Baroness, Lady Seear, referred to Amendment No. 113AM she said that it was a probing amendment. I think that she meant to say that it was a paving amendment. There is an important distinction. It is a paving amendment, and I was concerned when she said that it was a probing amendment.
Baroness Hooper: According to my grouping, we are also speaking to Amendment No. 113AR.
Lord Carter: Amendments Nos. 113AM and 113AN seek to give local authorities the opportunity to demonstrate the scale of spending on a service which they would have wished to introduce had there been no constraints on their spending. They go a little further in that they require a community care plan report for the following financial year to specify the amount which will be spent, the amount which the authority would consider it desirable to be spent in that year and an explanation of the variance between the two figures.
Amendment No. 113AR places a duty on each local authority to prepare and publish a community care plan report after the adoption of its annual budget. That report will have to specify the amounts to be spent on different aspects of community care.
As the Committee will be aware, the removal of the local business rate from the control of the local authorities has meant that one half of the locally determined revenue of the local authority has been removed to central government. (We shall be looking at that point again and again in regard to different amendments.) To the extent that it is not financed by increased central grant or business rate, 1 per cent. local authority spending will amount to approximately a 4 per cent. increase on the community charge. The reality of the matter is that without significant support from central government, community care will be one of the most prejudiced areas of spending because it has to compete with existing responsibilities. The pressure on the community charge that is produced by local spending as a whole is such that local authorities have little room to manoeuvre. Indeed, that was the Government's intention when they introduced the poll tax.
As the noble Baroness stated when moving the amendment, it underlines the importance of the decision of your Lordships on Amendment No. 108E on the first day of Committee. The Committee agreed with the earmarking of the government grant element of community care spending with ring-fence funding. A timetable for the implementation of community care is now the responsibility of the Secretary of State, who must satisfy himself that adequate resources are available and help with

1499
start-up costs. Those points were agreed by the Committee on Tuesday.
This group of amendments is of crucial importance if the performance of community care is to be measured against expectations.
Baroness Carnegy of Lour: I share the anxiety of the noble Baroness, Lady Seear. As the matter progresses it is important that local authorities should have the means to ensure that the procedures work correctly for individuals. In the initial stages that will be difficult. There is no question about that matter. Change is difficult, and it is most difficult for vulnerable people.
I do not know whether the ring-fencing decision will stand. If local authorities' organisations want ring fencing (and I find that completely astonishing, as I have said before), the Government may let them have it, and they would have to live with the situation. I pity them; but that is their affair.
Given the fact that we look at this amendment not knowing whether there will be ring fencing, the way to ensure that individuals get the care they need and that the funding is there is not for local authorities to publish what they would like to spend, say what they think they will be able to spend and complain about the difference, which would be the effect of the report. There would be an annual row about the funding of community care. The whole matter then turns into politics and, as I am sure the noble Baroness agrees, that is not the way to ensure the best possible care of individuals.
I do not think that this is the right amendment. I am very anxious to hear what my noble friend has to say about standards and quality. I hope that the Government are thinking hard about the matter as the Bill goes through the House. The noble Baroness made an important point but I do not think that this amendment is the way to arrive at that situation.
Baroness Hooper: I cannot speak for or pre-empt another place in saying what will happen in regard to the ring-fencing amendment. I am somewhat surprised that the noble Baroness should ask me to attempt to do so.
The plans required by Clause 44 have to be kept under review. We have talked about them previously. In carrying out the obligations to produce a plan, we are providing that local authorities must consult with health authorities, family health service authorities, housing authorities, voluntary housing agencies and other relevant bodies.
There are two key features of that new responsibility which we are placing on local authorities to which I should like to draw particular attention. The first is the fact that plans have to be produced at all. A number of authorities already do so and seek to do so in conjunction with the other agencies with which they have to collaborate. We are now moving from a position where people tend to be fitted into services to a situation where the authority, in its enabler role, plans to meet the needs of the community it serves by clearly setting out its objectives and targets. The plans are therefore a tool
1500
to enable inter-agency collaboration towards meeting the needs of the local community.
The second feature is that the plans will be published. This is designed to heighten the local accountability of the authority and to enable statutory, voluntary and other organisations to participate in the planning process.
Our intention in preparing guidance for the planning approach is that they should be prepared on a three-year rolling basis which will involve annual review. Our approach meets the substance of Amendments Nos. 113AM, 113AN and 113AR. Therefore, to require local authorities further to produce reports in accordance with a particular format in the way that Amendments Nos. 113AN and 113 AR propose is asking them in many ways to duplicate what we are already expecting them to do.
The plans will in any case have to have full regard to the resources at the disposal of the local authority, and reviews will show progress according to overall objectives and particular targets and how resources have been applied to meet those targets. Our guidance, which we aim to produce in draft form for the widest possible consultation within the next few weeks, will indicate the main issues to be covered in the plans. That said, their purpose is primarily to facilitate the indentification of local needs and moves towards meeting them and to heighten the local accountability of the responsible authorities. Details of the way in which plans should be prepared are therefore something best left for local decision.
The noble Baronesses, Lady Seear and Lady Carnegy, raised the question of quality. There are several safeguards for quality in our proposals. Authorities will have to agree quality standards in drawing up contracts and arrange to monitor them. They will have to set up arm's length inspection units. We are introducing Amendment No. 115FC, which would require authorities to have a complaints procedure. Those matters would safeguard the important aspects of quality in which we all believe.
On that basis, I ask the proposers to these amendments to withdraw them.
Baroness Seear: Although the noble Baroness's answer shows that the Government have some awareness of the quality problem, there is little in the Bill itself to reassure us that it will be taken into account. We attach such great importance to quality that its failure to figure adequately in the Bill means that I must take the opinion of the Committee.
5.10 p.m.
On Question, Whether the said amendment (No. 113AM) shall be agreed to?
Their Lordships divided: Contents, 81; Not-Contents, 105.

Division No. 2

CONTENTS

Airedale, L.

Blease, L.

Aylestone, L.

Bonham-Carter, L.

Bancroft, L.

Bottomley, L.

Birk, B.

Bruce of Donington, L.

1501

Campbell of Eskan, L.

Lloyd of Kilgerran, L.

Carmichael of Kelvingrove, L.

Lockwood, B.

Longford, E.

Carter, L.

Lovell-Davis, L.

Cledwyn of Penrhos, L.

Macaulay of Bragar, L.

Clinton-Davis, L.

McIntosh of Haringey, L.

Cocks of Hartcliffe, L.

McNair, L.

Darcy (de Knayth), B.

Masham of Ilton, B.

David, B.

Milner of Leeds, L.

Dean of Beswick, L.

Molloy, L.

Diamond, L.

Morris of Castle Morris, L.

Donaldson of Kingsbridge, L.

Mulley, L.

Dormand of Easington, L.

Nicol, B.

Ennals, L.

Northfield, L.

Ewart-Biggs, B.

Ogmore, L.

Falkland, V.

Oram, L.

Fisher of Rednal, B.

Peston, L.

Gallacher, L.

Pitt of Hampstead, L.

Gladwyn, L.

Prys-Davies, L.

Graham of Edmonton, L. [Teller.]

Rea, L.

Ritchie of Dundee, L.

Henderson of Brompton, L.

Robson of Kiddington, B.

Houghton of Sowerby, L.

Rochester, L.

Hughes, L.

Russell, E.

Hunt, L.

Seear, B. [Teller.]

Jacques, L.

Seebohm, L.

Jay, L.

Shackleton, L.

Jeger, B.

Stallard, L.

Jenkins of Hillhead, L.

Stedman, B.

Jenkins of Putney, L.

Stoddart of Swindon, L.

John-Mackie, L.

Strabolgi, L.

Kilbracken, L.

Swinfen, L.

Kilmarnock, L.

Thurlow, L.

Kirkhill, L.

Tordoff, L.

Leatherland, L.

Underhill, L.

Listowel, E.

Wallace of Coslany, L.

Llewelyn-Davies of Hastoe, B.

Williams of Elvel, L.

Winterbottom, L

NOT-CONTENTS

Alexander of Tunis, E.

Hailsham of Saint Marylebone, L.

Allenby of Megiddo, V.

Ampthill, L.

Halsbury, E.

Arran, E.

Hanson, L.

Auckland, L.

Henley, L.

Balfour, E.

Hesketh, L.

Belhaven and Stenton, L.

Hives, L.

Beloff, L.

Hood, V.

Belstead, L.

Hooper, B.

Blatch, B.

Howe, E.

Blyth, L.

Hylton-Foster, B.

Boardman, L.

Jenkin of Roding, L.

Boyd-Carpenter, L.

Lauderdale, E.

Bridgeman, V.

Limerick, E.

Broadbridge, L.

Lloyd of Hampstead, L.

Brougham and Vaux, L.

Long, V.

Butterworth, L.

Lyell, L.

Caithness, E.

McColl of Dulwich, L.

Campbell of Alloway, L.

Mackay of Clashfern, L.

Campbell of Croy, L.

Macleod of Borve, B.

Carnegy of Lour, B.

Mancroft, L.

Carnock, L.

Massereene and Ferrard, V.

Carr of Hadley, L.

Merrivale, L.

Clanwilliam, E.

Mersey, V.

Coleraine, L.

Milverton, L.

Constantine of Stanmore, L.

Monk Bretton, L.

Cork and Orrery, E.

Mottistone, L.

Cornwallis, L.

Mountevans, L.

Cox, B.

Munster, E.

Craigavon, V.

Murton of Lindisfarne, L.

Cullen of Ashbourne, L.

Nelson, E.

Dacre of Glanton, L.

Nelson of Stafford, L.

Davidson, V. [Teller.]

Nugent of Guildford, L.

Denham, L. [Teller.]

Orkney, E.

Dilhorne, V.

Oxfuird, V.

Elles, B.

Peel, E.

Elliot of Harwood, B.

Pender, L.

Erroll, E.

Platt of Writtle, B.

Faithfull, B.

Porritt, L.

Fraser of Kilmorack, L.

Pym, L.

Gisborough, L.

Rankeillour, L.

Glenarthur, L.

Reay, L.

1502

Rees, L.

Swansea, L.

Renton, L.

Swinton, E.

St. Davids, V.

Thomas of Gwydir, L.

St. John of Bletso, L.

Thomas of Swynnerton, L.

Saltoun of Abernethy, Ly.

Trefgarne, L.

Sanderson of Bowden, L.

Trumpington, B.

Sandys, L.

Tryon, L.

Sempill, Ly.

Ullswater, V.

Somers, L.

Vaux of Harrowden, L.

Strathclyde, L.

Wise, L.

Strathmore and Kinghorne, E.

Wolfson, L.

Resolved in the negative, and amendment disagreed to accordingly.
5.17 p.m.
[Amendment No. 113AN not moved.]
Baroness Cox Baroness Cox moved Amendment No. 113ANA:
Page 50, line 12, at end insert: ("(d) shall, in consultation with relevant health authorities identify staff currently in the employment of any such health authority whose duties and responsibilities may be significantly affected by the local authority's proposed plan, and shall incorporate in the plan measures to secure the continued employment of such staff.").
The noble Baroness said: This is essentially a probing amendment designed to gain some assurances, we hope, on behalf of staff who will be affected by the transfer of responsibility from the health authority to the local authority in terms of providing care in the community, particularly for the elderly and the mentally handicapped.
In Community Care: Agenda for Action Sir Roy Griffiths noted:
"It is important that the skills of staff formerly employed in long stay hospitals are not lost, as patients are discharged and responsibility for their care passes to another authority. Such staff are likely to have direct personal knowledge of individual former patients and their needs, as well as a wide range of skills which are equally valuable in a community care setting. There are legislative and other problems which inhibit the smooth transfer of staff between agencies at present, which can delay desirable changes".
Sir Roy went on to say:
"There are a number of options for local action in regard to staff. They may be seconded to the local authority, which has the advantage of being a flexible approach. There can be locally arranged transfers to a local authority employment with no redundancy compensation and with the retention of NHS superannuation scheme membership, which can be an important consideration for the staff concerned. Finally the health authority can make the staff redundant followed by engagement of the same staff by the local authority. Each of these options has its own advantages and disadvantages".
However, he urged that central government should make,
"a clear decision on the action to be taken".
He argued that, if this did not involve legislation, local management should at least have clear instructions and detailed guidance.
Perhaps I may shift my focus for a moment to deal specifically with nurses. They represent possibly the largest number of staff who will be involved. The Royal College of Nursing is concerned that the Government have not been more specific about how they envisage the transfer of nursing staff into the community to follow their clients and patients. It may be that local authorities will wish to take over the employment of nursing staff. Obviously, if that

1503
is to be the case, the college wish to see an acceptable transfer of terms and conditions of service for its members who will then be working in the community.
The college believes that such nurses should not be denied any benefits which accrue to nurses who remain in the employment of district health authorities. For example, mental handicap nurses have long valued their entitlement to retire at the age of 55, their special duty payments for working in a priority group and their mental health officer status. That is a consideration affecting not only mental handicap nurses; it also affects all district nurses.
The Royal College of Nursing is also concerned to ensure that the statutory accountability of nurses to the United Kingdom Central Council is also protected if they are transferred to local authority employment. That is a most important issue in terms of professional accountability and maintenance of professional standards of conduct. Respect for that accountability will, therefore, be a vital safeguard in ensuring high standards of nursing care. Additionally, it is important that nurses working in a local authority environment have access to their own professional peer review and that they have a professional chain of management to ensure that they have access to managers with nursing experience. The RCN is also anxious that any nurses employed by local authorities are allowed time to attend mandatory refreshment courses which are shortly to be required by the United Kingdom Central Council for Nursing Midwifery and Health Visiting.
In conclusion, perhaps I may make the point that the Royal College of Nursing believes that nursing staff will be of fundamental importance if community care is to become a reality, especially given the growing numbers of clients and patients who will be in the community and who will have health needs. It is therefore vital that the Government make clear how such staff and other staff currently working in institutions who will be moving into the community will be affected by the transfer to local authority employment. I beg to move.
Lord Ennals: I fully support the amendment. The noble Baroness presented the case on behalf of the Royal College of Nursing, and I support her in that respect. However, I should stress that the arguments do not apply only to nurses, as I am sure she recognises. We must consider, for example, occupational therapists. I have an interest through the College of Occupational Therapists.
There is more to the argument than simply picking out which professions must follow the patient. Mention has been made of the fact that funds must follow patients. I wish to ensure that staff follow patients. We are talking in many cases about people who may have been residents, occupants or patients of long-stay hospitals. Many establish a very close link with the staff looking after them. They will be moving into the community; in certain respects possibly moving into institutions in the community. We do not know the exact position.
1504
It is important to ensure, in the interests of staff and of patients, that those who might be called "key workers" can also be moved. Many patients who have to move from long-stay hospitals are not keen to do so. They have become institutionalised or have come to accept the hospital as their home. Accordingly, they are somewhat reluctant to move into the community.
I am not saying that there are no patients who need to stay in long-stay hospitals of one kind or another. However, every encouragement and assistance must be given to settlement into the community. Such encouragement could be enhanced by some staff—not necessarily those working in hospitals—moving into the community. We are dealing with both continuity of employment and continuity of treatment, friendship and understanding.
I hope that when the Minister replies to what, as the noble Baroness said, is a probing amendment, she will accept that aspect of the matter as well as the conditions of service argument put forward by the noble Baroness, Lady Cox, with which I agree.
Lord Swinfen: I too support the amendment. I especially agree with the remarks of the noble Lord, Lord Ennals. Members of the Committee will know that I work for the John Grooms Association for the Disabled. Over the past few years the association has taken very severely physically disabled people out of permanent long-stay hospital wards and has turned them from patients into residents, giving them a much greater degree of control over their own lives. The association has also taken staff from those hospitals, with local area health authorities' agreement, under various arrangements. It is essential not only to ensure continued employment but also to see that disabled people have the benefit of being looked after by people with whom they are familiar.
Baroness Blatch: This is an important issue. There is no doubt that the introduction of reforms can be unsettling not only for the staff but also for the recipients of the service; namely, the patients. Therefore, I hope that I can assure Members of the Committee about the Government's concern in the area.
In drawing up plans local authorities will most certainly need to consider the staffing implications and devise a personnel and training strategy to meet service requirements. District health authorities will need to go through a similar process in producing the plans. The two authorities will have to consult each other to decide who will be responsible for providing various services and how they will be staffed and funded.
If, in the event, it appears that the duties and responsibilities of employees of district health authorities are affected by the new arrangements, it will be for those health authorities to deal with the situation in accordance with arrangements which exist for this purpose. It may be that in some circumstances a transfer of staff to local authorities would be the best solution to maintain or provide services. But I do not think that it is sensible to

1505
pre-empt or to prejudge such issues. Indeed, amending the Bill as proposed could prevent local authorities and district health authorities from reaching agreements which would benefit their patients and clients.
I believe that local authority community care plans are not the right place in which to attempt to address the issue of the future of employees of district health authorities. Health authorities already have arrangements for dealing with changes in the duties and responsibilities of their staff. However, we accept that transfer of staff from health to local authorities may occur and the details of arrangements are already under discussion. But I do not believe that this amendment will assist authorities to reach the agreements which are essential for collaborative working.
My noble friend Lady Cox asked about the fate of community nurses moving from the health service into the community. I can assure her that they will continue to be employed by health authorities. The assumption is that conditions of service will remain unchanged.
I wish to emphasise that the Government appreciate the problems which can arise for members of staff as people previously cared for by the NHS move into the community to receive more appropriate care from local authorities. That theme was discussed at length in another place. In the light of that discussion the Government have tabled Amendment No. 115AEA which will be discussed in Committee on Monday. The amendment allows for regulations to be made dealing with issues such as continuity of employment which arise on transfer. My noble friend Lord Sanderson will be tabling a similar amendment for Scotland on Report.
I trust that this illustrates to the Committee that the Government are concerned and prepared to act on the important issue of continuity of employment.
Baroness Cox: I am most grateful to those who have contributed to this short and constructive debate. I thank the noble Lord, Lord Ennals, for helpfully broadening the points that I raised in my opening remarks to include, entirely appropriately, the other members of the health workforce. He also emphasised the importance of continuity of care and relationships which have been established during long-stay care.
I am also grateful to my noble friend Lord Swinfen. I strongly agree with the points he made concerning the continuity of friendship and personal support for people who have to face the challenges of moving out of long-stay care into what is often a frightening, strange and daunting community. I know from my own experience that many people making those adjustments need the continuity of care and support from the people with whom they have been familiar and who have formed part of their world for many years. I am grateful that those points have been made and an: on the record.
I thank my noble friend the Minister for her sympathetic reply. I was glad to hear that the details of arrangements for the transfer of staff are under discussion and to know that reassurances can be
1506
given concerning nursing staff. We shall look carefully at the other points which she made in her helpful reply. In the meantime, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
5.30 p.m.
Lord Peston Lord Peston moved Amendment No. 113AP:
Page 50, line 12, at end insert:
("(1A) A plan prepared under this section shall set out what steps the local authority intend to take to ensure that they are able to provide assessments of and community care services for persons with low incidence disabilities, and in particular how they intend to secure such expertise as is necessary for the performance of those functions.
(1B) If the Secretary of State is not satisfied that the steps set out under subsection (1A) above are adequate for the purpose of the proper assessment of and provision of services to persons with low incidence disabilities, he may by order provide for alternative steps to be included in the plan for that purpose and it shall be the duty of the local authority to take such steps.").
The noble Lord said: In moving this amendment which stands in the name of my noble friend Lord Carter, the noble Lord, Lord Hunter of Newington, and the noble Baroness, Lady Cox, I wish to make a few general points. I shall leave some of the detailed considerations that arise to the noble Lord, Lord Hunter, and the noble Baroness, Lady Cox.
In introducing the amendment I hope that I do not have to emphasise that we generally approve of the idea that local authorities should introduce plans for community care services. I believe that the noble Baroness, Lady Seear, was right with her amendment which, regrettably, was not accepted by the Government. It specified more clearly the nature of the planning process that would be desirable and in particular the importance of the distinction in the planning process between stating needs and objectives, on the one hand, and what can be afforded, on the other. It is a great pity that the Committee did not accept that we should place on the face of the Bill what the noble Baroness, Lady Seear, said at that time. So be it.
The amendment is a rather minor variant of the bigger amendment that we rejected. It concerns a particular aspect of the planning process. Again, it is one which I believe should commend itself to the Committee and it should be placed on the face of the Bill. I hope to receive a sympathetic response from the Government.
The amendment describes specific details about the plan that the local authorities should draw up; namely, that it should pay special attention to people with low incidence disabilities. In emphasising that, although I am a totally committed supporter of the National Health Service I do not pretend that it is perfect. I am not greatly sympathetic to the Bill but one of its advantages is that it enables us to put forward certain suggestions to improve the National Health Service.
The area we are discussing—that of low incidence disabilities—is one where we cannot be happy that the National Health Service has up to now done quite all that we should like. That is one good reason for introducing the amendment. Subsection (1B) goes further. It will enable the noble Baroness, in

1507
her reply, to say something more about the role of the Secretary of State. Subsection (1B) says that we cannot take it for granted that local authorities will do precisely what we want, even if they are instructed to do it under subsection (1A). Therefore the Secretary of State himself should be in a position to take the matter further. Those are the main points at issue and the principles involved.
The example to which I understand the noble Baroness will refer, concerns the deaf-blind. Here I wish to pay tribute to Deaf Accord, which, as the Committee knows, is a consortium of organisations concerned with the deaf. I pay tribute to it both for its work and for the excellent briefing it has given a number of us on this matter. The deaf-blind are not the only people to whom one refers when talking about low incidence disabilities. There are other more rare conditions which give rise to what are called low incidence disabilities.
I do not wish to pursue the matter any further in detail except to reiterate that although much good work is done here, it is an area where we are not doing enough. I am not convinced that the reason is solely to do with resources. It is not; nor is it obvious to me that this amendment is one on which an appropriate response on the part of the Government would be, "This is yet another of those blank cheque amendments". Certainly I shall not be happy with such an answer.
This concerns the perception of the role of the NHS, a perception of its priorities and the desire to emphasise that although this group of people is neither enormous in numbers nor trivially small, it is important for each person. The amendment seeks to ensure that they are not neglected. That is its purpose. I shall now give way to my collegues to allow them to make their remarks. I beg to move.
Baroness Cox: In supporting the amendment I believe that it may be helpful if I compliment —in both senses of the word—the noble Lord, Lord Peston, on his opening remarks. I do so by highlighting the seriousness of the needs of many people who suffer from low incidence disabilities. I highlight the complexity of their problems in order to show the need for the provisions of the amendment. These problems often represent some of the most acute, the most poignant and complex problems which can be confronted by people who live in the community.
Before I highlight two particular groups of such people, I join the noble Lord, Lord Peston, in paying tribute to those organisations that work with and for people who suffer from low incidence disabilities. I wish, without being invidious, to mention Headway, people who work with those suffering from brain damage and who have provided valuable information backing the need for the amendment; Deaf Accord, who do so much work with and for the deaf-blind; and also Combat, who do much work for people suffering from Huntington's chorea. I have the great honour to be associated with their work.
Perhaps I may illustrate, to assist the Committee, some of the problems that are confronted by people
1508
with low incidence disabilities, to show the need for the amendment. First, I take those who suffer from brain damage. They are inclined to fall, in terms of their problems, between the physically and mentally ill and the mentally handicapped classifications. They are not acknowledged as being in any of these categories. In addition, they may sometimes have behavioural or personality disorders as a result of their brain damage. They may therefore sometimes be discriminated against by those providing normal services, if I may put it that way. They often require care which involves a high staffing ratio.
Achievement of an adequate quality of life for people who suffer from brain damage is very difficult indeed. The assessment of the problems of this client group will be difficult because the range of deficits is often not widely understood. It is therefore j important that representatives of the relevant voluntary organisations are involved in these assessments and also in the subsequent decisions making, especially as in many cases the patients and clients themselves are unable to make a coherent or a coherently presented choice. Equally, appeal against assessment is an area in which those with normal cognitive powers have difficulty. Therefore people with such multiple disabilities will obviously have even greater difficulties. It will be particularly difficult for them to ensure that they obtain the quality of care that they need and for others to assure them on that front.
I wish to pass from the particular problems of those with brain damage to the problems of those who suffer from deaf-blindness. This is a low incidence disability which requires services specifically designed to meet the needs of people with a dual sensory impairment. The problems are highlighted by the fact that, again, they do not fall directly into any immediately predefined category. A deaf-blind person cannot just fit into a service designed for other needs. A service designed for mentally handicapped people will obviously not be good for those who are not intellectually impaired but who have communication, information and mobility problems as a result of sensory impairment. A service designed for hearing impaired people is probably no use for those with limited vision. A service designed for the visually impaired will probably depend on hearing. Therefore an alternative approach, based on tactile communication, will be required. That is a specialist approach but it is not necessarily widely available. It is important that deaf-blindness is diagnosed as early as possible and that the individual is supported through services that are designed to meet his specific needs.
I shall conclude by highlighting the fact that deaf-blind people are not an homogeneous group. Their degrees of hearing and sight loss influences their degrees of disability and their pattern of needs. Many have additional disabilities such as mental handicap. Their needs for education, habilitation or rehabilitation, help with communication for personal development and obtaining appropriate occupations and recreations and their needs for assistance with all the activities of daily living will depend to a significant extent upon all the related

