Lords Sitting of 14 May 1990

Preamble
The House met at half-past two of the clock: The CHAIRMAN OF COMMITTEES on the Woolsack.
Prayers—Read by the Lord Bishop of Chester.

Israel: Detainees
Lord Mayhew Lord Mayhew asked Her Majesty's Government:
What representations they have made to the Israeli Government for the release of persons kidnapped and held in Khiam prison.
Lord Reay: My Lords, we have not made specific representations to the Israelis on the Khiam detainees. The Israeli authorities are fully aware of our long-held opposition to the presence of Israeli forces in South Lebanon. We have consistently sought their complete withdrawal. Our policy on the taking of captives by anyone anywhere is well known.
Lord Mayhew: My Lords, I thank the Minister for that reply. Is he aware that the taking of hostages by the Israelis is one of the reasons given for not releasing Western hostages in Lebanon? Further, should not the Government make quite clear to the Israelis that their hostage taking is not only a crime in itself but is also making the task of obtaining the release of Western hostages more difficult?
Lord Reay: My Lords, we call for the release of all hostages in the Lebanon by whomever and wherever they are held. The Israeli and the United States governments have recently denied having any discussions about the possible release of Khiam captives in return for the release of Western hostages.
Lord Cledwyn of Penrhos: My Lords, can the noble Lord be more specific and say whether Her Majesty's Government think that the release of the prisoners at Khiam could have a bearing on the release of Western hostages? If the answer to that question is
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in the affirmative, is there not therefore a case for Her Majesty's Government speaking to the Government of Israel on the matter?
Lord Reay: My Lords, the noble Lord will appreciate that although the question is timely, this is a very delicate moment. I must be cautious in anything I say. Our efforts are concentrated upon trying to secure the release of British hostages and other Western hostages. They will continue unabated. We follow up every lead both in London and in Beirut, and indeed that is a principal reason why our embassy staff have remained there throughout a very dangerous and difficult period. We shall continue to maintain and use every contact which we think may possibly bring results.
Lord Cledwyn of Penrhos: My Lords, I am much obliged to the noble Lord. If this is a sensitive matter, I do not wish to press it further at present.
Lord Beloff: My Lords, I must press my noble friend the Minister a little further on the issue of Western hostages. Will he confirm that the Israeli Government have publicly stated more than once that they will return these prisoners if Israelis held in Arab hands are returned? Does he agree that this really has nothing to do with the question of Western hostages?
Lord Reay: My Lords, the Israelis said that the prisoners in Khiam prison are held on suspicion of involvement in resistance operations in the security zone against the South Lebanese and Israeli armies. On 1st May an Israeli MoD spokesman acknowledged publicly that some, if not all, are held pending the release of Israeli servicemen missing in Lebanon.
The Lord Bishop of Chester: My Lords, is the noble Lord aware that this House would warmly support the Government in any steps they take to persuade all governments with influence to use that influence to bring about the release of all hostages in Lebanon, whoever holds them and whatever faith and allegiance they may have? Will he reassert the

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British Government's recognition that the grief of the families is the same whatever the religious faith or allegiance of the hostages?
Lord Reay: My Lords, I am grateful to the right reverend Prelate for his remarks. Everyone in this House realises the position of the hostages and their families and appreciates the cruelty of their ordeal.
Baroness Phillips: My Lords, is the noble Lord aware —and this also applies to the noble Lord who tabled the Question—that Israel has no direct responsibility for this Lebanese prison? Is he also aware that the people held there could certainly not be compared with hostages in any way?
Lord Reay: My Lords, Khiam is run and controlled by the South Lebanese army. We believe that Israel would have a decisive influence on the conditions and on the freeing of those prisoners.
Lord Molloy: My Lords, will the Minister agree that nations which have had their people taken as hostages, as we have, and countries that hold hostages or influence the holding of hostages must now make an ultimate endeavour to ensure that talks take place with the object of securing the release of these people who have suffered so much for so long?
Lord Reay: My Lords, we hope that there has been some progress in the release of hostages. We also hope that the recent releases will be the first step towards the freedom of all hostages held in Lebanon.
Lord Mayhew: My Lords, I appreciate the difficulty in which the Minister finds himself in fully answering these questions. However, does he recall the official statement from the Iranian foreign minister that the kidnapping by the Israelis of Sheikh Obeid and others is a relevant part of the question of solving the hostage problem? Further, is not another obstacle to obtaining the release of Western hostages the substantial evidence which has now been accumulated that the Israelis are condoning the systematic use of torture in this prison?
Lord Reay: My Lords, we are concerned at reports received from humanitarian organisations, including Amnesty International, relating to ill-treatment of the Khiam prisoners. We call on the Israeli authorities to exercise their influence with the South Lebanese army to improve conditions at the prison. We shall take an early opportunity to raise the matter with the Israeli Government.
Baroness Phillips: My Lords, I must ask the Minister whether the record shows that the Israelis are not responsible for that prison. That is a vital point which I should have thought the Minister would have mentioned in his first Answer.
Lord Reay: My Lords, with respect, I believe that I have answered that question.

The Inflation Rate
2.43 p.m.
Lord Donoughue Lord Donoughue asked Her Majesty's Government:
What is the annual rate of inflation to April 1990; and what was the equivalent annual rate of inflation to April 1979 announced in May 1979.
The Paymaster General (The Earl of Caithness): My Lords, the all-items RPI annual inflation rate for April 1990 is 9·4 per cent. The comparable rate for April 1979 was 10·1 per cent.
Lord Donoughue: My Lords, I thank the Minister for that Answer. I note that after 11 years of the crusade against inflation the change is just a few decimal points. I again ask the Minister whether the Government will concede that the Chancellor's Budget forecast for end year inflation will once again be wrong and for the third year in succession be an underestimate.
The Earl of Caithness: My Lords, I am aware that the noble Lord is disappointed that the present inflation rate is not above 10.1 per cent. We stick by the Chancellor's forecast of what the inflation rate will be at the end of the year.
Lord Hailsham of Saint Marylebone: My Lords, does my noble friend agree that any change in economic policy takes between two and five years to work through to the economy and that therefore the precise date in the original Question totally lacks relevance to anything?
The Earl of Caithness: My Lords, I appreciate that economic policy takes a long time to work, but if one is asked a Question, one must answer it.
Lord Stoddart of Swindon: My Lords, is it not clear that the Government's policy of high interest rates is not working? Is the Minister aware that figures published today show that factory-gate prices rose by one whole point last month, and that the retail sales figures show that retail spending is still increasing? Is it not clear that high interest rates are not the right medicine? Will the Government do something more to control credit, which is causing the problem at present?
The Earl of Caithness: My Lords, no, interest rates are the right policy with which to deal with this problem. Consumer credit control does not work except in the short term, and then it leads to massive distortions, as every country has found. If the noble Lord looks at the key markets, such as the retail sales market, he will find —not on a monthly basis because that is the wrong way to look at such figures, but on a three-monthly basis—that in the last three months compared with the comparable three months a year ago, retail sales are up 1.5 per cent. The noble Lord will also be aware that car registrations are well down and the housing market is flat, which show that high interest rates are working.
Lord Boyd-Carpenter: My Lords, will my noble friend remind the noble Lord, Lord Donoughue, that when recently asked on radio how he would deal with inflation, the leader of his party said that, to cut a long story short, he did not know?
The Earl of Caithness: My Lords, my noble friend is correct, but we can appreciate the difficulties of those who have to operate in a thought-free zone.
Viscount Hanworth: My Lords, for a long time we have been told that the Government's priority was to reduce inflation. They have clearly not done so. One mus. wonder how much trust one can put in their other aspirations.
The Earl of Caithness: My Lords, we clearly have reduced inflation. The noble Viscount's memory must, alas, be extremely short. He does not have to think that: far back to the days when inflation was well into double figures and up into the 20s. As the noble Viscount will be aware, the recent monthly figures have been distorted by two items which are not taken into account in other European countries. One is the community charge. In that, no allowance is made for the generous government rebates which are not taken into account when calculating the RPI. Secondly, in the Community no country other than Ireland includes mortgage interest payments.
Lord Boardman: My Lords, will my noble friend put those figures in context? What has been the annual average rate of inflation in the United Kingdom since May 1979? How does that compare with the annual average rate of inflation of the 12 European Community countries during the same period? Secondly, how does it compare with the record of the previous Labour Government?
The Earl of Caithness: My Lords, the previous Labour Government's average increase in RPI was 15.5 per cent., whereas ours is 7.9 per cent. That may be slightly misleading because if one takes out mortgage interest payments, the matter becomes more relevant. On that basis, the Labour Government's average was 15.6 per cent. and ours is 7.4 per cent. One can see that the current inflation rate of 7.9 per cent., excluding mortgage interest payments, is about only 0.25 per cent. above the lowest that Labour ever achieved. In comparison to Europe, in the 10-year period betwen May 1979 and February 1990 our inflation rate—that is, our headline inflation rate—was 0.1 per cent. above the EC average. If one works that out on a comparable basis—I said earlier that one has to remove the community charge or the rates, as they were, and mortgage interest payments—one finds that our inflation rate was 0.7 per cent. lower than the Community average.
Lord Stallard: My Lords, does the Minister recall that in reply to a previous question he told us that it takes between five and 10 years for any change to work its way through? Yet a few moments ago he told us that the immediate effects resulted from the poll tax and other taxes. It did not take any time for the mortgage and poll tax increases to be seen in the
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rise in the inflation rate. They showed up almost immediately, not within the five to 10 years mentioned.
Is the Minister aware that I am more concerned that the recent increases in the retirement pension were pitched at 7.6 per cent., as always a couple of per centage points below the current rate of inflation? Have the Government any plans to review the recent pension increases to bring them in line with inflation?
The Earl of Caithness: My Lords, the increase in the rate of inflation between September 1989 and April 1990, as the noble Lord well knows, will be reflected in the next uprating of benefits.
Lord Jay: My Lords, if the Minister believes that the mortgage rate should be taken out of the RPI, does he also believe that rents should be removed?
The Earl of Caithness: My Lords, the noble Lord will know that some countries charge nothing for owner-occupied or tenanted property costs. Some do. I was trying to give a truer comparison than using the headline rate.
Lord Orr-Ewing: My Lords, can my noble friend remind the House when it was under a Labour Government that inflation hit just over 27 per cent.? Is it not true that, as a result of that government going on bended knee to the IMF and making savage cuts in all the public services, they began to get the rate under better control? However, it was even then much higher than today.
The Earl of Caithness: My Lords, I think that the date for which my noble friend is looking is August 1975, when the rate reached 26.9 per cent. That shows just how high it went. I have explained on numerous occasions, not only today, how much better it is under our Government than under the Labour Government.
Lord Mayhew: My Lords, is the noble Earl aware that an important section of opinion in this House considers that the handling of inflation by both main parties has been grossly incompetent?
The Earl of Caithness: My Lords, I agree with the noble Lord that the current rate of inflation, both the headline and the underlying rate, is far too high. That is why we shall get it down.
Lord Bruce of Donington: My Lords, is the noble Earl aware that we welcome the fact that the rate of inflation today is marginally lower than it was when his Government took office? Nevertheless does he accept that after 11 years, the achievement of a balance of payments deficit of £22 billion in place of a surplus of £200 million when the Government took over is less than impressive? Bearing that in mind, is he prepared to say that the Government's battle against inflation is an economic miracle at this time?
The Earl of Caithness: My Lords, this Government's battle against inflation is never done.

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It is top of my priorities. We shall continue to fight it and it would be quite nice to hear from noble Lords opposite whether the Labour Party has a policy on it.
Lord Donoughue: My Lords, I have listened to the Minister's sterling defence. Has he read the latest Bank of England Quarterly Bulletin? It states that inflation will remain at around 10 per cent. through to the end of the year. If he has read it, do the Government agree or disagree with the Bank of England?
The Earl of Caithness: My Lords, I agree with the statement of the Bank of England that economic policy is back on track.

European Commission: Financial Scrutiny
2.54 p.m.
The Earl of Kinnoull The Earl of Kinnoull asked Her Majesty's Government:
Whether they would support the extension of the European Parliament's powers to investigate payments by the European Commission to interest groups within and outside the Community.
Lord Reay: My Lords, we can see the case for extending the Commission's financial accountability to the European Parliament. The European Parliament's Budgetary Control Committee is already responsible for scrutinising the Commission's financial management.
The Earl of Kinnoull: My Lords, I thank my noble friend for that Answer. Can he say, following the debate last July initiated by the noble Baroness, Lady Robson, on the report on fraud in the Community, vhether the task force promised by the Commission has now been set up? Further, has there been any reaction by the Commission to the excellent recommendations set out in that report?
Lord Reay: My Lords, the anti-fraud unit to which my noble friend referred was set up last year by the Commission. It published its first annual report earlier this year, which focused on reporting fraud and simplifying legislation. The group of experts has also been set up under the same initiative and has already succeeded in cutting the number of product classifications, particularly in the meat sector.
Lord Cledwyn of Penrhos: My Lords, can the noble Lord tell the House the amount of money paid to British interest groups by the European Commission? What criteria had to be satisfied before those payments were made?
Lord Reay: My Lords, I am afraid that I have no information with me on the amounts of the payments made to interest groups. I shall happily find that out and let the noble Lord the Leader of the Opposition know about it. I shall possibly place a copy of the information in the Library.
The Earl of Kinnoull: My Lords, is the subject of improved scrutiny of the Commission's work likely to be on the agenda of the inter-governmental conference next December?
Lord Reay: My Lords, the agenda has not yet been set for the inter-governmental conference set up for next December to discuss economic and monetary union. At the Dublin Council on 25th and 26th June a decision will be taken on whether to set up at the same time another inter-governmental conference on political union. Meanwhile, the Foreign Ministers of the member states are examining the options for political union. They will report to the Dublin Summit. One of these issues will undoubtedly be the increasing efficiency of the Community institutions. It will cover the subject of any possible changes in the relationship between the European Parliament and the Commission. We shall have our own constructive ideas to put forward on trying to ensure that the Community's institutions are made more effective and more efficient.
Lord Stoddart of Swindon: My Lords, is the noble Lord aware that some people might be puzzled about this Question? Who are the "interest groups" within and outside the Community? Can he give us a list of them?
Lord Reay: My Lords, I believe that there is a very long list of interest groups which receive assistance from the Commission. I do not have that list with me, as I indicated in my reply to the noble Lord the Leader of the Opposition. However, I shall make one available to the House.

NHS Nursing Strength
2.57 p.m.
Lord Molloy Lord Molloy asked Her Majesty's Government:
How they are combating the shortage of nurses in the United Kingdom, and whether they will ensure that foreign nurses employed to make up this shortfall will not be exploited.
Barones Blatch: My Lords, there is no national shortage of nurses in the National Health Service. A survey by the Office of Manpower Economics showed that at 31st March 1989, 3·2 per cent. of all qualified nursing posts in Great Britain had been vacant for three months or more, compared with 3·3 per cent. in 1988. The number of nursing staff employed in the National Health Service rose by 13·2 per cent. between 1979 and 1988. Even after allowing for the change in working hours from 40 to 37 ½ in 1980–81, the increase is still over 6 per cent.
Obviously there will always be recruitment difficulties in particular areas and specialties. However, the declining numbers of school-leavers over the next few years has implications for the National Health Service.
Lord Molloy: My Lords, does not this flurry of figures constitute a hopelessly inadequate reply to a question about the chronic shortage of nurses in the

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NHS? I am willing to challenge the Minister to say so if I am incorrect, but I believe that this shortage can be testified to by the Royal College of Nursing and the major royal colleges, which are all woefully aware that there is a chronic shortage of trained nurses. The Government's response is to try to get agency nurses, which costs £33 million more per year. They go to EC countries and non-EC countries, and is the noble Baroness aware that they even go as far as Hong Kong? Many of the so-called nurses recruited are far below our standards; some of them have no proper salary. All this constitutes a threat to the National Health Service.
Baroness Blatch: My Lords, the facts simply do not bear out anything that the noble Lord has just said. I shall deal with just one inaccurate figure that the noble Lord gave concerning agency staff. Of all staff employed in the National Health Service only 1.5 per cent. are agency nurses and of that figure 83 per cent. are employed in Greater London. As I said in my initial Answer, there will always be particular difficulties with specialisms in certain areas, but the facts that. I gave in that Answer do not bear out anything that the noble Lord has said.
Baroness Ewart-Biggs: My Lords, is the Minister aware that the National Health Service loses married nurses with children because of the low rate of child care and creche provision that is made? Will the Minister say what the Government think about that?
Baroness Blatch: My Lords, it is true that nurses leave the health service for retirement, pregnancy, family reasons and other reasons. However, the figures again show that there has been a net gain to the nursing service. Some 24,200 nurses a year leave nursing in England but in 1988 to 1989 that figure was mors than covered by 16,400 new nurses qualifying. In addition, 9,700 nurses returned to nursing. That made a total of 26,100 nurses. That represents a net gain to the nursing service.
Lord Dormand of Easington: My Lords, what are the specialties in which there are shortages and what are the Government doing about that?
Baroness Blatch: My Lords, I can list a number of things the Government are doing as regards improving recruitment and retention of nurses. A massive advertising campaign is being conducted and has already produced 170,000 inquiries about nursing as. a career. There are a number of district health authorities which are targeting mature entrants and re-entrants to the service. Pay has increased in real terms by 43 per cent. There is a pilot scheme of flexible pay arrangements which enables more money to be paid for particular specialisms and scarce specialisms. There are local initiatives, flexible working, job sharing schemes and child care schemes. The Department of Health is supporting the Open College's return to nursing project which is offering a package of resource materials that will be launched in September. I could go on.
Lord Dormand of Easington: My Lords, my main question was: what are the specialties in which there are shortages? May I have an answer to that question, please?
Baroness Blatch: My Lords, I referred to particular shortages. I have described some of the ways in which those shortages are being addressed by different district health authorities. A considerable amount of work is being carried out in this respect.
Lord Ennals: My Lords, is the Minister aware that I am amazed by her Answer? If there is no shortage of nurses, why has she referred to a massive advertising campaign to recruit more nurses? Further, has the Minister seen the report that was published today which showed that in every single region there is a grave shortage in the number of nurses being recruited? This is more serious in some regions than in others. Did the Minister also see the statement made by the general secretary of the Royal College of Nursing which emphasised the problem of the shortage of nurses and the need to improve conditions, not just pay but also creche facilities and opportunities for part-time work? Those facilities have proved to be absolutely inadequate. I am amazed by the Answer the Minister gave.
Baroness Blatch: My Lords, I have read the press reports published today. I believe they did a great disservice to the amount of work that is being carried out in many district and regional health authorities. I checked one of the reports concerning a health authority which was deemed to be the fourth worst in the country. I must report that that authority had 9,644 qualified staff in post at the end of March this year. That is 225 nurses up on the previous year. That figure represents the highest number of qualified staff at the end of the year. If one asks health authorities whether they are having difficulties in recruiting nurses, the answer is yes. However, if one asks them whether nurses are in post after many of the efforts that I have outlined have been made, the answer is that the nurses are in post.
Lord Auckland: My Lords, I have recently travelled in the Nordic countries, Australia and New Zealand. Is my noble friend the Minister aware that those countries have a far smaller population than this country but our nursing recruitment is much better per capita than that in those countries which have a nursing shortage, particularly in rural areas? Is she further aware that as regards exploitation.—
Lord Denham: That is two questions!
Baroness Blatch: My Lords, I believe I have covered the particular difficulties experienced by some local authorities. I have also outlined the enormous efforts that are being made by many district health authorities to improve recruitment and to face up to the difficulties that will occur when a shortage among the people available for nursing arises due to the fall in the numbers of 16 year-olds in the population.
Lord Wallace of Coslany: My Lords, will the Minister say what effect the payment of the poll tax by nurses has had on recruitment?
Baroness Blatch: My Lords, it is much too early to give a specific answer to that question. However, eventually all nurses will be trained under the auspices of Project 2000 and will receive the maximum relief for the community charge. If a special case were made for nurses it would discriminate quite considerably against many young people who earn the same as student nurses.
Lord Molloy: My Lords, will the noble Baroness be kind enough to consider contacting the Royal College of Nursing, the Confederation of Health Service Employees and the Royal Colleges of Physicians and of Surgeons to seek their views on what they feel is a chronic situation as regards the shortage of nurses? I think that is a fair proposition.
Baroness Blatch: My Lords, the department is in touch with all those bodies all the time. I believe that that is right and should continue. However, I also prefer to deal in facts.
Lord Mellish: My Lords, is the noble Baroness aware that some of us were intrigued by the statement in the Question that foreign nurses who are being employed to make up the shortfall may be exploited? As far as I can judge, the reply that the Minister gave has not resolved that problem. Is she further aware that if I had any evidence that such exploitation was occurring I would go direct to the Minister and would not waste my time putting down a Question?
Baroness Blatch: My Lords, I believe the remarks of the noble Lord were comments rather than a question. However, had that part of the Question been addressed, I could have proved that there was no exploitation of these young people.

