National Health Service and Community Care Bill

HL Deb 10 May 1990 vol 518 cc1533-96

House again in Committee on Clause 44.

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 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 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 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 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 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 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 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 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 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 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) 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 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): 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 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 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 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.

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 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 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 moved Amendment No. 113BC:

Page 54, line 18, leave out ("or").

On Question, amendment agreed to.

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 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—

1. (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;
2. (b) any person whose request for such a service has been refused by a local authority; or
3. (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—

1. (a) his parent;
2. (b) any person having parental rights in respect of him;
3. (c) any local authority foster parent; or
4. (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 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 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.

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 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 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.

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 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 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 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, 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 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 —

1. (a) that person is homeless; and
2. (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 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.

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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 —

1. (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
2. (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 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 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 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.

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 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 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 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 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 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 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—

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

a local authority 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 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 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.

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 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 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 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 —

1. (a) a person who is now or was recently dependent upon alcohol or drugs;
2. (b) a person who has any HIV related disease;
3. (c) a person who has the Acquired Immune Deficiency Syndrome; and
4. (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 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 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 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 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 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 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 —

1. (a) of any services under the National Health Service (Scotland) Act 1978 by the Health Board —
1. (i) in whose area he is ordinarily resident; or
2. (ii) in whose area the services to be supplied by the local authority are, or are likely, to be provided; or
2. (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.