1509
aspects of their particular unique disability and on the age at which they become afflicted with their disability and their personal circumstances.
Given the complex nature of this syndrome of disabilities, the need for specialist involvement in assessment, planning and provision of services and in the evaluation of the quality of those services is obvious. As the number of individuals involved is small, suitable services will not usually be available within any particular local area. A specialist service will often need to be provided from several local authorities, either by a voluntary organisation or by a consortium of authorities. At present there are hundreds of deaf-blind people in long stay mental handicap hospitals. They are often treated with drugs for their behaviour, which seems challenging or sometimes provocative. Many have not had their sensory impairment diagnosed and are receiving no specialist help. Their lives are often empty and confused. Without help and training they are unable to communicate as well as they could.
As the policy of community care begins increasingly to come into effect, many of these people will be considered for care in the community. Others are in the community but at the moment their handicap is not recognised, understood or given appropriate help. That is the position for many of them. They do not receive the support they need and they too often lead lonely confused, unhappy and sometimes isolated lives. With appropriate support and education they could maximise their potential and many could achieve a high level of independence and personal fulfilment.
People with such low incidence disabilities have profound needs. They are extremely vulnerable and they need specialist help. There must be provision for that specialist help to be available for them, wherever they live, in a systematic and comprehensive way and in a way that gives the best possible quality of life to people who often have agonising and acute problems.
5.45 p.m.
Lord Hunter of Newington: Little remains to be said, but the challenge is there. How does a local authority that does not have specialist knowledge obtain an accurate assessment of a person who is suffering from a rare disability? That is the key to the matter. We are talking about a rare and difficult disability. When it occurs in children, the matter may become urgent as new treatments and new possibilities arise. I suggest to the Minister that what is required here for a quality service is a special contract between a local authority and a hospital or a specialised unit within the health service that knows about this disability.
We should not rely on the former arrangement, which was for patients to go to the local hospital. Local hospitals then acquire the ambition to obtain doctors with additional skills. They want to extend their field of interest. However, that is not the way to tackle this matter under the new conditions that will apply to the National Health Service.
In other fields the Government have promoted the drawing up of contracts. We should take the
1510
opportunity here to draw up a contract which sets up a specialised paediatric unit in a town perhaps some distance away. A paediatric nurse with specialised skills who belongs to that unit can then visit a child and make arrangements for what has to be done. An avenue is then open for a child or an adult in the community to have access to the best possible advice on how he can be best looked after in the community.
Lord Renton: One must be sympathetic to the broad case that has been made with regard to this matter. Extreme cases of disability have been mentioned as being intended to be covered. The deaf-blind are the most extreme and tragic of all. But we have also been told of Huntingdon's chorea. We have also heard the expression "mental handicap". There are various causes of mental handicap. However, if I may refer to the speech of the noble Lord, Lord Peston, there should be no doubt about the difference between mental handicap and mental illness. I do not think it is feasible to think of a half-way stage between them either, because the essence of mental handicap is that it is a form of brain damage or brain deformity which is incurable.
Having said that, I want to understand the meaning of the words "low incidence" in this amendment. I at first thought that the words "low incidence" meant that the person suffered from the disability only from time to time. As a simple student of the language, that was what I thought it meant. Now I understand from the speech of my noble friend Lady Cox that it means that there are not many people suffering from it, and that therefore these are very special cases which do not often arise. But let me tell the Committee that it is estimated that one person in 100 is born mentally handicapped. If they all lived to adulthood and had a normal length of life it would mean that there would be 500,000 of them in our society. In fact a great many of them die, although not as many as formerly because antibiotics have prevented that —
Baroness Cox: As I was one of the speakers who referred to mental handicap, I should like to clarify the situation. I did not intend to suggest that mental handicap was a low incidence disability. The conjunction of mental handicap with some of the low incidence disability problems was the context in which the words "mental handicap" came into the discussion. It is not that mental handicap itself is a low incidence disability, but sometimes it is an associated symptom or problem with some of the genuinely low incidence disability problems.
Lord Renton: I am most grateful to my noble friend for that clarifying amplification. Nevertheless, I must point out from my own knowledge that there are many handicapped people who also suffer from other disabilities. They are referred to as those with multiple handicaps. They are numerous. If the term "low incidence" is intended to point to their rarity, then the amendment should not have included that expression.
Having said that, I believe that those who have asked that the local authority should in some way

1511
be required to consider what is to happen to each type of disability have a good point. The question is whether the amendment is an appropriate way of doing that. It follows from what I have said that I would wish the wording of the amendment to be reconsidered.
I should be interested to hear from my noble friend on the Front Bench when she replies to the debate to what extent Clause 44 as it stands—which is pretty broad in its terms—would already require the local authority to do what the amendment asks should be done. Having said that, this is a serious matter and I shall be interested to hear what my noble friend has to say.
Baroness Masham of Ilton: I should like to comment at this point. The term "low incidence" adds yet another complication, as has been mentioned by the noble Lord, Lord Renton. The field of disability is so complicated and so wide that nobody understands it very well.
With reference to the White Papers, there is a great worry that there is almost no mention of handicap. Therefore it is very important that there is some provision, although perhaps the amendment is not the right one.
I have on my desk at home a letter setting out great anxiety about the pending closure of a school in Leeds which caters for children with multiple disabilities. They are assessed, looked after and helped at the school. The parents are also helped. The parents are now very worried. Those are the people who may fall between health and social services with no one to help them. Therefore, the Government should look very carefully at the matter. As has been said, a number of people are affected but their cases are complicated. However, we should not complicate legislation more, because the definition of disability is not easy.
Lord Butterfield: Perhaps I may make two points. The first concerns the word "incidence". Technically "low incidence" means that something occurs very few times each year. "Incidence" is the number of case or categories admitted to a certain diagnosis. "Prevalence" tells one the total of people with a particular condition at any time who have to be cared for. Therefore it may be that the amendment might benefit from a change from the word "incidence" to "prevalence". We are dealing here with chronic conditions and it is the chronicity which is reflected in the use of the word "prevalence". I make no apology for making this short intervention because it is a question which frequently appears in medical exams—"define the difference between incidence and prevalence".
I hope that my second point may be helpful when the Government reply to the amendment. There are people who may be able to help in the process in the course of their daily work. I am thinking particularly of regional rehabilitation consultants. All the people who need special limb apparatus or have special problems due to head injuries, for example, are brought to those consultants. I hope that the noble
1512
Baroness will reassure us that the Government will encourage local authorities to talk to those consultants—who have special lists and special experience —more than they have perhaps talked to them in the past, along the lines referred to by my noble friend Lord Hunter in his remarks.
Lord Swinfen: Surely the matter could be dealt with quite simply if the Government were to bring into operation Section 3 of the Disabled Persons (Services, Consultation and Representation) Act 1986. That Act requests local authorities to make a proper assessment of each individual disabled person. Able-bodied people are like peas in a pod; disabled people, no matter what their disability, are all different. Although the disability may have the same clinical name the degree of handicap is different in each person, particularly when different disabilities occur in the same person. That makes matters very much more complicated.
Baroness Blatch: Perhaps I may begin by assuring the noble Lord, Lord Peston, that I do not intend to respond to the amendment as an issue of resources but more one of genuine concern that the needs of any client group or individual will be excluded from the planning process and thereby will be denied health or community care provision.
I hope that my noble friend Lord Renton will see from my response that the facility in the Bill as drafted provides what the amendment seeks.
I very much recognise the anxiety of the noble Lords who moved the amendment that people with low incidence disabilities should not be overlooked in our provisions. I accept what has been said about the confusion surrounding the term "low incidence". I believe that we now all understand what is meant by it even though there may be some argument about the word itself.
Lord Renton: Will my noble friend permit me to intervene? It has taken me 80 years to understand it. I had never seen the expression until I saw it in the amendment.
Baroness Blatch: I am greatly comforted by that intervention. When I saw the amendment I had to ask what it meant. I believe that it is accepted that we are talking about those illnesses from which few people suffer. We are also concerned with complex cases in which somebody may have a main illness, which may be a mental handicap, and also suffer from one of the illnesses which have been described or from multiple disabilities. We are anxious that people with substantial care needs should not be overlooked in our local authority provision. We have already, in connection with Clause 40, talked about which people are covered by the broad term community care services. We reassured noble Lords then, and I do so again now, that we include any person for whom it appears to a local authority that it may provide or arrange for the provision of community care services. That includes disabled people which, in the terms of the National Assistance Act 1948, covers people with communicative disorders—which would include blindness and

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deafness—mentally disordered or substantially handicapped by illness, injury or congenital deformity. I believe that there is a phrase which also refers to any other illness. That is genuinely intended to be a catch-all definition. Therefore, all the groups which have been mentioned by noble Lords in this and previous debates are covered by all of our provisions.
I can therefore assure noble Lords that community care plans will have to be comprehensive of the totality of need which the local authority has to address and the totality of the service provision it aims to provide within the resources available to it. I confirm that that also means working together with other agencies on the preparation of the care plan to ensure that all the resources at the disposal of the local community are brought to bear on both identifying the needs and then seeking out the most effective services to meet those needs, which will be further refined by the assessment process. The first part of the amendment is therefore unnecessary.
The second part of the amendment is also unnecessary because the Secretary of State may, in the terms in which the Bill is already drafted, direct local authorities to prepare and publish modifications to their current plans or, indeed, if the need arises, to direct that a new plan be produced. Therefore, the powers that the amendment seeks to give the Secretary of State already exist and no further words are required on the face of the Bill.
In their very effective interventions the noble Lords, Lord Butterfield and Lord Hunter, referred to how that would be done rather that what should be written on the face of the Bill in terms of providing powers to enable it to be done. The example given by the noble Lord, Lord Hunter, and the advice given by the noble Lord, Lord Butterfield, will be well worth thinking about in terms of the guidance offered to the authorities. I believe that those watching the debate will certainly take those comments on board.
Perhaps I may reaffirm what I said previously. Our guidance on community care plans will make clear that we are talking about the totality of potential provision for all client groups which the local authority serves. I hope that in the light of that reply, the noble Lords will feel able to withdraw their amendment.
6 p.m.
Lord Peston: I thank noble Lords for that interesting debate. I am interested to learn that medical education has improved to such an extent that medical students now learn the difference between "incidence" and "prevalence" and will presumably learn about other aspects of epidemiology. That will stand them in good stead.
I am not entirely happy with the reply of the noble Baroness. As I said in my opening remarks, I would have been much more reassured if the Government had accepted the previous amendment of the noble Baroness, Lady Seear, which would have left in the Bill a much more specific provision about the planning process. Essentially, all we have is Clause 44. The guidance is not in the Bill. The guidance is
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simply the guidance. None of us doubts that it is possible for local authorities to do what we want them to do, but there is a world of difference between possibility, even with guidance, and making a specific provision in the Bill. That is the point. We do not suggest that those people with low-incidence disabilities will automatically be neglected. We simply say that, in order to ensure that they are not neglected, we would like to see a specific provision written into the legislation.
On the other hand, I am particularly glad that the noble Baroness has drawn our attention to Clause 44(1)(c) which states that
"the Secretary of State may direct, prepare and publish modifications to the current plan, or if the case requires, a new plan".
It is well worth bearing in mind that it looks, at least in theory, as if the second of the provisions in our amendment might be covered by the wording in the Bill. I say "might" because the wording in the amendment is more specific and places a greater obligation on the Secretary of State.
This is an important matter. Perhaps I may emphasise the point raised by the noble Lord, Lord Renton, in his more commonsense way; namely, the worry that an important but minor group will be neglected, to put matters in ordinary, every-day language. That is the worry. That is not to say that they will be neglected. We hope that they will not, but one must recognise that they have perhaps been neglected until now. That is an important piece of evidence.
The noble Lord, Lord Hunter of Newington, raised the point about expertise and the possibility that the local authority must look over a much wider range than within its own area to gain that expertise. The best step that those of us who tabled and spoke to the amendment—I hope that this includes the Government—can take is to reflect on the amendment and perhaps come back on Report with a measure that will commend itself to the Government and will produce the fail-safe state of affairs that we seek. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Lord Seebohm Lord Seebohm moved Amendment No. 113AQ:
Page 50, line 12, at end insert:
("( ) The plan for the provision of community care services referred to in subsection (1) above shall, in the case of those local authorities which are housing authorities, include details on how those authorities propose to meet the housing needs of the persons in their areas who are in need of community care services.").
The noble Lord said: This is an important amendment. The Committee will recollect that the importance of housing was made clear in the Griffiths Report, the White Paper and in Second Reading speeches. As far as I can make out, there is no specific reference to it in the Bill. The amendment seeks to ensure that, in drawing up community care plans, local authorities are obliged to provide information on how the housing needs of people who require community care services are to be met.
One tends to think perhaps too much that the community care provisions in the Bill refer solely to social services department and directors of social

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services, but local authorities have other services, such as housing, under their command. The Bill refers to local authorities, not to particular departments, so it is important that the Bill should make clear that those other departments are involved.
The special arrangements to be made with housing associations were discussed under a previous amendment on Tuesday and I not propose to take that matter further. However, the National Federation of Housing Associations has pointed out that there is as much need to consider and determine where and how people are to live as there is to provide other care services. This matter is as important as any other matter that we are to consider under Parts III and IV of the Bill. Not only is the welfare of the client vitally affected by his housing conditions, but the cost element of the provision, particularly in the early stages, could form the main cost of the bill.
Housing is the infrastructure of all welfare and it will require capital expenditure way beyond any possibility of financing it from the community charge. Perhaps we should have included arrangements in cases where the local authority is not the housing authority, but perhaps that point will be dealt with at another time. I shall be interested to know what the Government have in mind to deal with this matter. We are talking mainly about disabled people. It is no good providing a wheelchair or recommending the provision of one if there is no possibility of getting it in and out of the front door. Similarly, as people living in flats on the third or fourth floor grow older, there is no earthly way for them to get out and they need special separate accommodation arrangements. The strategy of housing provision with regard to community care must be looked at carefully. I have great pleasure in moving the amendment. I beg to move.
Lord Ennals: I am grateful to the noble Lord, Lord Seebohm, for raising the issue because housing is one of the most important provisions for those with social need. As he said, there is no acknowledgement in the legislation that many people with social care needs are either homeless or inappropriately housed. That fact should be recognised in the Bill.
The provision of appropriate housing is of fundamental importance in the promotion of community care policies. There is often a relationship between the presence of social care problems and housing problems. Clients with social care needs are frequently also either roofless or inappropriately housed. We see that especially when we consider the problems of people who have been in and out of psychiatric hospitals. We all know of cases involving people who have been in and out of psychiatric hospitals three, four or even five times. A person is discharged from hospital and may land up in a night shelter, on the floor of a friend's house or under a bridge. More than anything else they need adequate housing which is appropriate to meet their needs. That is the strength of the amendment. The wording may not be the best, but it must find its way into the Bill.
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As the noble Lord, Lord Seebohm, said, we are talking about disabled people. Some Members of the Committee may have seen a new report by Dr. Terry Morris, published by Shelter and entitled Our Homes, Our Rights. The survey reviews the extent to which independent living for disabled people is dependent on adequate housing provision together with effective social support. It paints a gloomy picture of recent trends which have been exacerbated by growing financial problems, both for local authorities and for housing associations.
The report states that the number of wheelchair and mobility properties built by housing associations has declined. The building of new wheelchair-accessible properties declined from 129 in 1979 to 63 in 1988. Even more startling is the drop in mobility standard properties from 2,316 in 1979 to only 207 in 1988. The new financial system for housing associations is putting on a squeeze that will threaten their existence.
There are very few local authorities with strategies for the provision of appropriate housing. There is little evidence of the needs of people with disabilities being taken into account in the increasing number of deals with the private sector.
We are not talking only about housing and the availability of a place to live. For disabled people we are talking about appropriate housing. It may often have to be housing that has been converted to meet the needs of disabled people. My name and that of my noble friend Lord Carter are synonymous; we are one and the same man or woman on the Bill. We do not pretend that the amendment solves the problems. But it will ensure that housing authorities have a duty to assess the need and make plans to meet it in line with the other aspects of the community care plans. Without that requirement the community care plans for individuals both in the community and in residential care will lack credibility or effectiveness.
I hope that the arguments that have been used and those to come will convince the Minister that this amendment, or words to its effect, is needed to show the importance of housing within the provision of social care.
6.15 p.m.
Baroness Llewelyn-Davies of Hastoe: I am very glad to follow the noble Lord, Lord Seebohm, and my noble friend Lord Ennals in their emphasis on the housing problems, which are absolutely central to the situation. Members of the Committee who are active in this field know that it is often impossible to implement the social care services until the housing problem is solved. Just imagine the difficulties of social workers who have to contact families in bed and breakfast accommodation, with all its attendant horrors. They often have to follow families from relatives to relatives. When the situation becomes desperate many relatives have to take these families in. It becomes very difficult for social workers to produce the social care services that they know the client needs.
Social services will have to work very closely with housing departments, housing associations, charities

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and, as my noble friend Lord Ennals said, the private sector in particular. If they do not do so we shall not be able to develop a full and flexible range of housing.
I am sure that all Members of the Committee have been inundated with letters and briefing about the Bill. I was impressed, but sadly, by the citizens advice bureaux, which made a report that it found, and I quote,
"very poor liaison between social services departments and housing departments and a reluctance by the latter to accept their statutory responsibility for homeless clients".
Frail and elderly people cannot live independently, comfortably and safely at home unless their home is well repaired and properly adapted. The Committee knows that housing associations have over the years acquired the experience and expertise that is needed to provide appropriate accommodation, as the noble Lord, Lord Ennals, said. But it is essential that they should be in at the very beginning of the local authorities' planning. If the community care plans ignore the necessity for available housing, the community care services may well fail. That would be a very serious matter. It is essential that the local authorities co-ordinate with the relevant departments and organisations and, above all, with the users of the services. It gives me great pleasure to support the amendment.
Baroness Masham of Ilton: I should like to add a few points that have not yet been mentioned. I speak now as president and founder of the Spinal Injuries Association. I assure the Committee that in every single spinal unit in the country there are acute beds being blocked by patients who cannot go home.
I have had numerous letters from a surgeon in Newcastle, many of which I have sent on to the department. He is a surgeon of vascular surgery. Many of his patients cannot go home because the local housing authorities will not help with rehousing them. Some of their homes are completely and utterly inadequate. Many of his patients are elderly. They will have only a few years of life left. It is very important that the quality of that life should be good. He has had to keep patients for more than one further year in an acute hospital bed. That is not very good for the operating waiting lists. I am sorry that the noble Lord, Lord McColl, is not present. It is a very serious problem.
There are also many people who go home to very inadequate housing. Some time ago I dealt with a young man who had to evacuate his bowels in the kitchen. That was not very hygienic and not very pleasant for the remainder of his family. But is was the only room that he could get into with his wheelchair. The bathroom was totally inaccessible and he had to use a commode. I could tell the Committee many horror stories about paraplegics.
A young women with a child and husband cannot get out of her house. She becomes very seriously depressed. Depression is a problem. If people cannot get in and out of their homes to go shopping—they have a family to provide for—the situation is bad. Some measure ought to be provided to make local authorities do something about this very serious issue. But it is expensive to their health service.
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At the Second Reading of the Bill I asked a question to which I have not yet had the answer. With the new system, if someone remains in hospital after he has completed his hospital treatment and rehabilitation, who pays the bill? It is quite unfair that the hospital, the health authority or the GP should have to pay it. That patient is ready to go home but cannot because he has no suitable house. Is it therefore the housing authority, the local authority, which will pay that bill? I am still waiting for a reply.
Baroness Darcy (de Knayth): I too should like to support the amendment. My noble friend has said much of what I should have liked to have said in relation to people with spinal cord injury, the problem of blocking hospital beds and of trying to rehabilitate people in unsuitable housing.
I refer briefly to one letter from the Spinal Injuries Association to a director of housing about a paraplegic woman. She was moved into unsuitable housing on the understanding that it would be for just six months. That was five years ago. She now has a baby. She cannot take the baby out unless her husband is home to help her up the step back into the house. They have one bedroom. She can hardly move around the room in her wheelchair to look after her baby. She has injured herself on numerous occasions trying to reach for things which were difficult to reach. She injured herself and required stitches at one point after trying to leap onto a work surface to reach items in a cupboard in the kitchen. That has continued for five years. It is not acceptable. In terms of human happiness, independence, ability to contribute to the community, medical fitness and, as my noble friend said, leaving valuable hospital beds free for those who need them, the amendment is necessary.
Lord Swinfen: I also support the amendment. It is absolutely essential that we should be able to move people out of hospital to give them a much better quality of life. I have said in the Chamber on a number of occasions that an alteration to the building regulations would make very many more houses accessible to people in wheelchairs.
The ordinary house built by private developers in particular has doors, passages and rooms which are too small for anyone in a wheelchair. For the most part, the housing associations and local housing authorities are now building dwellings with sufficient space. However, the problem needs to be taken into account when considering such building. It is interesting to note that in the past financial year the Housing Corporation gave a great deal less funding to housing associations catering for physically disabled people. I understand that this year there is virtually no funding for residential accommodation for physically disabled people. That, coupled with the new financial arrangements for the housing associations whereby they must raise some 30 per cent. of their funds from voluntary or other sources, makes it extremely difficult to provide sufficient accommodation.
The population as a whole is becoming older and therefore many more people are becoming disabled

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as a result of infirmity and disease. The doctors do a good job and can keep people alive when they are merely becoming older or when they have a medical condition. However, that is resulting in a problem because we are running out of properly designed accommodation. That problem must be considered fully.
Lord Wise: I too support the amendment. The citizens advice bureaux have reported a number of cases where there is a relationship between the presence of social care and housing problems. People with social care needs are often homeless or in entirely inappropriate housing conditions. Not only do those conditions exacerbate the problems, but they make it impossible to deliver the necessary social care services. That cannot be done until the housing problem has been resolved.
If the intentions of the community care legislation are achieved there will be a significant increase in the demand for an inadequate supply of housing for the disabled. It is crucial that legislation provides a mechanism for that expansion to take place. I shall support the amendment because it provides a starting point for such a process. It proposes that the community care planners shall determine how any additional accommodation shall be provided.
Baroness Hooper: This is a difficult area and it was beneficial for the Committee to be made aware of those examples. In reply to my noble friend Lady Masham, I point out that while anyone remains in hospital, the health authority must foot the bill. Therefore, the problem of bed blocking is best solved by co-operation between health and local authorities. The problem cannot be solved by elaborate cross-charging systems between the authorities. Later today the Committee will consider a Government amendment, No. 114ZA, which will require the social services departments to bring apparent housing needs to the attention of the housing authorities. Although that applies only where the authorities are separate we agree that a similar situation should apply when the same local authority is involved.
The effect of the amendment will be to require local authorities which are both social service and housing authorities—they are the metropolitan district councils and London boroughs—to include in their community care plans details of the way in which housing needs are to be met for everyone, whether they are disabled or merely have housing needs. I was surprised that no mention was made of the fact that the Government have already amended Clause 44 to include a provision for consultation with housing interests, including housing authorities, where they are different from the social services authority. The changes that were introduced by the amendment agreed in another place are contained in Clause 44(2) to which Members of the Committee may wish to refer.
I take the point behind the amendment which is designed to cover the situation where there will be no requirement to consult. I suggest that we should
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consider further the best way of addressing that situation. It may be that we shall decide that guidance should be given to authorities; but if legislation appears to be necessary, that could be introduced at a later stage of the Bill.
I must hide behind the fact that the points raised by my noble friend Lord Swinfen about building regulations are a matter for a different department. Therefore, I must research the subject a little further and write to him.
Lord Swinfen: I realise that it is the responsibility of a different department. However, perhaps my noble friend can bring pressure to bear on that department because the situation would be made easier for elderly and disabled people.
Baroness Masham of Ilton: A point raised by the noble Lord, Lord Winstanley, has been forgotten; it is the serious lack of hospital social workers and occupational therapists working in local authorities as a link. There must be that important link between the hospital and the community particularly in respect of housing.
Baroness Hooper: I fully agree that it will be important to have proper and appropriate co-operation. Whether that can be achieved as a result of the provisions in the amendment is another matter.
Lord Hylton: The Committee will be grateful to the Minister for the sympathetic views she expressed, particularly about the possibility of a tighter or better-drawn Government amendment.
Nevertheless, further remarks must be made because the impression should not be given that the problem affects only people in wheelchairs, for example.
The recent survey of homeless people in London carried out by the Salvation Army and Surrey University showed that approximately one third of ex-mental patients discharged from hospital become homeless within a matter of months. That is a serious matter. Other groups are affected such as drug addicts and alcoholics who have been rehabilitated in hospital or elsewhere. There are also people suffering from AIDS or who are HIV positive. There is the generality of single homeless people many of whom suffered from a lack of medical attention and primary care in the first instance. That may mean that later they must be admitted to hospital. We know that there is a lack of liaison between the Department of Health and the Housing Corporation. They are additional reasons showing why the Government need to reconsider the position and bring forward a suitable amendment.
6.30 p.m.
Lord Seebohm: Before I decide what action to take on this amendment, perhaps the noble Baroness will give an assurance that there will be something like this written on the face of the Bill, whether that is by an amendment brought in by the Government or by acceptance of a similar amendment at a later stage. Without that, I do not believe that the Committee will be satisfied.
Baroness Hooper: I am sorry, but I feel that it is very important to recognise that as valuable as is the co-operation about which we have been speaking, that will not be achieved by writing something on the face of the Bill. That will be achieved by effective co-operation and methods of co-operation being developed at local level. There are other ways of achieving that. Therefore, in agreeing to consider the amendment, I make that offer without commitment.
Baroness Masham of Ilton: Before the noble Lord decides what to do, I should point out that if something is written on the face of the Bill, it places emphasis on it and it is not then forgotten. Sometimes people forget matters which are not written on to the face of the Bill.
Baroness Hooper: As I pointed out, in Clause 44 there is already reference to this matter. That is the amendment which was introduced in another place.
Lord Hylton: With respect, that only says "shall consult".
Lord Seebohm: I am not satisfied, and I feel that I must ask the Committee to express an opinion.
6.31 p.m.
On Question, Whether the said amendment (No. 113AQ) shall be agreed to?
Their Lordships divided: Contents, 67; Not-Contents, 66.

DIVISION NO. 3

CONTENTS

Airedale, L.

Jenkins of Putney, L.

Allen of Abbeydale, L.

Kilbracken, L.

Ampthill, L.

Kilmarnock, L.

Aylestone, L.

Kirkhill, L.

Bancroft. L.

Llewelyn-Davies of Hastoe, B.

Birk, B.

Bonham-Carter, L.

Longford, E.

Bruce of Donington, L.

Lovell-Davis, L.

Butterfield, L.

Macaulay of Bragar, L.

Carmichael of Kelvingrove, L.

McIntosh of Haringey, L.

Masham of Ilton, B.

Carter, L.

Milner of Leeds, L.

Cledwyn of Penrhos, L.

Molloy, L.

Clinton-Davis, L.

Morris of Castle Morris, L.

Cocks of Hartcliffe, L.

Nicol, B.

Craigavon, V.

Ogmore, L.

Darcy (de Knayth), B

Peston, L.

David, B.

Prys-Davies, L.

Dormand of Easington, L.

Robson of Kiddington, B.

Ennals, L.

Rochester, L.

Ewart-Biggs, B.

Russell, E.

Faithfull, B.

Saltoun of Abernethy, Ly.

Gallacher, L.

Seear, B.

Graham of Edmonton, L. [Teller.]

Seebohm, L. [Teller.]

Shackleton, L.

Grimond, L.

Stoddart of Swindon, L.

Hacking, L.

Swinfen, L.

Henderson of Brompton, L.

Thurlow, L.

Houghton of Sowerby, L.

Underhill, L.

Hunter of Newington, L.

Wallace of Coslany, L.

Hylton, L.

Williams of Elvel, L.

Hylton-Foster, B.

Winchilsea and Nottingham, E.

Irvine of Lairg, L.