Business
Lord Denham: My Lords, it may be for the convenience of the House to know that the Committee stage of the National Health Service and Community Care Bill will be adjourned at about 7 p. m. for about one hour and that during this adjournment the Report stage of the Property Services Agency and Crown Suppliers Bill will be taken.

National Health Service and Community Care Bill
3.7 p.m.
The Parliamentary Under-Secretary of State, Department of Health (Baroness Hooper): My Lords, I beg to move that the House do now again resolve itself into Committee on this Bill.
Moved, That the House do now again resolve itself into Committee.—(Baroness Hooper.)
On Question, Motion agreed to.
House in Committee accordingly.
[The CHAIRMAN OF COMMITTEES in the Chair.]
Lord Carter Lord Carter moved Amendment No. 115DD:
Before Clause 46, insert the following new clause:
("General duly of local authorities to consult
.—(1) Each local authority shall maintain a statement of their proposals to consult on the exercise of their functions under this Part with —

(a) users of community care services resident in the area of the authority;

(b) carers of such users;

(c) local community and voluntary organisations including organisations representative of ethnic minorities.

(2) In preparing or revising the statement, a local authority shall consult with those persons mentioned in subsection (1) above.
(3) The local authority shall publish the statement and take such other steps as are necessary to secure a wide knowledge of its contents in the area.").
The noble Lord said: In moving this amendment I wish to speak also to Amendment No. 115DF. There has been a general welcome from all sides for the Government's proposals for community care, certainly in principle. The Committee has helped to improve the initial proposals, particularly by agreeing to amendments regarding ring fencing, the timetable for implementation and assistance with start-up costs.
Amendments Nos. 115DD and 115DF seek to introduce into the Bill a new clause which imposes a general duty on local authorities to consult the users of community care services, the carers, the local community and voluntary organisations. Amendment No. 115DF requires organisations of disabled persons and any organisations which provide care for disabled persons to be consulted by local authorities. It seems an extraordinary omission that Clause 44 (2) should leave out disabled people from the list of bodies that should be consulted.
There is already a system of joint consultative committees which brings together health authorities, local authorities and voluntary organisations to plan community care services. The amendments seek to build on that system by ensuring proper consultation procedures as of right. Amendment No. 115DD specifically mentions ethnic minorities which are under-represented and have particular problems which need to be taken into account in the planning of community care.
We feel sure that the Government will either accept the amendment or offer to bring forward a substitute amendment because the Minister of State for Health, Virginia Bottomley, indicated at Committee stage in another place that that was the Government's intention. In that debate she said:
"Conservative Members are interested in the user, the consumer, the individual. We know that the individual could not care less whether care comes from the private sector, the voluntary sector or the local authority. Individuals want high-quality, good-value care, and that is what the Government will secure under the new regime… I should like Opposition Members to consult the writings of Tessa Jowell. She states time and again that the key to community care is to consider the interests of the consumers rather than the providers".—[Official Report, Commons, Standing Committee E, 13/2/90; col. 910.)
The amendments provide the opportunity to put those words of the Minister of State for Health into practice in the Bill.
The amendments also have particular importance in the light of the Committee's decision last week to accept amendments regarding ring fencing, the timetable for implementation and assistance with start-up costs. However, since those decisions last week it appears that the department's spin doctors have been at work. The press has been full of inspired briefings regarding possible delay in the implementation of community care. I quote from today's independent:
"The Government is considering delaying implementation of its care in the community proposals until after the general election, amid fears that they may prove a political and financial minefield. Despite widespread support for the changes, which from next April would see the councils take responsibility for co-ordinating community care for the elderly, handicapped and mentally ill people, ministers outside the Department of Health are more worried about the impact of these changes than they are over the more conteoversial NHS shake-up".
There have been a number of similar stories in several other newspapers.
The Government cannot say that they did not warn them. Today's debate provides the first opportunity for a Minister from the Department of Health to state the Government's position on the possible delay in the implementation of the community care proposals. When the Minister replies I hope that she will be able to tell the Committee, which surely has as much right to know as the press, whether the Government intend to delay implementation of the Bill's community care proposals. If the Government propose to allocate sufficient resources, which will be properly ring fenced, and an adequate timetable with help as regards start-up costs there is no need for delay. The worst of all worlds would result from the Government providing inadequate resources, unprotected by ring fencing, and having to force through the community care proposals on an impossible timetable.
For those reasons it is crucial that proper consultation takes place with all interested parties. That is the purpose of the amendments. I beg to move.
3.15 p.m.
Baroness Hooper: Local authorities should be answerable to their local population for the exercise of their community care responsibilities. We already propose in the Bill that plans for community care should be published, as the noble Lord has said, and that local authorities should consult widely in drawing them up. Indeed, Clause 44 includes an amendment accepted at Report stage in another place to clarify the situation.
It is also right that care services should be responsive to the needs of users and carers. Our proposals seek to achieve that in several ways. First, the arrangements for assessing individuals' care needs will take into account the views and wishes both of the individual service user and his or her carer. Secondly, their views can be made known through the case management process and the formal quality monitoring arrangements which will form
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part of contracts for care services. Thirdly, I hardly need to remind the Committee, following our acceptance in principle of Amendment No. 113AS and my undertaking to reconsider the matter and to come back with a government amendment at a later stage, that local authorities will be required to consult representatives of users and carers in drawing up their plans.
As we have mentioned previously, the Bill seeks to provide a framework which will enable local authorities to deliver community care services in line with our proposals in Caring for People. We shall soon issue draft guidance which will give more detailed information to local authorities about what we expect of them. It will spell out the need to involve users of services and their carers. If it is found that guidance is not followed, as we have established in previous discussions on similar points, the Secretary of State has powers of direction which he will not hesitate to use.
Therefore, while I sympathise with the thinking behind the proposals, in practice it would seem that requiring the authorities not only to consult with those involved in providing and using community care services but also, as the amendment implies, to consult on proposals for consulting others is excessive. That is particularly so when it involves consulting groups who, while they may be interested in seeing plans—which they will be able to do in any event—are not involved directly in providing or using services. I believe that the greater transparency which will result from our proposals in this area of provision will be beneficial to everyone.
To grapple with the question of the press comment to which the noble Lord, Lord Carter, referred, that is purely speculation. The Government and the department are continuing to work towards the implementation in April 1991 of the community care proposals in the Bill. That is the Government's position.
We have already made provision to ensure that users and carers can make substantial input into decisions about the type of care services which are available to them. The new clauses would place a burden on authorities which might hinder rather than help that provision. I therefore urge the noble Lord to withdraw the amendment.
Lord Ennals: I should be grateful if the noble Baroness would comment on whether or not the Government intend to postpone implementation of the proposals. Comments in both the Sunday press and today's newspapers give the impression to anyone who has been in politics for some time that there has been some discreet, off-the-record briefing. My noble friend read some words from the Independent:
"The Government is considering delaying implementation of its care in the community proposals until after the general election, amid fears that they may prove a political and financial minefield".
The Observer, in its leading sentence, says:
"The Government is considering delaying the implementation of its community care reforms for fear that rows over funding will be damaging in the run-up to the next election".

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There is a remarkable similarity between those reports which gives the impression that someone in the department or in No. 10 Downing Street or elsewhere has said something off the record. The noble Baroness gave an assurance that the Government still intend to implement these parts of the Bill. Can she also give me an assurance there has not been some subtle behind-the-scenes briefing?
Baroness Hooper: The noble Lord has been in politics longer than I have and it may be for that reason that I did not gain the same impression from the press comment. However, I can only reaffirm that the Government will continue to keep the timetable under review in the light of circumstances. For example, we shall take careful note of what local authorities tell us about their preparations. However, April 1991 remains the date for implementation.
Lord Lloyd of Kilgerran: We on these Benches support the amendments. In the unfortunate absence of my noble friend Lady Seear I should like to intervene briefly on the matter.
The Minister said that her department had issued guidelines for voluntary organisations in these matters. Do voluntary organisations include the universities?
I must declare an interest because 10 years ago, through a charitable organisation known as the Education Trust Ltd, of which I am still the chairman—it was founded by the Industrial and Provident Societies in about 1922—we founded at Addenbrooke's Hospital a research clinic to care for and treat free of charge undergraduates of both sexes from the colleges of the University of Cambridge. The clinic is concerned with research into the prevention and treatment of soft tissue injuries.
We are involved with the Cambridge Health Authority and the University. Will the guidelines have been issued to the university or to the health authority? Certainly, the guidelines have not come to the Education Trust Ltd. which was so influential in setting up the clinic. As this is a technical and local matter, I do not expect the Minister to reply at this stage. However, we support the amendments.
Baroness Hooper: Perhaps I may take the opportunity to clarify the position slightly. I referred to guidance, not to guidelines. We have established that guidance is a rather stronger weapon than guidelines in that respect because it is subject to the Secretary of State's power of directions. As far as I am aware, that guidance, which has not yet been issued—it is about to be issued—can be made available to anyone who requests it. In the normal course of events, it will go out to health authorities and voluntary sector organisations which provide services in the area.
Lord Lloyd of Kilgerran: I am obliged to the Minister for that answer. The term "guidance" is a little harsher than the term "guidelines" and is probably more useful. As chairman of the Education Trust Ltd. I shall put myself on the list to obtain some information.
Lord Carter: I am sure that the Minister will agree that we do not want to enter into debate about the difference between guidance and guidelines, as we did at a late hour last Thursday evening. I listened with care to what she said. On the question of the press stories, we shall simply have to put it down to coincidence that they have all appeared over three or four days and said exactly the same thing.
The duty to consult users should be included in the Bill and not simply left to guidance to be taken account of in assessments and the excessive interests of certain groups. It is important that that duty should be included in the Bill and it is therefore important to ask the opinion of the Committee.
3. 23 p.m.
On Question, Whether the said amendment (No. 115DD) shall be agreed to?
Their Lordships divided: Contents, 86; Not-Contents, 112.

DIVISION NO. 1

CONTENTS

Airedale, L.

Leatherland, L.

Allen of Abbeydale, L.

Listowel, E.

Birk, B.

Llewelyn-Davies of Hastoe, B.

Bonham-Carter, L.

Bruce of Donington, L.

Lloyd of Kilgerran, L.

Carmichael of Kelvingrove, L.

[Teller.]

Lockwood, B.

Carter, L.

Longford, E.

Chester, Bp.

Mcintosh of Haringey, L.

Cledwyn of Penrhos, L.

Mackie of Benshie, L.

Clinton-Davis, L.

Mais, L.

Cocks of Hartcliffe, L.

Masham of Ilton, B.

Darcy (de Knayth), B.

Mason of Barnsley, L.

David, B.

Mayhew, L.

Davies of Penrhys, L.

Molloy, L.

Dean of Beswick, L.

Monkswell, L.

Diamond, L.

Morris of Castle Morris, L.

Dormand of Easington, L.

Nicol, B.

Dunrossil, V.

Ogmore, L.

Ennals, L.

Peston, L.

Ewart-Biggs, B.

Phillips, B.

Ezra, L.

Ponsonby of Shulbrede, L.

Fisher of Rednal, B.

Prys-Davies, L.

Gallacher, L.

Rea, L.

Galpern, L.

Ritchie of Dundee, L.

Gladwyn, L.

Rochester, L.

Graham of Edmonton, L.

Sainsbury, L.

[Teller.]

Seear, B.

Grey, E.

Seebohm, L.

Hampton, L.

Serota, B.

Hanworth, V.

Somers, L.

Harris of Greenwich, L.

Soper, L.

Hatch of Lusby, L.

Stallard, L.

Hayter, L.

Stedman, B.

Henderson of Brompton, L.

Stoddart of Swindon, L.

Hirshfield, L.

Strabolgi, L.

Hunt, L.

Taylor of Blackburn, L.

Jacques, L.

Tordoff, L.

Jay, L.

Turner of Camden, B.

Jenkins of Putney, L.

Underhill, L.

John-Mackie, L.

Wallace of Coslany, L.

Kearton, L.

Walston, L.

Kilmarnock, L.

White, B.

Kinloss, Ly.

Williams of Elvel, L.

Kirkwood, L.

Winstanley, L.

NOT-CONTENTS

Aldington, L.

Annaly, L.

Alexander of Tunis, E.

Arran, E.

Allerton, L.

Auckland, L.

Ampthill, L.

Belhaven and Stenton, L.

17

Beloff, L.

Margadale, L.

Belstead, L.

Marsh, L.

Blatch, B.

Merrivale, L.

Blyth, L.

Mersey, V.

Borthwick, L.

Middleton, L.

Boyd-Carpenter, L.

Mills, V.

Bridgeman, V.

Morris, L.

Brightman, L.

Mottistone, L.

Brougham and Vaux, L.

Mowbray and Stourton, L.

Butterfield, L.

Munster, E.

Butterworth, L.

Murton of Lindisfarne, L.

Campbell of Croy, L.

Nelson, E.

Carnegy of Lour, B.

Nugent of Guildford, L.

Carnock, L.

Orkney, E.

Colnbrook, L.

Orr-Ewing, L.

Constantine of Stanmore, L.

Oxfuird, V.

Cottesloe, L.

Pender, L.

Cox, B.

Penrhyn, L.

Dacre of Glanton, L.

Porritt, L.

Davidson, V. [Teller.]

Portsmouth, E.

De Freyne, L.

Rankeillour, L.

Denham, L. [Teller.]

Reay, L.

Dudley, B.

Renton, L.

Effingham. E.

Rippon of Hexham, L.

Ellenborough, L.

Rodney, L.

Elles, B.

Romney, E.

Erroll of Hale, L.

St. Davids, V.

Ferrers, E.

Saint Oswald, L.

Fraser of Carmyllie, L.

Saltoun of Abernethy, Ly.

Gainford, L.

Sanderson of Bowden, L.

Gibson-Watt, L.

Selkirk, E.

Gridley, L.

Sempill, Ly.

Hailsham of Saint

Shannon, E.

Marylebone, L.

Sharpies, B.

Henley, L.

Shaughnessy, L.

Hesketh, L

Skelmersdale, L.

Hives, L.

Stockton, E.

Hood, V.

Strange, B.

Hooper, B.

Strathcarron, L.

Hylton-Foster, B.

Strathmore and Kinghorne,

Johnston of Rockport, L

E.

Joseph, L.

Sudeley, L.

Kimball, L.

Terrington, L.

Kinnaird, L.

Teviot, L.

Kinnoull, E.

Thomas of Gwydir, L.

Kitchener, E.

Thurlow, L.

Long, V.

Trumpington, B.

Lyell, L.

Ullswater, V.

McColl of Dulwich, L.

Vaux of Harrowden, L.

Macleod of Borve, B.

Westbury, L.

Malmesbury, E.

Wise, L.

Manchester, D.

Wolfson, L.

Mancroft, L.

Wynford, L.

Resolved in the negative, and amendment disagreed to accordingly.
3.31 p.m.
Lord Ennals Lord Ennals moved Amendment No. 115DE:
Before Clause 46, insert the following new clause:
("Regional Inspectorate
.— (1) The Secretary of State shall as soon as practicable satisfy himself that there is adequate provision and resources for the inspection of community care in each region of England and Wales for the purposes specified in this section.
(2) The Secretary of State shall ensure that such inspection shall include the following functions—

(a) the setting of service standards for community care;

(b) the provision of advice and assistance to any local inspectors employed by local authorities and to agencies providing community care; and

(c) the undertaking, in liaison with any local inspectorate, of detailed inspections of aspects of community care provision.