Jay, L.

Winterbottom, L.

Jeger, B.

Wise, L.

Jenkins cf Hillhead, L.

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NOT-CONTENTS

Ailesbury, M.

Layton, L.

Alexander of Tunis, E.

Long, V. [Teller.]

Allenby of Megiddo, V.

Lyell, L.

Arran, E.

McColl of Dulwich, L.

Balfour, E.

Mackay of Clashfern, L.

Belstead, L.

Macleod of Borve, B.

Birdwood, L.

Massereene and Ferrard, V.

Blatch, B.

Merrivale, L.

Blyth, L.

Mersey, V.

Boardman, L.

Monk Bretton, L.

Boyd-Carpenter, L.

Mottistone, L.

Bridgeman, V.

Mountevans, L.

Brougham and Vaux, L.

Munster, E.

Caithness, E.

Murton of Lindisfarne, L.

Campbell of Alloway, L.

Nelson, E.

Campbell of Croy, L.

Nugent of Guildford, L.

Carnegy of Lour, B.

O'Hagan, L.

Carnock, L.

Orkney, E.

Carr of Hadley, L.

Peel, E.

Colwyn, L.

Pender, L.

Constantine of Stanmore, L.

Rankeillour, L.

Cork and Orrery, E.

Reay, L.

Dacre of Glanton, L.

St. John of Fawsley, L.

Davidson, V. [Teller.]

Sanderson of Bowden, L.

Eden of Winton, L.

Strathclyde, L.

Elles, B.

Strathmore and Kinghorne, E.

Hailsham of Saint Marylebone, L.

Swinton, E.

Henley, L.

Thomas of Gwydir, L.

Hesketh, L.

Thomas of Swynnerton, L.

Hives, L.

Trefgarne, L.

Hooper, B.

Trumpington, B.

Kinnoull, E.

Ullswater, V.

Lauderdale, E.

Vinson, L.

Resolved in the affirmative, and amendment agreed to accordingly.
6.39 p.m.
[Amendment No. 113AR not moved.]
Lord Carter Lord Carter moved Amendment No. 113ZAS:
Page 50, line 12, at end insert:
("(1A) Any plan as defined by subsection (1) above shall include the local authority's proposals for ensuring that community care services are provided in a manner consistent with its powers and duties under the Children Act 1989.").
The noble Lord said: In moving Amendment No. 113ZAS, with the leave of the Committee I shall speak also to Amendment No. 115ZCA. These are probing amendments whose purpose is to clarify the relationship between the National Health Service and Community Care Bill and the Children Act 1989. These are two major and overlapping pieces of legislation which will come into force within the same parliamentary Session. However, there seems to be an absence of a clear government or departmental rationale for the relationship between the two pieces of legislation. There is an urgent need for clarification of the relationship and, if a relationship between the two is intended, what the nature of that relationship might be. These amendments are intended to probe that relationship.
The government and departmental statements which deal with the overlapping of the two pieces of legislation are somewhat confused and apparently in conflict with each other. Both the Children Act and the National Health Service and Community Care Bill require the assessement of the need for services. Each allows the assessment to be carried out under the relevant sections of the Disabled Persons (Services Consultation and Representation) Act 1986. As that Act requires the ability of carers to

1523
continue to provide care to be taken into consideration, some clarification is required of the position of parents as carers under the provisions of these related pieces of legislation.
Under Clause 44(3)(c) of this Bill, local authorities may provide or arrange services under Section 21 of and Schedule 8 to the National Health Service Act 1977. They relate to certain social services for mothers and children. Under the Children Act 1989 those relevant sections are removed. That means that for an interim period between the Children Act and the implementation of this Bill there is a direct recognition of the provision of some community care services for children and their families. However, it appears to be inconsistent to allow that relationship for a few months but not to ensure that it continues in the longer term.
The need for clarification is exemplified by the experience of organisations which are trying to provide services for children in such a way that they can be encouraged to move towards independence and the acceptance of adult responsibilities in the most constructive manner achievable. Those points have been put to us by Dr. Barnardo's, the Children's Society and the National Council of Voluntary Childcare Organisations.
The two amendments emphasise the need to ensure consistency between the two pieces of legislation which affect child care and community care. That is the intention of both amendments. Amendment No. 113ZAS attempts to ensure that in elaborating their plans local authorities take account in practice of the inevitable relationship between the two pieces of legislation, particularly at the point when young people with special needs move from childhood to adulthood. As we all know, there are some very real problems when special educational provision ceases because there is a major gap in disability care at that point.
The second amendment addresses the need for local authorities to work jointly with other organisations. It is a slightly modified version of Section 27 of the Children Act 1989 and attempts to incorporate the principle of co-operation between authorities equally in both pieces of legislation. Again, that is essential. Perhaps that requirement should be more forceful, as is set out later in Amendment No. 113E. We shall consider that point later.
It cannot be emphasised too much that there is an urgent need to ensure consistency between these two pieces of major legislation —the Children Act and this Bill—affecting the delivery of social services. For that reason I hope that the principles incorporated will be widely recognised and will gain general support. I beg to move.
Baroness Blatch: I listened with care to what the noble Lord, Lord Carter, had to say about the interrelation of services for children and community care services. The Government share his concern that the two sectors should be managed as effectively as possible and that the boundary between the two does not cause any problems. It is a well-established fact that territorial disputes are most unproductive.
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There are three possible areas where this type of provision might apply. First, in what may be termed philosophy of care, a local authority may wish to apply similar principles and practices in its children and community care work. The needs of different client groups will of course be distinct, but there may be lessons from one that can be applied to another. That is essentially a matter for professional and local judgment, however, not one for legislation.
Secondly, at the level of planning a local authority will have to have regard to its commitments and duties in relation to child care when it frames its community care plan. That is simply part and parcel of good management. Given that we have integrated social services departments, I see no reason why that should cause difficulty to any director of social services or to a social services committee. Even if it did, I am bound to say that a statutory duty would sow further confusion rather than clarify matters.
Finally and perhaps most importantly, the amendment could relate to the circumstances in which somebody needs to move from a service designed for children or teenagers to one designed for adults. That is always a challenge to professional social workers and can be unsettling for the young person concerned. The key is surely good communication and co-operation within the social services department and with any other agencies that may be involved. Again, I am not clear what a statutory duty would add in practical terms for the individual client.
I am also reluctant to endorse any amendment that seems to merge the statutory base for the provision of adult and children's services. As noble Lords will be aware, the base legislation we are discussing in this part of the Bill is quite separate from that which underpinned the Children Act 1989. That separation has borne the test of time remarkably well and has given social services departments clear statements of their responsibilities in each field. We lose that distinction at our peril.
In the light of what I have said about the need to recognise and manage carefully the problems which can arise for individual clients and for local authorities at the boundary of their two areas of responsibility, I hope that some of the noble Lord's concerns have been allayed.
Turning to Amendment No. 115ZCA, this new clause would empower a local authority to seek the help of any other local authority, education authority, housing authority, health authority, or person authorised by the Secretary of State—for example, a social services inspector—who they consider could help them with their community care functions. The noble Lord has underlined, quite rightly, the importance for community care of collaboration between authorities. The guidance on these functions which we are in the process of preparing will also stress that point. We plan to issue this guidance to other authorities concerned as well as to local authorities. But we do not see any need to add to existing statutory provision. Section 22 of the National Health Service Act 1977 already requires local authorities of all types to collaborate in the exercise of their respective functions.

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In the spirit of this provision collaboration is something which must be worked out locally by the authorities concerned. I do not feel new legislative provisions which give wide-ranging powers to local authorities and lay such an open-ended duty on those receiving requests will prove helpful in improving collaboration. I can assure the Committee that the social services inspectorate and other staff of the department stand ready at all times to respond to requests from local authorities with advice and assistance with their community care functions. I hope that the noble Lord will accept that we shall cover that aspect fully in our guidance.
Baroness Faithfull: I apologise for not giving notice of this question, but perhaps I may ask my noble friend the Minister how many handicapped children are still being cared for in hospitals in this country. I am sure that the noble Lord, Lord Carter, will feel that his amendment is applicable to that point, because there are a number of hospitals and therefore there are children who are not in the care of the local authority. They are not children in care, but they are children in mental hospitals.
Baroness Blatch: I hope that my noble friend will accept that I am unable to give a specific reply to that question at this time. In view of the promise that these amendments will not be pressed this afternoon we shall all have time to consider that point. I shall write to my noble friend and make the reply available to the noble Lord, Lord Carter.
Lord Hylton: I am sorry that the Government do not feel able to be a little more forthcoming on these two amendments. We must bear in mind that an increasing number of children in need of care or support of one kind or another are either adopted or fostered.
Secondly, in regard to the second amendment spoken to by the noble Lord, Lord Carter, the wording, should be helpful to the noble Baroness, Lady Hooper, in relation to the problem she was seeking to address on the previous amendment. I say that because Amendment No. 115ZCA states,
"may request the help of that other authority or person, specifying the action in question".
That, I submit, is much more helpful than the existing wording of Clause 44 which, as I have already pointed out, simply says "shall consult". The amendment continues in subsection (2) to use the words,
"shall comply with the request [provided it] does not unduly prejudice the discharge of any of their functions".
That also seems to be highly relevant.
Baroness Blatch: I think that my response addressed the issue of properly serving the needs of both children and adults, and also the transitional point where children become adults. We are all concerned about effective working relationships that transcend both the provisions for children and for adults.
I believe I clearly made the point that separation of provision for children has worked very well. I have also promised that I will take into account the
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question posed by my noble friend to see whether there is room for modification. I hope that for the moment that will suffice.
Lord Carter: I think it is only for the moment. As I said, these are probing amendments and although I am grateful to the noble Baroness for her reply, I have to say that I am a little disappointed. We shall need to read carefully what she said. In addition to the point raised by the noble Baroness, Lady Faithfull, there are other examples which I shall not take up the time of the Committee by relating. There are a number of areas of overlap and confusion. If there is an opportunity for discussions before the next stage of the Bill perhaps we could usefully have them. However, in the meantime I reserve the right to come back later. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Baroness Seear Baroness Seear moved Amendment No. 113AS:
Page 50, line 27, after ("area") insert:
("(dd) organisations of or for service users, their families or carers").
The noble Baroness said: The Government claim, sometimes with justification, that they stand for the interests of the consumer. We seem to have heard that rather often. They also preach the doctrine, with which many of us agree, of collaboration between the statutory, voluntary and private sectors. That is not always an easy doctrine to apply but it is one of which we on these Benches certainly approve.
The amendment is aimed at inviting the Government to apply the doctrine to which they pay so much lip service. In the drawing up of a local authority plan the Committee will notice that the local authority is told that it must consult the district health authority (a statutory body), the family health services authority (another statutory body), the local authority, the local housing authority and the voluntary housing agencies—the voluntary sector gets a look in there—to provide housing or community care services in its area.
The people at the receiving end or the people who speak to the people at the receiving end do not feature in that consultation. We believe that it is of the greatest importance that in drawing up the plan there should be consultation with the beneficiaries of the plan, who may not think that all these bureaucratic bodies necessarily fully understand exactly what they would like.
I remind the Government that partly in response to and, I have to say, partly as a result of the encouragement given by the Government, there are now many organisations who are well placed to speak for the beneficiaries, the clients or whatever one wishes to call them, of these services. All that we ask in this amendment is that after the word "area" in Clause 44(2)(d) there should be explicitly included, "organisations of or for service users, their families or carers".
It is extremely important that at the stage of the drawing up of the plan these people are consulted and are able to put their contribution into the consideration of the plan. It is not good enough for them to come along to make comments on it after

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the plan has been formulated and when thinking has been crystallised.
I suppose that I should declare an interest, in a sense, in that I am president of the Carers' National Association. That body has branches throughout the country as well as a national organisation. It is steeped in knowledge of the problems of people who are doing the caring and, together with other organisations, it should be given the opportunity when the plans are formulated to put a point of view on what the plan should include. I beg to move.
Baroness Cox: I support the amendment, for three brief reasons. First, it would allow people to be consulted who can make a most important contribution to planning. For example, they may be aware of a range or, if I may use the word, prevalence of need which is not perhaps known to those who are charged with planning the arrangements for care.
Many potential recipients of care who could benefit from it may not be known to the local authorities or social service departments and therefore might never come within the orbit of being included. It is important that organisations representing carers' families and receivers have the opportunity to be involved in the planning process. Equally, it is important for an effective contribution to the appropriateness of the care provided that there is the best possible match between needs and services.
Finally—an important point which will arise in later amendments but which is met in this one—the amendment is one way of ensuring that the interests of the carers themselves are taken into account in the formulation and planning of care. For those three general reasons I strongly support the amendment.
Lord Hylton: Perhaps I may be permitted to say a few words in support of the amendment. If accepted it may well be the first time that carers will appear on the face of the Bill. If so, it is high time that they did. From personal experience within my family I know how extremely wearing it can be to support people who, for example, have lost their memory or are suffering from a depressive illness. There is a great need for respite help for carers and their views should be very much taken into consideration.
Lord Kilmarnock: I find it hard to imagine that the Government could actually refuse this amendment, for the reasons which have already been well stated. One consideration that we must take into account—I hope this is in the Government's mind—is the sheer volume of the number of people affected. According to a reputable article in The Times of 10th May, more than 2.5 million elderly people are looking after someone older, more ill, more disabled or more frail than themselves. Of the estimated 6 million carers nationally who provide a regular unpaid service to friends or relatives, 42 per cent. are over the age of retirement.
That is an enormous volume of effort, but the Bill as drafted does not appear to be prepared to take that into account. After all, these people perform a 24-hour-a-day job, seven days a week, with little or
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no assistance from either the statutory or voluntary services. I know that there has been a slight improvement in the invalid care allowance but it does not affect a large number of people. It has been estimated that 90 per cent. of the mentally ill and 80 per cent. of the mentally handicapped are cared for full time by their families. The number of long-stay hospital beds has been reduced but the necessary places in the community—for example, in NHS and local authority day-care centres—have not increased correspondingly. The result has been an increased burden on carers.
Families are now expected to cope on an unprecedented scale. I do not want to give too many statistics, but beds in the geriatric, mental illness and mentally handicapped sectors have declined in the period 1979 to 1989 from 55,000 to 51,000, from 89,000 to 63,000 and from 50,000 to 30,000 respectively. That is a total reduction of 50,000 beds in all those sectors, whereas the residential places in local authority homes for the equivalent groups over the same period have risen by only 17,000. There is a loss of 50,000 beds being replaced by only 17,000 places in the community. The gap is obviously being coped with by the growing army of informal carers. They are the people who make up the difference. These are figures on a large scale. It seems inconceivable that the Bill can be written in such a way that those carers are not consulted at all at the point of drawing up the local authority's community care plan. My party has advocated all sorts of things for carers. We have advocated a carers' benefit and various other rights that we shall come to in subsequent amendments. The amendment before us simply requires that carers, or their organisation, should be consulted in the preparation of the local authority community care plan. I would have thought the case absolutely unanswerable and I should be totally amazed if the noble Baroness did not accept the amendment.
7 p.m.
Lord Swinfen: The statutory authorities, as will be apparent from the face of the Bill, have a large number of functions to perform. They are probably understaffed and will tend from year to year to come up with the same ideas and plans. There will be a tendency to become fossilised. The carers and disabled people themselves are facing, and dealing with, problems on a daily basis. They know the changing needs not only of themselves but also of society in general. They will have a much clearer idea of what is needed and will produce far more accurate advice in the way of consultation than will the statutory bodies.
Lord Carmichael of Kelvingrove: The Government will realise that they have grouped this amendment with Amendments Nos. 113AW and 113AX. We were quite happy about that. The amendments refer specifically to Scotland. The Minister will see that Amendment No. 113AW proposes to omit in line 9 the words,
"as appear to the authority to".
so that the Bill reads,
"such voluntary housing agencies and other bodies which provide housing or community care services".

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I do not think that there is any necessity for examination by an authority. Once it was discovered whether such bodies did or did not provide housing, no question would arise of appearing to provide housing. The amendment tidies up the Bill.
Amendment No. 113AX deals with a matter on which much has already been said. I shall be brief. The Bill lists a number of bodies to be consulted in the preparation of community care plans. It fails however to list the most important group—the consumers of community care. After all, if there were no consumers of community care we should not be discussing this matter now. If there were none we would not be discussing them.
The Bill says that voluntary organisations providing services rather than those which represent service users need to be consulted. The omission is surprising when paragraph 5.7 of the White Paper clearly states that the views of the service users and carers should be taken into account. It is not sufficient to argue that this will be achieved by another method. The views of consumers should be afforded the same status in the legislation as those of service providers.
In Committee in another place the Minister for Health, on 13th February at col. 940, recognised the strength of feeling on this issue and undertook to reconsider the position. Clearly, if the omission is being rectified it should be recognised in those clauses referring to Scotland.
Lord Mottistone: I am advised, as I believe the Committee knows, by the National Schizophrenia Fellowship. Our view is that the amendment should be supported. It is really a question of whether the reference to "community care" in paragraph (d) is good enough. Those who work in the field do not think it is.. I would not go to the stake on the wording of the amendment that we are discussing, and I do not suppose that anyone else would. But there is need for something more than the existing paragraph (d). I hope that the Government will be able to consider some sort of change even if they do not accept the amendment as it stands.
Baroness Carnegy of Lour: The noble Baroness, Lady Seear, spoke powerfully at Second Reading about the position of the carers and the fact that she did not feel that they had sufficient mention in the Bill. I looked afterwards at the White Paper. At the beginning in Chapter II, paragraph 3, the Government point out—and I must remind them of this—that,
"the reality is that most care is provided by family, friends and neighbours. The majority of carers take on these responsibilities willingly, but the Government recognises that many need help to be able to manage what can become a heavy burden".
I take it therefore that the Government see the involvement of carers in the planning as important. This must be the case. Whether their inclusion as a category, along with users, in the list of people to consult is right I do not know. However, the point made by the noble Baroness is important. I hope that having heard the barrage of approval for the amendment my noble friend will take it on board. I do not think that we shall be very pleased if she does not.
The Earl of Balfour: As we are discussing this group of amendments I should like to refer to the last amendment, Amendment No. 113AX, put forward by the noble Lord, Lord Carmichael. I feel that at line 12, on page 54. the words,
"such other persons as the Secretary of State may direct"
achieve a great deal of what we need. I had hoped that perhaps my noble friend Lord Sanderson could add a few words.
This is the sort of case where the new organisation, Scottish Homes, could provide accommodation where required for those people who require wheelchair facilities or special facilities in a home. I feel that this is one of its functions and something it should do.
Baroness Masham of Ilton: The noble Baroness, Lady Carnegy of Lour, may not be sure, or may not quite know, but I certainly know. I consider it most extraordinary for consumers and carers to be left out of a decision. It looks to me like the age of Dickens and forgetting to involve those people who are the most important.
Baroness Carnegy of Lour: May I remind the noble Baroness that we are talking about local government which represents all those people and is in close touch with them. My only query was whether putting them in a list and looking for organisations was the right way to proceed. Much sympathy exists in Scotland and I think that people there feel that there are sufficient organisations, so I back the amendment.
Baroness Masham of Ilton: I thought that the Government's whole emphasis was that people should be as responsible for themselves as possible. I should be very surprised if the amendment were not accepted.
Baroness Hooper: I would hate to cause so much surprise. I am sorry that I have not been able to intervene sooner in this interesting discussion. I have been keen to comply with the invitation made by the noble Baroness, Lady Seear, and to underline the Government's commitment to the involvement of users and carers in the whole process of planning through to service delivery, and in achieving the best possible outcomes for the clients of the services.
As the noble Baroness, Lady Carnegy of Lour, stated—a fact which the noble Baroness, Lady Masham, chose to ignore—that is something which is both implicit and explicit in the White Paper and in the guidance that we are preparing.
I am entirely sympathetic to the reasons behind the amendment, although we may wish to make some modification to its wording. If we may consider this matter further, I undertake to come back at a later stage to introduce a government amendment. I understand from my noble friend Lord Sanderson that this commitment applies equally to the Scottish amendments. I hope that in the light of that assurance, the movers of the amendment will feel able to withdraw it.
Baroness Seear: In the light of that near promise and on the strict understanding that if the provision is not to our liking we shall move our amendment at the next 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 resumes not before ten minutes past eight.
Moved accordingly, and, on Question, Motion agreed to.
House resumed.

European Parliament Electoral Reform Bill [H.L.]
7.12 p.m.
Report received.
Clause 1 [Amendment to European Assembly Elections Act 1978]:
Lord Bonham-Carter Lord Bonham-Carter moved Amendment No. 1:
Page 1, line 5, leave out ("Assembly") and insert ("Parliamentary").
The noble Lord said: My Lords, I move Amendment No. 1, but what I shall say also applies to Amendments Nos. 2 to 32. These are entirely technical amendments which were drawn to your Lordships' attention by the noble Lord, Lord Cockfield, and the noble Earl, Lord Ferrers, at Second Reading. I undertook to make the necessary alterations which they suggested should be made.
I should like to mention in passing that it would have been of considerable assistance if the European Assembly Elections Act 1978 had been updated to take account of the 1986 Act, which changed the term "assembly" into "parliament".
Perhaps the Minister will look into this matter so that members of the public who try to obtain a copy of the relevant Act from Her Majesty's Stationery Office are not misled by the use of an out of date term. I beg to move.
Lord Underhill: My Lords, I support Amendment No. 1 in the light of the amendment which I moved at Committee stage. If that amendment had been approved, this amendment would have been essential. I withdrew the amendment at Committee stage. Some noble Lords have questioned why, in the light of the comments that I made at Committee stage, I have not submitted any amendments of my own at Report stage. The reason for that situation is that, having submitted my amendment at Committee stage, there was nothing left which I could propose because that would have required amending Clauses 2 and 3. As I made quite clear, I oppose a Private Member's Bill which lays down a
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system of election, and there would be no point in my submitting an amendment.
Viscount Ullswater: My Lords, I accept that these amendments are necessary to make the Bill technically correct. Therefore I agree the amendments. I shall also undertake to pass the comments that were made by the noble Lord, Lord Bonham-Carter, about the Act to the right quarters and hope that that matter can be put right.
On Question, amendment agreed to.
Lord Bonham-Carter Lord Bonham-Carter moved Amendment No. 2:
Page 1, line 8, leave out ("Assembly election") and insert ("Elections to the European Parliament").
On Question, amendment agreed to.
Clause 2 [The electoral system.]
Lord Bonham-Carter Lord Bonham-Carter moved Amendments Nos. 3 to 12:
Page 1, line 13, leave out ("Assembly") and insert ("European Parliamentary").
Page 1, line 14, leave out ("Assembly") and insert ("European Parliament").
Page 1, line 15, leave out ("Assembly") and insert ("European Parliamentary").
Page 1, line 17, leave out ("Assembly") and insert ("European Parliamentary").
Page 1, line 20, leave out ("Assembly") and insert ("European Parliamentary").
Page 1, line 22, leave out ("Assembly") and insert ("European Parliamentary").
Page 1, line 24, leave out ("Assembly") and insert ("European Parliamentary").
Page 2, line 1, leave out ("Assembly") and insert ("European Parliamentary").
Page 2, line 3, leave out ("Assembly") and insert ("European Parliamentary").
Page 2, line 12, leave out ("Assembly") and insert ("European Parliamentary").
On Question, amendments agreed to.
Clause 3 [Assembly constituencies in England.]
Lord Bonham-Carter Lord Bonham-Carter moved Amendments Nos. 13 to 32:
Page 2, line 19, leave out ("Assembly") and insert ("European Parliamentary").
Page 2, line 24, leave out ("2(1) of the 1949 Act") and insert ("3(1) of the 1986 Act").
Page 2, line 26, leave out ("Assembly") and insert ("European Parliamentary").
Page 2, line 31, leave out ("Assembly") and insert ("European Parliamentary").
Page 2, line 34, leave out ("2(3) of the 1949 Act") and insert ("3(3) of the 1986 Act").
Page 2, line 35, leave out ("Assembly") and insert ("European Parliamentary").
Page 2, line 39, leave out ("Assembly") and insert ("European Parliamentary").
Page 2, line 43, leave out ("paragraph 4 of Part III of Schedule 1 to that Act (local inquiries) and section 4 of the 1958 Act (procedure)") and insert ("section 6 of the 1986 Act (local inquiries)").
Page 3, line 4, leave out ("Assembly") and insert ("European Parliamentary").
Page 3, line 14, leave out ("Assembly") and insert ("European Parliamentary").
Page 3, line 16, leave out ("Assembly") and insert ("European Parliamentary").
Page 3 line 19, leave out ("Assembly") and insert ("European Parliamentary").
Page 3 line 20, leave out ("Assembly") and insert ("European Parliamentary").
Page 3, leave out lines 28 to 31 and insert (" "the 1986 Act" means the Parliamentary Constituencies Act 1986;").
Page 3, line 41, leave out ("an Assembly") and insert ("a European Parliamentary").
Page 3. line 43, leave out ("Assembly") and insert ("European Parliamentary").
Page 4, line 8, leave out ("2(4) of the 1949 Act") and insert ("5(1) of the 1986").
Page 4, line 12, leave out ("an Assembly") and insert ("a Europear Parliamentary").
Page 4, line 13, leave out ("an Assembly") and insert ("a Europear Parliamentary").
Page 4, line 14, leave out second ("Assembly") and insert ("European Parliamentary").
On Question, amendments agreed to.
Lord Reay: My Lords, I beg to move that the House do now adjourn during pleasure until 8.10 p.m.
Moved accordingly, and, on Question, Motion agreed to.
[The Sitting was suspended from 7.15 to 8.10 p.m.]