(3) A local authority shall, in carrying out its functions under this Part have regard to any relevant advice of the inspectorate in respect of matters falling within subsection (2) above.").
The noble Lord said: I move this amendment at the request of the noble Baroness, Lady Faithfull,
18
who will speak to it during the course of the debate. There is widespread agreement in both Chambers and in all parties as well as among the multiplicity of statutory and voluntary organisations involved in community care that above all this Bill must raise the quality of community care.
Social work is and always will be fraught with problems. It is the nature of social work to deal with problems. Those problems are not just of the kind which hits the headlines, such as child abuse. That was dealt with in the Children Act. We are not talking about such issues today. We are concerned with community care for a whole range of problems such as mental illness, mental handicap, disability, drug and alcohol abuse and homelessness, which are no less fraught with difficulty than those that affect children.
The Government's White Paper Caring for People outlined ways in which the quality of community care services would be monitored and promoted. Their proposal was that local authorities should set up free-standing inspection units, accountable in each case to the director of social services. The Government issued a consultation document on that matter.
From these Benches we warmly welcome that approach. It is right that each local authority should be in a position to have what is called an arm's length inspectorate. But the proposals—which, as I said, are broadly welcomed—fail to deal with issues of natural justice, for which a wholly independent inspectorate is required and for which regional arrangements are necessary. This amendment proposes a structure to meet those ends.
I do not believe that in controversial issues people are ever totally satisfied with an inquiry that is made solely by a local authority about its own work. There is a case for ensuring that the investigation is done on a broader basis. This amendment offers a fundamentally different system in order to ensure that independence and consistency which were so strongly argued for and recommended by the committee chaired by Lady Wagner. Our proposal is for a regional inspectorate governed by a regional board consisting of representatives of health bodies, voluntary organisations, local authorities, personal social services and housing at elected member level, as well as of the users of their services.
If this amendment is accepted as a principle, later amendments could deal with the detailed issues of composition. Therefore this amendment is designed to establish a principle. It will ensure that there is no intentional or unintentional collusion between those people who provide the inspectorate and those who provide the service. That has always been a problem with a purely internal investigation or inquiry. Because of major involvement by local government in this matter, there would be a majority representation of elected members.
Beyond that, the regional inspectorates would be steered by a national council whose purpose was to receive the views of regional boards in order to be able to develop national guidelines on registration, re-registration and inspection of local authority, private and statutory homes, as well as nursing

19
homes. The Government's proposal for an arm's length inspectorate includes children's homes and independent schools. That is yet another reason for providing an umbrella council and regional boards.
None of this proposed structure in any way cuts across the proposition for an arm's length inspectorate within the registration authority. This very local service would be an officer-and-administration-led arm's length inspection and would have a broader quality control function at the local level. The boards could set the context within which the arm's length inspectorates for each local authority would operate.
I should like to point out that there is no conflict between this and the social services inspectorate established by the department and very well directed by Mr. Bill Utting. The Department of Health's own guidance suggests that one authority might undertake inspection on behalf of another on an agency basis. This proposal acknowledges some degree of co-operative arrangement. It is argued that such arrangements could be much more successfully managed within the framework of regional boards which themselves would be under a national advisory structure of councils.
We therefore do not propose that there should be any change in the role of the social services inspectorate, nor should there be any change in the role of supervision at an authority level. There is a need for an independent inspectorate which would command the respect of the public, local authorities and the Government. The overriding rationale for a body such as a regional inspectorate unit is to ensure absolute detachment from each local authority for the registration and inspection functions.
Another advantage of that kind of body would be that it would ensure consistency of standards across the region and contribute to the raising of standards in some areas. That is very important. One of the problems that we face at the present time is the enormous variation in standards from one local authority to another. I believe that a body established on a regional basis would help to raise the level of performance of some local authorities to that of the best.
I hope that this proposal will commend itself to the Committee. If the principle is accepted, either by the Government in their reply or by other means, the opportunity will be created to work out in greater detail just what should be done. We do not want anything heavily bureaucratic. We want to establish an independent inspectorate, one that is independent of those for whom it would be responsible. I beg to move.
Baroness Faithfull: I am grateful to the noble Lord, Lord Ennals, for generously moving this amendment, which stands in my name. After due consideration I felt it right that another point of view should be put to the Committee; namely, the point of view of the Association of Directors of Social Services.
The noble Lord, Lord Ennals, has spoken of the need for an inspectorate that is wholly independent
20
of the local authorities. That need could be met by a regional inspectorate governed by a regional board. However, there are inspection units within the majority of local authorities in this country. Those inspection units have proved to be successful. Furthermore, such units give to each local authority a right to consider problems and to set standards in their own departments. The directors of social services feel that to add yet another tier will make for difficulties.
One has also to consider the geographical difficulties. If there is a regional board, as is provided in the amendment, it will not be easily accessible to staff, to carers or to those making complaints.
Finally, we have an inspectorate based on the Department of Health under the leadership of the Chief Inspector, Mr. Bill Utting. The inspectorate has proved itself to be of high value. It was proved at the time of the Cleveland Inquiry, when it did an excellent job of work inquiring into what was going wrong in the Cleveland area.
I would prefer to see resources spent on developing local inspection units. I would also prefer to see resources spent on expanding the national inspectorate under the Department of Health. Although I have put my name to the amendment, I thought that another point of view should be put to the Committee. It is perhaps inevitable as an ex-director of social services that I should put the view of my colleagues who are now in the field.
3.45 p.m.
Baroness Cox: I support the amendment with even greater conviction than when I originally put my name to it as an amendment embodying the principle of the need of some form of systematic and genuinely independent inspection. My conviction has grown, as my concern has grown, with the passage of the Bill through this Committee. The more debates I have heard, the more acutely aware I am of the potential suffering that may arise as a result of some of the unforeseen effects of the proposed legislative changes and the lack of safeguards being built into the operation of the new system from its inception.
The amendment has no party political connotations. My support for it is born of a profound concern that the proposed changes, however good and commendable in principle and potentially good in practice, are by definition untried. In policy areas as complex as health and welfare there are almost bound to be problems in the implementation of radical changes. In the fields of health and welfare administrative problems lead to anxiety and distress and possibly suffering for patients, clients, families and carers. Among them will be some of the most vulnerable people in our society. There will be the frail and/or confused elderly whose numbers we know will increase dramatically in the next few years, as well as the growing numbers of the mentally handicapped, mentally ill and chronic sick people who will be living in the community. They are the people who are least able to articulate their needs, to assert themselves or to claim their rights. Therefore I believe that it is of the utmost importance that there is in the Bill some form of quality assurance for basic

21
standards of care for those who will be affected by the radical changes in provision for care in the community.
I said at the outset that my concern has been growing during the passage of the Bill through its Committee stage. The reasons for that are threefold. The first is the lack of adequate information on which to base with confidence and accuracy some of the costings of the proposed changes. Secondly, there are the problems currently being experienced in some local authorities in fulfilling their present responsibilities, let alone for taking on their new enlarged remit and doing so in such a tight timescale. Thirdly, there is the need in principle and in practice for a genuinely independent inspectorate. That is especially necessary in an area where there is great variability in standards of provision and where the stakes are so high in terms of potential human suffering, much of which could remain hidden.
Perhaps I may say a few brief words to amplify each of those areas of concern. First, on the lack of adequate information on which to set up some of the new arrangements, I believe that it has become alarmingly clear during the debates on amendments proposing some form of evaluation that there is a large irformation deficit. The Minister has used again and again phrases which indicate that the introduction of change will be an evolutionary learning process.
There has also been a disturbing reference on more than one occasion in the field of community care that once an assessment has been made of a client's needs there is no assurance that those needs will be met. The extent to which they will be met will depend on the availability of resources. What happens if those resources are not available? Even now organisations such as the citizens advice bureaux have numerous very sad cases of people being discharged into the community whose diagnosed needs are not being met. That is before the expansion of responsibilities which will increase the workload and pressures on social service departments.
My second area of concern relates to issues which are causing particular anxiety. I refer reluctantly to those cases where social service departments are currently failing to meet many of their clients' needs. Many Members of the Committee come from areas with excellent local authority provision and excellent social service departments, providing very good services. I am sure that they will continue to provide those good services. But it is no secret that some local authorities are not so efficient and effective.
In one local authority I know a director of nursing services has had to employ private social workers to care for cancer patients being discharged from hospital because he did not receive adequate support from local social service departments. I am not imputing blame but stating facts. In another area, I know of a primary school head teacher in a very deprived district, where there are children from desperately unhappy backgrounds, marred by broken families, living in squalor, where drug and alcohol abuse are part of their daily lives. This dedicated head teacher finds the local social department less than helpful with the children's problems when she asks for help. If I may for a
22
moment be tactless enough to raise the unhappy question, what happens if social workers feel that they have to take strike action again? Who will then care for all the vulnerable people who will be their responsibility?
I raise these examples not to be invidious or to make political points but only to try to inject some realism into a situation before us. It is a realism born of working and living for many years in areas where I fear that the problems will be even greater than they are now as more prople come to be cared for in the community and where therefore it is even more important to have an adequate independent inspectorate to try to ensure consistent, at least minimum, standards of care.
My third and concluding concern is to reaffirm and endorse in principle the need for an inspectorate to fulfil the functions set out in the amendment, an inspectorate which will be independent and which I hope will be multi-professional, to ensure adequate provision for health as well as social needs. If the amendment, or something on that line, were to be accepted I believe that it would be good for the Government. It would be a great relief to all concerned over future developments. The Government would be seen to be building in a quality control mechanism, thus demonstrating good faith that they care for those who will be affected by the changes that they are introducing and that they are committed to ensuring that they will not suffer as a result of any unforeseen effects. It would also reassure all those who are worried about the possible suffering accruing from unanticipated problems.
The concept of community care is premised on the hypothesis that the community cares. Many people in the community, both professionals and informal carers, do care and care marvellously for people with diverse needs and problems. But many other people are also suffering from lacunas in provision. Many people are falling through the safety net and many carers are suffering from having to meet excessive demands with inadequate support. As even more people come into the orbit of community care the already overstretched resources may fail to meet the increasing demands. Many people with serious problems may fail to receive the help they need.
Without some kind of independent monitoring of a systematic kind in the form of an inspectorate not necessarily along the lines stated in the amendment, such people may suffer unnoticed. They are more likely to do so in the anonymity and isolation of the community than in hospitals. There, as was said in previous debates by the noble Lord, Lord Butterfield, there are at least some forms of monitoring in, for example, clinical areas for medical education or the education of other health professionals and nurses.
The principle of the amendment is of fundamental importance. I believe that failure to accept the principle of an independent inspectorate for community care will exacerbate the serious and legitimate anxieties which currently abound among professionals, patients, clients, carers and the public. Acceptance of the concept of an independent inspectorate would do a great deal to allay those anxieties. I sincerely hope that the Minister will

23
give a sympathetic response to the principles of the amendment.
Lord Seebohm: I was interested to hear the comments of the noble Baroness, Lady Faithfull. In the world in which I earn my living there are always internal and external auditors. It is right and proper that there should be an external body in this case so that it can make a general supervision of community care in the country as a whole.
I have discussed the matter with those in my local authority. There is no doubt that the director is keen to have his finger on his own inspection and internal audit. Indeed, he says that his senior inspector, or local auditor, has the rank of deputy director answering directly to him. He can make certain that such services are run in the manner that he would wish.
I do not know whether the amendment is correct as it stands. There is a case for providing an overall inspectorate, although I do not know whether it would be done more sensibly by the regions or by the Government. There is no doubt that the directors are determined to have a high level of inspectors on their own staff.
Lord Renton: The amendment must be read together with Clause 46, as the noble Lord, Lord Ennals, quite rightly pointed out. Clause 46 will give the Secretary of State the power, although not an obligation, to appoint local inspectors for each local authority. However, under the clause as it stands he might not appoint any at all. Either the local or the regional method of inspectorate would cost public money at a time when we should be saving that to the greatest possible extent. That is especially so when we are dealing with people in society who are unable to care for themselves. They are the first to suffer from inflation.
Having listened to the speech of my noble friend Lady Cox and to those which preceded it, and taking account of my experience, I believe that a system of inspection is necessary. I have thought about the matter a good deal in the past day or two and I have come to the conclusion that a regional inspectorate would be better. We need a system analogous to the well-established regional inspectorate of the constabulary. It may well be that the regions dealt with by the police are bigger than would be required for this work. The regions must not be too large
I take the point that it is better to have regionally-appointed, independent inspectors rather than those appointed for each local authority. As was wisely pointed out by my noble friend Lady Faithfull, local inspectorate units are appointed by the local authorities and we do not want duality. We do not want one inspectorate falling over the other, otherwise we shall have the situation—if I dare utter a Latin tag—quis custodiet, ipsos custodes?
Lord Ennals: Please translate.
Lord Renton: Who will inspect the inspectors? Which inspectors will do what? I believe that the independent regional inspectors will be of greater
24
value as regards the advice that they can give to local authorities than the local authority inspectors appointed by the Secretary of State for local authorities. They would be too close.
The subject of costs should be regarded as fundamental and should override all our discussions. A regional inspectorate could sometimes give advice to those working locally which would enable public money to be better spent than at present. There may even be an opportunity for saving public money without departing from standards of care. Therefore, I opt for the regional inspectorate.
I do not like the way in which the clause has been drafted. It contains one grammatical mistake, but that is small and we all make those. Although the side note refers to "Regional Inspectorate" the contents of the clause refer only by implication to there being an inspector for each region. We must make the situation more clear and precise.
I hope that the Government will accept the views that have been put forward. I also hope that on Report they will replace Clause 46 with provisions along the lines of those in the clause that we are now discussing.
Baroness Seear: I support the principle behind the amendment although I am not certain whether the wording is correct. Surely the noble Lord, Lord Seebohm, gave a clue about the need for an inspectorate. He said that of course the social services departments and the local authorities want their own inspectorate to ensure that they are up to standard but that the person appointed was the deputy director to the director of social services. If a subordinate employee is inspecting your work surely there will not be the objectivity—to put it mildly—that there would be from a regional inspector who is completely independent of the body being inspected. That is what we want.
Although I am second to none in believing that we must be extremely careful with public money, in this case I do not believe that money should be the overriding consideration. Unless we get the provisions right and have proper inspections we shall have the most hideous casualties in community care. By any measurement that is too expensive.
Lord Kilmarnock: I always listen with great respect to everything said by the noble Baroness, Lady Faithfull, about social services. However, on this occasion I am not inclined to follow her. She is quite correct that the Government proposals for arm's length inspection units have some positive features. They would inspect and report on both local authority and independent residential homes. It was intended that they should include inspectors recruited from outside the social services department and from former home owners. Therefore, there are certain encouraging developments.
As has already been said, none of that adds up to a national monitoring system of quality control or assurance which the noble Baroness, Lady Cox, mentioned. There is a tide of anxiety running through the Committee on this whole matter of quality control, not only in this part of the Bill but also at the beginning of it. If something along these

25
lines is achieved now, it may be possible to link that with a similar system for the National Health Service.
I believe that it is very unlikely that the Committee will be happy to leave the Bill as it stands on the question of quality assurance. As has already been said, whether this is the right form of words—and the noble Lord, Lord Renton, suggested that it is not—and one might have some doubts about the way the amendment is expressed, the general feeling of the Committee seems to be that something along these lines will be required before the Report stage. That should be taken on board by the Government because if not, I am certain that the House will wish to return to the matter.
4 p.m.
Lord Boyd-Carpenter: I wonder whether any Members of the Committee have any idea of what will be the cost to the public funds of this proposal—a network of regional inspectorates all over the country. It is one's experience of such organisations that once instituted they tend to grow. Keen, eager people interested in the work—and the work will be both interesting and important —tend to cause the work to increase and to recruit additional members of staff.
In our present situation it would be rather odd if Members of the Committee were to support a proposal, the cost of which they have no idea. I have no idea what would be the cost. It may be that the Minister can tell us what will be the initial cost and the contemplated increase. However, until we have that information it seems rather irresponsible for us to support a proposal of this kind.
Lord Renton: I am sure that my noble friend will have borne in mind that the proposals under Clause 46 would also involve public expenditure. It is possibly a question of whether it would be better expenditure to have a few regional inspectors or many local ones. Personally, I prefer a few regional inspectors.
Lord Boyd-Carpenter: My noble friend was trying to save me trouble because he anticipated the point to which I was coming and, as always, I am deeply indebted to him for that.
We have not yet discussed Clause 46. It is clear—and I should have thought generally agreed —that we do not want both this amendment and Clause 46. Until we have discussed Clause 46, includirg the question of its cost as well as its efficacy, it is difficult to ask us to vote for this amendment and the whole series of regional inspectorates which that would involve.
I was struck too by the fact that my noble friend Lady Faithfull who, with a display of courage such as one associates with her in discarding an amendment which bears her name—and it is very brave to do that —referred to the setting up of another tier of inspectorates. As some Members of the Committee will know, I have a little experience of social security administration. Something which has always haunted social security administration in this and other countries is the tendency to multiply bureaucratic organisations—and I do not say that offensively —and to build up staff.
26
Basically, very often one must take a decision as to whether the money should be spent on direct assistance to unfortunate people or on building up staff who are supposed to secure that that assistance is most efficiently given. Obviously there must be a balance between those two. However, when we are asked to set up another tier of inspectorates as my noble friend so well described it, I should have thought that there was good reason to hesitate.
As my noble friend Lord Renton reminded us perhaps a trifle prematurely, until we have discussed Clause 46 the Committee is not able to take a balanced view as to whether the proposal in Clause 46 is or is not likely to be more effective and economical in operation than what is proposed in this amendment. Therefore, although I shall listen to what the Minister says with great interest, my present view is that until we have discussed and decided on Clause 46, it is a great mistake to adopt this amendment.
Lord Ennals: Will the noble Lord accept that Clause 46 is entirely about the inspection of premises used for the provisiion of community care services? It is not about the quality of care provided, which is what this amendment is about. Here we are dealing with service standards of community care and so on. Clause 46 is about premises.
Lord Boyd-Carpenter: The noble Lord makes my point for me. Until we have discussed Clause 46 and are clear as to exactly what it does, it remains premature to adopt a partially conflicting amendment. As always, I am deeply indebted to the noble Lord.
Baroness Seear: The noble Lord, Lord Boyd-Carpenter, says that inspectorates tend to proliferate. If one looks at the figures as regards the factory inspectorate, which is a group with which I am familiar, one sees that that inspectorate has proliferated not at all. I am not sure about the inspectorate of schools. However, I challenge whether it is correct to say, based on experience, that such inspectorates grow and grow.
Lord Boyd-Carpenter: I specifically limited that observation to inspectorates and organisations in the social security area. As regards the tax inspectorate, I can only say—
Baroness Seear: I said factory, not tax.
Lord Boyd-Carpenter: I am sorry. I understood that the noble Baroness was referring to tax inspectors and one always has great admiration for them or at least it is expedient to say so. The factory inspectorate is a different area. The point I made is that I am afraid that in the social service sphere that danger is real. I believe that, from her own experience, the noble Baroness will realise that.
Lord Renton: On the matter raised by the noble Lord, Lord Ennals, it is relevant to point out that subsection (4) provides:

27
"Any person inspecting any premises under this section —
(a) may interview any person residing there in private— (i) for the purpose of investigating any complaint as to those premises or the community care services provided".
Therefore, it goes beyond the sphere of premises.
Baroness Carnegy of Lour: Is it not important when we discuss means of quality control, which is undoubtedly a crucial area to get right, to remember what the Bill is about and how it works?
To talk about regional inspectors setting service standards seems to me somewhat unrealistic. The standard will be set by the local authority in the specification which it puts forward to whatever agency or home with which it is making arrangements, and then it must ensure that it obtains that which it specifies. That is how the standard will be set. The standards relate to what happens to an individual in a particular home. It is essential that the local authority produces the right specifications and monitors them to see that they are properly carried out. That is basic to the working of the Bill. It is a new system; we do not know how long it will take for it to settle down or whether it will work 100 per cent.
There has to be a method of complaint and inspection, but it is wrong to say that regional inspectors will set the standards. If they existed, they could look at the standards and try to obtain national standards, but they could not set the standards; they would have no way of doing that. It is said that the regional inspectors will provide advice and assistance to local inspectors. One can imagine the top tier saying, "Come on boys, you are not doing this right". However, local inspectors are employed by the local authority to ensure that the standards set by the local authority in its deals with the local agencies are met. Two sets of inspectors talking will not necessarily achieve that.
Subsection (2) (c) refers to the undertaking, in liaison with any local inspectorate, to carry out detailed inspections. That means that two lots of inspectors from two different areas will go along together to look at something which the social services department arranged with a local home. They will then discuss together whether what is happening should be happening. That does not make very much sense.
I accept the point made by the noble Lord, Lord Seebohm, that internal and external audits are extremely useful in business and in running any large organisation. But this legislation concerns obtaining the best one can from local homes and agencies and from local authority staff. There needs to be a complaints procedure and a way of ensuring that specifications are met. Councillors from local authorities must ensure that the specifications are sufficiently high. One cannot have all those layers. As my noble friend Lord Renton said, a different system may apply for inspection. However, it would be a fundamental change in the context of the way in which the Bill will work.
I shall listen with great interest to my noble friend Lady Hooper, but she must take on board that it is essential to obtain the highest possible standards;
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and it must be one of the Government's objectives to apply those standards uniformly throughout the country. We need to know how that will be achieved. If my noble friend can explain that then I hope noble Lords who tabled the amendment will not feel the need to press it.
Baroness Masham of Ilton: Perhaps I may ask a few questions before the Minister speaks. Last weekend in Suffolk I attended an engagement which concerned disabled people. I met a lady who was extremely disabled. She used an electric wheelchair, and told me that she had just had her home help cut completely. Also, I live in rural North Yorkshire and I know someone with Alzheimer's disease who is living in a cottage by herself. She has no home help because no one will travel to the cottage to clean it.
When we speak of inspecting and trying to obtain services for those who need them, it is worrying because sometimes there are no services provided at all. I ask the Minister how she will ensure that the people who need help will receive it? When I asked the lady in Suffolk why her home help had been cut, she said, "I was told that there were people more disabled than I coming into the community"; that was the reason.
It would be difficult to be more disabled than that lady. I think that she probably had multiple sclerosis; she was paralysed from her shoulders down and had no use in her arms at all. She had a husband, but he was working. That puts tremendous stress on a marriage. What will happen if he walks out?
I ask the Minister those questions because it is worrying, and I can only see the situation worsening.
4.15 p.m.
Lord Somers: The noble Lord, Lord Boyd-Carpenter, spoke of the number of bureaucratic organisations which we could well do without. I entirely agree with him. There are too many such organisations which are completely needless. However, the organisation which we are considering in the amendment today surely comes under an entirely different heading.
That organisation is necessary because the authorities who organise care are not necessarily—shall I say?—reliable. It is essential that there should be some kind of inspection procedure which will force them to go to the fullest lengths possible in carrying out that care.
Baroness Hooper: This has been a most useful discussion. If the amendment serves no other purpose it has enabled everyone to understand the problems and, we hope, the kinds of solutions that are available. I am most grateful to everyone who took part, particularly my noble friend Lady Faithfull for her act of courage, and also my noble friends Lord Boyd-Carpenter and Lord Renton for reminding us to look at Clause 46, which gives persons authorised by the Secretary of State a right to enter and inspect premises where community care services are provided if they are thought not to be satisfactory.
As has also been said, there is the inspection of residential care by the authorities themselves. That

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will be extended by the arm's length inspection units which the local authorities will be setting up to inspect their own direct provision and provision arranged through others. I hope that the intention in having arm's length inspection units will overcome the problems in the particular example quoted by the noble Lord, Lord Seebohm.
In the White Paper we devote a large part of Chapter Five to questions of quality of inspection and monitoring. We also made clear our intention to strengthen the role of the social services inspectorate, both to support and help local authorities to adapt to their new role and to carry out inspection functions on behalf of the Secretary of State. The inspectorate already produces, and will continue to develop, guides to good practice and standards, whether in domiciliary or residential care. The Departrrent of Health will continue to collect statistical data regarding social services provision and will develop the key indicators which are already produced. The department will also continue to support relevant research and evaluation to inform the development of standards and quality of service.
The social service inspectorate, which is part of the Department of Health, already has a network of regional offices. They provide the necessary scrutiny of local authorities at regional level independent of individual local authorities. There are therefore already in existence the two tiers of inspection advocated by the noble Lord, Lord Seebohm: the authorities arm's length unit and the SSI. A third tier of independent inspection would only add confusion and the additional bureaucracy to which some of my noble friends referred.
The Committee will, I hope, agree that the approach that we are taking therefore meets the thinking behind this new clause. It is important that the SSI is adequately resourced with good quality people carrying out its tasks; and that will be the case. We do not want to set up a bureaucratic regional structure with too closely defined responsibilities along the lines proposed in the new clause but rather to develop the role of inspectors as outlined in the White Paper. For example, the new clause does not cover the significant role in both policy and practice which the social services inspectorate plays in training; another area of great significance.
My noble friends Lady Carnegy of Lour and Lady Cox both asked for more assurances in regard to quality. Certainly the main aim behind the proposals is to improve quality of care. We believe that quality will be assured by building quality standards into all the contracts for care which will have to be entered into; by monitoring quality through case management and through monitoring of contracts; by complaints procedures which are provided for—an example of a fall-back position which might meet the case put forward by the noble Baroness, Lady Masham—and also through the inspection units to which I have already referred. Those will be the routine methods. In addition, there will be longer term research and evaluation projects.
Where local authorities fail to provide services—a point raised by my noble frend Lady Cox—the Secretary of State can find them to be in default and has the power to require them to remedy the fault.
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Therefore, the role of the social services inspectorate will continue to develop in response to local authorities taking on these additional responsibilities. We feel that we need the flexibility to respond to new areas where its advice and expertise is needed. We are all anxious to improve the quality of community care but I do not believe that the new clause is necessary to achieve that.
Lord Renton: Before my noble friend sits down, can she explain whether the social services inspectorate will have power to take on the work envisaged under the Bill —in particular under Clause 46—as she implied? Is there some provision in the Bill which I have overlooked?
Baroness Seear: The noble Baroness made an interesting comment on the social services inspectorate, but can she give the Committee any idea of the scale involved? There is a great deal of work to be done. How many inspectors will there be and what background will they have? It may be that they are needed, but we should have more information about them.
Lord Kilmarnock: My understanding—the noble Baroness will correct me if I am wrong—is that the inspectorate is responsible to the Secretary of State but that it cannot initiate inspections of its own volition; it has to be called in by local authorities which desire to have their services looked at. Is not that the current position? If so, have the Government any plans for strengthening the role and the powers of the inspectorate?
Baroness Hooper: Perhaps I may remind the Committee that, as I said, the intention outlined in the White Paper is to strengthen the role of the Social Services Inspectorate; in other words, we will be building on the existing structure and experience. The Social Services Inspectorate will report to the Secretary of State on the effectiveness of local inspection arrrangements and on the methodologies and standards applied when measuring the quality of services and care secured. I hope that meets the point put by my noble friend Lord Renton.
As regards the number of people working in the inspectorate and their adequacy, I gave the assurance that we intend the inspectorate to be adequately resourced with good quality people. I realise that that is not going as far as the noble Baroness, Lady Seear, would wish me to go. However, I understand that there are currently 200 inspectors and supporting staff, and that the Bill allows for the Secretary of State to initiate inspections by the SSI.
Lord Ennals: I am most grateful to all who have taken part in this interesting debate and, of course, to the Minister for her reply. The noble Baroness, Lady Cox, said that this is not a party political matter and the debate proved that it is not. The debate was in fact more interesting and well -informed between the Members of the Government Benches than on these Benches, because there was not much debate on this side of the Committee.
The noble Baroness, Lady Faithfull, is always such an honest person. She will never say anything that

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she does not believe. I respect her for deciding that there are parts of the amendment that she does not like and therefore will not press it. That raises her even higher in my estimation; but if I am to pay a compliment I must return with something else. Of course the noble Baroness and other directors of social services do not want to see some other form of inspectorate that might conceivably be critical of the way in which the directors are working in their own local authorities.
Baroness Faithfull: The point I was making in that connection is that there is another inspectorate outside the local authority—the Ministry of Health local inspectorate. Perhaps I may be allowed to add that I have been an inspector as well as a director of social services.
In reply to the noble Lord, Lord Kilmarnock, the inspectorate has the right to initiate an inspection without being invited by the local authority. It is its right and duty to do so. As my noble friend the Minister said, inspectors are regionalised. After every inspection a very full report must be submitted to the Secretary of State. If faults are found the Secretary of State, through his inspectorate and officers, consults the local authority. In that way, standards are lifted.
Lord Ennals: I am glad that I provoked the noble Baroness into making that response because it yet again brought out her experience from which we always benefit in these debates. We have learned much from this debate and it is a matter to which we must return on Report.
I do not think that anyone in his or her right mind would want to see well-established and well-staffed local inspectorates, well-established and well-staffed regional inspectorates and a well-established and well-staffed national inspectorate. I was slightly amused when the Minister, when asked how many people work in the SSI, replied that they were good quality people. I hope so, but I do not know how many there are and I ought to know.
Baroness Hooper: I said that there were 200 inspectors.
Lord Ennals: The noble Baroness says that there are 200. Frankly, we should be moving towards some system where the regional structure of the SSI is developed so that it can perform the kind of function that lies behind this amendment. A number of noble Lords have said—including the noble Lord, Lord Renton and the noble Lord, Lord Seebohm, who did so with some strength—that it is important to reach the standards we are seeking to achieve and that anyone from outside who looks at those standards should do so with independence. None of us is the best judge of our own performance. It is always better to have someone with a degree of impartiality brought in to look at the service.
As always, the noble Baroness, Lady Carnegy, made a very interesting contribution to the debate. She was absolutely right: We want to raise standards. Sometimes that may mean bringing the standards
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of those local authorities which are rather poor in performance up to a higher standard. Whatever words we use—whether we call it a regional inspectorate or something else—we need an organisation at regional level which will be better able to raise standards than a body at national level. People who work together in the same region, the same county or even in the same country are much more likely to be able to influence each other.
The noble Lord, Lord Boyd-Carpenter, was obviously worried about costs, and I understand that. I favour the view of the noble Baroness, Lady Seear. When we come to judge the cost of a service we have to judge the cost of not providing it. None of us can doubt that the standard of community care in some authorities is very poor indeed. The noble Baroness, Lady Masham, referred to the enormous amount of unmet need. The whole purpose of this Bill is to try to meet that unmet need and to see that there are structures which will enable us in 10 years' time, when we come to look at our community care provision, to find that we have raised the standards.
There is worth in that. There should be some element of payment to ensure that our structure for ensuring good standards is of itself of a high quality. There should be good standards in ensuring good standards. I return to what I said at the beginning. I had no intention, and have no intention, of pressing this amendment to a vote. If the Minister agrees, I hope that there can be some consultation among those who have taken such a very constructive role in this debate to see whether we can provide an organisation at regional level which is obviously linked with the SSI, which draws on what is being done at local level and which does not stand as a free and independent bureaucracy.
Strong feelings have been expressed by the many people who have spoken that there needs to be an independent inspection. We are talking about the whole field of community care and not about buildings, and so on. Therefore, we need a structure which is not in the Bill nor the amendment. I beg leave to withdraw the amendment in the hope that there may be some consultation. I hope the Minister can say that she will be prepared to consider returning with an amendment at Report stage which is more generally acceptable.
Amendment, by leave, withdrawn.
[Amendment No. 115DF not moved.]
4.30 p.m.
Clause 46 [Inspection of premises used for provision of community care services]:
Baroness Seear moved Amendment No. 115DG:
"Page 51, line 21, at beginning insert:
("() The Secretary of State shall, by regulation, require local authorities with responsibility for care in the community services to establish a registiation and inspection system for those services not already subject to registration by virtue of this or any other enactment.
() Such registration and inspection schemes shall include such guidance and regulation as the Secretary of State considers appropriate for the purpose of ensuring that —

(a) a voluntary organisation or other person desiring to provide care in the community, not covered by existing registration; or

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(b) a voluntary organisation or other person contracted by a local authority to provide care in the community not covered by existing registration procedure,

shall at all times have regard to the welfare, health, safety and property of those persons for whom the care in the community services are provided.").
The noble Baroness said: This amendment also concerns inspection but on a somewhat smaller scale and on a more particular point than the wider issue of inspection which we have just been debating. I put forward this amendment in the same spirit as the previous amendment in order to develop the argument about the kind of inspection that we need to have and why we need it.
I am particularly concerned here with,
"a registration and inspection system for those services not already subject to registration by virtue of this or any other enactment".
What I am getting at is the large number of privately financed and profit-making concerns. There is nothing wrong with profit making. I have in mind private concerns and voluntary bodies which in particular provide domiciliary care. It is the home help type of care on a commercial or non-commercial basis. That is an extremely important part of community care. My own view, for what it is worth, is that there is nothing more important, when looking after people in their own homes, than to have someone who will come in to make sure that the place is kept clean and that the washing up is done. It is care at that level that I am speaking about here.
It is very difficult to ensure that that kind of care is done properly. Years ago I was involved in a study as to how the home help organisers controlled the people for whom they were responsible. It is remote control because the controllers cannot see what is being done. The home helps get into the homes of the clients, because that is the only place they can be, and they are subject to a dual loyalty. They have a loyalty towards the people employing them—the local authority—and also a loyalty to the clients. Some of the home helps do their work extremely well but —let us be frank about it —some of them exploit old people. I have seen that and it is very difficult to stop. The old people who are being looked after are too afraid to report the home helps. Exploitation takes place because nobody finds out.
This amendment covers a limited area but it is an important one. Inevitably and rightly, there are private organisations which are being set up and some of them are excellent. I suggest that some of them may not be. We need to have included in our inspection the registration of all these bodies so that there cannot be exploitative groups which will take advantage of the situation in the homes. The organisations should be registered and subject to inspection.
I hope that that provision will do something to stop possible abuses. I say that, realising from personal experience just how difficult it is to pin down this problem. I have no intention of pressing this amendment to a Division. I shall be very interested to hear the comments of the Minister. I beg to move.
Lord Ennals: I rise to support the noble Baroness on this amendment. As she said, private and voluntary care homes are subject to registration. We
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want to find ways in which small homes can be included. At present, domiciliary and day care services provided by private agencies and voluntary organisations are not included in a registration scheme. That must be a mistake because the matter is extremely important. It is quite obvious that the Government expect that there will be major developments in the provision of domiciliary and day care by the private agencies and voluntary organisations.
Where these services are provided under contract by an organisation acting on behalf of a local authority there should be less of a problem. The local authority can specify in the contract what standards are required. It can monitor adherence to those standards. The encouragement of enterprise and innovation which the new deal for community care is intended to promote may bring with it some dangers which were touched on by the noble Baroness. There is a growing demand for services funded wholly from the means of the user or the user's family. It is not necessarily a safeguard that the organisation which an individual approaches already has a contract with the local social services department. There may be no contract with it. The non-contractual work is not subject to regulation either by inspection or by registration.
It is in that area that we can find abuse. There are obvious dangers. The noble Baroness referred to the elderly who may be exploited by unscrupulous people. That may be done through excessively high charges for domiciliary services or services which are not up to standard. As the noble Baroness has also said, elderly and disabled people are the last to complain. They do not want to have a row. Most of us do not want to have a row if we can avoid it, though we get involved in rows now and again. The people we are concerned with do not want to row at all. They feel heavily dependent on and often deeply respectful of those who provide them with domiciliary services and also those who help with day care facilities at day centres, social clubs, and so on.
This amendment builds on the proposals contained in Clause 43. It aims to strengthen the arm of the local authority to ensure that agencies are not run by unsuitable people. The Secretary of State will have power to specify the criteria of unsuitability. The local authority would have power to enforce such criteria. The amendment also proposes that voluntary organisations or private companies which provide such services,
"shall at all times have regard to the welfare, health, safety",
which may refer to fire precautions or other aspects of the service being provided.
The noble Baroness argued the case very well. I may have taken a little longer in doing so. I believe that there is a very powerful case indeed for extending the area of inspection into the fields described in the amendment. I hope that the Government will agree to it.
Lord Kilmarnock: I do not wish to lengthen this discussion; but my name is attached to the amendment and I fully support it. The noble

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Baroness, Lady Seear, and the noble Lord, Lord Ennals, referred to the domiciliary dimension which will obviously become increasingly important and which is not at present covered by legislation. There is also the fact that homes with fewer than four beds do not currently have to register under the Registered Homes Act 1984. That is another peculiar aspect of the matter. I think that I am right in saying that both the Wagner Report and the Griffiths Report recommended that registration should be extended to homes with fewer than four residents.
There are regulations under the 1984 Act which regulate the conduct of residential care homes and the provision of facilities and services. They attempt to ensure that a home should provide for each resident such accommodation and space by day and by night as is reasonable. That is a fairly weak provision, but there are certain smaller homes to which it does not even apply. Whatever regulations exist should be extended right up and down the scale in terms of size. As the noble Baroness, Lady Seear, said, they should certainly include the delivery of services in the home. On those grounds, I support the amendment.
Lord Butterfield: I have one point to make. I am most concerned that we should appreciate the delicate line which exists between entry and intrusion into the homes of old people. We must be most careful when we frame these regulations that we do not give people the impression that, if they are receiving domiciliary care, their house is an extension of the outpatients' department of a hospital.
We must realise how important it is that those who frame the regulations get the matter right. This is also important for those who will be responsible for carrying out the very important extension of the work of the National Health Service and community care services. We do not want people closing their doors to domiciliary care because they do not want the inspector visiting them and finding that they do not do the washing up, and so on. That is rather an extreme example. However, I am sure that what I am saying is in the minds of all those who are behind this most interesting amendment.
I remember how much difficulty there was long ago during the last century when a great problem arose in Manchester about mothers making up artificial milk for their children incorrectly. The whole profession of health visitors had to be evolved. It was most difficult to ensure that they could get into the homes of the mothers and show them how to make up the milk. I understand the difficulties which have arisen in some people's minds about health visitors having the right of access. I want the noble Baroness to know that I realise it will not be very easy to frame the regulations which will cover those activities.
4.45 p.m.
Baroness Hooper: I understand that a similar amendment was tabled and discussed in another place. Therefore, we are aware of the concern behind the amendment about the need for safeguards for
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the new forms of community care. I hope to be able to establish why we feel those worries are not justified. We had a wide-ranging discussion on the previous amendment which is linked in part with this one. We recognise the problem of small homes containing fewer than four people to which the noble Baroness, Lady Seear, referred. We are looking at the situation.
We believe that it is unrealistic and impracticable to place another statutory duty on local authorities to register and inspect services. There are many ways—and I referred to some of them during the debate on the last amendment —in which the quality of service provision will be controlled. First, from April 1991 local authorities will be placing contracts with providers of social care services. Those contracts will contain mechanisms for monitoring and for ensuring that the specifications, including any requirements as to standards, are being met.
In my view, the noble Lord, Lord Ennals, under-estimates the motivation and power of those who will be buying their own services. I am sure that in order to survive in a competitive situation, private companies will need to provide good quality services at reasonable prices.
Baroness Seear: I am most grateful to the noble Baroness for giving way. In my opinion, her assertions are totally unrealistic. Perhaps I may give Members of the Committee an example. I once knew an old lady who was dying and who eventually died. She was 78 years old and uneducated. She had a home help who was a lifeline to her because no one else came to see her except the occasional visitor. The home help would say to her, "Oh, I do like that vase!". A long pause would follow and the old lady would say, "Would you like to have it?". On her next visit she would say, "I do like that rug". That is the kind of situation which will arise.
Therefore, to say that such an old lady would go into the market and trade in order to get another home help is toally unrealistic. Those are the kind of people about whom we are talking. Of course there are other people who will trade; but this is not where the market operates. I believe in the market principle, as does the noble Baroness. However, it has its limits. Old women at home who are half dotty already will not go into the market and say, "My home help is a crook".
Baroness Hooper: The noble Baroness underlines the great difficulty which arises in this connection. I referred to the contractual mechanism. That is one of many safeguards. In the situation just illustrated, clearly that may not be very successful; but we anticipate that it will be in others.
Secondly, there is also the process of case management which will ensure that those who receive care in the community have their cases reviewed at regular intervals. Thirdly, we accept the importance of local authorities establishing and promoting their complaints procedures to ensure that difficulties are dealt with satisfactorily. That is an issue to which we shall no doubt return in more detail at a later stage.