National Health Service and Community Care Bill
House again in Committee on Clause 44.
Lord Seebohm Lord Seebohm moved Amendment No. 113AT: Page 50, line 28, at end insert:
("2A) The plans shall include arrangements agreed between the local authority and each District Health Authority concerred regarding the discharge from hospital of disabled persons who have been resident for more than 3 months.
(2B) In accordance with such arrangements the local authority shall (subject to subsection (2D) below carry out an assessment to satisfy the provisions of section 45 below regarding the needs of that person for community care services.
(2C) The arrangements shall provide for the assessment to be carried out where reasonably practicable before the person is discharged from hospital but otherwise no later than 14 days thereafter.
(2D) The assessment shall specify the services which are required to meet the needs of the person for continuing health and social care following his discharge from hospital, and shall appoint a named individual to ensure that the needs of the person are met in accordance with the assessment.
(2E) For the purposes of this section "disabled person" shall have the same meaning as in the Disabled Persons (Services, Consultation and Representation) Act 1986.)").
The noble Lord said: This is an important amendment. It should not take too long to explain because practically half of it at least is lifted straight out of the White Paper, although, admittedly, the White Paper dealt primarily with those suffering mental illness. It is important that people should not be discharged from hospital without genuine arrangements being made for their care. I have made inquiries of a friend of mine who has a schizophrenic son who lives with another schizophrenic boy. She asked them about my amendment. Both said that it was first rate and admitted that they had discharged themselves before now knowing that they were not
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well. Tremendous dangers can arise. We know that there are large numbers of schizophrenics among the homeless and among those who get into serious trouble and sometimes end up in prison.
The amendment states:
"The assessment shall specify the services which are required to meet the needs of the person for continuing health and social care following his discharge from hospital, and shall appoint a named individual"—
that is extremely important to my mind —
"to ensure that the needs of the person are met in accordance with the assessment".
The difference between the amendment and the White Paper is that we extend it to people other than the mentally ill. It covers those who have been in hospital for a considerable time and the disabled. It is important that they should be covered because they are just as important. We should ensure that proper and appropriate arrangements are made when they are discharged.
I need not say much more. Some people have said that what is in the White Paper does not really matter because it is not a legal document. It is important that in this instance the proposal should come out of the White Paper and be placed on the face of the Bill. I beg to move.
8.15 p.m.
Lord Mottistone: Grouped with this amendment is my Amendment No. 113C. Perhaps I may speak to both. In respect of schizophrenics, I much prefer Amendment No. 113C because Amendment No. 113AT introduces the most unfortunate aspect of Section 7 of the Disabled Persons (Services, Consultation and Representation) Act, to which has been added a three month limit. Of 25,046 admissions of schizophrenics in 1986, 13,307 were discharged in less than a month and 20,665 in less than three months. For the purposes of schizophrenics, the amendment of the noble Lord, Lord Seebohm, does not suit.
I would prefer to direct the Committee's attention to Amendment No. 113C, which of itself is not restricted to schizophrenics but picks up an essential feature of my Schizophrenia After-Care Bill which we debated at about this time last year. The Bill had three main features—the assessment of a person's needs; a decision as to whether any services should be called for and what they should be; and the provision of those services. This Bill very splendidly takes care of the first two requirements. I should like to thank the Government and my noble friends on the Front Bench for taking in so much of what I was trying to say during the discussions on my Bill last year. However, this Bill does not cover anything with regard to the provisions.
I do not want to waste the Committee's time with long argument, but the purpose of my amendment is to make it possible for the provisions to be discussed and provided. That is what is lacking from the Bill as a whole. I should like to see the provisions in it. Although I would be quite prepared for my noble friends on the Front Bench to say that my amendment is not suitable—at this stage, I am speaking to my amendment and not to Amendment No. 113AT—I should be very happy if they could

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say that they see the point of my argument and would be prepared to take it away and consider it.
It is not my intention to press my amendment at this stage; but I shall certainly come back at a later stage if I am not satisfied today. I do not know what the noble Lord, Lord Seebohm, will do about his amendment, but that is up to him. However, in due course, when it comes to my turn, I shall be ready to move my amendment and even speak to it if I am not happy.
Baroness Faithfull: I rise to support the spirit of both amendments. We have already said how important it is that there should be joint assessment and joint planning between the district health authority and social services. That is written into the amendment. Secondly, as the noble Lord, Lord Seebohm, has said, it is important to have the words, "shall appoint a named individual".
It is sad that many social services departments are not stable in that people do not stay very long in them. When a social worker leaves a department, it is often some time before someone else is nominated to take over his cases. It is important that it should be written into the Bill that a social worker should always be attached to each case.
My noble friend Lord Renton is unable to be present. He especially wishes me to say that on behalf of MENCAP he supports the amendment.
Lord Ennals: I support the principle of the two amendments. The name of my noble friend Lord Carter is attached to Amendment No. 113AT. If I had to make a choice, I might choose the amendment in the name of the noble Lord, Lord Mottistone. But we are not in the game here of choosing. I wish to make a number of points which I hope will eventually see their way into the Bill whether by means of these amendments or by something put forward by the Government.
Both amendments deal with the important question of assessment. Amendment No. 113AT states:
"The assessment shall specify the services which are required to meet the needs of the person".
The assessment with the specification of creating a plan for the patient is extremely important. I go along also with the concept of a named individual. The more I look at the problems of people, especially those who have been discharged from hospital, the more I am convinced that there needs to be one person whom the authorities know and whom the patient knows. It does not matter much whether it is a nurse, an occupational therapist or even a volunteer of some kind. Unless there is one person who understands the patient and can take him by the hand and help him with the plans which have been made as a result of the assessment something is lost.
During discussions on an earlier amendment moved by the noble Baroness, Lady Cox, which I also supported, I referred to the importance of having an individual who has been given the responsibility to ensure that the people who are to provide the services
1536
are there, that they meet the patient and that he can in a sense be steered through all the problems of bureaucracy. We know of case after case concerning people who have been discharged from a long-stay mental hospital, a hospital where they have been treated for a handicap of some kind or even from a mental hospital, where a plan was made. In some cases the patient did not really understand the plan and those responsible for carrying it out did not really understand the patient. Subsequently the plan was lost somewhere along the way. I want to see the provision for a named person in the Bill. In my view it is a crucial issue.
In the amendment tabled in the name of the noble Lord, Lord Mottistone, reference is made to,
"the advance notification to the local authority of the discharges into their area from the Authority's hospitals of all persons who in the opinion of the Authority may need the provision".
That consideration is most important. It ensures that the information is known to the local authority as well as the main person involved. The authority knows when it will happen and can ensure that the plan is put into practice. I have read a report from the social services inspectorate regarding day services for people with mental handicap published in 1989. It says:
"A number of units expressed concern about the adequacy of information provided on discharged clients. Records seen by the SSI lacked important elements, including medical information, which would be of considerable significance for the care of the clients".
We must ensure that that advance information is made known.
Those are that main points that I wish to raise. I realise that the Minister may not perhaps be able to accept the exact wording of either amendment. Indeed, if I were in her place I think that I would have some doubt about specifying the period of three months. Some people may say that it is too long in the case of schizophrenics, while others may say that it is too short if one is trying to describe long-stay patients.
In my view to require that an assessment is carried out,
"where reasonably practicable… no later than 14 days thereafter",
is too quick. We must recognise the difficulties in that connection. Those are the kind of changes that I should wish to make. However, I hope that the Minister in her reply will admit that there are some points which ought to be on the face of the Bill and that she will return to them on Report.
Baroness Seear: Although on these Benches we have not put our names to these amendments, I should like to confirm that we entirely support the idea behind them.
Lord Seebohm: Before the noble Baroness replies I should like to make a suggestion. Perhaps the noble Lord, Lord Mottistone, and myself could get together and produce another amendment which may be tabled on Report. However, we would of course submit it before that time to the Minister to see whether it meets with her approval. I make that suggestion on the assumption that the spirit of what

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is proposed is already accepted by her. That may perhaps be a simple way of short-circuiting future argument.
Lord Mottistone: I must say that I like the idea suggested. However, I should like my noble friend the Minister to say more positively at this stage that she likes the idea behind these amendments and therefore there will be no need for her to wait for the noble Lord, Lord Seebohm, and myself to produce a further proposal. If we produce yet another amendment we shall waste a whole stage of the Bill's proceedings.
Baroness Blatch: This is an important subject which has exercised the minds of Members of this Chamber on many occasions. We have already outlined what we see as the major purpose of Clause 44 in requiring local authorities to prepare and publish plans which are compatible with those of other agencies involved in the provision of community care. We will be issuing more detailed guidance on the interface between health and social service authorities. Essentially we want them to agree on how they will handle arrangements for the care of people in whom they have a mutual interest.
I believe that it is important that both social service and health authorities are allowed the freedom to determine the detailed arrangements about how they will consult one another and work jointly to ensure that a seamless community care service is available which covers both health and social needs.
I should like first to mention some general points about these amendments, which are concerned with assessment. Local authorities will be required to assess the needs of those who may require care services. My noble friend Lady Hooper will be putting; before the Chamber at a later stage a government amendment (Amendment No. 114ZA) which requires local authorities to invite involvement by district health authorities and local housing authorities in the assessment process. I believe that this goes a long way towards meeting the proposal in Amendment No. 113C and subsection (2D) of Amendment No. 113AT which seems t.o seek a way to ensure health as well as social care needs are met. But we shall have an opportunity to debate this in due course.
Perhaps I may say at this point of the proceedings that I am not clear as to the meaning of subsection (2B) of Amendment No. 113AT, although I believe that it follows on from proposed Amendment No. 115 to Clause 45. Therefore at this stage I shall not address that point in my response.
I turn now to deal with subsection (2D) of Amendment No. 113AT. This requires that a client's or patient's need for services should be specified and an individual named who would be responsible for ensuring that needs are met in accordance with assessment. On that particular point, the naming of an individual as a case manager is something that we accept would be good in practice. As such it is the type of practice that we would expect the social services inspectorate to include in advice to all local authorities. However, it is not something that we
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believe should be included in the Bill and in a Bill designed to provide a framework for good practice, given that it is a framework and that the actual operational practice will be dealt with in guidelines.
Noble Lords have drawn attention to the practical difficulties which local authorities would face in implementing the proposal at present. I believe that it can only be developed once the local authorities have put in place the organisation and trained the necessary staff to carry out the type of case management which we hope will develop. I must emphasise that we do not expect such change to occur overnight.
Baroness Seear: I am most grateful to the noble Baroness for giving way. She said that the provision mentioned in subsection (2D) would be better dealt with by regulation or by advice and not by provision in the Bill. It has been said, although it is not mentioned in the Bill, that no one will be discharged from an institution until satisfactory arrangements have been made. It is extremely important that that provision should be covered by legislation so that if proper arrangements are not made the matter can be challenged in terms of the legislation. I hope that the noble Baroness can comment on that point. What is proposed would give people the right to challenge if it is thought that adequate arrangements have not been made. The fact that people may be discharged from hospitals without such arrangements being made is a source of great anxiety.
Baroness Blatch: I understand the point made by the noble Baroness. I certainly take it on board. If during the course of my response I have not adequately addressed her point then we shall see where the amendment leads us and perhaps meet in order to discuss the matter.
Assessment will identify needs for services. However, Clause 45 requires that, following assessment, local authorities must decide, having regard to the results of the assessment, whether there is a need for them to provide services. Therefore, the local authority is required to decide which of the needs it will meet taking into account duties under Section 2 of the Chronically Sick and Disabled Persons Act 1970. Apart from that, it is not obliged to meet all needs and will wish to take into account its priorities and resources. We believe that local authorities are best placed to decide which care needs of any individual they can meet, bearing in mind the statutory duties and the local availability of services and resources.
The final part of Amendment No. 113AT requiring a named individual to be responsible to ensure care needs are met is, I believe, a matter better dealt with in good practice guidance rather than legislation. Local authorities are diverse organisations; their structure and staffing bear witness to that. While this proposal undoubtedly reflects good practice in many authorities, there are also other ways, perhaps equally good, of ensuring that the services which the authority has agreed to fund are delivered.
As regards disabled people and domiciliary and day care, local authorities are already under a duty

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to provide such services as they decide are called for by virtue of Section 2 of the Chronically Sick and Disabled Persons Act 1970. That is not affected by the proposals in the Bill.
I understand the thinking behind subsections (1A) and (1B) of Amendment No. 113C in the name of my noble friend Lord Mottistone. I realise that he is concerned that patients should not be discharged from hospitals into situations in the community where adequate social care has not been arranged. That is the very point which the noble Baroness, Lady Seear, raised.
We believe that the proposals in the Bill and the action that the Government have already taken will address the valid concerns that have been raised in this area, particularly in the case of mentally ill people. Our approach has four main strands. First, we have issued guidance on discharge planning for all patients in a comprehensive circular issued last year. This covered the care of patients released after a short spell in hospital, as well as those who have received long-term care.
Secondly, the improved arrangements for the planning of services enshrined in the Bill and the need for consultation with health authorities should help to guarantee that effective discharge plans are made and implemented at local level.
Thirdly, in relation to mentally ill people, we have made it crystal clear that mentally ill people discharged into the community should have a precise plan drawn up for their aftercare. This should also help both to prevent inappropriate discharge and to lessen the risk of people losing touch with the caring services at a later stage.
Finally, thearrangements for the mental illness specific grant which will be paid through the regional health authorities will bring further pressure to bear on local authorities to bring all their services and arrangements up to scratch and encourage co-operative planning locally. I believe that this approach represents a sensible mixture of guidance and legislation which will be more effective in practice in addressing the aims that we share than the rather more blunt instrument of the amendment. With that assurance, I hope that the noble Lords will feel able to withdraw their amendment.
8.30 p.m.
Baroness Seear: Before the noble Baroness sits down, I hope that I shall be able to get satisfaction on my point. The issue I raise is this. Suppose someone is discharged and their next of kin or a close friend who will be concerned believes that the plan is inadequate. What right have they to challenge it? That is what I am getting at. If it is in the legislation, they have a right of challenge. I believe that there should be a right of challenge. If the noble Baroness can assure me that somewhere in the Bill there is the right of the next of kin to challenge a plan as being inadequate then I am happy. If that is not so then I am not.
Baroness Blatch: I understand that if problems occur in this respect the direction-making powers in Clause 47 can be used to address them. However, I
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believe that the action I have already outlined should adequately cover the requirements.
Lord Mottistone: I am grateful to my noble friend for what she has said. Much of it has gone a long way towards satisfying me; I do not know about the noble Lord, Lord Seebohm. However, my noble friend has not covered the opening part of my Amendment No. 113C, which states:
"and (c) if they decide that any such services are called for, shall provide, or arrange for the provision of, all the services necessary to meet his needs".
On that point my noble friend started to talk about resources, and I quite understand that. There may be another way of putting this, but I do not believe that her answer covered this part of my amendment.
Lord Seebohm: I feel that what we have heard is not quite sufficient. The local authority knows nothing about it. These people either discharge themselves and walk out of hospital or they are discharged by the hospital without reference to the local authority because it may think that they do not need care and it pushes them out.
The other comment I wish to make concerns the named individual. The White Paper states on page 56, paragraph 7, that this shall be done. It is rather odd if something is stated in the White Paper but in this Chamber the Government say that it is not necessary. We always have to guard against this. White Papers are not law. We have to pick out of the White Paper matters which we should see on the face of the Bill. I would rather go back to my previous suggestion and try to work out with my colleagues and the noble Lord, Lord Mottistone, an amendment which we might bring forward again at Report stage. Naturally I do not propose to press the amendment, but much more thought should go into the matter. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Baroness Hooper Baroness Hooper moved Amendment No. 113AU:
Page 50, line 38, leave out ("and").
The noble Baroness said: In moving Amendment No. 113AU, I wish also to speak to Amendments Nos. 113AV, 118DB and 118EA. Subsection (3) of Clause 44 of the Bill defines community care services by listing the various statutes which empower local authorities to provide the services we wish to designate in this way. Most services for mentally disordered people are already covered by the references to Part III of the National Assistance Act 1948 and Section 21 and Schedule 8 to the National Health Service Act 1977. However, Section 117 of the Mental Health Act 1983 gives an additional duty to local authorities to provide aftercare services for people leaving hospital after a period of compulsory detention under the terms of the Act. These amendments add this provision to the statutory definition and bring the duty within the provisions for community care services in the Bill. I therefore commend them to the House.
In looking at the Mental Health Act 1983 we decided that two further amendments were required. First, the reference to the district health authority needs amending in line with the amendment that

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the Committee made the day before yesterday to Clause 40 of the Bill. This is done by Amendment No. 118DB. Secondly, Amendment No. 118EA repeals Section 124 of the Mental Health Act 1983. This contains default powers which are rendered redundant by the general default powers in Clause 47 of the Bill. I beg to move Amendment No. 113AU.
Lord Mottistone: May I just say, thank you.
Lord Ennals: I shall say a little more than that. I am somewhat surprised that the Government have only now got around to realising that it was necessary to make these clarifications of Section 117 of the Mental Health Act 1983. This enables us to return to the debate that we had on the amendment of the noble Lord, Lord Allen. The inclusion of the services described under Section 117 of the Mental Health Act on the face of the Bill perhaps gives some encouragement for the argument that we put forward in relation to other parts of the Bill and a clear list of the category of persons covered by community care. This seems to follow on the amendment which the noble Baroness herself proposed and which I support. Perhaps she would re-examine the debate on the amendment proposed by the noble Lord, Lord Allen, to see whether she could consider a follow-on amendment to those now before us.
Baroness Hooper: We always conscientiously read the debates that take place in the Chamber.
On Question, amendment agreed to.
Baroness Hooper Baroness Hooper moved Amendment No. 113AV:
Page 50, line 40, at end insert ("and
(d) section 117 of the Mental Health Act 1983.").
On Question, amendment agreed to.
Clause 44, as amended, agreed to.
Clause 49 [Local authority plans for community care services]:
The Minister of State, Scottish Office (Lord Sanderson of Bowden)The Minister of State, Scottish Office (Lord Sanderson of Bowden) moved Amendment No. 113AVA:
Page 53, line 33, leave out ("section") and insert ("sections").
The noble Lord said: I am pleased to move Amendment No. 113AVA, and I shall speak also to Amendments Nos. 113BDA and 115FC which respond to concern expressed when the Bill was being discussed in another place. I know that what is being proposed will also be acceptable to the noble Lord, Lord Carmichael, who was anxious that people should have scope to make representations about the results of their assessments and the services they are offered.
These amendments insert two lengthy sections into the appropriate legislation. For Scotland, that is the Social Work (Scotland) Act 1968 and, for England and Wales, it is the Local Authority Social Services Act 1970. The effect is to give the Secretaries of State power to make orders requiring local authorities to establish a complaints procedure.
We need to ensure a proper hearing for the concerns and complaints that people inevitably have
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about the services they are getting, or may not be getting. Some local authorities have introduced or are building up effective arrangements for dealing with representations and complaints. We want now to see this good practice spread across the country. The amendments are the first and perhaps the most important step in that direction. They reflect the belief we all share that the voice of the often vulnerable people who need social care —and those who care for them at home—must be heard; and that the structure and ethos of the system should allow this to happen. I beg to move.
Lord Carmichael of Kelvingrove: I am sorry to be marginally less enthusiastic than perhaps the Minister had hoped after he has gone to so much trouble. I must stress that I welcome his attempts as far as they go. However, they are limited in their scope of representation. It is not clear, for instance, whether an individual's assessment of needs is covered by the measure. It appears to be activated only after the individual has either been provided with a service in terms of the proposed new Section 5B(1)(A) or has been refused a service. I believe it would be better if the measure included representation prior to the granting or refusing of a service. That might avoid that procedure.
The wording should include an obligation to implement such a scheme. At present that is not mandatory. That provision should be stated on the face of the Bill. The scope of representation in relation to a child is also welcome but other categories—for example, the mentally handicapped, the disabled and others—should be included in the term "representations" so that they can be properly represented. An excellent guide to this topic—it has already been mentioned—is provided in the Disabled Persons (Services, Consultation and Representation) (Scotland) Act 1986. I have made a mistake. I mentioned Scotland because a colleague in another place, Mr. Tom Clarke, was the driving force in that legislation and I think of it in terms of a Scottish Act. In the second part of that Act an excellent guide was provided. The Act was in fact entitled the Disabled Persons (Services, Consultation and Representation) Act 1986.
Unfortunately, at present it appears that local authorities could act as the judge and jury in an appeal. Some kind of procedure should be established which would protect the client. I beg to move the amendment.
Noble Lords: Oh!
Lord Carmichael of Kelvingrove: I apologise to the Committee. This is not my amendment. I thought that my suggestions were rather better than the Government's suggestions and that is why I attempted to move the amendment.
8.45 p.m.
Baroness Carnegy of Lour: I listened with interest to what the noble Lord, Lord Carmichael, had to say because this is an important government amendment. I noticed that Amendment No. 113BDA states at 5B(1)(4):

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"A local authority shall comply with any directions given by the Secretary of State as to the procedure to be adopted in considering representations … and as to the taking of such action as may be necessary in consequence of such representations".
I took that to be a safeguard that the Secretary of State was watching over local authorities to see that they carried out the provisions that they had undertaken to carry out. That provision would be helpful to the kind of people to whom the noble Lord referred. It will be interesting to see whether my noble friend can confirm that.
Lord Sanderson of Bowden: I am not sure whether or not the noble Lord, Lord Carmichael, was helping me in attempting to move the amendment. All I can do is try to put the mind of the noble Lord at rest. I shall come to appeals in a moment as that is quite important. He asked whether individuals could complain at the assessment stage. The answer is yes. The amendment does not prevent that. I should draw his attention to my Amendment No. 113BDA, which states:
"The Secretary of State may by order require local authorities to establish a procedure for considering any representations (including any complaints) which are made to them with respect to the discharge of their functions under this Act".
The word "functions" includes assessments.
On the question of appeals, our intention is to lay the foundations for the setting up of local procedures which will give anyone who might have reason to complain the means of doing so. The amendment seeks therefore to cover everyone who uses services and those who have some claim to a service whether or not that claim is being met. I know that some say —indeed, the noble Lord has suggested it —that a complaints procedure cannot deal with representations from people who have been refused a service. For this, it is said, we need a separate appeal mechanism. I do not agree. Of course local authorities' procedures will have to be sufficiently flexible to deal with the whole range of complaints, from grumbles to serious accusations of abuse.
The guidance which will be produced by the Department of Health in the case of the English and Welsh versions, and the Scottish Office will have this need for flexibility as one of the main concerns. It will, I think, be quite feasible for a single, carefully thought out procedure to give proper attention to representations about the non-availability of services. This unified approach seems to me to have distinct attractions. It avoids the complication of separate systems. It will not impose on authorities and service users the rigidities of a legalistic appeal system.
We believe it is also realistic. We have embarked on ambitious reforms. There is a great deal to achieve over the next 12 months and beyond. The targets we set must be achievable.
I hope that with those explanations the noble Lord will reconsider the amendments which I am proposing and which I hope will be carried. I hope he will realise that we have gone all the way in meeting the concerns which were expressed on a previous occasion in another place.
Baroness Seear: Before the noble Lord sits down—I must apologise for being a bore on the subject—will he clarify what he meant when he said that one can appeal against an assessment? I hope to get this on the record. Did he mean by that that if an assessment is made of someone who was coming out of an institution and it is appealed against, that person will not leave the institution until the appeal has been settled? The important point here concerns whether such a person will be held in an institution until there is a satisfactory plan. Is that what the noble Lord meant?
Lord Sanderson of Bowden: The important point that the noble Lord, Lord Carmichael, made concerned whether an individual could complain at the assessment stage. I have given an assurance on that point. As regards the specific point of whether someone who is leaving an institution is held there until something is settled, I wish to consider that matter and I shall write to the noble Baroness on it.
Lord Carmichael of Kelvingrove: I do not want to be churlish. I agree that the Minister has gone a very long way and listened to many of the representations that have been made. There are still some problems which may be resolved with experience. One of my worries was that the local authority could be judge and jury, which is always dangerous, but that may perhaps be straightened out when the legislation has been in operation for a period. If the local authority still has some independence there may be other ways of tackling that particular problem. Despite what I have said, I am grateful to the Minister for the efforts he has made.
On Question, amendment agreed to.
[Amendments Nos. 113AW and 113AX not moved.]
Lord Carmichael of Kelvingrove Lord Carmichael of Kelvingrove moved Amendment No. 113B:
Page 54, line 13, at end insert:
("( ) Each local authority shall report annually to the Secretary of State on progress in relation to the implementation of the community care plan. The Report shall be in a form to be specified by the Secretary of State by regulation.").
The noble Lord said: It may be convenient for the Committee if Amendments Nos. 113B and 113BA are taken together. The purposes of the amendments is to require a progress report relating to the implementation of the community care plan.
There is no requirement in this clause, or anywhere else in this part of the Bill, for the local authority to report on progress in relation to the plan. It may be thought that Clause 45 gives sufficient sanction to the Secretary of State to issue directions to any local authority which is not meeting the objectives set out in its published plan. However, we believe that in this important area local authorities must have a degree of accountability and we would welcome the inclusion in the Bill of a clause requiring the local authority to report annually to the Secretary of State on progress in relation to implementation of the plan. The Disabled Persons (Services, Consultation and Representation) Act 1986 contains such a requirement in Section 11. It appears to us to be

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appropriate that this amendment should be made to Clause 49.
Turning to Amendment No. 113BA, one of the main obstacles to good community care is that services; are provided and planned by a multiplicity of agencies without proper co-ordination. Although it has been stated that social work departments will take the lead role in delivering community care, the definition of community care services in Clause 49(4) restricts the plan to those services provided by social work departments. People's needs for social work services cannot be considered in isolation from their needs in education, training, housing and health care. The proposed subsection is intended to ensure that community care plans take all of those aspects into account.
Furthermore, it is important that the bodies providing those services are not only consulted in the preparation of plans but do not act in a way which contradicts the aim of the plans. Therefore the subsection would oblige them to take the current community care plan into account so far as is appropriate in performing their own functions. The subsection is very much in the spirit of the White Paper, which explicitly stated that housing and health were vital parts of community care. Despite that statement, the Government seem reluctant to take practical steps to deal with the matter. They have failed to implement the section of the National Health Service (Scotland) Act 1978 which would establish joint liaison committees to plan services.
In the debates on this Bill the Government have repeatedly said that community care will cover wider issues than social service provision. However, they have refused to say how social services authorities can be forced to consider what they might view as extraneous matters given the narrow definition of community care services in the Bill. They have conceded that there will be no obligation, for example, on housing authorities to pay any attention to community care plans. We believe that those are great omissions from the Bill. We hope that the Minister will look at the matter with sympathy and perhaps even come back at a later stage with proposals going some way towards meeting our objectives. I beg to move.
Lord Sanderson of Bowden: I entirely share the noble Lord's concern expressed in Amendment No. 113B that local authorities should be fully accountable to the Secretary of State for implementing their community care plans. Indeed, as the noble Lord said, one of the Government's key objectives, set out in the White Paper Caring for People, is
"to clarify the responsibilities of agencies and so make it easier to hold them to account for their performance".
We wanted to be as clear as possible whether or not local authorities are achieving their aims, and that is why we intend to issue guidance to authorities about the contents of their community care plans.
As part of that process, we shall require them to specify their strategic objectives for community care, as well as the range of services they intend to develop, and to say what quality assurance and systems for
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safeguarding service standards they will establish, including their procedure for handling complaints. In this way we shall be able to measure local authorities' deeds against their words. I can assure the noble Lord that the Scottish Office will be closely involved in monitoring the performance of social work authorities and of health boards under their separate plans.
Of course we want local authorities to be accountable not only to the Secretary of State but also, and arguably more importantly, to the populations they serve. That is why community care plans will have to be public documents which, in the words of the White Paper, are
"intended to communicate an authority's policies and plans to the widest possible audience in as straightforward a manner as possible".
The central guidance which I have referred to will deal with the procedure for an annual review of plans and require that the progress made in each year is brought to account in that process.
Given the lines of local accountability we are creating, subject to central oversight, I am not convinced that any additional purpose would be usefully served by requiring local authorities to produce an annual report of the kind suggested in the amendment. We must be careful not to overburden local authorities in this way when major new responsibilities will already be conferred on them by the Bill.
I turn now to Amendment No. 113BA. It seeks to extend the coverage of community care plans by requiring them to address a wide range of services which might be needed by the users of community care services. Like many of the amendments which have been tabled by the noble Lord opposite, it has the perfectly laudable aim of ensuring that all relevant interests co-operate and that services are properly co-ordinated and planned on a comprehensive basis. I can certainly assure the Committee that the need for this type of co-operation is accepted by the Government and close attention will be paid to it in the guidance which is being prepared on the drawing up of community care plans and the need for consultations.
I am afraid, however, that Amendment No. 113BA goes further than is necessary or desirable and is in any case incompatible with the framework of the existing provisions in the Bill on community care plans. Community care plans can properly relate only to community care services as defined in Clause 49. Community care plans in this limited field alone will be quite complex documents as matters stand. We should not wish to see them further enlarged to include detail about all of the many services which elderly, handicapped or disabled persons might require outside the local authority social work sector. That is a factor to which the noble Lord referred. They are not designed to be information packs, nor is it desirable that responsibility for producing them should be shared with several other agencies, thus diluting accountability. Clearly, community care users have a need for services in those various fields but the plans should address only those services which the local authority itself intends to provide after consultation with other providers.