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Finally, Clause 46 gives the Secretary of State the powers, which we have already discussed, to inspect premise.) where community care is being undertaken, especially those premises which are not safeguarded by existing legislation. I can assure the noble Lord, Lord Ennals, that Clause 46 will allow inspection by the Secretary of State's appointee of private and voluntary services with which the local authorities have made contracts.
Lord Ennals: Can the noble Baroness say what those powers include? Are services other than residential services covered?
Baroness Hooper: I believe that this extends to domiciliary and day care services. However, I think perhaps I should check that fact and confirm it to the noble Lord.
The arrangements to which I referred will go a long way towards achieving the control which this amendment seeks without the introduction of new regulatory controls. I can assure Members of the Committee that we shall continue to watch the operation of these services. As I said, there are other provisions in the Bill to promote and safeguard quality. I know that the noble Baroness has said that she does not intend to move that amendment and therefore I shall not need to urge her to withdraw it.
Lord Kilmarnock: Before the noble Lord decides what to do, will what the Minister has just said extend to homes with fewer than four residents? Have I understood her correctly? Subsection (1) includes the words:
"(other thin premises in respect of which any person is registered under the Registered Homes Act 1984)".
The homes to which I am referring are not of course registered under that Act. Therefore will the powers about which she has just been talking extend to those smaller homes?
Baroness Hooper: Clause 46 gives the Secretary of State pcwers to inspect premises where community care is being undertaken. It does not exclude smaller homes.
Lord Carter: Perhaps I may press the Minister on the same point. She has said that the Government are considering the problem of small homes. We understand the difficulty. There was a recent press release from her department, which I do not have with me, in which Mrs. Bottomley, the Minister of State, Said that the Government intended to bring forward legislation on that matter when the opportunity was right. What is that legislation, and when might we see it? There is a problem with small homes.
Lord Ennals: Perhaps I may ask a further question before the Minister replies. I should have asked the same question if my noble friend had not done so. The part of Clause 46 that the Minister read did not seem to include inspection. Inspection may not be the correct word. It did not seem to include the observance of domiciliary services. I bear in mind the point made by the noble Lord, Lord Butterfield.
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Does the clause also include domiciliary services and day care services provided by private agencies? My reading of the clause was that it did not, but if I have it wrong I shall be relieved to hear that the clause includes, first, small homes; secondly, domiciliary services; and thirdly, services provided by private agencies.
Baroness Masham of Ilton: Before the Minister replies, is it not a fact that some people who wish to make money out of vulnerable people have groups of small homes with fewer than four residents? There is nothing to stop them doing that. They may have several homes with 30 or more residents. There may be three or four people only in each home and therefore the homes are not registered.
The Minister mentioned competition in the marketplace. It is difficult to find anyone who is honest and willing to clean people's homes. There is not much competition in this sphere. There is therefore a danger.
Baroness Hooper: The answer to some of those queries is that the Bill covers day and domiciliary services and small homes where there is a contract for the services. That point applies equally to Scotland. We have perhaps not made it clear that we are talking about a group of amendments which include Scottish amendments. My noble friend has drawn that point to my attention. Those areas of concern are covered where a contract exists.
The noble Lord, Lord Carter, asked about the timing for carrying out the consideration offered by my honourable friend the Minister of State. I have no timing to give him at the moment.
Baroness Carnegy of Lour: I am glad that my noble friend made the point about the contract. The noble Baroness, Lady Seear, gave an important example of the old lady who had been deceived by her home help. We have all known that happen. I do not believe that it need be a cause for pouring such scorn on the Bill. If the home help is employed by the local authority, she will only be discovered to be unsatisfactory if someone reports the matter. One cannot have the inspector calling on every old lady when the home help is there. Some member of the family would have to report that the vase had gone. That home help would then cease to be used by the local authority.
If the home help is employed by a private agency, the private agency will be responsible. The contract is the means of control. That agency would have to be told that it would not continue to hold the contract or it would have to get rid of unsatisfactory people. The Bill applies even in the case of that old lady. It is not she who goes into the market for another home help; it is the authority which goes into the market for another agency or changes the home helps that it employs. I believe that the provision applies. I dislike the use of the work "market" as a type of joke in that context because it frightens people. Strong control on this point is built into the Bill and matters should be a lot better than they are at the moment.
Lord Ennals: Before the Minister decides what to do, I am still puzzled. I understand that in another place the Government gave assurances that there would be "inspection of clients' homes". If that is the case, I cannot see how Clause 46 can cover domiciliary services in the way the Minister suggested. We are anxious because the home help service is only one service provided by local authorities, but it is an important one. The quality is sometimes worsening. The noble Baroness, Lady Masham, referred to the fact that home helps often do not do cleaning and yet that is frequently the most important thing that an old gentleman or an old lady—there are some old gentleman who need home helps because they are not as good at housework as the ladies—needs. There is still some ambiguity and uncertainty about the matter. The Minister should settle our minds about it or assure us in some other way. We need to be sure about this matter.
Baroness Hooper: It is much the same point as that raised by my noble friend Lord Renton when we were discussing the previous amendment. Clause 46 refers to premises:
"in which community care services are or are proposed to be provided by a local authority".
Lord Ennals: That does not include private houses.
Baroness Hooper: It does not exclude them.
Baroness Seear: Does the clause mean the physical premises or the care that goes on within those premises? The clause is not clear. It could mean either.
Baroness Hooper: The clause refers to "premises" and "community care services" which are being provided there. It seems to me that the inspection of premises is to see not just that they are adequate but that the community care services that are being carried on there are adequate.
Baroness Seear: This matter is not clear. "Premises" to me suggest a physical building—seeing whether the loos are all right and that type of thing—not checking on the quality of care given to the inmates. The clause may mean that, but the wording is not clear. We should know which it means. I agree that it could mean either.
Lord Seebohm: I do not wish to prolong the matter any longer. I am sorry to make the Minister get up, sit down and get up again. I have discussed this matter with my local authority. The director of social services is worried about the small homes. The Bill allows him to inspect only where the services are provided by the local authority. The small commercial homes are not provided by the local authority and so do not come under the Bill. That is the trouble. There must a completely new approach to get this matter right.
Baroness Faithfull: I too am puzzled about this matter because under the Children Act where there is one child in premises those premises must be
40
visited and inspected. I am not sure why the Children Act should be different from the Bill.
Baroness Hooper: When we refer to "premises", it seems that Members of the Committee are concerned about an individual's home, as in the case of domiciliary care. Obviously there would be no question of an inspector inspecting the client's own home. Therefore we must draw the distinction between that and the inspection of the services provided in a client's home. It follows that the reference in Clause 46 (1) to,
"premises … in which community care services are or are proposed to be provided by a local authority".
covers the services and not just the building. However, we shall read the comments made, as we always try to do, bearing in mind the points made by the noble Lord, Lord Seebohm. We shall try to ascertain whether there is any need to clarify the matter, at least by a clear statement from me on the position at a future stage.
Lord Ennals: I am glad that the noble Baroness will look at this, because we are in a state of great confusion. On page 52, Clause 46 (4) states:
"Any person inspecting any premises under this section—
(a) may interview any person residing there in private".
Does this imply someone in a day centre or a place where home helps foregather to plan their services? I do not believe that the noble Baroness knows what it means and I know damned well that I do not. I suspect that no Member of the Committee does. Those sitting in the boxes may know what it means but they have not brought it to light in the legislation. I hope that the noble Baroness will return at Report stage with a statement as to what the powers are and what they are not.
Baroness Hooper: I believe that what is intended is clear—that is, to ensure that when a complaint is made a reasonable investigation can be carried out. That meets much of the concern raised in the course of the discussion.
Baroness Seear: I am grateful to the noble Baroness for the consideration that she has given to this. As I said at the beginning, I have no intention of pressing the amendment at this stage. We shall wait to hear what further clarification the noble Baroness can give at a later stage. We shall certainly come back to the issue and not leave it at the next stage. However, I now beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
5 p. m.
Lord Mottistone Lord Mottistone moved Amendment No. 115E:
Page 52, line 14, leave out from ("practitioner") to end of line 16.
The noble Lord said: I wish to talk about a slightly different aspect of Clause 46. As Members of the Committee know, I am advised by the National Schizophrenia Fellowship, and my concern lies in that area. Clause 46 (2) (b). which was mentioned

41
earlier, states that any person inspecting any premises may,
"inspect any records … relating to the premises, or any person for whom community care services have been or are to be provided there".
Subsection (5) on page 52 states:
"No person may—

(a) exercise the power conferred by subsection (2) (b) above so as to inspect medical records …

unless he is a registered medical practitioner".
So far, so good. My amendment would delete the rest of subsection (5), which states:
"in the case of the power conferred by subsection (2) (b) … the records relate to medical treatment given at the premises in question".
The difficulty there for schizophrenics is that it could well be that the records held elsewhere or that relate to treatment given elsewhere may be of more importance than the treatment given at the premises in question. As the Committee knows, these unfortunate people from time to time have to go into hospital, where their treatment is stipulated. Then, if suitably fit, they are discharged into the community and will come under the general auspices of this part of the Bill. What these schizophrenics have been given or told in the hospital to do with regard to medical treatment may be of much greater importance than the treatment they receive at the care centre or elsewhere.
It therefore seems to us that the qualification of,
"medical treatment given at the premises in question",
is too tight for the kind of people whose main treatment has been given elsewhere and may be of great importance. Also, I do not know but I suspect that this may apply to other types of illness and not just to schizophrenics. That is why I have not narrowed the amendment to apply only to the mentally ill. I should be most grateful if my noble friend the Minister could explain whether I am wrong. If not, will she agree to the amendment or something similar that she might introduce at a later stage? I beg to move.
Baroness Blatch: I believe that there is a misunderstanding about the purpose of this clause. Its purpose is to provide to persons authorised by the Secretary of State the power to inspect certain premises. The persons authorised will normally be members of the social service inspectorate or nursing and medical staff of the Department of Health in England and their opposite numbers in Scotland and Wales. The premises are those premises in which community care services are provided and in respect of which no power of inspection exists in other legislation. This means unregistered residential care homes and day centres and similar establishments.
The purpose of the power is to enable the authorised persons to inspect both the services provided and the way a local authority is exercising its community care functions. We would expect such inspections to form part of the investigation of serious complaints and other major irregularities. They may also be used in conjunction with monitoring of local authorities' performance. In any
42
event we do not expect that it will be necessary to make a great deal of use of them. The main inspection and monitoring function in respect of private and voluntary facilities with which local authorities have made arrangements will fall to the authorities themselves. They do not need special legislative provision for this and will be expected to include in contracts the arrangements for access and inspection. It may happen, especially in small houses, that the residents' doctors may decide to keep case notes on the premises. Medical records held on other premises such as day centres may contain details of care or treatment provided elsewhere. Given the general purpose of these provisions, we do not feel that it would be right for such records to be open to inspection nor do we see any need for them to be.
I believe that the confusion is because my noble friend is concerned about the records specifically relating to an individual patient. However, the purpose of the clause is to inspect the premises and the quality of the provision provided at those premises as well as to look at the local authority and the way in which it carries out its duties. In the light of this explanation, I hope that my noble friend will feel able to withdraw his amendment.
Lord Peston: Before the noble Lord rises, perhaps I may ask whether the noble Baroness is aware that her answer to this question pre-empts the answer given by her noble friend on the previous amendment. It still seemed to be somewhat doubtful exactly what was being inspected. The noble Baroness, Lady Blatch, has now said in terms that there is no doubt whatever that the quality of care being provided is to be inspected, whereas earlier there was some doubt as to whether that was so. It may well be that in order fully to understand the amendment of the noble Lord, Lord Mottistone, we need the clarification that we were promised on the previous amendment.
My own interpretation of the clause was different. I believed that it concerned solely premises. I do not say that the noble Baroness is wrong. I should find it reassuring to discover that the provision is not only about premises but about the care offered in those premises. However, until we know that, we cannot interpret the validity of the amendment of the noble Lord, Lord Mottistone.
Baroness Blatch: I believe that what I said was consistent with what my noble friend said on the previous amendment. First, the provision covers those premises that are not subject to inspection, premises where the local authority will have contracted to provide services. Therefore three things are being inspected: the premises themselves, the provision that is provided from those premises and the way in which the local authority has exercised its function in contracting with those premises. My noble friend, on the other hand, is concerned about the specific provision for a particular patient and the records that pertain to that patient.
Lord Mottistone: We are getting closer but not close enough. Clause 46 (5) states:
"No person may —

(a) exercise the power conferred by subsection (2) (b) above so as to inspect medical records; or

(b) exercise the power conferred by subsection (4) (b) above, unless he is a registered medical practitioner".

The power conferred by subsection (4) (b) is to examine people in private. I accept the point that my noble friend is making which is that the Government are mainly concerned with examining the overall provision of services. However, in order to determine that, a doctor may want to examine a particular patient as that is a good way of finding out whether an institution looks after schizophrenics, for example. Therefore the doctor exercises his rights conferred under subsection (4) (b) and examines a patient.
By that I mean that if the patient is mentally ill, the doctor talks to that patient. He does not do anything nasty. I know that some people around the country are doing nasty things to children in this respect. The doctor talks to the patient. He may want to consult the records to see what treatment the patient is receiving. As the patient has left hospital, he may have stopped taking his medication. The doctor will want to know what the medication is. That information will probably be in the records which relate to the medical treatment that was given on the premises. Until the patient said he no longer wanted the medication, that medication would have been provided. If the doctor can refer back to the treatment that was given when the patient was last in hospital, he will also find out what medication was given then.
My point has still not been taken. The inspector may say to himself, "I really do not know whether this schizophrenic is being properly looked after because I cannot tell what treatment he has received in the past. Therefore I need to have that extra piece of information to put all the pieces of the jigsaw together. If I do not know whether the schizophrenic is being looked after properly, I do not know whether the care that is provided in this institution is good enough".
One of the points that my noble friend did not address was that of the limitation to consult only records relating to medical treatment that is given at the premises in question. That is the point at issue. She did not give me an answer to that. She took us down another track which, whatever she may say to the noble Lord, Lord Peston, contradicts what my noble friend Lady Hooper said earlier. If that is not the case, I hope they will both look into the matter together and sort it out. We must know the answer to that matter for the sake of the previous amendment and this one and perhaps many that will come on Report. That stage could last a week, if we are to judge by the present rate of progress.
Lord Ennals: Before the noble Lord sits down, I should say that the matter may also involve a long-acting medication that may have been given in the premises in question by a psychiatric nurse.
Lord Mottistone: That is true. I invite my noble friend to clarify this matter. If she can, that will be a jolly good show; but so far there has not been much hope that she will do so.
Lord Winstanley: The noble Lord, Lord Mottistone, has a point here. He knows, as do many of us, that there is a tendency for patients who are suffering from schizophrenia to stop taking their medication once they are removed from the immediate control of the consultant who has been looking after them in hospital. They tend almost by definition to stop taking their medication. The noble Lord, Lord Mottistone, is concerned that when inspections are carried out those who are conducting them should ensure that patients are receiving the proper treatment. That is not a matter that is connected with community care. The noble Lord, Lord Mottistone, wants to see some kind of inspection carried out of the standard of therapy which is being provided for patients. That is a clinical matter. It is a matter which needs attending to; but I am not entirely sure that the noble Lord is right in thinking that this is the way to deal with it.
Lord Rea: As a visiting medical officer who was often called to see patients in elderly people's accommodation, I should say that I have often looked at medical records. I would have found it quite impossible to distinguish between the notes relating to the treatment that was being received at those premises and those relating to previous treatment. If the medical officer concerned has recorded the whole history of treatment, all the notes will be there in any case.
5.15 p.m.
Baroness Blatch: This amendment seeks to permit someone who is authorised by the Secretary of State to examine any medical records which are held on premises being inspected, whether or not they relate to care or treatment that is provided on those premises. It is that blanket approval to examine records that is causing concern. However, there is a further confusion here to which the noble Lord, Lord Winstanley, referred. A doctor may be concerned about the medical condition of a particular patient. He will have access to the medical records anyway if he is the patient's doctor. If he is not the patient's doctor but is concerned about the care that the patient is receiving, no doubt he will alert the patient's doctor to that problem and the case will be investigated. We are confusing again the inspection of premises—and the inspection of the quality of care that is provided on those premises—and access to medical records concerning the treatment of a particular patient.
It may not be entirely relevant, but it is worth mentioning that a Bill which concerns access to health records is being discussed at the moment. There is widespread anxiety that there should be greater access to medical records. However, for the purposes of this clause we are talking about two different things. We shall look at what has been said in this debate when considering the previous amendment and this one. In the light of those

45
remarks. I hope that my noble friend will withdraw the amendment.
Lord Mottistone: I shall not push the amendment any further. We have aired the subject sufficiently well in any case. However, I suggest to my noble friend Lady Blatch that she did not answer the point made by the noble Lord, Lord Rea, that it is impossible within the meaning of Clause 46 (5) to distinguish between medical treatment that is given on the premises concerned or medical treatment that has been given somewhere else. There is room at least for clarification, whatever the purpose behind the clause may be. However, at this stage I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 46 agreed to.
Baroness Hooper Baroness Hooper moved Amendment No. 115AEA:
After Clause 46, insert the following new clause:
("Transfer of staff from health service to local authorities
.—(1) In connection with arrangements relating to community care services made by virtue of this Part of this Act, the Secretary of State may make regulations with respect to the transfer to employment by a local authority of persons previously employed by a National Health Service body.
(2) Regulations under this section may also make provision with respect to the return to employment by a National Health Service body of a person to whom the regulations previously applied on his transfer (whether from that or another National Health Service body) to employment by a local authority.
(3) Without prejudice to the generality of subsections (1) and (2) above regulations under this section may make provision with respect to—

(a) the terms on which a person is to be employed by a local authority or National Health Service body;

(b) the period and continuity of a person's employment for the purposes of the Employment Protection (Consolidation) Act 1978;

(c) superannuation benefits; and

(d) the circumstances in which, when a person ceases to be employed by a National Health Service body or local authority, he is not to be regarded as entitled to benefits in connection with redundancy.

(4) In this section —

(a) "local authority" and "community care services" have the same meaning as in section 44 above; and

(b) "National Health Service body" means a Regional, District or Special Health Authority or a National Health Service trust.