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The further requirement in the amendment that other agencies should have regard to community care plans is both unnecessary and incompatible with the long title of the Bill, which in the context of community care refers only to the social service functions of local authorities and not to transport, housing and education. Such matters can in any case be dealt with in administrative guidance addressed directly to the authorities concerned if that is felt to be necessary in due course.
The noble Lord mentioned the interaction between agencies. The whole process of integrating the use of local resources for community care will require close inter-agency consultation at local level. That was one of the main reasons why we accepted Sir Roy Griffiths' recommendation that the local authority should have the main co-ordinating role in community care. We are equally clear, however, that consultation should be a matter for a simple statement of basic duty and that is what we already have in subsection (3) of the new Section 5A of the 1968 Act provided by Clause 49. The inclusion of specific housing agencies is not necessary and the duty of consultation within a regional council, which is both social work and education authority, does not lend itself to statutory prescription at all. Consultations with Scottish Homes will be at regional rather than national level and will be more suitably dealt with in directions as provided for in Clause 49 as it stands.
The Government are keenly aware of the need for full consultation and collaboration among service providers. That is stressed in the White Paper, covered in the clause and will be dealt with in guidance.
The noble Lord was concerned as to whether Section 13B of the National Health Service (Scotland) Act would be implemented. Joint liaison committees exist in a number of areas on a voluntary basis without the section having been implemented. The Bill now repeals Section 13B, as noble Lords will see on page 112 of the Bill. We are confident that the new statutory basis of co-operation between authorities under the Bill will be a more satisfactory arrangement. That accords with the Griffiths Report conclusions.
I have spoken at length about this matter which is extremely important. Given those general assurances and the fact that Amendment No. 113BA extends beyond the proper bounds of Clause 49 as drawn up and agreed in another place, I hope that the noble Lord will look carefully at what I have said, as I shall look at what he has said. I hope he will realise that the spirit, if not the wording, of his amendment is certainly contained in the various answers that I have given.
9 p.m.
Lord Thurlow: Before the noble Lord sits down, perhaps I may ask him whether the guidelines which occupy an important place in the scheme of things will be published and therefore available for public comment.
Lord Sanderson of Bowden: Yes, indeed. Unfortunately, the drafting of those guidelines is not yet complete and I cannot quote the terms of the proposed guidance at this stage. However, they will be published as soon as possible.
Baroness Carnegy of Lour: Perhaps I may ask my noble friend a question regarding what he said about Amendment No. 113B. The Law Society of Scotland is anxious to know whether my noble friend thinks that Clause 45 gives sufficient sanction to the Secretary of State to issue directions to any local authority which does not meet the objectives set out in its published plan. Clearly, if that is an adequate arrangement, the annual report will probably not be necessary. However, I wonder how the Secretary of State will know whether the plan is being implemented correctly. Is that a problem?
Lord Sanderson of Bowden: I do not think that it is. The Secretary of State has adequate powers to deal with the situation if, as I think my noble friend suggests, there should be any backsliding. I am sure that that is the case, but again I shall look to see whether there is a loophole here, although I do not think so.
Lord Carmichael of Kelvingrove: The Minister gave a long reply. I had the impression that he attempted to meet the spirit of the amendments, although, as is usually the case, the wording from outside the Government is never quite right. He has given me a great deal to think about. I shall take the amendment away with the greatest of goodwill. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendment No. 113BA not moved.)
Lord Sanderson of Bowden Lord Sanderson of Bowden moved Amendment No. 113BB:
Page 54, line 15, after ("services") insert (", other than services for children,").
The noble Lord said: In moving this amendment, I wish to speak also to Amendments Nos. 113BC and 113BD.
The definition of community care services as originally drafted was not quite right. Clause 49(4) defines those services as including those which a local authority has a power or a duty to provide under Part II of the Social Work (Scotland) Act 1968. Unfortunately, that simple definition would bring in services for children which are excluded in the corresponding English definition in Clause 44.
The first of the two amendments now before us therefore serves to exclude services for children from the definition of "community care services" and hence from the provisions in the Bill on community care plans, assessment of needs and other matters. The second amendment extends the scope of the same definition in a rather different direction. Section 11 of the Mental Health (Scotland) Act 1984 creates for local authorities a duty to provide for the training and occupation of mentally handicapped people in their areas. Clearly such provision should form an integral part of community care and there

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is no doubt that the definition should be extended to include it alongside the duties in relation to after-care and the provision of accommodation which are already included in the definition. That matter was brought to our attention by the Scottish Society for Mentally Handicapped and I am glad to acknowledge the helpfulness of its action in this regard.
The effect of the amendments and those made earlier to the equivalent definition for England and Wales is to ensure that the scope of community care services is the same throughout Great Britain.
I wish to say a little more about children's services so that there is no doubt about the matter. At present, the full range of children's services are provided under the various parts of the Social Work (Scotland) Act 1968 and, with regard to day-care and child-minding, under the Children Act 1989. The White Paper, Caring for People, makes it clear that services for children are different from those for elderly and disabled people and should be considered separately. They are subject to separate proposals for service development, but those matters should be carefully and fully considered and not simply included in the present Bill without proper groundwork of the kind which Sir Roy Griffiths so ably carried out for other services. For England and Wales, proposals are contained in the Children Act, and for Scotland they are being formulated through the childcare law review. I beg to move.
On Question, amendment agreed to.
Lord Sanderson of Bowden Lord Sanderson of Bowden moved Amendment No. 113BC:
Page 54, line 18, leave out ("or").
On Question, amendment agreed to.
Lord Sanderson of Bowden Lord Sanderson of Bowden moved Amendment No. 113BD:
Page 5 4, line 18, after ("services)") insert ("or 11 (training and occupation of the mentally handicapped)").
On Question, amendment agreed to.
Lord Sanderson of Bowden Lord Sanderson of Bowden moved Amendment No. 113BDA:
Page 54, line 19, at end insert:
("Complaints procedure.
5B. —(1) The Secretary of State may by order require local authorities to establish a procedure for considering any representations (including any complaints) which are made to them with respect to the discharge of their functions under this Act by or on behalf of—

(a) any person for whom, in the exercise of those functions, a local authority provide a service, either directly or by making arrangements with another person;

(b) any person whose request for such a service has been refused by a local authority; or

(c) any person who, as a private carer, is providing a substantial amount of care on a regular basis to a person who is living at home and for whom, in the exercise of their functions under this Act, a local authority have a power or duty to provide a service.

and any such order may be commenced at different times in respect of such different classes of person as may be specified in the order.
(2) In relation to a child, representations may be made by virtue of subsection (1) above by the child, or on his behalf by—
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(a) his parent;

(b) any person having parental rights in respect of him;

(c) any local authority foster parent; or

(d) any other person appearing to the authority to have a sufficient interest in the child's wellbeing to warrant his making representations on the child's behalf;

(3) In this section —

child" means a child under the age of 18 years;

"parent" and "parental rights" have the same meaning as in section 8 (interpretation) of the Law Reform (Parent and Child) (Scotland) Act 1986; and

"private carer" means a person who is not employed to provide the care in question by any body in the exercise of its functions under any enactment.

(4) A local authority shall comply with any directions given by the Secretary of State as to the procedure to be adopted in considering representations made as mentioned in subsection (1) of this section and as to the taking of such action as may be necessary in consequence of such representations.
(5) Every local authority shall give such publicity to the procedure established under this section as they consider appropriate.").
On Question, amendment agreed to.
Clause 49, as amended, agreed to.
Clause 45 [Assessment of needs for community care services]:
Lord Peston Lord Peston moved Amendment No. 113BE:
Page 50, line 43, after second ("services") insert ("or when requested to do so by any person").
The noble Lord said: I move the amendment standing in the name of my noble friend Lord Carter and the noble Baroness, Lady Cox.
Assessment of needs is an integral part of this section of the Bill of which we all strongly approve. It represents a genuine step forward. Clause 45(1) imposes a duty on the local authority to provide or arrange for the provision of community care if it appears to the local authority that that needs to be done. On the basis of the experience of people over many years on the provision of community care, the clause weights the duty too much on the side of the local authority.
The Government throughout the Bill are arguing the primacy of the individual. That is the philosophy of the Bill. It is curious therefore that nothing is said about the rights of the individual in the clause. I cannot see a provision anywhere else in the Bill which covers that issue.
I shall not weary the Committee with the large number of cases that one can cite of dependent individuals failing to obtain the help that they need for reasons which, in the cases that I have in mind, I do not find persuasive. It appears that some people who are most in need of help in our society fall to the bottom of priority lists.
The purpose of the amendment is straightforward. The Bill states that any person—one has in mind the individual or a relevant carer—can request the local authority to carry out the assessment. That is all that it provides at this stage. On reflection, I wonder whether the wording is exactly right. However, since it is merely an amendment to test the Government view about the matter, whether the

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wording is right is immaterial. The point that is being made is the need to get the balance slightly closer to the individual and away from the local authority. Are the Government willing to take that on board? Are they willing either to bring forward an amendment or to consult with my noble friend and the noble Baroness on the matter?
I am asking the Government, first, to recognise the problem. It is based on experience. I ask them then to produce some sympathetic response to what I insist again is very much in the spirit of what the Government advocate in this part of the Bill. I beg to move.
Baroness Cox: Perhaps I may briefly give three reasons for supporting the spirit of the amendment. They relate to the client and the client's own needs, the accountability of social services, and the needs of carers. First, given that the client or patient always must know best what his or her own needs are and how best they might be met, it seems strange that at the moment there is no ostensible provision for him to have the right to take the initiative to request an assessment. I therefore support that part of the amendment on the fundamental principles of consumer or client power and consumer or client independence.
Secondly, as regards the accountability of social services, unfortunately it is well known that social services may not always be able effectively to fulfil their responsibilities. Already there are cases where they are proving to be less than efficient or effective. Therefore, it may be important for someone else to be able to require an assessment of a situation as a corrective device.
The citizens advice bureau has given examples, pointing out that many of its clients are receiving an extremely poor response from social services departments when they request help. It gives numerous examples of, at best, long delays when seeking help and, at worst, no response at all. Under the Bill as it currently stands the decision as to whether to provide an assessment rests with the social services departments. Unless the amendment is accepted it is highly probable that when they ask for help many people will continue to be faced with a totally inadequate response to their needs.
Thirdly, I support the amendment with the interests of carers at heart. It will provide a corrective device for them when it is apparent that the person for whom they are caring is receiving inadequate support or perhaps did not have an adequate assessment in the first instance.
I strongly support the amendment in terms of the principle of the independence of patients and clients, of the accountability of social services departments and of preventing people from falling through the safety net of care and support.
9.15 p.m.
Lord Allen of Abbeydale: The noble Lord, Lord Peston, is right in having doubts about the drafting of the amendment. It will put an obligation on the local authority to carry out an assessment on request, however frivolous or ill founded that may be.
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I have looked at Section 4 of the Disabled Persons (Services, Consultation and Representation) Act 1986 to which I had intended to refer in relation to the next amendment; perhaps that is a preferable approach. It relates only to disabled persons, but it provides that:
"When requested to do so by a disabled person, his authorised representative [or a carer] a local authority shall decide whether the needs of the disabled person call for the provision by the authority of any services in accordance with [the Chronically Sick and Disabled Persons Act 1970".
If the idea were accepted, such an approach would be preferable.
Lord Mottistone: I too support the amendment. In Amendments Nos. 113BDA and 115FC, which are grouped with this amendment, the Government have accepted that an individual person can ask for a social service and complain if it is refused. Presumably that would not happen without an assessment and therefore there is no harm in enabling an individual to ask for one.
The present clause is worrying, as indicated by the noble Lord, Lord Peston, because it depends on whether it appears to the local authority to be necessary without any other body being involved. I accept the point made by the noble Lord, Allen, that perhaps the wording is incorrect. However, I hope that my noble friend on the Front Bench will say that a similar provision could be introduced involving another body apart from the local authority. If the pressures were such that it would be difficult to provide an assessment it would be easy for a local authority to say that it does not appear to be necessary. I hope that the Government will give the amendment sympathetic support even though they may not like the wording.
Lord Henderson of Brompton: I am glad that the question of the positive voice of the patient is raised at the outset of discussions on the clause. I agree with the noble Lord, Lord Allen of Abbeydale, that the amendment is too imprecise to prosper. Subsequent amendments may be more eligible for the Government's agreement.
The noble Lord, Lord Peston, obviously has in mind that one of the key objectives set out in the White Paper Caring for People was to make proper assessment of need and so forth. It is no good designing packages of care unless they are in line with individual needs and preferences. Unless there is a more specific amendment on the same lines, one cannot know what the individual needs and preferences are. I am much in favour of the spirit behind the amendment.
Baroness Blatch: The amendment would require the social services authority to carry out an assessment whenever it is asked to do so. Clause 45 as drafted provides that a local authority must carry out an assessment whenever it appears to it that a person may need community care. The wording was deliberately chosen to reflect the situation in which a person presents himself to a social services department and asks what can be done for him. At that stage the social services department does not

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know whether he will turn out to need community care. Obviously further preliminary inquiries are needed to determine whether this is likely to be the case. If the person's needs turn out not be for community care services then the preliminary inquires may in fact amount to the assessment and this may be a perfectly reasonable way of dealing with the request. The noble Lord, Lord Allen of Abbeydale, made the point that some requests can be very simple and can be dealt with by one visit to the department. Until one has made inquiries one simply does not know.
The words;
"where it appears to a local authority"
in this clause mean that when anyone presents himself to a social services department, or is otherwise drawn to its attention as being likely to need community care services, the local authority must carry out an assessment, although, as I have already explained, the form that assessment may take is. a matter for the local authority to decide having regard both to the outcome of preliminary inquiries and to the likely care needs of the person concerned.
To expect local authorities to carry out assessments on request —and the word "assessment" is not defined in the legislation but again is a matter of local authority discretion—would impose upon the authorities the wholly unrealistic burden of requiring them to carry out some form of proper assessment in every case; otherwise, it would amount in practice to no more than what happens under the clause as drafted.
The form of the assessment must be left to the local authority. To raise expectations that a full, detailed assessment would be carried out in every case, even where the person's needs are manifestly simple, would not be helpful.
In answer to my noble friend Lady Cox and other Members of the Committee, I assure the Chamber that a carer can ask for an assessment both of his own needs and those of the persons for whom he is caring. I hope that the noble Lord, Lord Peston, feels reassured that we meet the spirit of the amendment. We share the objectives. I hope that the noble Lord is sufficiently convinced that his amendment is unnecessary.
Lord Peston: I thank Members of the Committee for their interesting contributions. I thank especially the noble Lord, Lord Allen of Abbeydale, the point which he raised was precisely that which I had in mind when I said that on reflection I was not very happy with the wording of the amendment. The matter was further clarified by the noble Lord, Lord Mottistone.
I am not very happy with the Minister's answer. My point was one of balance. Unless I have totally misunderstood the Bill, it does not say what the noble Baroness said. It is left entirely to the local authority to say whether or not it will make an assessment. As I see it, there is no obligation on the local authority to respond to any individual request.
As someone who has spent his life in the general study of markets and consumers, I feel that all those
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who oppose markets and consumers do so in terms of the frivolous consumer. That is the whole foundation of the consumer as nuisance. The Government should face up to the fact that if they adopt a consumer orientated approach to the National Health Service, then certain matters follow; namely, that if the consumer intends to insist on his rights, that is what the system must provide. Therefore, perhaps the noble Baroness will go away and think further about the matter.
At this late hour it would be ridiculous to divide the Committee. However, those of us who have spoken on the amendment are trying not to over-burden local authorities but to move the balance a little further towards the patient qua consumer. I know that the noble Baroness always tries to reassure me but I should be less than honest if I said that her answer had reassured me. I must say that it did not.
Baroness Blatch: The noble Lord is quite wrong to suggest that the Bill does not lay an obligation on local authorities. Clause 45 does just that.
Lord Peston: In that case, I must go away—as I am sure will other Members of the Committee—and read the Bill again. However, the Bill states:
"Where it appears to a local authority that any person",
and does not say at any point "where it appears to any person", he should go to a local authority. I have never claimed to have any degree of expertise in the law or in reading Bills, but I can on the whole follow the English language. That does not correspond to what I and the noble Baroness, Lady Cox, were talking about. However, at half-past nine at night it may be that we are unable to follow elementary logic or English.
All I ask is that the noble Baroness accept the fact that this is a point within the spirit of the Bill. She may find it advantageous from the Government's point of view to think about it a little more. We shall certainly think about it a little more. We shall come back to it with a view to persuading Ministers that we are right and that the Bill does not do precisely what the noble Baroness thinks it does and what I say it should do.
Baroness Blatch: The noble Lord is raising his expectations of what may happen from here on. The discretion that he is reading into Clause 45 is there for precisely the reason raised by the noble Lord, Lord Allen of Abbeydale. Where the local authority deems that there is no case to take the assessment further, it may choose not to do so. The obligation to make an assessment where it is needed is contained in Clause 45. I do not believe that there is any more to consider on that matter.
Lord Peston: In absolute terms the noble Baroness has now made the point very clearly. The Bill says that it is where the local authority thinks the assessment is needed. The noble Baroness does not understand my point, which is that the person or carer may think that assessment is needed and may disagree with the local authority. That is the whole point of the amendment.

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I have not raised my hopes. The noble Baroness knows my view of the Government's attempt to respond to my amendment. My hopes are not raised, but do not let the noble Baroness raise her hopes. It is not a matter one can possibly allow to go away nor is it one which the noble Lords opposite who espouse the spirit of the Bill should allow to go away. Having said that, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Baroness Seear Baroness Seear moved Amendment No. 113BF:
Page 50, line 44, after ("needs") insert ("and the needs of his carer").
The noble Baroness said: A number of amendments are grouped together, but I wish to speak to Amendments Nos. 113BF, 113BG, 113BH and 114ZB. These amendments together may be regarded—to put it rather grandly—as a carers' charter as regards this Bill. The point I wish to make and which was referred to earlier is that the position of the carer as distinct from the person cared for does not figure sufficiently on the face of the Bill.
Amendment No. 113BF requires that it is not only the needs of the person requiring care that should be assessed; it is also the needs of the carer. Amendment No. 114ZB makes the point quite bluntly that that includes the carer's right not to care. It puts on the face of the Bill the requirement that because a carer is a member of the family or a close friend it should not be taken for granted by the local authority that that person will begin to care and go on caring however difficult that caring task may be.
Those of us who support the amendment believe that the carer has a right to say no and that that right should be on the face of the Bill. We all know that it is only too easy for those in authority, when they find it difficult to deal with a particular case, to take advantage of the fact that most members of a family will continue struggling to care without adequate resources when it is really not practical or in the interests of either the person being cared for or the carer that that should happen.
As the noble Lords have said this evening, there are a large number of people already struggling with the job of caring with very inadequate resources. By definition the people leaving institutions will be more difficult to look after than the people who are not in institutions and are looked after at home at the present time. I am sure that many carers, sooner or later, will feel that that task is quite beyond them, and they should have the right so to say.
When these assessments are carried out they should include an assessment of the needs of the carer as well as those of the person who is to be cared for. Amendment No. 113BG provides for respite care to be considered if requested. That is only one example. Other examples are adequate domiciliary help and adequate community nursing, which are absolutely essential.
In particular, there is a need for assistance in looking after people during the night. I suppose all
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of us have had experience at one time or another with our families of what that is like. If a carer has to go on night after night without relief looking after a person who awakens them four, five or six times a night, sooner or later both the carer and the person being cared for will be in a very bad state indeed. That will come back on the local authority to make far more drastic and expensive provision than giving support to the carer while it is still possible to do so. I hope that we can have proper protection for carers written on the face of the Bill. I beg to move.
9.30 p.m.
Baroness Cox: As my name is linked with the amendment, perhaps I may speak briefly in support of the group of amendments which, as the noble Baroness, Lady Seear, said, is a kind of carers' charter. Carers make a major contribution in the provision of care but often receive an extremely raw deal.
Perhaps the first point one should make is that the financial implications of the amendment should be dear to the Government's heart. Carers are helping to support a system which is very cost-effective. It is estimated by the carers' national association that carers save about £24 billion a year by providing care in the community. Often that care is provided at very great cost. The majority of carers are women. They are unpaid and provide a service at great cost to themselves both financially and often in terms of their own personal lives. In the case of younger women, it is often at great cost to their own careers and personal development.
At the other end of the age scale, many carers are elderly people caring for the even more elderly. It is common for people who have reached the age of three score years and ten, or more, to be caring for those who are well over the octagenarian hurdle. One often hears poignant stories of the elderly caring for the even more elderly, with broken nights and in difficult financial circumstances.
The Government are ostensibly committed to supporting the carers and community care. The White Paper states that, but that is not enough; it must be on the face of the Bill. Many carers face enormous difficulties. According to the National Association of Carers, 83 per cent. of carers receive no help of any kind for the care which they provide, either from professionals, family or friends. They carry this enormously important burden entirely alone. We are asking too much of them.
I should like to make one or two suggestions on what should be done. The amendments put forward some proposals. I strongly support what the noble Baroness, Lady Seear, said about respite care, particularly night respite care. I should like to see the proposal for night respite care centres taken seriously. Elderly people, and particularly confused elderly people, could be taken to such centres to be looked after at night and given the appropriate care. It would not matter if they were incontinent. The most important point is that relatives could get a good night's sleep. The major reason for re-admission of people back into residential care from the community is that those who care for them

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can no longer put up with broken nights for week after week, month after month and even year after year. It is utterly exhausting and puts people at the end of their tether quicker than anything else.
Night respite centres would be extremely cost effective in terms of staffing. Day centres which often have to be kept warm at night could be used. They would be a very humane and appropriate form of helping people in the community to stay in their homes. If they have insomnia and are confused at night, the night respite centres would enable the relatives to get a good night's sleep while giving the elderly person the right kind of care.
There are other forms of more systematic, practical help in addition to those mentioned by the noble Baroness, for example, assistance with laundering for people who look after incontinent relatives. Another important point is that relatives who are carers must be given the right to say no. They must be encouraged to say no without feeling guilty. That is one of the most important aspects of these amendments—to encourage the right to say no; to say that one can no longer provide care on either a temporary or permanent basis. A final point is the need for financial support or compensation for the implicit, or explicit, financial costs of caring.
These amendments are crucial for carers, for those they care for, and, I might just finish by saying, for the implementation of the objectives of the Bill itself. After all, this part of the Bill is designed to keep as many people in the community as possible and as many people out of long-stay care as possible for as long as possible. It is impossible to achieve that goal with good quality care without exploitation of carers, without due recognition of the care they provide and without recompense for the costs they incur.
Lord Allen of Abbeydale: I was glad to add my name to the amendment. The noble Baroness, Lady Carnegy, reminded us some time ago that the White Paper explained that the great bulk of community care is provided by friends, families and neighbours, and fiat many carers may need help to be able to manage what can become a heavy burden. When we came to read the Bill the carer was invisible. There was perhaps a chink of light in what we were told earlier when discussing Amendment No. 113AS. It could even be that the Government will come forward themselves with an amendment that actually refers to carers.
We have been reminded that there are perhaps six million carers. The numbers are hardly likely to grow less as longevity increase. Some three-quarters of them are over 50 and, as we have been reminded, most get no help from the statutory services. Most of us know from personal experience of the great strain people suffer in looking after elderly or disabled people all the time: it can be a great burden.
It seems to me, despite what the noble Baroness the Minister has said, that without some provision on the face of the Bill local authorities may well be uncertain about the right of carers to ask for an assessment and about their role when an assessment is carried out. There is also the need to take account of the needs of carers themselves. A particular need,
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as has been well explained, is that of respite care. This is complicated by the fact that quite often the disabled or elderly person violently objects to respite care being taken. The carer quite often needs some help in resolving a difficulty of that kind. It is important that a local authority should not automatically assume without inquiry that the carer will simply be willing to carry on with his, or her, responsibilities.
I referred earlier to Section 4 of the Disabled Persons Act 1986. Clause 45(4) says rather mysteriously:
"This section is without prejudice to section 3 of the Disabled Persons … Act 1986".
But it does not refer to Section 4 which, as I explained, specifically gives a carer a right to ask a local authority whether the needs of the disabled person call for the provision of services. I could not remember the Act when I spoke earlier: it is the Chronically Sick and Disabled Persons Act 1970. That Act, I think, does not provide for respite care.
It seems that if some such amendment as we are now proposing is not put into the Bill there is a risk of a sort of two-tier arrangement under which there will be certain rights under the 1986 Act and an absence of rights, or an ambiguity about rights, under the present legislation, whereas amendments on the lines proposed would put the matter beyond doubt. The carers, who are the main prop of community care, deserve statutory recognition and a rather clearer statement of the local authorities' responsibility towards carers than can be inferred from the Bill.
Lord Mottistone: I strongly support the amendments. The National Schizophrenia Fellowship, which advises me, was created by carers who had been caring for decades and longer. It consists mainly of carers.
I do not intend to say much more because my noble friend Lady Cox has said it all. It is of interest that respite care it something that has recently come to cognisance, and I strongly support that aspect of the amendments.
The National Schizophrenia Fellowship in Northern Ireland has recently pioneered a respite home, but it has only recently opened and there is no experience of it as yet. That is a factor that will grow, and it is right that it should be included in the Bill. Above all, it is right that the carers should be provided for because they suffer as much, and sometimes more, than those that are cared for.
Lord Ennals: The case has been powerfully put by the noble Baronesses, Lady Seear and Lady Cox, and the noble Lords, Lord Allen of Abbeydale and Lord Mottistone. However, I feel that I must emphasise some points. Before doing so it should be noted that the last five amendments in this very large group apply the same principles to Scotland. Therefore, it is not necessary for my noble friend Lord Carmichael to speak to this amendment.
I should like to refer particularly to Amendment No. 114ZB. If it were not for the carers, the burden upon local authorities, the Government and

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everyone else would be tremendous. All of us, including local authorities, governments, politicians and people who are not yet involved as carers—although they may have had a role in the past —take so much for granted. As the population grows older, the carers are themselves getting older. Some carers almost need carers to look after them. People who are entitled in the last years of their lives to rest, pleasure and enjoyment are being denied those things because of the family responsibility which they feel they must take.
I do not think that any of us can criticise the way in which families support their own. However, there comes a time when we ought to intervene. It is not that carers should have "the right not to care" —the words used by the noble Baroness, Lady Seear —but the community ought to say to that carer: do you think that you should go on any longer with this burden?
I read of a case that was sent to us by the Spastics Society. It concerned a woman in her late sixties who was caring for a disabled husband and a 36 year-old son with cerebral palsy. The son cannot walk and sit, he is blind and can only speak a few words. He is totally incontinent. He requires full personal care and has to be fed a special liquid diet. Sometimes he is violent. Both of the two older people suffer as a result of that situation.
The condition of the carer must be taken into consideration when an assessment is made. A carer's right to an independent community care services assessment must be written into the Bill. It is difficult to see how respite care can best be written into the Bill—although I support the amendments that are before us. The amendment is very important from the point of view of the people who care so much but at the same time suffer so much.
I should also like to draw attention to Amendment No. 114ZD, in the name of my noble friend Lord Carter, which deals with the homeless. It states:
"If at any time during the assessment of the needs of any person … it appears to a local authority that —

(a) that person is homeless; and

(b) he is in need of advice or counselling as to the provision of accommodation for him,

then the local authority shall provide him with written details of where such advice or counselling may be obtained in the local authority's area".
We should not leave out the tragically growing number of homeless people. They have rights too. They have a right to decent opportunities in their lives. Local authorities cannot simply shuffle it off. I hope that the noble Baroness will demonstrate a sympathetic approach to these issues. The rights of the carers must be written into the Bill. If we do not do it today, we must do it on Report.
9.45 p.m.
Baroness Carnegy of Lour: I do not know what the Government's position is at the moment, but come what may, it must somewhere be made plain to local authorities that they have to take proper account of the carer. We all have experience of what it feels like to do the job. One feels that one cannot do it any
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more. One tries to get help but one does not get it. Someone may say, "You will go on, won't you?" but one is not sure that one can. It is a difficult burden to bear. Because of the nature of local authorities and the nature of the job that people will be doing, it will not be an easy thing to get right.
I hope that, come what may this evening, the Secretary of State will look carefully at this issue. It seems to me that the point of assessment is the nub of the matter. The words,
"shall not assume that the carer will continue",
certainly give the spirit of what we all mean, although perhaps it is not completely appropriate to include such a provision in the Bill. I hope that my noble friend, who I am sure understands everything that has been said, will give serious consideration to this issue.
Baroness Masham of Ilton: I support the amendments. I should like to give one example of respite care which has not been mentioned. I refer to the carer who is caring day in and day out for someone who is heavy. If carers know that they will have a holiday, just for a week or two weeks, it can make all the difference and enable them to carry on for the rest of the year. Otherwise, relationships can sometimes break. I know that relationships break. In this case, it can be that absence makes the heart grow fonder. A stitch in time saves nine. It is so important.
Baroness Hooper: I should like to make it clear that I am speaking to the grouping of Amendments Nos. 113BF to 113BH and to Amendments Nos. 114ZB, 115ZD, 115ZE, 115AA, 115AB and 115DA, as all those amendments have not been specificaly referred to before.
I am capable of understanding the thinking behind the amendment. We have at several stages in our debates talked about the involvement of carers in the process of arranging and providing services. I wonder sometimes if the parents of small children regard themselves as carers. They certainly have to cope with interrupted sleep and probably they too need night respite care. Nevertheless, however wide the term "carers" is defined, the development of practical support for carers is a major overall objective behind our White Paper. We want to work towards a situation where the independence, dignity and choice of carers figure largely from planning through to delivery of services.
In speaking to Amendment No. 113AS, which I undertook to reconsider, although I fully appreciate the scepticism which that undertaking received, I explained that the approach of the Government is to make a reality of more support for carers and to ensure that the guidance we issue to local authorities covers the interests of the carer.
The interests and needs of carers are not, of course, necessarily the same as the needs of the person they care for. Therefore, apart from thinking it unnecessary, I believe that the amendment before us is flawed in that it suggests that the needs of the carers should be assessed in the same way as the person they care for; this may not be the case at all.

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I entirely agree that the need for respite care may often be one of the important services that could be provided to assist an individual, him or herself, or the carer of that person. During visits around the country, I have seen very good examples of the development of that kind of respite care. But respite care is one among many options that may be more or less appropriate to the individuals concerned, and each case needs to be considered on its own merits. I see no value at all in singling out one particular form of care over and above any others on the face of the Bill. All this is likely to do is to channel the thinking of those undertaking assessment, and those who need to think what provision they might be able to make and how and when, towards narrow objectives rather than considering the overall needs of the individuals with whom they are dealing. I therefore urge Members of the Committee not to agree to the amendments for those reasons.
At the same time, it is quite obvious that any particular form of service needs to be considered should the person being assessed ask for it. A two-way process is needed throughout assessment so that needs, wishes and available or potential services can be brought into the most appropriate package. With my assurances that our guidance will cover this important point of taking account of the needs of carers themselves, perhaps for respite or other support care, I can only repeat that I hope Members of the Committee will not find it necessary to press the amendments.
Reference was made to Section 2 of the Chronically Sick and Disabled Persons Act 1970 which refers to assisting disabled people in taking holidays and which would also provide a break for the carer. Assuming that carers are prepared to continue caring, which is a point made by the noble Baroness, Lady Seear, I have already explained that carers can ask for an assessment of their own care needs. Our guidance on assessment will provide for carers to be consulted during the course of the assessment of the needs of the person for whom they are caring. That would include seeking the views of the carer on continuing to care. In other words, in accepting the spirit of the amendment, I nevertheless feel that it is not appropriate to put such a provision on the face of the Bill.
So far as concerns disabled people, I should point out that there is already provision for their carers to be consulted when their needs for day and domiciliary care are being assessed by virtue of Section 8 of the Disabled Persons (Services, Consultation and Representation) Act 1986. To that extent, no further statutory provision is required. Further, Section 4 of that Act, which refers to requests for assessment, is also specifically mentioned in Clause 45(2)(a) of the Bill. For those reasons I urge the Committee not to accept the amendment.
Baroness Seear: I find the response of the noble Baroness totally unsatisfactory. Apparently she has not grasped the point of what we were trying to say. It is essential that the carers' position and the carers should be on the face of the Bill. I wish to press the amendment.
9.55 p.m.
On Question, Whether the said amendment (No. 113BF) shall be agreed to?
Their Lordships divided: Contents, 20; Not-Contents, 29.

Division No. 4

CONTENTS

Allen of Abbeydale, L.

Hylton, L.

Ampthill, L.

Llewelyn-Davies of Hastoe, B.

Bonham-Carter, L.

Carmichael of Kelvingrove, L.

Macaulay of Bragar, L.

Masham of Ilton, B.

Carnegy of Lour, B.

Peston, L.

Carter, L.

Robson of Kiddington, B.

Cox, B. [Teller.]

Russell, E.

Darcy (de Knayth), B.

Seear, B. [Teller.]

Ennals, L.

Seebohm, L.

Henderson of Brompton, L.

Thurlow, L.

NOT-CONTENTS

Arran, E.

Long, V. [Teller.]

Balfour, E.

Lyell, L.

Belstead, L.

Mackay of Clashfern, L.

Blatch, B.

Mersey, V.

Bridgeman, V.

Monk Bretton, L.

Brougham and Vaux, L.

Mottistone, L.

Butterfield, L.

Reay, L.

Caithness, E.

Sanderson of Bowden, L.

Carnock, L.

Strathclyde, L.

Davidson, V. [Teller.]

Strathmore and Kinghorne, E.

Elliot of Harwood, B.

Hailsham of Saint Marylebone, L.

Swinton, E.

Thomas of Gwydir, L.

Henley, L.

Trumpington, B.

Hesketh, L.

Ullswater, V.

Hooper, B.

Resolved in the negative, and amendment disagreed to accordingly.
10.2 p.m.
[Amendments Nos. 113BG to 113C not moved.]
Lord Carter Lord Carter moved Amendment No. 113D:
Page 50, line 47, at end insert:
("and
(c) if, as a result of that assessment, they decide that his needs call for the provision by them of any such services, it shall be their duty to make arrangements for the provision of those services.").
The noble Lord said: In moving Amendment No. 113D, I wish to speak also to Amendment No. 115D. I shall be brief although in this case brevity does not reduce the importance of the amendments. They are intended to ensure that once a local authority has undertaken an assessment and decided that certain services are needed by an individual, it then has a duty to provide those services. We are advised that throughout the country there is concern over the failure of local authorities to provide the services which are desperately needed by elderly and disabled people in order for them to be able to remain in the community.
We feel it is of fundamental importance, if the express commitment to community care service is to be translated into good practice, that the local authority should have a duty—I emphasise the word "duty"—to provide the level of service which is judged to be necessary for an individual. Without

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that duty the elderly, the vulnerable and disabled people who are living in the community have no guarantee of the provision of the services they need in order to cope. This amendment would provide potential users of services with a right to those services and a right to a satisfactory quality of care in the community.
The organisation, Turning Point, which helps people with drink, drugs and mental health problems fears that without a duty on local authorities to implement the conclusions of assessments, the needs of people with drug and alcohol problems will not be met. The present lack of priority afforded by local authorities to those groups is evident. Extreme difficulty has been experienced by Turning Point in obtaining maintenance payments for clients from individual authorities. Turning Point says that at a conservative estimate it should have received £870,000 in maintenance payments for 1989-90. In fact, only £107,000 was received, leaving a shortfall of more than £700,000. The amount received was only 12 per cent. of that requested from local authorities in respect of clients for whom they are responsible and who were placed in Turning Point projects.
It has been pointed out that in view of the re-routed income support payments the top-up money required from local authorities will increase significantly and therefore it is likely that many of the residential projects will close.
The figures which I gave in respect of the shortfall in maintenance payments and the point about the re-routing of income support indicate the importance of the first group of amendments which were rejected by the Committee.
There is concern that without a duty on local authorities to provide services which have been assessed as needed the clients who need care as a result of drug or alcohol dependency will not receive the assistance. For those reasons I hope that the Government will accept the amendments or agree to come back with their own versions of them. I beg to move.
Baroness Hooper: The amendment and Amendment No. 115D to which we are also speaking would lay on authorities a duty to provide services to meet assessed needs. As I have said, as regards disabled people in domiciliary and day care, local authorities are already under such a duty by virtue of Section 2 of the Chronically Sick and Disabled Persons Act 1970.
As the White Paper Caring for People makes plain, the aim of assessment should be to arrive at a decision on whether services should be provided by the local authority and in what form. Decisions must take account of what is available and affordable. It follows that local authorities, apart from where they are under a statutory obligation, will be expected, wherever possible and practicable, to supply or arrange the services for which assessments of need call, taking account of the policies and priorities laid down by the social services committee. Where high priority needs are identified which cannot be met within the resources available, information flowing
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from the assessment process will need to feed back into the local authority's planning process so that a view can be taken on whether new provision is necessary. It would not be realistic under their statutory duty in Section 2 of the 1970 Act to lay authorities under a specific duty to meet all conceivable needs for community care across the board. Thus, given the practicabilities of arranging care provision we do not think that it would be desirable to impose on an authority a specific duty to provide services to meet all individuals' assessed needs, as would be required if the amendments were agreed to.
For those reasons I hope that the noble Lord will feel able to withdraw his amendment.
Lord Carter: I am grateful to the Minister for that reply although I found it disappointing. I believe that she gave the game away when she mentioned "affordable". It is a question of resources. As a result of the Govenment's view, we could end up with a patchwork quilt of community care which will differ in quality from authority to authority. I do not propose to divide the Committee on the issue. I shall read what the noble Baroness said and reserve the right to come back to the matter at the next stage of the Bill. In the meantime I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Lord Peston Lord Peston moved Amendment No. 113E:
Page 50, line 47, at end insert:
("( ) Where it appears to the local authority that a person who is the subject of an assessment under this section may be in need of the services provided by a relevant authority, they shall notify the relevant authority and the relevant authority shall co-operate with the local authority in assessing the needs of that person;
( ) Where it appears to the local authority that a person who is the subject of an assessment under this section may be in need of specialised diagnosis or assessment or the assessment requires skills not available amongst the employees of that authority, that authority must involve the services of a relevant authority or other agency or some suitably qualified or skilled individual in the assessment.").
The noble Lord said: Amendment No. 113E, which stands in the name of my noble friend Lord Carter and the noble Baroness, Lady Cox, is grouped with Amendments Nos. 114ZA, 114ZC, 114C and with Amendments Nos. 115CB, 115CBA and 115DB, which are Scottish variants of those amendments.
The two amendments are variations on the theme of assessment. Perhaps I may concentrate initially on Amendment No. 113E, which has two parts. The first is very straightforward and is recognised by the Government because they have an amendment which falls at least within the same broad area; namely, Amendment No. 114ZA. Essentially, the amendment recognises that the assessment may not be capable of being done correctly within the local authority. In order to ensure that the quality of assessment is sufficiently high, it may be necessary for the local authority to obtain help from other bodies.
I draw the Committee's attention to the wording of the first paragraph where, for reasons that I do

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not understand, the brackets contain no numbers or letters. I assume that that is standard procedure. By the first paragraph, I mean the first unnumbered paragraph. The key phrase there is:
"shall notify the relevant authority and the relevant authority shall co-operate".
I draw the Committee's attention to the fact that the word "shall" is there and the word "may" is not. That is extremely important.
The second part of the amendment is rather different and again leads us back to the vexed question of what should be in the Bill. The amendment concerns the authority having a duty to ensure that properly qualified people—people with sufficient skills —are available for or can be involved in the assessment. To anticipate the Government's reply, I assume that they will say, "We believe that the local authority will do that because that is the sensible thing to do", or will use some such argument to show that they do not like the provision being included in the Bill.
My judgment and that of those who tabled the amendment and others who have spoken to it is that it is better to spell out those points in such important areas. That is why the provision is included in the amendment. Clearly, since the Government must have thought about the matter, they have decided not to include an equivalent provision in their Amendment No. 114ZA. Perhaps I may summarise the arguments. Essentially, Amendment No. 113E is just a much stronger version of the thoughts that the Government have expressed in their amendment.
Perhaps I may now draw the Committee's attention to Amendment No. 114C, which defines the relevant authority mentioned in our original amendment. Again, I draw the Committee's attention to the fact that the list of relevant authorities is longer than the list that the Government have in mind for their amendment.
I assume that the amendment of the noble Baroness, Lady Masham of Ilton, Amendment No. 114ZC, is grouped with this amendment because it concerns bringing in other organisations, in this case voluntary organisations. I am interested that the noble Baroness states in her amendment that,
"a local authority shall have power to enter into arrangements".
Like the noble Baroness, I shall be interested to hear from the Government whether that power is already there and her amendment therefore merely teases out the information or whether it is needed to ensure that the power is there. One way or the other that matter reeds determining most strongly.
Unless I have misunderstood the situation, other than paying due deference to the importance always of spelling out the Scottish interests I do not believe that the Scottish amendments raise any further points of principle. I simply take it for granted that the arguments that apply cogently to the remainder of the country always apply at least as cogently to Scotland. I beg to move.
10.15 p.m.
Baroness Cox: I rise to support the amendment. It addresses one of the most fundamental problems associated with community care: the fact that the
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needs of many clients involve both health and social problems. The proposed legislation places the primary responsibility on social services departments which have great expertise in social problems. The amendment puts a duty on those concerned with assessment to consult and collaborate with other disciplines relevant to each client's own distinctive needs. Without the amendment there is a real danger that appropriate personnel will not be involved in the assessment of clients. For example, to call on the incontinence adviser or the occupational therapist requires the ability to recognise a disability and knowledge of the possible solutions.
I have great respect for social workers and their professional competence in their own fields. But they are not clinically trained. They will not have the expertise at the initial diagnostic stage of assessment. It is a possible and indeed real danger that people may fall through the net of care because adequate expertise was not available at the initial crucial stage. I believe that the strong version of these amendments is very important.
Baroness Seear: I am a strong supporter of the social services taking primary responsibility. I wish also strongly to support the amendment. I fully recognise the point that the noble Baroness, Lady Cox, has made that at this stage it is vital that those with health and medical expertise should be involved in the assessment.
Baroness Masham of Ilton: I should like to speak on Amendment No. 114ZC. It has the backing of the Crossroads care attendant scheme, John Groom's Association for the Disabled—and had he been here the noble Lord, Lord Swinfen, would have spoken—Alcohol Concern and SCODA, the Standing Conference on Drug Abuse.
The amendment is very important to local Crossroads care attendant schemes. At present those operating the schemes are responsible for carrying our their own assessment of families' needs. This is an integral part of Crossroads' approach to service provision and is important to its continued independence as a voluntary sector organisation. There is very real fear that under the Government's proposals local authorities will carry out an assessment of the needs of a carer and then approach Crossroads to ask it to provide the necessary care attendant services. That is unacceptable to the schemes which feel that they will lose their autonomy and become no more than an arm of the statutory sector. There is a danger that they will lose the goodwill of the voluntary management committee whose commitment is to Crossroads and not necessarily to the social services department.
Local schemes would like to have a block contract with local authorities under which they would be able to continue to assess the needs of the carers requesting their services. Crossroads believes that that is an arrangement which most local authorities would prefer as they know of its expertise in the matter.
On drug and alcohol abuse, perhaps I may clarify the current ambiguous position as to whether or not

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local authorities may contract out the assessment of individual needs to voluntary organisations with the appropriate expertise. There are a number of reasons why, in the case of people with drug and alcohol problems, it may be necessary for assessments to be carried out by a voluntary organisation on behalf of the local authority social services department.
First, and most importantly, the majority of people with drug or alcohol problems simply will not be willing to present themselves for an assessment by social services. That may be for fear of consequences such as having their children taken into care, for fear of an unsympathetic hearing or simply to avoid adding the stigma attached to being on the books of social services to that of having a drink or drug problem. Problem drinkers or drug users generally present themselves only at specialised agencies where they can expect an understanding and sympathetic reception. The visibility of specialist agencies is an important factor in that respect.
The second issue is that of confidentiality. The confidentiality that can be maintained by a voluntary organisation contrasts sharply in many people's minds with the formal record-keeping of the statutory agencies. A large proportion of the clients of drug and alcohol services undoubtedly see confidentiality as being a major issue, especially those who may be HIV positive and will develop AIDS. That is particularly so at the initial assessment stage when they may be unsure about whether they will want or be able to engage the service.
Thirdly, many people make the decision to seek help as a direct result of the public education and training work carried out by a voluntary agency. The decision is directly linked to the image of the people projected by the local agency and it would be nullified if the client was asked to go somewhere completley different for his assessment.
Fourthly, such assessments call for specialised skills and expertise which do not exist within most social service departments. The White Paper Caring for People makes it plain that there must be a variety of potential routes into assessment. The chosen route for large numbers of people with drug and alcohol problems is through a voluntary agency. Many arrive with mixed feelings about whether they want or feel able to go through with the initiative they have taken to seek help. It is vital that such clients are given immediate access to assessment and, if appropriate, to services. Suggestions that they should be passed on to the social services for an assessment would be counter-productive and result in the loss of the client. Therefore, it is vital that it is open to local authorities to contract out certain specialised areas of assessment to appropriately skilled and experienced voluntary agencies.
I chair an organisation called Phoenix House, of which the noble Lord, Lord Ennals, is a member of the board. A director of the organisation is an adviser to the Department of Health. One of our concerns is that at present drugs and alcohol come under health authorities and the change to social services is new. I shall be interested to hear what the Minister says about the matter.
Lord Hylton: In connection with this group of amendments it is relevant to mention a matter which may appear to be extremely obvious but it should be stated. There can be little point in conducting painstaking assessments unless they are followed up by a form of treatment, provision of services or action that will remedy the condition in question. First, if an assessment is carried out and nothing happens for several years, that is a waste of the professional effort involved. Secondly, if nothing follows the assessment, that can be extremely depressing for the person assessed.
For that reason I like the phrase which appears at the end of the Government's Amendment No. 114ZA:
"likely to be made available for him by that District Health Authority or local housing authority".
I do not believe that that goes far enough. I suspect that it should add at the end, "or voluntary body".
Baroness Hooper: Amendment No. 113E addresses two situations. The first is where a person needs services not provided by the social services department and the second where the person needs a specialist assessment involving skills not present among employees of the authority concerned. I have already explained to the Committee how the assessment process will work and that we intend that it should go wider than the statutory requirement which the Bill lays on social services departments and would embrace health and housing needs. The first part of this amendment shares that concern. The second part overlaps with Amendment No. 114ZC, which like it concerns the need for social services departments to seek help from other bodies in carrying out community care needs assessment.
I have much sympathy with the intention behind these amendments. We want assessments to be assessments—objective explorations of individual need with a view to determining the best way to help the person concerned within the resources available. It should not be "guesstimate" and we recognise that social services department staff may need training in order to carry out this new duty effectively. But even so there will be some areas where the social services department is likely, initially at any rate, to have little relevant experience. I know that services for problem drinkers and substance abusers are very much in the minds of some Members of the Committee but the whole question of assessments for nursing home care is likely to loom larger in the minds of some authorities.
Clearly in such cases the local authority will need to bring in outside expertise. The White Paper states:
"all agencies and professions involved with the individual and his or her problems should be brought into the assessment procedure when necessary"
and goes on to list a wide range of people, some from the social services department and some from other agencies who may need to be involved. The White Paper lists:
"social workers, GPs, community nurses, hospital staff such as consultants in geriatric medicine, psychiatry, rehabilitation and other hospital specialties, nurses, physiotherapists, occupational therapists, continence advisors, community psychiatric nurses, staff involved with vision and hearing impairment, housing officers, the Employment Department's resettlement officers and