(5) Regulations under this section may make different provision with respect to different cases or description of case, including different provision for different areas.").
The noble Baroness said: The issue which this new clause addresses is one which was raised in the Griffiths Report; that is, the question of ensuring that the skills of staff employed in long-stay hospitals are not lost when responsibility for their patients passes to another authority. As the report pointed out, such staff will have direct personal knowledge of individual former patients and their needs, as well as a wide range of skills which are equally valuable in a community setting. This has been a matter of some concern to National Health Service staff interests and was also raised during the Bill's Committee stage in another place. My honourable friend the Minister of State undertook that we would be bringing forward proposals in this area. I am
46
glad to be able to fulfil that undertaking today. I understand that my noble friend Lord Sanderson will bring forward a similar amendment for Scotland on Report.
At present staff who transfer to the employment of the local authority at the same time as their former patients move to local authority care would not be regarded as continuously employed for various statutory purposes. They will finish one employment and begin another. That means that, unless the NHS could offer them a suitable alternative job, they would become redundant and be entitled to compensation. Furthermore, they would have to work for the local authority for two years if they were full time in order to acquire statutory rights in their new employment.
Amendment No. 115AEA therefore empowers the Secretary of State to make regulations providing for the transfer of such staff. In particular, that would allow a person's service with the NHS and local authorities to be treated as continuous employment. That means that statutory rights, such as access to an industrial tribunal, would be protected and that NHS service would continue to be counted for the purposes of calculating any future redundancy payments or compensation for unfair dismissal.
The purpose of the clause is straightforward but the detailed definition of the circumstances to which it should apply requires some care. It is important that proper account is taken of the views of those immediately involved, including health and local authorities and representatives of the NHS staff. That points to a regulation-making power as the best way of proceeding because there can be detailed consultation about the terms of the regulations, and that is what we intend.
My noble friend Lady Cox raised a similar point at an earlier stage. To ensure consistency I should say, as my noble friend Lady Blatch said last week in response to that point, that local health authorities will continue to employ nurses to work both in hospitals and in the community.
As regards people with a mental handicap, we said in paragraph 2.17 of the White Paper that we would be exploring with the professions, local authority associations and other interests how nurses' skills and experience can best be made available in the new pattern of services. The present amendment ensures that, where it is agreed that staff should transfer, there will be a simple means of achieving that which avoids unnecessary redundancies. That does not in any way prejudice consideration of the wider issue.
The Government recognises that the new clause does not address every single aspect of the move to community care. In particular, the voluntary and private sectors will have an increasing part to play in the new mixed economy. It would be impracticable to bring them within a clause such as this given the great variety of employment conditions they may be operating. However, we believe that the clause, within its limits, has a useful part to play in assisting the smooth transition to community care and I commend it to the Committee. I beg to move.
Lord Carter: The Committee will be grateful to the Minister for explaining the clause. I have just a couple of points to make. The first concerns the point that she made that there will be full consultation with staff in all transfers. The Government have taken some wide enabling powers by regulation in the clause. What rights will employees have if they do not agree with the proposal to transfer them? Will they have all the normal rights under employment law?
Secondly, subsection (2) deals with a person who has been employed by the National Health Service, transfers to a local authority and subsequently returns to work in the National Health Service and protects his rights in those circumstances. What is the position regarding a member of staff who was employed ab initio by a local authority and had not previously been employed by a health authority and is then transferred to the employment of a health authority. Would he be protected under the terms of the clause?
Baroness Hooper: I can answer yes to both of those questions.
On Question, amendment agreed to.
Lord Carter Lord Carter moved Amendment No. 115EA:
After Clause 46, insert the following new clause:
("Standard Spending Assessment and community care in rural areas
.—After subsection (9) of section 80 of the Local Government Finance Act 1988, there shall be inserted the following subsection—
"(10) The basis of distribution contained in a report under subsections (1) or (5) (a) above shall include components reflecting the higher cost of providing community care in rural areas."").
The noble Lord said: In moving Amendment No. 115EA I should also like to speak to Amendment No. 115EB. The Committee will see that the amendments deal with the higher cost of providing community care in both rural areas and inner city areas.
Turning first to Amendment No. 115EA, which deals with rural areas, there is no specific provision in the legislation for local authorities to meet the extra cost of providing community care for individuals in rural areas. The new powers for local authorities to assess individuals' needs and to secure the means for alleviating those needs will almost certainly result in the demands for existing and predicted budgets to be more fully addressed. The cost and the time taken in the delivery of service to individuals who are scattered across a locality will inevitable affect the decisions of those who have to set the standards for service delivery and the subsequent placing of contracts.
I draw the attention of the Committee to a recent report on rural housing by ACRE (Action for Communities in Rural England). It was commissioned by the Rural Development Commission and revealed that there are 376,000 cases of housing need in rural areas. The report indicates that that is more than double the estimate of those who are registered on council waiting lists in rural England for 1989. It emphasises that there are serious housing needs throughout rural England.
The Parliamentary Under-Secretary of State Department of Social Security (Lord Henley): Will the noble Lord give way? I did not catch the name of the report.
Lord Carter: It is a report by ACRE—Action for Communities in Rural England. It is a housing needs report prepared for the Rural Development Commission.
In addition to mentioning the figures concerning housing need in rural areas—53 per cent. of the homeless are to be found outside the metropolitan areas—perhaps I may repeat figures which I have given before regarding the district council where I live in Wiltshire. It is an area of 67,000 people, and includes small market towns. Three years ago the budget for bed and breakfast accommodation for the homeless in that district council area was a little less than £5,000. The out-turn expenditure for 1989–90 is £95,000. That is for one small district council.
We all know that bad housing can lead to many of the problems which have to be dealt with through community care provisions. In addition to housing there are problems relating to rural transport which lead to elderly people effectively being marooned in their homes and the additional cost of providing a comprehensive service over a wide area. There is therefore a strong case for extra help with the cost of providing community care in rural reas.
I turn now to Amendment No. 115EB, which deals with inner city areas. We are all aware of the high cost of providing accommodation in inner city areas: the higher staffing costs and the cost of serving a high-need population in inner city areas—the homeless, those with drug and alcohol problems, those infected with HIV or with AIDS and ethnic minorities. I understand that black people are between three and five times more likely to be diagnosed as schizophrenic than white people. That probably says something about the standards of assessment of schizophrenia. However, that is a problem in inner city areas.
There is poor infrastructure of community care in inner city areas, which one might describe as a patchwork quilt. The quality of service varies from borough to borough, particularly in London. There are problems of co-ordination of the provision of the service that is required across the boundaries of the boroughs. How will that affect the placing of contracts which specify that users must be from a particular local authority area?
It is clear that there will be substantial problems in delivering effective community care in both rural and inner city areas. The amendments are intended to deal with those problems. I beg to move.
Baroness Faithfull: The National Council for Voluntary Organisations wishes me to point out the number of young people who are moving away from rural areas and of elderly people who are staying and the number of village shops and post offices which are closing. The situation in rural areas is becoming difficult for the elderly, particularly those who are disabled and those who become ill. Perhaps those factors should be taken into account.
Lord Boyd-Carpenter: As I understand it, those matters would be taken into account when the revenue support grant for the local authority concerned is under consideration. As I understand the amendments, they simply pick out those two specific items and seek to treat them separately in respect either of rural areas or of inner cities. I shall be interested to hear from my noble friend what the effects of doing that will be. It is certainly my understanding that questions such as the degree of extra costs in particular areas must be taken into account when the general revenue support grant is under assessment and that there would not necessarly be any case for simply picking out those two matters and dealing with them differently from every other issue that arises in that respect.
Lord Henley: I appreciate the concern of the noble Lord, Lord Carter, in moving the amendment, but I hope that I can convince him that the amendment is unnecessary. As my noble friend Lord Boyd-Carpenter said, those factors will be covered in the general consideration of the revenue support grant. I do not think that it would be wise to pick out two factors and enshrine them in legislation in Section 80 of the Local Government Finance Act so that they would be given more prominence than others.
The allocation of funds to individual authorities through the revenue support grant is based on standard spending assessments which give a central Government view of appropriate revenue expenditure by individual authorities to enable them to provide a standard level of service. Included in the overall assessment is a notional element for the personal social services, which from 1991–92 onwards will include the cost of our community care policies. That element is in turn based on detailed formulae which take account of the numbers and needs of residents of each authority.
The formula upon which the distribution report is based, therefore, already takes account of the varying needs of different local authority areas in relation to the provision of community care services. The current distribution arrangements are deliberately designed to be sufficiently flexible to respond to the whole range of diverse factors affecting local authority expenditure needs, not simply those two factors. For instance, the formulae place particular emphasis on the elderly and, most importantly in view of demographic changes, the proportion of very elderly. They also have regard to the numbers living alone and allow for such factors as the numbers of elderly in receipt of income support.
We recognise that the way in which central funds are distributed may have to be reconsidered in the light of the new responsibilities that our community care proposals will place on local authorities. We are actively discussing the implications for the personal social services' distribution formula with the local authority associations. My right honourable friend the Secretary of State for the Environment has already made it clear that he will take account of any new evidence made available to him when setting the standard spending assessments for 1991–92. That could, of course include views on particular
50
difficulties of providing services in rural or inner-city areas. I am sure that my right honourable friend will take note of what the noble Lord, Lord Carter, said, about the ACRE report and of the NCVO's evidence presented by my noble friend Lady Faithfull.
The present arrangements already have the capacity to respond to local factors in the way that the noble Lord seeks. For example, with regard to inner cities, they take account of the unavoidable labour cost factors relating to London and the surrounding south-eastern counties. To introduce a legislative requirement to focus on specific concerns would unnecessarily restrict both the distribution mechanism itself and the discussions which inform the distribution decisions.
I hope that the noble Lord will withdraw his amendment following my assurances that my right honourable friend is engaged in discussions with the local authority associations.
Lord Renton: I must apologise to the Committee for having missed the first three minutes of the debate, but I nevertheless hope that noble Lords will bear with me because it seems to me that, if the community charge needs modification—and there is a general feeling that in some respects it may —it should be considered not selectively or in a piecemeal fashion, but in the broad. We should not therefore try to amend it by the provisions of the Bill.
However, it so happens that, as my noble friend Lord Henley pointed out, in relation to the cost of community care in rural areas and in the inner cities, the arrangements for the revenue support grant which affect the amount of the community charge are of a kind which take account of the varying needs of each area, including the social services and community care needs. In any event, it would therefore seem that the amendments are not necessary. I certainly join with the plea that the noble Lord who moved the amendment, no doubt in great sincerity and with zeal, should now withdraw it.
Lord Henley: My noble friend is correct. Obviously, we must discuss the implications of the community care proposals with the local authority associations. That might lead to slightly different weight being placed on different factors in reaching the SSA on which the RSG is based.
Lord Carter: I find the Minister's answer disappointing. It does not recognise what is now happening. The Minister set great store by what he called the present arrangements which are designed to deal with the problems to which I referred. If that is the case, why did the ACRE report discover that there were 376,000 cases of housing need in rural areas? Everyone was amazed by the findings of that independent report. I referred to the figures for the homeless in rural areas. In the case of inner city areas, you have only to walk across the river over Waterloo Bridge to see how community care is failing and to see the people who live in "Cardboard City".
On the point raised by the noble Lords, Lord Boyd-Carpenter and Lord Renton, there are no

51
general needs indicators in the SSA calculations for the higher cost of provision in, for example, rural areas. The personal social services element does not reflect the service character—for example, the cost of providing services over a wide area as in rural areas.
For all those reasons, the Minister's answer is not satisfactory. There is a problem. As the present arrangements are not working well, it ought to be written into the Bill that that extra provision should be provided. The only thing to do is to ask the opinion of the Committee.
5. 38 p.m.
On Question, Whether the said amendment (No. 115EA) shall be agreed to?
Their Lordships divided: Contents, 85; Not-Contents, 117.

DIVISION NO. 2

CONTENTS

Airedale, L.

Jenkins of Hillhead, L.

Aylestone, L.

Jenkins of Putney, L.

Birk, B.

John-Mackie, L.

Boston of Faversham, L.

Kennett, L.

Bottomley, L.

Kilbracken, L.

Bruce of Donington, L.

Kinloss, Ly.

Carmichael of Kelvingrove,

Listowei, E.

L.

Llewelyn-Davies of Hastoe,

Carter, L.

B.

Cledwyn of Penrhos, L.

Lloyd of Kilgerran, L.

Clinton-Davis, L.

Lockwood, B.

Cudlipp, L.

Macaulay of Bragar, L.

Darcy (de Knayth), B.

Mcintosh of Haringey, L.

David, B.

Mackie of Benshie, L.

Davies of Penrhys, L.

Masham of Ilton, B.

Dean of Beswick, L.

Mason of Barnsley, L.

Diamond, L.

Milner of Leeds, L.

Dormand of Easington, L.

Molloy, L.

Ennals, L.

Morris of Castle Morris, L.

Ewart-Biggs, B.

Mulley, L.

Falkender, B.

Murray of Epping Forest, L.

Falkland, V.

Nicol, B.

Fisher of Rednal, B.

Ogmore, L.

Foot, L.

Oram, L.

Gallacher, L. [Teller.]

Peston, L.

Galpern, L.

Phillips, B.

Gladwyn, L.

Pitt of Hampstead, L.

Graham of Edmonton, L. [Teller.]

Prys-Davies, L.

Rea, L.

Grey, E.

Rochester, L.

Grimond, L.

Shackleton, L.

Hampton, L.

Stedman, B.

Hanworth, V.

Stoddart of Swindon, L.

Harris of Greenwich, L.

Strabolgi, L.

Hatch of Lusby, L.

Taylor of Blackburn, L.

Hayter, L.

Turner of Camden, B.

Henderson of Brompton, L.

Underhill, L.

Hirshfield, L.

Wallace of Coslany, L.

Houghton of Sowerby, L.

Walston, L.

Howie of Troon, L.

Whaddon, L.

Hughes, L.

White, B.

Irvine of Lairg, L.

Wigoder, L.

Jacques, L.

Williams of Elvel, L.

Jay, L.

Winstanley, L.

NOT-CONTENTS

Abercorn, D.

Belhaven and Stenton, L.

Airey of Abingdon, B.

Bellwin, L.

Aldington, L.

Beloff, L.

Alexander of Tunis, E.

Belstead, L.

Allerton, L.

Bessborough, E.

Arran, E.

Blatch, B.

52

Blyth, L.

Macleod of Borve, B.

Boardman, L.

Malmesbury, E.

Borthwick, L.

Mancroft, L.

Boyd-Carpenter, L.

Margadale, L.

Bridgeman, V.

Merrivale, L.

Brougham and Vaux, L.

Mersey, V.

Butterfield, L.

Milverton, L.

Caithness, E.

Morris, L.

Campbell of Alloway, L.

Mottistone, L.

Campbell of Croy, L.

Munster, E.

Carnegy of Lour, B.

Murton of Lindisfarne, L.

Carnock, L.

Nelson, E.

Coleraine, L.

Newall, L.

Constantine of Stanmore, L.

Norrie, L.

Craigavon, V.

Nugent of Guildford, L.

Dacre of Glanton, L.

Oppenheim-Barnes, B.

Davidson, V. [Teller.]

Orkney, E.

Denham, L. [Teller.]

Orr-Ewing, L.

Digby, L.

Pender, L.

Dilhorne, V.

Penrhyn, L.

Donegal!, M.

Portsmouth, E.

Dundee, E.

Prior, L.

Elles, B.

Rankeillour, L.

Ferrers, E.

Reay, L.

Fraser of Carmyllie, L.

Renton, L.

Gray of Contin, L.

Renwick, L.

Greenway, L.

Rippon of Hexham, L.

Gridley, L.

Robertson of Oakridge, L.

Hailsham of Saint

Rodney, L.

Marylebone, L.

Romney, E.

Harmar-Nicholls, L.

Saint Oswald, L.

Henley, L.

Sanderson of Bowden, L.

Hesketh, L.

Seebohm, L.

Hives, L.

Selkirk, E.

Hood, V.

Sharpies, B.

Hooper, B.

Skelmersdale, L.

Howe, E.

Stockton, E.

Hunter of Newington, L.

Strange, B.

Hylton-Foster, B.

Strathclyde, L.

Ironside, L.

Strathmore and Kinghorne,

Jenkin of Roding, L.

E.

Johnston of Rockport, L.

Sudeley, L.

Joseph, L.

Swinfen, L.

Kaberry of Adel, L.

Teviot, L.

Keyes, L.

Thomas of Gwydir, L.

Killearn, L.

Thurlow, L.

Kitchener, E.

Tranmire, L.

Lauderdale, E.

Trumpington, B.

Layton, L.

Ullswater, V.

Lindsey and Abingdon, E.

Vaux of Harrowden, L.

Long, V.

Windlesham, L.

Lyell, L.

Wynford, L.

McColl of Dulwich, L.

Young, B.

Mackay of Clashfern, L.

Resolved in the negative, and amendment disagreed to accordingly.
5. 46 p. m.
[Amendment No. 115EB not moved.]
Lord Peston Lord Peston moved Amendment No. 115EC:
After Clause 46, insert the following new clause:
("Training for voluntary organisations: general power.
—(1) The Secretary of State may, with the approval of the Treasury, give financial assistance—

(a) to persons providing educational or training courses in connection with the provision of community care services or support for users of community care services or carers of such users by voluntary organisations; and

(b) to persons providing financial or other assistance to those attending such courses.