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its employment rehabilitation service, home helps, home care assistants and voluntary workers".
To that extent I believe that we are all of one mind. The question we have to address is the best way of achieving what we all want. The first thing to make clear is that there is nothing to stop a social service;; authority doing any of the things suggested in these amendments. The guidance we will be issuing to authorities will say all this, and I remind the Committee that under the new powers we are taking in Clause 47 of the Bill we will be able to reinforce the guidance we give by directions. Much of the detailed provision is probably best left to guidance and it is not appropriate to include it on the face of the Bill. As my noble friend Lord Henley said in winding up the Second Reading debate, if we were to put on the face of the Bill everything suggested to us the Bill would be as thick and detailed as the White Paper itself. I am sure no one wants that. Assessment is essentially a social work process. I am sure that my noble friend Lady Faithfull will agree with that. It involves working with an individual and any carers to determine how his needs may best be addressed.
In carrying out an assessment a local authority's first concern should be to respond constructively to the individual situation, not to thread its way through a maze of legal requirements. Our intention therefore is that the legislation should be kept to a minimum. Following this principle we therefore intend to place nothing on the face of the Bill about the requirements of the community care assessment itself, except where these arise in connection with other statutory provision as is the case with disabled people. That is why we are not suggesting that there should be anything in the Bill to cover consultation with individuals or carers or involving other people, formally or informally, in the community care assessment.
Following debates in another place, something is required to cope with the situation where the assessment for community care needs reveals needs for other services. The social services department will have no responsibility for those services and it would be inappropriate for it to assess such needs and then to seek services from the responsible authority. We should also ensure that the assessment for community care needs does not take place in a vacuum; hence the proposal by the Government of Amendments Nos. 114ZA and 115CBA, which place on the face of the Bill a power to enable the authority to contract out assessment work. That covers the drug and alcohol abuse areas referred to by the noble Baroness, Lady Masham. I take the opportunity of saying to her that local authorities will need to know whose treatment they are paying for but that appropriate arrangements are intended to maintain confidentiality.
As I have already explained, we do not feel it necessary to place on the face of the Bill any detailed provision about local authority assessments, but special considerations arise over contracting out assessments. Assessment is closely related to the decisions the local authority has to make about whether an individual's care needs call for the
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provision by the local authority of any community care services. Such services should take into account both what may be provided by the health or housing authority involved in the assessment and also the overall level of resources available.
It follows as I have said, that although it may be necessary to involve other agencies, particularly certain voluntary organisations, in the assessment process there can be no question of the local authority writing a blank cheque to them to spend as they see fit on what they decide to be the needs of an individual for whom they provide services. That would simply transfer into another sphere some of the elements of the uncontrolled use of public funds which occurs through the use of income support and which our community care proposals are aimed at remedying.
Furthermore placing a power on the face of a Bill creates an expectation that the power will be used. Local authorities may be faced by demands from various bodies, suitable and unsuitable alike, to be allowed to assess and admit individuals. If we agree to that, that would be in a sense to undermine the local authority's key role as the enabler of community care. Our guidance will cover that point. It will offer advice which I hope authorities will find useful and which will enable them to use the freedom they already possess to involve other bodies in the assement process to best advantage. If they fail to do that we have the fall-back powers of the Secretary of State.
I have spoken at length in order to cover in detail the issues raised by these amendments. I hope that they will be withdrawn at this stage.
Earl Russell: The noble Baroness caused me a little surprise by quoting my noble kinsman, Lord Henley, as saying that if the amendments were accepted the Bill would be as thick as the White Paper. I have been looking at it; I think it is already.
Seriously, I do not see what is so very wrong with having a Bill which is as thick as a White Paper. When Bills are drafted with the sort of verbiage they regularly have, if this Bill is properly filled out it should be thicker than the White Paper.
The noble Baroness, Lady Blatch, has already referred to the concept of a framework Bill. There is a certain amount of suspicion in some quarters of this Chamber regarding the tendency to leave so much to regulation that it becomes extremely difficult in the Chamber to give legislation proper scrutiny. That suspicion can only be increased by the noble Baroness's simile of the purpose of the Bill—to restrain the uncontrolled use of public funds.
The trouble with the whole question of community care is that mental illness, for example, does not happen in a planned way and one cannot plan exactly what will be needed. Therefore, if one does not have at some point the capacity in an emergency for an uncontrolled use of public funds one cannot have the capacity to meet need. There is a great deal of cause for anxiety in the speech we have just heard.
Lord Henderson of Brompton: The noble Baroness referred to guidance which is to be issued by the Government. Indeed, the main plank of her response to an earlier amendment was that the substance of the amendment should appear in guidance rather than on the face of the Bill. Can she tell the Committee in what form the guidance will appear? Will it be in the form of a code of practice and be generally available for scrutiny?
I hasten to say that I am not asking, as the noble Earl appeared to ask, that the guidance or subordinate legislation should be on the face of the Bill, which would thus exceed the size of the White Paper. I merely ask where the guidance will appear and what sort of authority it will have. Will there be any sanctions if it is not conformed to?
Baroness Hooper: My understanding is that the use of the word "guidance" is different from the use of the word "guidelines". "Guidance" apparently has some significance in that, if an authority fails to observe guidance, the Secretary of State can enforce the suggestion by means of directions. Therefore, the effect of guidance is quite strong.
Whether it will be in the form of a code of practice or whatever I should not like to say, but it will be clearly in written form and will go to the authorities, which will be expected to comply with the guidance.
Baroness Faithfull: Under the Children Act guidance has been issued called Working Together. It is used by every local authority in the country. It is known to every voluntary organisation and is well carried out.
Baroness Masham of Ilton: I was attracted to the suggestion made by the noble Lord, Lord Hylton. It is important to include voluntary agencies. One reason is that it is most important to keep their good will. It would be exceedingly expensive for the government if some of these agencies were to go out of business. The Government would then really be in trouble.
Another reason is that there is some professional jealousy between statutory and voluntary agencies. That is well known to many of us who work in this field. The Bill would not be much bigger if voluntary agencies were included. I shall not divide the Committee but I certainly intend to return to the matter on another occasion and that will make the Report stage longer.
Baroness Hooper: The noble Baroness must do what she feels to be appropriate. We have emphasised again and again that voluntary agencies will be consulted. They will certainly be mentioned in the guidance.
Baroness Seear: Is the noble Baroness right in saying that the guidance will be issued and if it is not followed the Secretary of State will have powers to enforce it? That means that the guidance ultimately will have the force of law. That being so, will we have the opportunity of seeing the guidance regulations when they are produced? Will they be in the form of an affirmative or negative resolution, or not at all? Will they be sent through the post?
Baroness Hooper: As I have said on a number of occasions, the guidance will be put out for consultation. It will be issued initially in draft form. I have raised this in the context of certain specific amendments and specific guidance which will relate to the performance of those amendments.
Lord Henderson of Brompton: I do not seek to press the noble Baroness closely on this matter but is what she calls "guidance" to be issued in the form of a circular? That is what I have in mind and if that is what the noble Baroness has in mind I know what she is talking about. That is all that I am concerned about.
Baroness Hooper: I apologise to the noble Lord if I did not pick up his initial question. As I understand it, it will be issued in the form of a circular or a book, and it will be comprehensive and detailed.
Baroness Masham of Ilton: With the indulgence of the Committee I want to try to impress on the noble Baroness the importance of this for the drug and the alcohol situation, not the disabled. They have been linked now with mental health, and there are no local authority votes in drugs and alcohol. They are exceedingly unpopular. You have no idea of the difficulty we have in setting up houses in various towns. One needs help over this and not hindrance. I can assure the noble Baroness that it is the most difficult field. She knows this because she is the Minister concerned with drugs.
Lord Peston: We have learnt a great deal this evening. We are most indebted to the noble Baroness. As I understand it, with guidelines you are free to choose what you do, and with guidance you are free to choose what you do so long as you do what you are told. Many of us have brought up children on that basis.
The noble Baroness has thrown light on these matters. Her statement was rather long and involved and I still do not know the answer to the point raised by the noble Baroness, Lady Masham, in her amendment. Is it or is it not the case that the local authority has this power stated in this amendment? I could not understand the noble Baroness on that. Does a local authority have the power to enter into arrangements with voluntary organisations in order to carry out assessments?
Baroness Hooper: I believe that I said yes.
Lord Peston: I was a little lost. It is my fault and not that of the noble Baroness. I am delighted —as is the noble Baroness, Lady Masham —to hear that the local authorities have that power, and I hope that the local authorities exercise it as required. Having said that, and having thanked the noble Baroness, Lady Hooper, for clarifying these matters, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Lord Seebohm Lord Seebohm moved Amendment No. 113F:M
Page 50, line 47, at end insert—
("()In the assessment of his needs for community care services under subsection (l)(a) and in the provision of services to rreet his needs under subsection (l)(b) above, a local authority shall take into account his housing circumstances, requirements and wishes.")
The noble Lord said: This amendment comes at the beginning of Clause 45, which is the procedure for the assessment of needs for community care. All it says in the Bill at the moment is:
"Where it appears to a local authority that any person for whom they may provide or arrange for the provision of community care services may be in need of any such services, the authority (a) shall carry out an assessment of his needs for those services; and
(b) having regard to the results of that assessment, shall then decide whether his needs call for the provision by them of any such services."
All we are asking to add on to that is that they,
"shall take into account his housing circumstances, requirements and wishes."
We have already, with a somewhat slender majority, passed a previous amendment on housing; but that is concerned with the overall plan of the local authority. This is specific on whether an assessment is being made. I hope that that could be accepted.
With the permission of the noble Lord, Lord Carter, I should like to speak to Amendment 114ZD. Where it appears to a local authority on making an assessment that the person is homeless, or is in need of advice or counselling as to the provision of accommodation for him, then the local authority shall provide him with written details of where such advice or counselling may be obtained in the local authority's area.
There is little enough about housing, as we know, in this Bill, and these two amendments seem to me to be perfectly harmless and could provide just a little extra authority that should be on the face of the Bill. I beg to move.
10.45 p.m.
Baroness Llewelyn-Davies of Hastoe: As the Committee has already demonstrated in regard to Amendment No. 113AQ, many noble Lords believe that it is crucial that housing should be a central part of the plans and just as crucial that it be a central part cf the assessment.
We welcome Amendment No. 114ZA, which suggests that housing and district health authorities should assist in the assessment process. The amendment will further advance the noble Baroness's amendment by ensuring that the needs and wishes of the people to be assessed form an essential part of the whole process. The housing associations should play an essential part in this process. They are much smaller than local authorities and more familiar with the intimate and down-to-earth special housing needs. They have particular skills in adapting housing to the special needs of people requiring community care services. Their advice to people being assessed will be invaluable.
The amendment will ensure that assessments consider whether improving, repairing or adapting people's existing homes can assist their
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independence in the community. That is a very important factor. It will also make more certain that the housing needs of people who do not have decent housing will be considered. For those reasons, I strongly support the amendment.
Lord Carter: I am very pleased to be able to support Amendment No. 113S, but I should like to speak to Amendment No. 114ZD which is in my name. It draws attention to the problems of homelessness and particularly to the operation of the Vagrancy Act. Sixty or so people a week are prosecuted for begging in London, which is in the order of 2,000 to 3,000 people a year.
We are all familiar with the problem. We have heard about it on a number of occasions in this House. Young people are discharged from care on to the streets with nowhere to go. If they are 16 or 17 and they are not on YTS they get no benefits. They cannot house themselves; they cannot raise a deposit and they cannot pay the high rents. They sleep rough and they beg. A similar cycle applies to the mentally ill who are discharged into the community. As we know, many of them end up sleeping on the streets and begging. They are then prosecuted. That is morally wrong because such prosecutions have no deterrent effect. Those people then have a criminal record. Harassment is commonplace. Such prosecutions merely add to the degradation of the homeless.
It is not just a question of numbers, although they are extremely important; a point of principle is involved. I should like to ask the Minister whether the Government intend to repeal the Vagrancy Act. The noble Baroness will be aware of the campaign to repeal this Act. If she does not wish to reply to me now, perhaps she can write to me about that because it is extremely important.
I should like to point out in passing that begging is no longer a criminal offence in Scotland, and many states in America have ruled that vagrancy laws are unconstitutional.
The amendment is intended to place a duty on local authorities to direct homeless people to places and organisations where they can obtain advice and counselling. Homelessness degrades our society. It seems extraordinary that we are using an Act of 1824 to deal with some of the results of homelessness—begging, sleeping out and being found on enclosed premises. I hope that the Minister can give the Committee some reassurance on that very important matter.
Earl Russell: I should like to add my support to these amendments, particularly to Amendment No. 114ZD. My name should have been put to that amendment. It is an oversight of my own that it is not, but I should like to speak in favour of it.
The Vagrancy Acts have been out of date for even longer than the noble Lord, Lord Carter, suggested. I am told that parish constables in Middlesex realised that they were ineffective and unenforceable as early as 1618. It is time something was done about the situation.
One does not do any good by picking up people and bringing rather minor prosecutions when they

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are not being given any practical way of meeting very urgent needs. This amendment offers a practical and, I hope, helpful alternative, and I very much hope that it will be considered.
Baroness Hooper: We do not feel it necessary to include either of the amendments as the government amendment, Amendment No. 114ZA, to which I have just spoken and to which the noble Baroness, Lady Llewelyn-Davies, referred, provides that, if an assessment made by a local authority for the provision of community care services uncovers a housing need, the person concerned will be referred to the housing authority. It would be for the authority to act as appropriate.
A local housing authority to which an apparent housing need is referred could if it agreed that there was such a need arrange housing through a housing association. Furthermore, we believe that it will not always be necessary to provide an individual with written details of where he or she can obtain advice and counselling about homelessness, and we do not think it appropriate to place a specific obligation on local authorities as suggested.
I am not in a position at this moment to respond to the noble Lord, Lord Carter, about the Vagrancy Act, but no doubt he will have heard what the noble Earl, Lord Russell, had to say on the subject. On that basis, I trust that the noble Lord will feel able to withdraw the amendment.
Lord Carter: Would the Minister be kind enough to write to me with the Government's views of the Vagrancy Act?
Baroness Hooper: Yes, if the noble Lord does not hold me to a timetable.
Lord Seebohm: I shall not divide the Committee at 10 minutes to 11 o'clock. On the other hand, it is important that the housing problem should be raised whenever possible in the Bill. It has been raised only once so far. We shall want to look at the matter again. In the meantime, I beg to withdraw the amendment.
Amendment, by leave, withdrawn.
Lord Seebohm Lord Seebohm moved Amendment No. 114:
Page 51, line 9, at end insert ("and
(c) shall convey to him in writing the outcome of his assessment and set out in writing the services they intend to provide.").
The noble Lord said: I should like to speak at the same time to Amendment No. 115. The Association of Directors of Social Services considers this amendment essential. It is easy for a busy person who is making an assessment to say something person to person or even on the telephone and then not deliver the goods. Much more important than that is the fact that many people who need care are confused. It is essential that they should have the assessment in writing. They can then discuss it with their friends. If they disagree with it they can go back to the local authority. For every reason, we must have assessments in writing.
I turn now to Amendment No. 115. With the many different advances in technology we may find that the services being given are not applicable and are not successful. Therefore, after eight weeks it is fair enough that there should be a reassessment to find out whether the services that are provided are satisfactory. I do not believe that that can be argued against. It is important that both amendments should be passed. I beg to move.
Baroness Faithfull: I support the amendment. Many people listen but do not hear. They interpret what they want to interpret and not what is actually said to them. If the assessment is in writing, it is a help not only to them but to the social workers who are dealing with them.
Lord Peston: I support the amendments. I agree that it would be best if they were accepted and included in the Bill. What the amendments say corresponds with what anyone would regard as good practice. It would be silly if an authority having become involved in this did not do what the amendments require. Nonetheless there are good reasons for making it clear that authorities ought to. The alternative, having listened to the noble Baroness, Lady Hooper, reply to an earlier amendment, would be to do it under guidance. That now seems to carry great weight. I wait to hear whether the Government will either accept the amendment, which I think would be the best course, or tell us that guidance will be the way that they will do it, which means that they will do it.
Baroness Blatch: We are in sympathy with Amendment No. 114. Clearly, people requiring an assessment of their needs and those caring for them need to know quite clearly and understand what services the local authority may be able to provide to meet those needs. I am sure that many authorities will quickly institute the kind of written procedure that the noble Lord has in mind. The guidance which the Department of Health is in the process of preparing will take on board this and other points from our discussions in Committee in order to advise and support local authorities in setting up the systems they will need to have available for assessment.
We do not want to enshrine in legislation the particular means by which local authorities decide to communicate with clients. For example, their method may well be most appropriately by regular visits from the responsible local case manager, not least in cases where written communications might be confusing or intimidating to confused clients. I agree, however, that communicating the outcome of any assessment to the individual is absolutely key to the mutual understanding of what can and cannot be provided, and one that the new system of assessment must foster.
Amendment No. 115 requires a local authority to review an initial assessment six weeks later and convey the results in writing to the client. It further requires that subsequent reviews of the assessment take place at intervals of not more than six months. We have no desire to enshrine in legislation the time

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period over which reviews of assessments should be carried out nor how these should be done. This takes away the flexibility that we want to give local authorities to provide the services that their clients most need.
We must not forget that the authority will be assessing people some of whom will have need of very substantial support to enable them to live at home and who may be on the verge of requiring residential care. They may need much more and frequent review and adjustment of services than the noble Lord's amendment suggests. At the same time many other people will need a much more modest level of support.
The key to meeting all these many and varied needs is the flexibility to target resources where they are most needed. I fully accept that this means review and monitoring but it is inappropriate in my view to prescribe the timescales over which this should be done. Our guidance on assessment will advise authorities that assessments should be reviewed at regular intervals and that the review intervals should be agreed with the client and carers at the initial assessment. Our White Paper commends the development of a case management type approach in local authorities where someone familiar with the cases can help to make adjustments to the services provided without waiting for the formality of a specifically timed and dated review.
Lord Seebohm: Do I understand from the Minister's reply that the guidance—if "guidance" is the right word —will contain rules that the outcome of such assessments will be given in writing? Can I take it that there will definitely be guidance in this respect?
Baroness Blatch: Yes. I am sorry. I did not hear the end of the noble Lord's question. Perhaps he will be kind enough to clarify his request.
Lord Seebohm: In the circumstances, I think that I should beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Baroness Hooper Baroness Hooper moved Amendment No. 114ZA:
Page 51, line 9, at end insert:
("(2) If at any time during the assessment of the needs of any person under subsection (l)(e) above, it appears to a local author ty —

(a) that there may be a need for the provision to that person by such District Health Authority as may be determined in accordance with regulations of any services under the National Health Service Act 1977, or

(b) that there may be a need for the provision to him of any services which fall within the functions of a local housing authority (within the meaning of the Housing Act 1985) which is not the local authority carrying out the assessment,

the local authority shall notify that District Health Authority or local housing authority and invite them to assist, to such extent us is reasonable in the circumstances, in the making of the assessment; and, in making their decision as to the provision of the services needed for the person in question, the local authority shall take into account any services which are likely to be made available for him by that District Health Authority or local housing authority.").
The noble Baroness said: This amendment was spoken to earlier in connection with Amendment No. 113E. I beg to move.
On Question, amendment agreed to.
[Amendments Nos. 114ZB and 114ZC not moved.]
Lord Allen of Abbeydale Lord Allen of Abbeydale moved Amendment No. 114A:
Page 51, line 16, at end insert:
("(4A) Sections 1 and 2 of the Disabled Persons (Services, Consultation and Representation) Act 1986 shall come into force on the same day as this section.").
The noble Lord said: I propose to speak only to Amendment No. 114A. It has been grouped with Amendment No. 114B, but it seems to me that they cover entirely separate issues and that they should not have been put together. The 1986 Act, which was piloted with great skill by the noble Baroness, Lady Masham, through this Chamber, has had a strange history. Four years after its enactment many of its sections have not been implemented and one of them —namely, Section 7 —we are told will probably never be enforced. Section 1 gives the disabled person the right to have an authorised representative. That is someone unpaid who acts on his behalf in his negotiations with the local authority and his assessment.
Section 2 lays down the rights of the authorised representative, which are similar to those of the disabled person. I know that Ministers have referred elsewhere to the desirability of an assessment taking account of those who support the individual concerned. However, the truth is that without an authorised representative, many handicapped people, especially the mentally handicapped, will have no one to support them or speak on their behalf.
When the 1986 Bill was being considered, as I recall, the Government expressed sympathy with the principle of advocacy, which would help those with mental illness or mental handicap to understand not only their rights but also the services available. It is pretty disappointing that four years later the Government are, I understand, still talking about beginning discussions with the local authorities on implementing these sections.
As the Committee will appreciate, disabled people have for a long time been told by professionals what they need and how it will be provided. They themselves have had very little say in the provision to be made for them. Even for the most articulate disabled person, a meeting with a professional can be quite intimidating. To have someone with them who they know is on their side can be an enormous support. Pilot schemes have confirmed that the resulting assessments and decisions are more likely to be successful and cost-effective. It has been proved possible to improve the quality of life of the individuals concerned without incurring additional expenditure. These sections have already received parliamentary approval and if they were in force it seems to me that the operation of Part III of the Bill would be made more effective. I beg to move.
11 p.m.
Lord Henderson of Brompton: I am grateful to the noble Lord, Lord Allen of Abbeydale, for moving these amendments. As he said, it should be the noble

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Baroness, Lady Masham, who piloted the 1986 Bill through this House, who should move them, particularly the first one, which is the one that covers Sections 1 and 2 of the 1986 Act. Amendment No. 114A, as the noble Lord said, falls firmly within Part III of the Bill. If we look at the White Paper and the Bill we see that Part III cannot be properly implemented without the bringing into force of Sections 1 and 2 of the 1986 Act. That is why we were disappointed to find Part III of the Bill without this clause and why we thought it necessary to introduce it. There is no hope of the proper implementation of Part III without it.
There are those who, because of mental, sensory, or physical impairment or disability, cannot express their wishes and require somebody to be their advocate. Unless that is provided for in Part III, the aspirations and intentions of the Government in the White Paper cannot be fulfilled in the Bill, which is supposed to be the statutory implementation of those aspirations and intentions. For that reason it is in my view, and certainly in the view of the noble Lord, Lord Allen, and I am sure in the view of the noble Baroness, Lady Masham, essential for this amendment to be incorporated into Part III of this Bill.
I regret that this amendment has been discussed so late at night. It is clearly not a time when one can take the opinion of the Committee. All one can hope is that the noble Baroness who speaks for the Government will agree that the Act which has the imprimatur of Parliament should now, belatedly, four or five years after its passage, be brought into operation when this clause in Part III of the Bill is brought into operation. I strongly support the noble Lord, Lord Allen, in what he has said.
Baroness Masham of Ilton: I also support this amendment; but having taken it through the Chamber, I did not want to say too much. I think it is better that I do not say too much. Physically handicapped people have to pay the community charge, and many of them find that difficult. Therefore they are even more deserving of this amendment.
Lord Carter: I am very pleased to support Amendment No. 114A from these Benches. The noble Lord, Lord Allen, is entirely correct that Amendments Nos. 114A and 114B should be treated separately. The arguments have been explained so well that I do not propose to add to them, but I must say—other speakers have already mentioned this—that it seems extraordinary that an Act which has been on the statute book for four years is still not fully enacted. The failure to enact the 1986 Act in full calls into question the Government's determination to ensure that a proper level of community care is provided for disabled people. I hope the Minister will be able to tell the Committee that the Government intend to implement those parts of the Act which have not been brought into use.
Baroness Darcy (de Knayth): I also wish to support these two amendments most warmly. However, I
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have one or two questions to ask the Minister. The Government are at the moment consulting with local authority associations on the full implementation of the Act. The consultation letter from the Department of Health is rather half-hearted in its approach, to say the least. It accepts that local authorities may not want to implement the remaining sections of the Act. The letter states:
Ministers would welcome your views on whether implementation should in any case be deferred until at least the community reforms … have been put into effect and had time to settle down".
In a way that misses the point because the Act, and in particular Section 3 of the Act, is highly relevant to community care. I should have thought it was very necessary. It has a symbiotic relationship with community care. The situation is worrying because services for physically disabled people in particular are being increasingly downgraded by local authorities as opposed to services for child abuse, the mentally ill and elderly people. That is something that the social services inspectorate report rather brought out.
I hope the Minister can tell me why the consultation letter was written, or at least why it was written in that lukewarm fashion. Do the Government accept that disabled people are a low priority for many local authorities? Will the Government accept the importance of Section 3, and if further funds need to be made available to implement it, will they make them available? It is worth pointing out that the pilot study on the implementation of Section 3 found that it proved very cost effective to involve disabled people in assessments. The pilot project also found that local authorities found Section 3 a useful tool and that it did not result in additional demands for services. There were no appeals under the pilot study. That indicated the value of involving disabled persons.
Baroness Hooper: It may be helpful if I recap the substantial progress that the Government have made so far in implementing the Disabled Persons (Services, Consultation and Representation) Act 1986. Noble Lords have referred to the passage of that Act as a Private Member's Bill. I am sure the Committee would agree that any other approach to a complex measure of this kind other than according to the sensible proviso that it could only be implemented as the necessary resources were identified would have been irresponsible.
The Government did not lose any time once the Act reached the statute book. Four important sections, Sections 4, 8(1), 9 and 10, were implemented on 1st April 1987. They require local authorities to assess need on request, to have regard to the abilities of carers, to provide additional imformation and to consult organisations representing disabled people when making appointments. Progress continued with the implementation on 1st February 1988 of Sections 5 and 6, which impose duties on local authorities to identify and assess the needs of young disabled people when they leave school. Recently, at the end of 1989, Section 11 was brought into force, with the laying of a report on community care for mentally ill and mentally handicapped people.

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All this has been achieved despite the considerable resource implications of the Act. At each stage agreement has been reached with the local authority associations as to the costs, and they have been taken into consideration in the relevant public expenditure round. This year the figure taken into account for the implemented sections of the Act was £31 million —a sizeable sum by any standards.
The noble Lord, Lord Allen of Abbeydale, referred to Section 7 of the Act. We announced in the White Paper Caring for People that we do not now intend to implement Section 7, which would impose statutory obligations on health and social service authorities to identify and assess the needs of people leaving hospital after receiving treatment for six months or more for a mental disorder. That decision was taken in the light of new proposals to improve the provision of services for mentally ill people, including from 1991 the preparation of care programmes. The need to implement Section 7 will of course be reconsidered in the light of several years' experience of the introduction of the care programmes.
Sections 1, 2 and 3 of the Act concern the appointment and rights of authorised representatives of disabled people and their rights to make representations about their needs. They are the most complex and potentially the most expensive of all the Act's provisions. I reconfirm statements that have been made previously that no decisions on their implementation can be made until we have established their cost. Following preliminary consideration of their resource and service implications, an official approach was made to the local authority associations in February this year seeking their views on these issues. Further action will depend on the outcome of those consultations.
The noble Baroness, Lady Darcy (de Knayth), referred to that point in her comments and asked about the consultation letter. Whether or not it was half-hearted must be a matter of opinion. In the letter we asked for a reply by the end of May and I understand that no reply has yet been received.
I should like to assure the Committee that the Government are anxious to ensure that disabled people and their carers have a say in the provision of services which affect their lives. Indeed, the whole thrust of our proposals for the future of community care is geared to maximising choice and independence for the consumer, as we have been reminded from the Opposition Benches. However, we cannot accept the amendents at this moment for the reasons I have given.
Lord Allen of Abbeydale: The noble Baroness has been put in to bat on some sticky wickets by the Government, but to explain why it has taken four years to fail to implement legislation approved by Parliament on behalf of the disabled is a task which is beyond a government spokesman. I fear that the reply is totally unsatisfactory. For one thing the noble Baroness lumped in Section 3, about which I was not talking but which could certainly involve a great deal of expenditure.
As the noble Lord, Lord Henderson, said, there is not much point in dividing the Committee at this
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time of night. However, I must put on record our profound dissatisfaction with the reply which has been given and our fears that this will hinder the implementation of Part III of the Act with which the Government have inspired so many hopes.
I cannot help thinking—this is going rather wide—that the Government would expedite their business if, just occasionally, when there is an overwhelming case for doing something they could accept an amendment. I thought that this was perhaps one such case. I must be disappointed and, in the circumstances, I can only ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
11.15 p.m.
Lord Henderson Lord Henderson of Brompton moved Amendment No. 114B:
Page 51, line 16, at end insert —
("(4B) Section 3 of the Disabled Persons (Services, Consultation and Representation) Act 1986 shall come into force on the same day as this section.").
The noble Lord said: As the noble Lord, Lord Allen of Abbeydale, said when he moved the previous amendment, this is a distinct amendment from the previous one and deserves separate treatment. The previous amendment concerned advocacy and this amendment does not concern advocacy. It concerns the assessment process, so it is essentially a different amendment. Although the reply of the noble Baroness purported to address itself to this amendment, it is worth separate consideration.
The principle of involving the disabled person in the assessment process has run through the Government's thinking from the White Paper into the Bill and has been current throughout the discussion, especially on this part of the Bill. I shall quote the White Paper to put on record the fact that,
"Assessments should take account of the wishes of the individual".
That is precisely what Section 3 of the 1986 Act is about.
I should have thought that the Government would think about that in advance of bringing the Bill before Parliament. Here we have an Act which has been on the statute book for four years and the Government have been preparing this part of the Bill for a long time; yet it is only now that they issue a consultation paper or that a letter is sent to local authorities to which they ask for replies by 31 st May. Here we are in the Committee stage; yet I doubt whether we shall hear what the reply to the Government from the local authorities is by the Report stage because the Government will say that they have not had time to assess the reply or react to it, even if they receive it by that date.
One cannot help feeling that, as the noble Baroness, Lady Darcy (de Knayth), said, the Government have not only been extremely tardy in their consultation letter, but are almost inviting the answer "No" from the local authorities which they purport to consult. That is extremely unsatisfactory when the implementation of Section 3 of the 1986 Act is just as essential as the implementation of

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Sections 1 and 2 and if Part III of the Act, particularly Clause 45, is to have the full meaning and effect which the Government say that it should have. That is entirely unsatisfactory. The Committee cannot be satisfied. At this hour of the night we cannot hope to test the opinion of the Committee as to whether the amendment should be incorporated in the Act, as it manifestly should be in the Government's own terms and in accordance with the Government's thinking.
I should like to say what Section 3 does. If I read out what it does, it will be manifest to the Committee and to anyone who reads Hansard that it is central to this part of the Bill that Section 3 of the 1986 Act should be implemented. Section 3 gives three rights to disabled people. The first is the right to make representations concerning their needs and to have their views taken into account during the assessment process. What could be more germane to the Bill than that requirement passed by Parliament in 1986?
Their second right is to have a written statement of the outcome of the assessment. Again I should have thought that that falls four square within the terms of Part III of the Bill. The noble Baroness has stated on an earlier amendment that a written assessment may not always be the right way to convey the information. We do not need to stand absolutely four square on it being written, but at least the assessment should be conveyed either in writing or in the most convenient manner appropriate to the disabled person.
The third right of the disabled person is enshrined in Section 3 of the 1986 Act. It is the right of review against the outcome of the assessment to which the disabled person may have some objection or may feel aggrieved by. Those seem to be elementary rights and should be incorporated in the Bill.
I shall say little more. Once again I have to refer to the unfortunate lateness of the hour. Pilot studies have been done on the implementation of the section. They tend to the conclusion that its implementation would not increase the call on government funds, which is the fear of government. It seemed to those who conducted the pilot scheme that the implementation of Section 3 would be cost-effective. I should like to hear what the noble Baroness has to say about Section 3. If it is as disappointing as her remarks about Sections 1 and 2, it will clearly be a matter to which we shall return at a later stage of the Bill.
Baroness Masham of Ilton: I should like briefly to ask how one undertakes an assessment without taking into consideration a person's views. It is most extraordinary. I cannot understand it. If a person has a view and can express himself and that view is not taken into consideration, he is being treated like an animal. When one assesses a pig or cow one cannot ask them, but with a human being one can. Otherwise relationships break down, and surely one wants good relationships.
I am sure that the noble Lord, Lord McColl, explains what he will do to a patient on whom he is going to operate. The patient has the right to say, "I do not wish to be operated on". Surely a person who
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is being assessed should have that right. I cannot understand why that cannot be accepted. It has already been accepted by Parliament.
Baroness Darcy (de Knayth): I rise briefly to support the amendment and to apologise to the noble Lord, Lord Henderson of Brompton. In my keenness to support my noble friend's amendments and to make only one speech I pre-empted what he was going to say on the importance of implementing Section 3.
I shall not repeat what I have already said. I agree with what the noble Lord said. I ask the Minister whether the Government accept that, if all local authorities will provide a uniform standard of assessment and good practice, Section 3 must be implemented and we should not rely on guidance from the Government.
Lord Carter: From these Benches, we support the amendment. I do not propose to extend the arguments. However, the Minister spoke about the consultation letter. The answer had to be received by the end of May and the department has still not had a reply. It is only 10th May. I understand that it will receive a reply before the end of May. The point that she made was a little unfortunate because in February, Act Now, the disability consortium, wrote asking for a meeting to discuss the implementation of the Act and it still has not received a reply.
Baroness Hooper: There is not a great deal that I can add to my previous response because I dealt with the amendment tabled by the noble Lord, Lord Henderson, in my comprehensive reply. I remind Members who have spoken to the amendment that the implemented sections of the Act to which I referred—Sections 4, 8(1), 9 and 10—require local authorities to assess need on request. I should find it amazing if someone who requested an assessment did not have their views taken into account.
It is only fair to admit that, with or without implementation of these provisions, considerable progress has been made in this respect. In response to an earlier question doubting the commitment of local authorities to this area, I remind the Committee that over the past decade spending on personal social services has increased substantially without the implementation of such provisions.
As regards the famous letter of 19th February, I am inclined to agree with the noble Lord, Lord Carter. Although we have not yet received any replies, I am sure that after this evening we shall receive them in abundance. The next step will then be to use the information contained in the responses in negotiations with local authorities which will be held on the same basis as those conducted prior to the implementation of the other provisions of the Bill.
Lord Henderson of Brompton: There is not a great deal that can be said at this stage. I re-emphasise that the pilot study stated that the implementation of Section 3 of the 1986 Act would be cost effective. That should weigh heavily with the Government in

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deciding whether they can agree to the implementation of the section when this part of the Bill comes into operation. I fully understand that the cost incurred by the Government during the past four or five years in respect of the welfare of disabled people is considerable. However, the implementation of Section 3 may not add to that cost or will add only very little. That should make the Government highly sympathetic to the implementation of Section 3 as enshrined in the amendment. I shall withdraw the amendment on the clear understanding that we must return to the matter at a later stage.
Amendment, by leave, withdrawn.
[Amendments Nos. 114C and 115 not moved.]
Clause 45, as amended, agreed to.
Lord Ennals Lord Ennals moved Amendment No. 115ZA:
After Clause 45, insert the following new clause:
("Provision of community care for disabled persons.
—(1) When requested to do so by—

(a) a disabled person,

(b) his authorised representative, or

(c) any person who provides care for him in the circumstances mentioned in section 8 of the Disabled Persons (Services, Consultation and Representation) Act 1986,

a local authority which provides or arranges the provision of community care services shall decide whether the needs of the disabled person call for the provision by the authority of any services in accordance with section 21 of the National Assistance Act 1948.
(2) Where a local authority are satisfied that in order to meet the needs of a disabled person it is necessary for that authority to make arrangements for any services referred to in subsection (1) above, it shall be the duty of that authority, with the consent of the said person, to make those arrangements.
(3) In this section —

"disabled person" and "authorised representative" have the same meanings as in the Disabled Persons (Services, Consultation and Representation) Act 1986.

"local authority" has the same meaning as in section 44 above.").

The noble Lord said: A great deal has been said about the disabled persons Act of 1986. Section 4 emphasised the obligation to assess a person's needs in response to a request. However, some local authorities maintained that they had no duty to do so, although it was then 15 years after the Chronically Sick and Disabled Persons Act 1970. The new clause merely extends the same principle to potential users of residential services and to the disabled.
I can be brief in moving the amendment because those Members whose names are also appended to the new clause will add their weight to it. The purpose of the clause is to give disabled people and their representatives the right to ask for an assessment of their need for residential care. Section 21 of the National Assistance Act 1948 places a duty upon local authorities to provide residential accommodation for people who need it. The question is: do these people need it?
Currently disabled people or their representatives or carers have the right to ask for an assessment of their need for domiciliary services. As I said, that is under Section 4 of the disabled persons Act 1986.
This new clause would give also a right to an assessment of their residential care needs. That is particularly important in view of the fact that the National Health Service and Community Care Bill passes to local authorities all responsibility for arranging residential care.
In that context, when we talk about disabled people we are also talking about those who are mentally handicapped. There is almost universal agreement that people who are mentally handicapped should not live in long-stay hospitals or be stuck in the family home beyond a point at which they can no longer be properly cared for. In most cases they cannot live wholly independently. Therefore, for that group, residential care is the preferred option rather than the last resort.
I hope that the Minister sees the significance of the amendment and will be able to accept it. I beg to move.
11.30 p.m.
Baroness Blatch: When considering this amendment one must refer to a corresponding provision in the Chronically Sick and Disabled Persons Act 1970 together with Section 4 of the 1986 Act. A duty is imposed on local authorities to assess a disabled person's need for day and domiciliary care and other forms of support to enable them to remain in their own homes.
The provision was sought because it protected the position of disabled people and recognised their right to remain in their own homes if at all possible. Where a disabled person has a variety of needs and it is necessary to arrange a complicated package of care, it would often be much simpler to place the person in a residential care home or some other form of institutional care. It was because of that that the special provision for day and domiciliary services was introduced. The amendment would undermine the position by putting residential care on the same basis as day and domiciliary care by virtue of the 1976 Act.
When a local authority assesses a person as needing residential or nursing home care, by virtue of that assessment it has concluded that it is not possible for the person to be supported in his own home and that it is therefore necessary to provide or arrange provision of the accommodation concerned. For those reasons I do not feel that the amendment proposed by the noble Lord is required and I ask him to withdraw it.
Lord Ennals: That was not a reply at all. However, it is half-past eleven and no one expects me to press the amendment. I hope that the noble Baroness will recognise—
Baroness Blatch: Does the noble Lord not agree that it is preferable, if at all possible, to keep such persons in their own home and that that should be the first priority? Only if that is not possible should residential care be resorted to. The amendment precludes that.
Lord Ennals: I submit that that is not the case. The amendment clearly states that the local authority,
"with the consent of the said person"
shall make the necessary arrangements. If the local authority could require that a person should go into a residential home, I should not support the amendment. It clearly establishes that a person would not go into residential care against his or her wishes but would have that right if it was so desired.
As I said, I shall not press the amendment to a Division but I am totally dissatisfied with the reply. I shall consult with other Members of the Committee whose names are appended to the amendment as to how we can return to the matter at a later stage. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Lord Pestons Lord Pestons moved Amendment No. 115ZB:
After Clause 45, insert the following new clause:
("Duty to take account of users background.
In preparing and publishing its plan for community care services under section 44 above, and in carrying out any assessment or making any decision under section 45 above, or providing any services or arranging for the provision of any services under section 45 above, or in monitoring or inspecting any services under any part of this Act, the local authority shall give due consideration to the religious persuasion, racial origin, gender and cultural and linguistic background of the persons for whom they may provide or arrange for the provision of community care services.").
The noble Lord said: This amendment addresses two matters. Again, perhaps they should have been separated. The first matter concerns considerations which arise in connection with the plans for community care services. I hope that I need not emphasise again how much we approve of the idea of having such a plan. In preparing and publishing its plan, one is saying that the local authority should take fully into account the society in which it finds itself.
If one reads the amendment carefully, one sees that it refers to making specific assessments. Again, when making specific assessments it is necessary to take into account the appropriate characteristics of the people concerned. Obviously a local authority behaving sensibly would do that. There is no doubt in my mind in that regard. It would certainly do it for the individual. It will be noted that I said "behaving sensibly".
However, it is regrettable that in community care people make assumptions about other people which are quite unwarranted; people whose racial background is different, who have rather esoteric religious beliefs or other special characteristics. People make assumptions and are often insensitive in so doing. None of us doubts that. The question therefore is how we should deal with it. I always look forward to hearing what the Ministers say, but as I have said before. I could easily write their replies in terms of their view that the amendment is not needed. My view is that it is needed.
I return to the point with which I am extremely taken —the idea of guidance. I have now become fully committed to guidance. It will be the basis of all future legislation. I must advise noble Lords that when we on this side of the Chamber are in power in the very near future we shall base our approach
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on guidance and not waste time on legislation or anything trivial of that sort. Guidance seems to me to be the way to get things done in the way one wants them done.
That may sound somewhat cynical, but we require some assurance from the Government that they take very seriously the point that it should not be assumed that all people are standard, ordinary people and do not have special needs and—I emphasise this—special sensitivities. The point which was put to me was that although we may agree that it makes perfectly good sense to behave in that way, there is a fair amount of insensitivity in this area and one would like to see some leadership, some guidance, coming from the Government on these matters. I beg to move.
Baroness Faithfull: I support the amendment and shall make just one point. In dealing with the various people who require help, if they want a particular sort of service—for example, a woman from the Middle East who does not want to go to a hospital where there are men, who does not want a male doctor and there is no suitable hospital in the area—it is very easy, when one is busy, to say that there is no other service. One must make some effort to find them a place, even if it is out of the area. The amendment was suggested to us by the National Council for Voluntary Organisations. We support it from the standpoint of gender, religious persuasion and the point of view of women.
Baroness Blatch: We appreciate the friendly atmosphere in which these amendments are being discussed but the remarks of the noble Lord, Lord Peston, belie the enormous amount of work and thought that have gone into the responses from these Benches.
The Government fully endorse the aim of the proposed clause. It is noteworthy to point out that paragraph 2.9 of Caring for People states:
"The Government recognise that people from different cultural backgrounds may have particular care needs and problems. Minority communities may have different concepts of community care and it is important that service providers are sensitive to these variations. Good community care will take account of the circumstances of minority communities and will be planned in consultation with them".
No such clause was included in the Bill because the obligation to carry out an assessment of need can be taken to require giving due consideration to the various factors listed. We do not believe that it would be helpful to put on the face of the Bill the need to take them into account and are therefore not prepared to support the inclusion in the Bill of a clause on these lines.
If the noble Lord will withdraw his amendment I can assure him that the need to account for these important social factors will be reinforced in the guidance.
Lord Peston: I thank the noble Baroness for her reply. I am delighted to discover that not only work but thought has gone into preparing the Government's case on these and related matters. I shall not reminisce on my own happy days in the public service, and so on.

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I was particularly delighted to hear the coda, so to speak, of the reply from the noble Baroness. I agree with her that good practice will be along those lines and if guidance, or indeed guidelines, are chosen we would find that most satisfactory. Having heard the reply, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Baroness Masham of Ilton Baroness Masham of Ilton moved Amendment No. 115ZC:
Alter Clause 45, insert the following new clause:
("Payments for purchase of care or personal assistance.
Notwithstanding the provisions of section 29(6) of the National Assistance Act 1948, a local authority, having regard to any guidance issued by the Secretary of State, may make payments to a disabled person for the purchase of care or persona assistance services.").
The noble Baroness said: This amendment would enable local authorities to make payments directly to disabled people so that they can make their own care arrangements. In another place the Minister, Mrs. Bottomley, said that she would reconsider the proposal because the issue is complex.
There are a number of local authorities that already make such payments, either directly to disabled people or via a charity such as the Spinal Injuries Association. Shropshire, Hampshire, Kingston, Somerset, Staffordshire, Westminster and Tower Hamlets are, to name but a few, places where this occurs and the arrangements work extremely well. Therefore, I hope that we shall hear some good news tonight. I beg to move.
Lord Henley: Earlier this evening the noble Lord, Lord Allen, asked the Government to accept a few amendments but I am afraid that I cannot go quite as far as that. However, I hope that I can assist the noble Baroness.
The noble Baroness reminded the Committee that a similar amendment was considered by another place and, as she knows, at that time my honourable friend the Minister for Health agreed to take the amendment away and consider it. I have to say that consideration is still in progress and that we are not in a position to bring forward a government amendment at this stage. Nevertheless, I listened to what the noble Baroness said and I assure the Committee that if it is at all possible we shall bring forward a government amendment at a later stage. On the understanding that we shall do all that we can to that end, I ask the noble Baroness to withdraw her amendment.
Lord Ennals: Before the noble Baroness withdraws the amendment, as I am sure she will, perhaps I may point out that it is a long time since that statement was made. I do not have the exact date—I have the wording—but it must be over two months ago that the Minister gave that assurance. Knowing that the amendment was to come before the Committee, I should have thought that at the very least the statement would have been turned into a conclusion, either positive or negative. For the Government to take two months and still not be able to make up their mind on the issue which the Minister was
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prepared to recognise had some merit does not seem to be satisfactory or even courteous to this Chamber.
Lord Henley: I hope that we are not being discourteous to this Committee. As I said consideration is still in progress and we are giving the matter much thought.
Baroness Masham of Ilton: I feel a glimmer of hope. As two stages of the Bill remain I hope that we shall be able to speed up the Government into doing something. I take this opportunity to say that disabled people come a long way down the list and they have to wait. One article from the Spastics Society written by a girl says, "I spend my life waiting". I hope that we do not have to wait too long. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendment No. J15ZCA not moved.]
11.45 p.m.
Lord Carter Lord Carter moved Amendment No. 115ZCB:
After Clause 45, insert the following new clause:
(".—For the avoidance of doubt, a disabled person within the meaning of the Disabled Persons (Services, Consultation and Representation) Act 1986 includes, inter alia —

(a) a person who is now or was recently dependent upon alcohol or drugs;

(b) a person who has any HIV related disease;

(c) a person who has the Acquired Immune Deficiency Syndrome; and

(d) a person who suffering from any mental disorder, or handicapped as a result of any previous mental disorder, and in particular any dementia, including Alzheimer's Disease.").

The noble Lord said: I shall brief. This is a probing amendment to seek an important elucidation of the Bill. The proposed new clause aims to clarify that people with drug or alcohol dependency, with HIV infection or AIDS, or people who are suffering from mental disorder or dementia, are entitled to community care services, and that services for people in these categories should be included in community care plans. Neither the White Paper nor the Bill is clear on that point. We are seeking assurance from the Minister that in the Government's view these categories of people are covered by the disabled persons Act 1986.
It seems that the Government's intention is that people with drug and alcohol problems should fall within the scope of the Bill. This is confirmed by paragraph 2.8 of Caring for People, which states:
"People with drug and alcohol related disorders … may also need community care at some time".
Also, because most residential alcohol projects are registered under the Registered Homes Act 1984, they fall within the change of funding structures set out in the White Paper. It is further clear that much of the work that is carried out by alcohol projects falls within the category of social care.
The Bill as framed makes references to previous Acts. It mentions specific groups, but nowhere among these references are alcohol or drugs included. In most areas alcohol projects receive little or no priority from social services departments, and this position will be unfairly reinforced unless the Bill

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clearly demonstrates the inclusion of alcohol within the scope of its provisions. The duties of local authorities to assess need and provide services for people who are vulnerable and in need of community care services, but who are not considered to be disabled within the meaning of the disabled persons Act 1986, are less clear and seem to rest much more on local authority discretion.
We can all agree, I think, that community care services are required for individuals in all the categories I have mentioned, and for their carers. There is concern that in the context of limited resources and the stigma frequently attached to people with drug or alcohol dependency, HIV, AIDS, or mental disorder, they may be given a lower priority and may not receive the community care services that they need. We are asking for clarification to ensure that these conditions are included in the community care plans. I beg to move.
Baroness Hooper: We touched on these arguments when discussing Amendment No. 113AP earlier and indeed Amendment No. 108AF last Tuesday. The essential thing to remember is that if people are sufficiently affected by their illness or dependency, whatever that may be, and certainly not confined to those mentioned in this amendment, then they will come within the existing definition in any event. I am talking of course about the definition provided by Section 29 of the National Assistance Act 1948, which specifically refers to people who are substantially and permanently handicapped through illness and injury or for other reasons.
The definition is deliberately cast in broad terms with the aim of being as inclusive as possible and related to a degree of severity rather than to a particular condition. This should ensure that people suffering from a comparable level of disability are treated as disabled people, with all that that entails in terms of the legal rights that they enjoy, regardless of the condition, or conditions, from which they suffer. In short, it is not so much a question of what the person is suffering from but the degree of disability that results which is covered by this provision. I hope that that helps the noble Lord.
Lord Carter: The problem with drug and alcohol dependency is that people seem to be cured and then they relapse. A substantial and permanent disablement is the question at issue. I shall read what the Minister has said. In the meantime, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 52 [Duty of local authority to make assessment of needs]:
[Amendments Nos. 115ZD and 115ZE not moved.]
Lord Carmichael of Kelvingrove Lord Carmichael of Kelvingrove moved Amendment No. 115A.
Page 55, line 37, at end insert ("shall consider representations by the person concerned or his representatives; and").
The noble Lord said: We have reached the end of the work for this evening. I intend to be extremely
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brief in dealing with the last three amendments. Amendment No. 115A has been referred to in other contexts outwith the Scottish section. I am concerned to hear a reply from the Minister so that we can pursue the matter at a later date.
It is self-evident that in regard to anyone who is going to be assessed, consideration should be given to representations that they make or that are made on their behalf. It is a question of natural justice. I beg to move.
Lord Sanderson of Bowden: I share the noble Lord's concern that proper regard should be paid to the wishes of individuals being assessed and their carers. One of the underlying reasons for the reform of the community care services which the Government have set in hand is to secure increased choice and more appropriate forms of care. In seeking to achieve that position, there should be no doubt that local authorities will need to listen carefully to the views of the people being assessed. That requirement is stated specifically in Chapter 10.5 of the White Paper.
We do not believe, however, that it is necessary or appropriate to write that kind of provision on to the face of the Bill. It is one of the range of matters which we believe should be subject to guidance—I notice that the noble Lord, Lord Peston, is not in his place; he will not be disappointed—from the Secretary of State which local authorities are required to follow under the existing legislative provisions on such matters.
The Secretary of State will have reserve powers of direction which he can use, if necessary, to ensure that local authorities have discharged their functions in the manner required of them under central guidance. My right honourable friend the Secretary of State for Scotland is currently drawing up a draft guidance on assessment. We propose to carry out full consultation with all interested parties, including representatives of users and carers.
I can assure the noble Lord that this guidance will make clear reference to the position of persons being assessed and their carers. With that assurance, I hope that the noble Lord can withdraw his amendment.
Baroness Masham of Ilton: I should like to ask one question. What happens if local authorities do not take notice of the guidance given in the guidance lines?
Lord Sanderson of Bowden: The Secretary of State for Scotland has reserve powers to require them to do so.
Lord Carmichael of Kelvingrove: I should like to thank the Minister for his very helpful reply. He has met all of the points except that raised by the noble Baroness just now. We always wonder what the powers are and how the ordinary citizen is able to stir up those reserve powers. I shall study the reply. In the meantime, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendments Nos. 115AA and 115AB not moved.]
Lord Carmichael of Kelvingrove Lord Carmichael of Kelvingrove moved Amendment No. 115B:
Page 55, line 41, at end insert ("and
(c) shall notify the person or his representatives of the result of the assessment, and shall consider representations aga nst the decision, made within 28 days of its date of issue.").
The noble Lord said: It may be for the convenience of the Committee if I speak at the same time to Amendment No. 115CA. It is a matter of natural justice that the person who has been assessed should be notif ed of the results but there should be some method by which the assessing body can hear any appeal, complaint or representation from the person being assessed. That is the intention behind Amendment No. 115B.
I now turn to Amendment No. 115CA, which seeks to ensure that the person being assessed shall have an opportunity to make representations and that there shall be a procedure by which he can make representations. It will then be clear to everyone that the 28-day period suggested in the amendment shall not be eroded by the wrong procedure being adopted by the applicant. I beg to move.
Lord Sanderson of Bowden: I thank the noble Lord for proposing the amendments. I shall be slightly longer in my reply because it is an area which requires a little explanation.
Amendment No. 115B seeks to impose in the Bill detailed requirements about matters which we believe would be better covered in guidance or, where necessary, by directions from the Secretary of State. In the case of representations about an assessment, it covers some of the same ground as government Amendment No. 113BDA about complaints which was passed earlier today.
The Bill would become long and complex if we included what are essentially administrative or good practice matters relating to the exchanges between the local authority and people whose needs it is assessing. But, more serious than that, it would establish a rigid structure for assessments and other aspects of community care which would inhibit the development of good practice and flexibility in the light of local circumstances. We believe that many detailed matters of this kind should be sorted out at local level in the light of general guidance.
There may be a place for time limits in the response which the local authority has to make in the light of representations about services. This will be considered as one of the issues to be covered in our forthcoming consultation paper on the complaints procedure. I can assure the noble Lord that the Government accept the need for guidance and safeguards in the assessment procedure and in the provision of services but we remain of the view that these matters are better kept out of the legislation. I hope that I have said enough on the first amendment to convince the noble Lord of the Government's sincerity in dealing with this part of his concern.
For reasons I shall explain, Amendment No. 115CA could well create an unnecessary complication in the local authority's assessment arrangements. The first half of it allows people to
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make representations about every assessment, even before they know what services might be made available. The second half of it creates an absolute right for individuals or their representatives to require reviews, apparently without limit of number or frequency. I shall take each in turn, because different arguments apply to each.
First, we agree that assessments should take account of the views of the individuals who are being assessed. I can give a firm assurance that this will be addressed in the guidance to local authorities which we are currently preparing.
Turning to the second part of Amendment No. 115CA, I agree too that the local authorities will need to review the needs of people receiving care. My difficulty is with the question of frequency. Sometimes these reviews will require to be frequent, other times less so, depending on the needs of the individual. The question of frequency is not something for legislation but for good practice backed by general guidance on the question of maximum intervals between assessments. I fear that the requirement for a review under this well-intentioned amendment could be used mischievously to overload local authorities with unnecessary reviews.
But I believe that the Government's new complaints procedure which we discussed earlier meets the noble Lord's point. It allows a person to complain or make representations; and as a safeguard for the complainer's position it creates a local authority duty to listen and respond. A right to claim a review would cut across our new complaints procedures by requiring the local authority to carry out such a review even if it has done exactly that only a very short time before.
I cannot agree to accept that Amendment No. 115CA should be written on to the face of the Bill. However, I shall consider whether the guidance which we propose to issue to local authorities should be backed up by directions under Clause 48 as a long stop. We shall have to consult the bodies involved about that proposition. But if following the consultation we conclude that a direction would be helpful we shall certainly act upon that conclusion. In the light of that assurance I hope that the noble Lord will consider withdrawing his amendments.
Lord Carmichael of Kelvingrove: I thank the Minister for that very full reply. However, I am sure he will realise that I, and others, will need to study it with care. It is always interesting when what one assumes to be a fairly simple and straightforward amendment, which will be of benefit to everyone, turns out to be a matter of great puzzlement. Nevertheless, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendment No. 115C had been withdrawn from the Marshalled List.]
[Amendments Nos. 115CA and 115CB not moved.]
Baroness Hooper Baroness Hooper moved Amendment No. 115CBA:
Page 55, line 45, at end insert:
("(2A) If, while they are carrying out their duty under subsection (1) of this section, it appears to a local authority that there may be a need for the provision to any person whom that subsection applies —

(a) of any services under the National Health Service (Scotland) Act 1978 by the Health Board —

(i) in whose area he is ordinarily resident; or

(ii) in whose area the services to be supplied by the local authority are, or are likely, to be provided; or

(b) of any services which fall within the functions of a housing authority (within the meaning of the section 130 (housing) of the Local Government (Scotland) Act 1973) which is not the local authority carrying out the assessment,

the local authority shall so notify that Health Board or housing authority, and shall request information from them as to what services are likely to be made available to that person by that Health Board or housing authority; and, thereafter, in carrying out their said duty, the local authority shall take into account any information received by them in response to that request.").
On Question, amendment agreed to.
[Amendments Nos. 115D to 115DB not moved.]
[Amendment No. 115DC had been withdrawn from the Marshalled List.]
Clause 52, as amended, agreed to.
Baroness Blatch: I beg to move that the House do now resume.
Moved accordingly, and, on Question, Motion agreed to.
House resumed.

Associated British Ports (No. 2) Bill
Reported from the Select Committee without amendment and recommitted to an Unopposed Bill Committee; a Special Report was made and ordered to be printed.
House adjourned at two minutes past midnight.