(2) Financial assistance may be given under this section in any form, and may in particular be given by way of grants, loans or guarantees or by incurring expenditure for the benefit of the person assisted.").
The noble Lord said: In moving Amendment No, 115EC which stands in my name and that of my

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noble friend Lord Carter, I shall speak also to Amendments Nos. 115ED, 116A and 116C. Although Amendment No. 116C is connected with the other three amendments, it is not very closely connected. As it has been tabled in the name also of the noble Lord, Lord Kilmarnock, I shall merely express support for it and leave the noble Lord to deal with the detail.
There is nothing between us on the importance of encouraging the voluntary organisations in this area. The case for the voluntary organisations was put clearly in the White Paper and by the noble Baroness's right honourable friend the Secretary of State. That is not the point at issue. I fully believe also that there is nothing between us on the question of the importance of quality of care, the need for quality assurance and so on. Where we may regretfully disagree is about how quality will be assured.
The purpose of the first three amendments in this group is to help to ensure that quality assurance by seeing that the appropriate education and training, notably in the voluntary sector, is provided to those who will be participating in the provision of community care. That is the point at issue.
We start from the position that, in encouraging the voluntary organisations to participate, we have to recognise that at the present time probably many if not all of them are not fully equipped to do that job. They have skills and understanding but may lack some of the appropriate expertise. One reason for the amendments therefore is to find a way to help them acquire the relevant education and training.
Let me say immediately that I am not one of those who believe that what we might call "amateurism" is good enough in this area. Indeed, I go further. I believe that throughout our economy and society amateurism has put us into many of the difficulties in which we find ourselves. The solution lies in many areas. It lies in enhancing the quality of educational training that we provide. I do not think that bumbling along relying on the devoted, gifted amateur is satisfactory. That is a general point. I do not refer only to the provision of community care, although the argument certainly holds for such provision.
The problem does not arise because we do not know what to do but because we do not do it. I refer to the voluntary sector. One reason is that it is very hard to obtain the funds that will enable such courses to take place. From my knowledge of the voluntary sector I do not see how these funds would become available unless the Secretary of State takes the lead to a very considerable degree and accepts some responsibility for providing funding.
If I am totally honest, as I always am with the Committee, I would go further. We are not discussing ad hoc courses. I should like to build on the excellent development of the National Council for Vocational Qualifications that the Government have encouraged. It seems an area in which the NCVQ could play a useful role. With regard to the NCVQ, the care sector consortium could become the lead industry body for work in this field. However, in order for it to do so funding has to be found somewhere. I do not see how the funding could come
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from the voluntary sector. I do not see the funding coming from the local authorities bidding for community care via the voluntary organisations. The local authorities will not find themselves able to fund them.
On Amendment No. 115ED, I regret to say—I have done this before to the Committee—that having considered the amendment, it does not state what I wish. I am a very slow learner; I tend to get there in the end. However, the Secretary of State should provide the broad framework, the broad guidelines, within which training and education would take place and the NCVQ, voluntary bodies and others would then get down to the detailed training programme.
I agree that "training programme" could be interpreted in the broad sense. However, the amendment could be read in the narrow sense. The role of the Secretary of State is not to lay down the training programme in detail but, to return to terminology used last week, to provide guidelines in that area.
Lord Ogmore: On the subject of professionalism—I believe that that was the intent of what the noble Lord said when he referred to amateurism—in this country we are gradually shifting towards professionalism. Some years ago I had some association with the world of rugby, which has become completely professional even though of amateur status. I know that it is seeking excellence all the time, but if we completely depart from the amateur status some aspects may be lost, especially if one refers to rugby where everything is geared to such excellence. The few who achieve such excellence maintain that level. However, so many of the minor clubs may miss out by a search for excellence. We have to take care that we do not go too fast down the road of excellence. There is a danger that the vast majority who are mediocre or average tend to miss out through the excellence of the high fliers.
Lord Peston: I am indebted to the noble Lord. I have to tell him that rugby is not my game. However, there are other games that one could take seriously. By his analogy he raises a vital point. In terms of community care there is no substitute for the devotion that the voluntary bodies bring to this area. I take that to be the analogy to the amateur spirit to which he referred. However, I make the same point about sports and games as I do about community care: it is better to do the thing properly. I even believe that about rugby, which is a game that I do not particularly care for. I always thought that it was a girl's game played by rather brutish men.
Lord Winstanley: To amplify the point made by my noble friend, when the noble Lord, Lord Peston, referred to amateurism and said that we wanted professionalism, he was not talking about people being paid but about people being trained. That is a very different thing. The matter of paying people is a very different factor. We want a very high standard of performance from the voluntary bodies but there is no way that they will be paid. However, they will be paid for the training that will give them that high

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standard of performance. Perhaps the noble Lord would have phrased it better if he had not referred to amateurism in the way that he did but qualified it in this way.
Lord Peston: No question of payment has arisen on the amendment. With regard to rugby, I thought it was an amateur game although I should like to see it played professionally. I believe that Rugby League is a professional game. I hope that the noble Lord will forgive me if I do not go through the whole sporting calendar in detail.
I hate to moan on about it, but doing things properly on the basis of correct training, education and expertise is still an aspect that we find hard to accept in this country. If we are ever to go forward as a successful country we have to take professionalism seriously in the sense that I use the word.
I hope that I may now proceed on that basis on Amendment No. 116A. In so far as local authorities can be persuaded to be involved in such arrangements, funds could come forth from the Secretary of State to enable them to be financed. I have raised the question of finance. In order to anticipate those Members of the Committee who may say that they are worried about government expenditure and so on, I rely on the same argument that the Government use. I draw the attention of the Committee to page (xi) of the Explanatory and Financial Memorandum. The Government recognise that Clauses 44, 45, 46, 49, 50 and 52 will require a general strengthening of management at all levels and an increase in running costs. The memorandum then states:
"These would be offset by better targeting of services as a result of these activities and by some reallocation of existing resources".
In other words, the Government are getting away from the question of, "Where does the money come from?" by arguing that what they want to do is self-financing. If the Government can put forward that argument on behalf of their proposals it is equally valid for me to do so in respect of these clauses.
I believe that the provision of education and training will make the measures much more effective. Therefore, rather than adding any net cost to the public purse they will, if anything, save money. I say that in anticipation of any Member who may argue, "Where will the money come from?". I argue that this is an investment which will yield returns and improve the provision of the Treasury. I hope that the Minister's brief contains a note from the Treasury saying that the amendments must be supported. I beg to move.
6 p.m.
Baroness Faithfull: I support the amendment in part based on the submission that I have received from the National Council for Voluntary Organisations. We must realise what the voluntary sector has to offer. However, it needs highly-trained people to organise its management. It is often unnecessary for voluntary workers to be fully qualified although they must be given certain
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information in order to point people in the right direction.
I like the words contained in Amendment No. 115ED:
"The Secretary of State shall establish a training programme for the purposes of better equipping voluntary organisations".
That is the real point. We are not looking to train every voluntary worker to carry out a skilled job alongside the highly-trained, skilled people. They are partners and supplement the service. I remember asking the local authority for three more staff in my department. It would not provide them because it considered that there were not the resources. I enlisted 30 voluntary workers to supplement the trained workers but they had to be given certain information and training. Therefore, the voluntary organisations need money to set up the appropriate training and information services.
Lord Ennals: I agree with everything that the noble Baroness has said. However, will she not go further and recognise the fact that many of the voluntary organisations providing services either in conjunction with local authorities or independently have professional staff members as skilled and as well-trained as those working for statutory bodies? For instance, MIND runs a casework and legal advice service and those employed to provide that are trained and highly-skilled professionals. It is a voluntary organisation because a great deal of its money is raised in that way. It has inspired and is helped by many volunteers throughout the country. However, its central work is carried out by highly-trained, highly-skilled professional people.
Baroness Faithfull: I thank the noble Lord, Lord Ennals. I agree that in every voluntary organisation there are highly-skilled people; for instance, in Barnardo's and the National Children's Home. However, there are others who supplement those people and who are vitally important. They need to be given information in a less-skilled training programme. We need training programmes for the highly-skilled and also the less-skilled people who offer a good service.
Lord Mancroft: I believe that in discussing the amendment we may enter a minefield. I have some expertise in the treatment of drug and alcohol abuse where by far the greater standard of excellence and expertise is in the voluntary sector. The expertise found in the health and local authorities is, in many cases, deplorable—and I choose the word carefully. It has a directly adverse effect on the patients or clients.
The problem is that there are now four voluntary sector establishments in that field which are training people to a high standard. On completion of training they have no certification nor magic letters after their names because none exists in this country. At present the best trained practitioners in the United Kingdom have been trained in America but the American qualification is not accepted here. One enters an area where one professional body is squabbling with another and saying, "My qualification is better than yours".

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I am slightly worried because, although one is making a provision for training, one is not specifying the training. Who is to say that it is the right training? What will be the qualification gained as a result? Unless that is made clear one is merely inviting a great deal of time and money to be spent and a great deal of trouble to be taken in order to have people trained in an area which may not be appropriate to their job.
In the area about which I am talking—that is drugs and alcohol—not many people are qualified. If they were undertaking training they would merely be teaching other people who did not know what to do. That is a dangerous area to enter. I believe that the professionals in the field—perhaps "professionals" with a small "p"—should decide the necessary qualifications, set up the registration and certification bodies and then approach the local and health authorities and ultimately the Department of Health.
I am slightly cheating because some months ago I had informal chats on the subject with my noble friend. It appears that the Government and the Department of Health are keen that such training should begin in that way. It seems to be a more sensible way than writing the provisions into the Bill in this form. If we agree to the new clause we are putting the ball in the Department of Health's court where it should not be; it should be in the court of the voluntary sector allowing it to reach its conclusions and to come forward for registration. That is the better way of providing training.
Lord Kilmarnock: As the noble Lord, Lord Peston, indicated in his opening remarks, Amendment No. 116C, to which I am speaking, has been grouped with the previous amendments on the ground that it concerns grants to voluntary bodies. The amendment seeks to deal specifically with the problem of voluntary organisations whose catchment areas cover the boundaries of more than one local authority and who will find themselves in danger of closing as a result of the new system of community care funding.
We are seeing a shift from providing general grant aid for voluntary bodies to the contractual system which the Bill introduces. I am aware that there is a London boroughs grant system which is run through the lead borough of Richmond. However, I understand that it is unlikely to be able to increase funding in the cross-boundary areas and that it is cash limited.
The White Paper and the Bill envisaged the general pattern of funding for community care shifting towards contracts negotiated between providers and local authorities, usually on a block basis. That makes sense in respect of such provisions as local day centres and residential care homes for the elderly. However, it makes somewhat less sense for other activities which may not be able to function so well under the arrangements. There are a few problem areas in which that model is not appropriate and to which I should like to draw attention. For example, there are eases in which the client group has no necessary link with any particular authority. That is so for many people who are dependent on alcohol or
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drugs, about which the noble Lord, Lord Mancroft, spoke, and for many single homeless people who may have become mentally ill as a result of their period of homelessness. It has been suggested that around 40 per cent. of users of some projects in central London for homeless people are suffering from some form of mental illness.
There is also the case of the client group which is not large enough in any one local authority to justify provision in that area alone. That will be the case for the so-called low incidence disabilities such as deafness and blindness which we have already discussed on an earlier amendment and for many specialist kinds of provision such as crisis intervention in drug and alcohol work.
It will also be the case in projects working with people who are HIV positive, who have AIDS-related conditions or who have full blown AIDS. Those people are not confined to local authority areas, and those conditions are essentially of a cross-boundary nature.
It will be the case for all agencies providing any kind of open-door services, as they are called, such as drop-in counselling or projects such as crisis intervention in drug dependency. In such cases people come from dozens of authorities and may be in contact with the agency for only a few weeks.
Neither the local authorities with which the clients have a link nor the local authority within whose area the service is situated may wish to accept the responsibility. The point is that voluntary organisations have been started in many of these fields because of their ability to tackle innovatory projects across local authority boundaries. One example is the alcohol recovery project. That accepts referrals from people who may be considered to have a link with 55 authorities, some of which are in Scotland or Ireland. If, before accepting someone for day-care counselling or residential care on an interim basis, the project has to contact all the authorities with which the person has any link in order to try to persuade one to accept the responsibility and then to negotiate a contract for the service, there will be chaos and the system will become totally ineffective. Another project which has been mentioned with which I know the noble Baroness, Lady Masham, is closely connected is Phoenix House. That is a project in North London which provides residential support, rehabilitation and treatment for drug users. It takes clients from anywhere in the country.
As we move into the new system, there is something of a problem as to how the cross-boundary voluntary sector activities will be funded. As I have already mentioned, the only mechanism in existence whereby local authorities can collectively fund voluntary services across their boundaries is through Section 48. In London that is the arrangement funded through the London borough of Richmond, but we are talking about a problem which is wider than London.
If we are to do anything about this, and if we are to recognise the role of these cross-boundary voluntary agencies, Clause 47 seems to be the most appropriate place. Therefore, the amendment is to that clause. It introduces a new subsection (7E) after

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(7D) which empowers the Secretary of State to make special grants for mental illness which we have already discussed in the ring fencing debate. The most appropriate place in the Bill to give recognition to cross-boundary voluntary bodies is at the end of this clause and that is why the amendment is there inserted. This is not an amendment which I propose to move to a division, but it is incumbent on the Government to tell us what they intend to do in this very important problem area.
Baroness Masham of Ilton: Crossroads care attendance schemes support these amendments. They give care to very severely disabled people in their own homes. They may have cancer; they may be very elderly or have a severe physical disability. The care attendants are often married women who have some time on their hands and are able to give a few hours to the scheme. They sometimes go to a person's home, stay the night, put the person to bed at night and get them up in the morning. There is lifting involved in that. Anyone who knows about lifting knows that the person should be properly trained otherwise there may be damage to the back. Therefore, to get these schemes off the ground there needs to be training and very often pump-priming grants. There is a danger that those might disappear.
Lord Motristone: I strongly support the principle of this group of amendments, and I hope that my noble friend Lady Blatch will have something encouraging to say about them.
6.15 p.m.
Lord Boyd-Carpenter: I take up one matter raised by the noble Lord, Lord Peston. I do not believe that he meant it seriously when he suggested that because of the greater efficiency which would follow from the adoption of these proposals, there would be no cost. In any event, he must face the fact that the expenditure incurred would be immediate and any of the savings for which he hopes would not mature for years. Therefore, we are concerned with some immediate expenditure.
Of itself that is no reason to reject the proposals. However, I believe that when any Member of the Committee makes a proposal for further expenditure on public funds, an explanation is owed to the Committee of the expenditure involved. Are we talking of five, six or seven figures? What sort of figure is contemplated?
Just as any Member of the Committee in private affairs would always consider on any proposal what was the right amount to be spent on it, so when we are dealing with public affairs—and particularly in this Chamber which has no responsibility for public expenditure—we owe it to ourselves to be able to say how much will be the cost of something which we are advocating. Without the advantages of official briefing, it is not expected that the noble Lord opposite will be able to give a precise figure. However, he owes it to the Committee to give an idea of the magnitude of the sum involved because while many Members of the Committee may feel well disposed towards certain proposals if the
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expenditure was small, as it rises one's doubts must be reinforced. It is very difficult to form a judgment on an amendment involving public expenditure unless those who bring it forward give some idea of what it will cost.
Lord Swinfen: As I understand it, the Government are looking for more and more assistance from the voluntary sector to help disabled and disadvantaged people of one kind or another. I know from my own experience of a charity that young people who come to look after very severely physically disabled people for the most part have a very limited life in that work. Their burn-out time is about 12 to 18 months. It takes very special people to make a career in that sort of work.
I know of one instance where a young man was working during his summer holidays looking after very severely physically disabled people. The following year his father asked him whether he would return to the John Groom's organisation. He said, "No. It was almost as much as I could take to complete the six weeks because I found it so distressing". That means that voluntary organisations train people who will not be with them for six, 10 or 15 years. They must continuously spend money on training replacement staff. That is voluntary money raised from the general public which cannot be used elsewhere.
Baroness Blatch: The noble Lord, Lord Peston, referred—I use his words—to bumbling along with the gifted amateur. That reference was unfortunate and I was grateful to the noble Lord, Lord Winstanley, for his qualification and the subsequent confirmation from the noble Lord, Lord Peston. I was also grateful for the comments made by my noble friend Lord Mancroft, who referred to the special contribution made by the voluntary sector which is very often significant and complementary to that of the professionals. It is therefore important to place on record the value of the voluntary sector and we must lay the ghost of the reference to "bumbling along".
Lord Peston: Perhaps I could interrupt the Minister because I do not want her to be too kind to me. I meant what I said. I do not for one moment doubt the contribution that the voluntary sector makes. I am also well aware that it contains a number of people who are very capable. However, I meant "bumbling along with the gifted amateur". It is what is wrong with the country; not what is wrong with the voluntary sector. I do not withdraw the remark, even if the noble Baroness becomes angry with me. It is what I meant to say.
Baroness Blatch: I say with equal vigour that a considerable part of the voluntary sector, with or without our help, makes a significant contribution. We do not have to bumble along with them. Their training needs are often met from within their own organisations.
These four amendments are all concerned with voluntary organisations. Amendments Nos. 115EC and 116A would in different ways enable the Secretary of State to make grants for the training of

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staff of voluntary organisations. Indeed, Amendment No. 115EC would go further than that and make it possible for grants to be put to profit-making concerns. I am sure that that was not intended. Amendment No. USED would require the Secretary of State to set up and finance a training programme to enable voluntary organisations to assist in the provision of community care services. Finally, Amendment No. 116D would enable the functions of voluntary organisations providing services to people from a wide area to be centrally funded.
The Government recognise the importance of the voluntary sector in providing much needed services to the community. The White Paper Caring for People stated that one of the key objectives for community care services was,
"to promote the development of a flourishing independent sector alongside good quality public services".
Thus local authority social services should be enabling agencies, stimulating and supporting service provision by voluntary and private organisations. The Government therefore recognise the need for staff in the voluntary sector to be trained and qualified for the work they do. However, the proposals in these amendments are not an appropriate means for achieving that objective.
First, the value of the voluntary sector is that it is in some measure independent of both central and local government. We already fund the voluntary sector to a considerable extent through Section 64 of the Health Services and Public Health Act 1968. Local authorities also make a considerable financial contribution to local voluntary organisations. For govenment to provide through a central initiative significant additional funding for the training of staff, even for three years, would begin to undermine the very notion that the voluntary sector is indeed in some meaningful way voluntary and independent.
Secondly, responsibility for training staff within the voluntary sector rests primarily with voluntary organisations as employers. Government have a role to play in encouraging relevant training for appropnate staff in all sectors of the personal social services and have already taken a number of important initiatives in that respect. The Secretary of State already has power under Section 64 of the Health Services and Public Health Act 1968 to make grants or loans to voluntary organisations providing community care type services.
The noble Lord, Lord Peston, referred to the National Council for Voluntary Organisations. I am pleased no be able to assure him that the Government are funding the council to participate in the work of the care sector consortium through a Section 64 grant. Furthermore, local authorities have powers under Section 65 to provide grants to voluntary organisations which they would be able to use in funding training for staff of organisations with which they agreed contracts for provision of community care services. Also, using powers under Section 63 of the Health Services and Public Health Act 1968, the Secretary of State has encouraged local authorities to provide places on their training courses for staff from the voluntary sector under the training support programme. In 1990–91 the
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training support programme includes £7.6 million I specific grant for the training of staff working with elderly people.
We have encouraged local authorities to provide places on their own training courses for staff from those sectors, particularly training provided using the Department of Health's training support programme funds. Also, as part of the follow up by the department to the Wagner report on residential care, the National Institute for Social Work has been commissioned to undertake a programme to promote the training of care staff in homes of all types. A further special programme of funding is unnecessary.
My department's social services inspectorate will continue to lead work on identifying training needs and setting up initiatives to deal with them. In relation to community care, it has set up, jointly with the Central Council for Education and Training in Social Work (CCETSW), a Training for Community Care Strategy Group. The voluntary sector in relation to personal social services is represented on that group and has already made a considerable contribution.
Amendment No. 116C covers rather different ground. It addresses the situation where a voluntary organisation runs a hostel which draws its clientele from a wide area, and indeed where it may not be obvious in which local authority the people concerned are ordinarily resident. I readily acknowledge the difficulties in coping with that situation, which the noble Lord, Lord Kilmarnock, so vividly described. However, I do not think that the proposals in this amendment, which break the important principle that local services should normally be locally funded, are the right way of tackling it.
First, I ask your Lordships to bear in mind that when they have little or no means such hostel dwellers can claim income support and housing benefit, which together should cover their accommodation and maintenance expenses, thus leaving only the balance of the cost to be met by the local authority. Secondly, it may help if I explain how the principle of ordinary residence works. That is the way in which the local authority responsible for a person's care can be identified. A person is reckoned to be ordinarily resident in the place where he has chosen to make his abode when the need for care arises. In the case of a homeless person that is simply the place where he happens to be when the need arises.
I agree that that can place a disproportionate burden on local authorities that have places within their areas where homeless people tend to congregate. But there are ways of dealing with that: local authorities can work together and agree that one should act on behalf of a number, or that each authority should look after the people who arise from within its own area on a knock-for-knock basis. In either event, as was explained when we were talking about urgent treatment earlier in our debates in Committee, the local authority has two alternatives. Either it can agree with the hostel that everyone admitted to it will be supported to the extent necessary by the local authority for the first

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few days of admission without further assessment or inquiry or the authority would grant-aid a voluntary organisation to care for people for short periods without local authority intervention.
Finally, it will be the case that under the community care arrangements the voluntary organisation would have to arrange permanent admissions with the local authority where the person it is caring for is ordinarily resident. That may involve the voluntary organisation in dealings with a number of authorities. I acknowledge the difficulty here but I hope that it could be overcome with sensible local organisation. Basically the answers to all those problems must be found locally. Making central grants available simply conceals the need and would prevent problems from being properly examined and tackled. It would also involve the centre inappropriately in local administration. I must therefore ask the Committee to reject these amendments.
Baroness Masham of Ilton: Before the noble Lord, Lord Peston, rises to speak, perhaps I may say that the Minister touched on the most difficult point. The voluntary organisations which run the national organisations do not know how to collect the money which they used to receive centrally from different social service departments throughout the country. Perhaps the Minister can give some idea as to what they should do. The voluntary organisations, including Phoenix House and ACET, which deal with home care for AIDS say that it will increase their workload by around 400 per cent. It is something about which they are extremely concerned.
6.30 p.m.
Baroness Blatch: I believe I addressed the point in terms of how one local authority will work with other local authorities in this area. It is important that there is now a qualification of what "ordinary residence" means. I must also refer to the sums of money that will be passed to local authorities which will increase their budgets and enable them to cope with community care. There will be more money available and it will be important for local authorities to address the problem of the very people of whom my noble friend is speaking when making their plans for their areas. That will include people, whether or not homeless, who reside in those areas at the time of need.
Lord Swinfen: Before the noble Lord, Lord Peston, replies, will he be good enough to define the term "voluntary organisations" used in his amendment? To my mind he seems to have been extremely rude to a number of very well established, very highly professional charitable organisations that have been the leaders in community care for generations.
Lord Peston: I thank all noble Lords for taking part in this interesting discussion. Perhaps I may start with the question put by the noble Lord, Lord Swinfen. He poses a very interesting problem. I, for one, hold the organisations he has in mind in the
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highest esteem. However, I do not believe that holding a body in high esteem means that it is not to be subject to criticism. This kind of area is always a matter of delicacy. It applies to all kinds of other areas. One can be discussing the education and training of teachers or of anyone else. One is confronted with the reaction, "Do you not appreciate what a good job they are doing?".
Let me say at once to the noble Lord, Lord Swinfen, that I very much appreciate the good job that these organisations are doing. Many of the participants in these organisations do things which I could not do because I could not cope psychologically with the work concerned. The case given by the noble Lord is a good example of why many of us have such a difficulty. It is not remotely my intention to insult the people involved in the organisations. When I say to someone who is an amateur, "Can't we get down to doing this professionally?" it is not meant to be an insult but to assist them to do the job more effectively.
In my support, or defence, perhaps I may make the point that my proposals are precisely what the voluntary bodies themselves support and what they want in order to do a better job. That is the point I seek to make. Therefore, I do not withdraw my remarks. I did not withdraw them as regards the noble Baroness. It is not because I do not hold these organisations in high esteem but precisely because I do and because I want to assist them to do a much better job in the new era which allegedly we are to get from the Government. I want the organisations to have this education and training. That is the point. I do not seek to insult them. I would make the same point about many other areas of our life with the same intention—to improve matters.
Lord Winstanley: I am grateful to the noble Lord for giving way. I am anxious to determine or elucidate his precise meaning. Does he consider that what he is now doing is as an amateur or as a professional?
Lord Peston: That is a very good question. If what I am now doing is as a politician —occasionally I am horrified to find myself referred to as such —I have to say to the noble Lord that I consider myself a bumbling amateur. I am not good at it. However, if the noble Lord will allow me to go on to discuss public expenditure I would regard myself as not merely an expert but as an expert with very few rivals. In that case I have not the slightest difficulty in referring to myself as a professional. However, where I am a bumbling amateur I welcome a great deal of help from the noble Lord and others to do my job slightly better.
Lord Swinfen: I thank the noble Lord for again giving way. Perhaps I may point out to him that the term "voluntary organisation" in many instances is a total misnomer, as I am sure the noble Lord, Lord Peston, and Members of the Committee will acknowledge. There may be some organisations which are, as he said, totally bumbling. However, the reputable organisations are highly professional and are pushing the community care profession further ahead than almost anyone else.
Lord Peston: I thank the noble Lord, but let me add that I did not use the word "reputable" and therefore, by contrast, the word "disreputable". I do not suggest that the question of being reputable arises in any way. However, I ask noble Lords—and specifically the noble Lord, Lord Swinfen —to bear in mind the point I made that voluntary organisations are themselves extremely keen on these amendments. They want to see these proposals accepted, as I understood did the noble Lord, Lord Swinfen. It is simply my being obstinate and refusing to back down on the question of amateur versus professional which may get between us on this matter; but perhaps the noble Lord will bear with me and allow me to be obstinate.
Fascinating though this debate is I am not certain that the matter is worth the amount of time we are putting into it, but perhaps I may make two further points. As regards the contribution made by the noble Lord, Lord Mancroft, I said earlier that I was not keen on the wording of Amendment No. 115ED and that was precisely because of the kind of points he was making. However, I should very much like to see the kind of professionalism that I want—the kind of criteria and needs—coming from the bodies. The noble Lord may not have listened to exactly what I said because this body exists—the National Council for Vocational Qualifications—which in my view can canalise those efforts. I agree that there is not much between us in that respect. I certainly do not see this as something imposed from on high; I see it as saying to people, "What is it you need? How can we provide it?".
Finally, I am very much with the noble Lord, Lord Boyd-Carpenter, in regard to public expenditure. However, there are two difficulties, or perhaps three, that I can see. The difficulty that I do not see is an inability to do the calculation. To be perfectly honest, I believe that I could do it. My difficulty is two-fold. First, I have a feeling that if I were to say that I propose we should spend £5 million, noble Lords will immediately tell me that I am not allowed in this Chamber to talk about spending money. Therefore, I am slightly caught. I could do the estimates but I think I would then be ruled out of order.
My second point—and on this I do insist—is that if the Government do not come up in this clause with a precise statement of how much money their proposa s will cost (the noble Lord, Lord Boyd-Carpenter, is well aware that the Government have only made broad remarks) I do not see why I should be accused of not providing a precise calculation. I refer back to the intervention of the noble Lord, Lord Boyd-Carpenter, on an earlier amendment. I should like the Government to tell me what Clause 46 will cost. The noble Lord raised that point. The Government have given absolutely no indication of what it will cost, though I have at the back of my mind a possible answer. Therefore, my defence is that I am entirely with the noble Lord, Lord Boyd-Carpenter, in regard to public expenditure. I do not believe that one should say that something should be done whatever the cost. However, we should all play by the same set of rules. If I am criticised for not suggesting a sum of money
66
then the Government should not be allowed to proceed with any of their proposals without telling me, clause by clause, what they will cost. I merely want to play under an equal set of rules.
I have been sidetracked in dealing with my amendment. I am acutely disappointed with the reply from the noble Baroness. I strongly believe that central to this whole development is education and training. The voluntary organisations, as they have advised me, do not find these amendments remotely threatening to their independence; on the contrary, they are extremely keen to have this support. All I can say at this stage is that I will reflect on what I have heard and come back with an amendment on Report with a view to testing the general view of the Chamber. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendment No. I15ED not moved.]
Lord Ennals Lord Ennals moved Amendment No. 115EE:
After Clause 46, insert the following new clause:
("Join! Finance
.—(1) The Secretary of State shall establish a scheme for the making of payments towards local authority expenditure on innovative forms of community care services.
(2) The scheme established under (1) above shall make provision for—

(a) payments by the Secretary of State to be made to a social services authority, and expenditure under the scheme to be made by the social services authority, a district council, an education authority, a housing authority, a housing association or a voluntary organisation;

(b) expenditure under the scheme to be made only when agreed by the social services authority in consultation with the District Health Authority, the district council and voluntary organisations active in the area;

(c) expenditure under the scheme to be of a capital or a revenue nature; and

(d) the social services authority to publish information in their area concerning the use made of expenditure under the scheme and such criteria as are applied in making decisions on proposals for such expenditure.").

The noble Lord said: Once again, for the purpose of this amendment, I am my noble friend Lord Carter and I move it on his behalf.
In an earlier debate we probed the Government's intentions in sustaining joint funding which, as I said, had been introduced when I was Secretary of State. We agreed that under successive governments joint funding had been a useful operation, that it had supported initiatives and had brought together health authorities, local authorities and voluntary organisations.
Bearing in mind the proper concern about funding of the noble Lord, Lord Boyd-Carpenter, I think that at the time we were referring to existing joint funding of about £146 million. I was told by the Minister that the future of joint funding was under consideration. I was given the impression that it was likely to continue in some form or another. This amendment does not seek to confine or restrict the discussions now being held by the Government; it seeks to ensure that this initiative launched 30 years ago finds its place in future arrangements and on to the face of the Bill.
So far there is no sign that the Government intend to table any amendments or that their timetable for discussions will enable them to do so before the Bill

67
receives Royal Assent. If I am wrong in that respect then no doubt the noble Lord will tell me. Obviously, joint finance is health service money which can be spent on local authority or voluntary organisational projects which promote community care. These projects are jointly agreed through the local joint planning mechanism which, as I have said, brings together, as regards the planning of community care, health authorities, local authorities and voluntary organisations.
I believe we have agreed across the Floor of the House that joint finance has been of great value in enabling new and innovative community care services to develop and particularly those provided by voluntary organisations. It has been used very effectively to complement major health and social service provisions. The provision has been used to fund initiatives across the whole range of community care, often crossing traditional service boundaries, including joint projects involving both statutory and voluntary sectors.
Joint finance has often enabled services to develop which meet the needs of people which would otherwise have remained unmet. I refer, for example, to rural projects about which my noble friend was speaking earlier, and those run by service users. Some very useful work is undertaken by service users and some of it is the result of joint finance. That has made a major contribution over the years and throughout the country to the development of a diverse range of services meeting local community care needs in ways which are flexible and appropriate to the needs of service users.
My own feeling and that of my noble friend is that joint funding should continue in one form or another. It may be that lessons need to be learnt from the experience of the past 12 years. Unless this provision is on the face of the Bill there may remain some uncertainty as to whether this kind of funding will continue. I want to see it on the face of the Bill. In some areas joint finance has been spent on services which should have been paid for out of health or social service budgets. In a number of areas voluntary organisations have had difficulty in obtaining access to joint finance, particularly in connection with black and minority ethnic groups and smaller groups, because of the lack of information, or local procedures and policies. Those deficiencies make it difficult for voluntary organisation applications to succeed.
Perhaps in future such funding can have clearer criteria laid down by the Secretary of State. Local authorities should have a duty to publicise the criteria—the procedure for applying—and they should publish details of how the funding has been spent. For example, that can be shown in the annual report on community care plans.
The Government are currently reviewing the future of joint finance. This clause would make provision for funding for innovative community care projects jointly agreed between health and local authorities, the voluntary sector and other appropriate bodies which could be run jointly by local authorities, voluntary organisations or housing
68
associations. I do not wish to put a cost on the provision other than to say that I believe £146 million was spent either last year or this year. I hope that the figure will continue to increase to meet the rising levels of inflation. I would not see that as an additional form of revenue not already provided for in our existing structures. I beg to move.
6.45 p.m.
Lord Henley: The noble Lord is quite correct in that we discussed a similar amendment at an earlier stage of the Bill. I can only repeat what I said then.
We said in the White Paper that we would review the policy and approach to joint finance to determine the most appropriate way forward for this kind of support. Let me take this opportunity to confirm that existing arrangements will continue unchanged until we have completed the review we said we would undertake in the White Paper. That review is in progress and officials are in the process of canvassing views and ideas from the statutory and independent sectors. The Government have an open mind and we seek the most constructive way forward.
I cannot help the noble Lord as regards the timetable. I hope that we go forward as fast as possible. We are interested to take on board the ideas behind the new clause put forward by the noble Lord. I fully support the collaborative approach adopted by the noble Lord and his approach to publishing information about how any funding has been used and how this funding can be accessed by a wide range of organisations.
Therefore, it may well be that the conclusions we draw following the review currently being undertaken will bear similarities to the new clauses which the noble Lord has put before us. I repeat my encouragement to the noble Lord and, for that matter, to any other noble Lord, to continue to feed to us ideas and proposals on this subject. As I said last time, as a review is in progress in terms which we announced in the White Paper, I ask the noble Lord to withdraw his amendment.
Lord Ennals: I certainly have no intention of pressing this amendment to a Division. I welcome the assurances given by the noble Lord that joint funding and joint finance will continue. I recognise the fact that he cannot give a timing for when the study will continue. The Minister gave some welcome to the principles contained in this amendment. Does he agree with me that there is merit in having some reference to joint funding within this Bill? Will the noble Lord consider that, in the light of the discussions that have gone on—it may be that more money will be provided or that different principles will be applied—and as there is much agreement between us, it would be a good thing that the provision should be written into the Bill between now and the later stage?
Lord Henley: I cannot make that promise. I repeat the assurance that we shall continue the existing arrangements unchanged until we have completed the review. I do not think I can give an assurance that we shall necessarily come forward with anything before the Bill reaches the end of its course.
Lord Ennals: I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Lord Winstanley Lord Winstanley moved Amendment No. 115EEA:
After Clause 46, insert the following new clause:
("Charges for hospital social work in connection with community care assessments.
—(1) A local authority may levy a charge on a District Health Authority, Special Health Authority or NHS Trust towards expenditure incurred by the local authority on the provision of social work support to any of these bodies arising from, or in connection with, any community care plan or assessment made under sections 44 or 45 above.
(2) The system of charging under this section shall be specified by the Secretary of State after consultation with the local authority associations and such other organisations he considers appropriate.
(3) Where the Secretary of State has approved any proposed system of charges for the purposes of this section, it shall be the duty of the bodies specified in subsection (1) above to pay that charge.").
The noble Lord said: In moving this amendment I return to a problem which I have raised not once but three times with the noble Baroness, Lady Hooper, in the course of our discussions on this Bill. That problem concerns the obstacles at present in the way of the appointment of hospital social workers. Members of the Committee of my generation may remember that hospital social workers were called almoners. They are not called that now; they are called hospital social workers. They do very important work which will be absolutely crucial to achieving successful community care.
Having said that I have raised the matter three times, I acknowledge at once that the noble Baroness has been conscientious beyond the call of duty in writing to me on each occasion when I have raised this subject. I think I last raised the matter last week and she wrote to me. She said that her reply had to be exactly the same as it was the week before; in other words there was no news.
There is an impasse of a kind. It may be that later we shall Tear that there has been some progress. This is a very serious problem. I am sorry to weary the Committee but I must go back over the history of the matter. The National Health Service Act 1977, in specifying the services to be provided by local authorities to health authorities, required local authorities to make available certain persons to enable health authorities to carry out their functions. Primarily, that referred to hospital-based social workers who, until 1974, had been employed directly by the health authorities but who had been transferred to local authorities at that time.
Local health authorities were given powers to cross-charge each other for services. However, by general agreement those powers were not used until 1987 when one London authority, providing social workers to a range of teaching hospitals (at a cost of more than £2 million to that local authority) claimed reimbursement from its local health authorities.
This move was the culmination of years of attempting to establish a system whereby local authorities with large numbers of hospital social workers (a problem for authorities with one or more
70
teaching hospitals and/or regional facilities) could charge out to those authorities whose residents used the hospital services.
The uneven distribution of hospitals, especially the concentration of teaching hospitals, in some parts of London, had led to expenditure of between £1 million and £2. 5 million for some of the most active providers, and virtually no cost for the peripheral authorities with only a small hospital provision, and virtually no hospital social workers. Close to London, we have one authority which has three teaching hospitals. It ought to be paying for the many social workers which will be needed there. However, there are other authorities that I know of which do not have a hospital. Therefore, they will not have to face that financial burden.
Authorities have received no recognition of that burden in the rate support grant. I thought that I had better mention that fact in case the noble Lord, Lord Boyd-Carpenter mentioned it. However, I see that the noble Lord has now left the Chamber. As I said, authorities have received no recognition of that burden; neither is there any recognition of it in the new system of local government finance. The problem has now become most serious. Some London authorities, and a few large provincial cities, are carrying a large burden. It is not recognised in the revenue support grant distribution. While all authorities in the Association of Metropolitan Authorities—both potential gainers and losers— (including London) agreed to a cost sharing formula based upon patient flows whereby there would be a pooling system of funding, the county councils which would have been net losers refused to participate. The Secretary of State was unwilling to enforce a system of cost sharing among those authorities and there the matter rests.
However, the situation is rapidly deteriorating at a time when, with the National Health Service reforms, the availability of hospital based social workers is crucial. Poll taxed authorities and those at risk of this in the future are beginning to reduce hospital social work services. They have done so not because they are of low priority —indeed, they are at the centre of the development of community care—but simply because they have to target expenditure on their own residents. Thus at a time when hospital providers and National Health Service trusts will have greater need of hospital-based social workers (for assessment needs, case management, practical support for patients and their families, together with the extraordinary effective emotional support which the hospital social workers provide to families and to individuals in distress) these services are now in danger of being run down.
In desperation one London authority is proposing to send bills for hospital social work to those authorities whose residents use their hospitals. County authorities are already signalling that they will not pay. Therefore, we have an impasse. In my view, it is absolutely essential that there should be an adequate number of hospital social workers in place at the time that this move continues to ensure the availability of community care.
What is the duty of hospital social workers? It is partly to assess need—and they are trained to do

71
so—but it is also in part to meet those needs. They do this through their contacts with the social services and their knowledge of the services available from social services. They also do so by virtue of their contacts with the voluntary sector and their knowledge of the way in which voluntary bodies can provide assistance. They play an essential part in the whole community care programme. They assess needs and provide for the needs of patients before they are discharged from hospital into the community.
If this Bill finishes its course through this Chamber and finds its way on to the statute book and we then have community care working in the way that the Government hoped it will work, it will break down if there are not enough hospital social workers in place. I beg to move.
Baroness Faithfull: I entirely agree with the noble Lord, Lord Winstanley. However, there is one difficult point in this respect. The value of hospital social workers is that they are also on the staff of the social services department. Therefore, if the doctors and the medical staff are going to recommend something in the community, they must know what is going on there. For example, they must know whether there is a home help or whether there is a place available in a home.
If these social workers are to be on the staff of the hospital, or paid for by the hospital, will they not be losing their affiliation to the social services department? I ask that because hospital social workers are the bridge between the hospital and the community. That is the only point that I wish to make. I do not wish to embark upon the question of pay.
Lord Winstanley: I intervene here to stress that my amendment makes no proposal to transfer social workers back to the health authorities. I agree that they used to belong to the health authorities. However, in my view it is much better that they should remain part of the social services department. Nevertheless, it is essential that somehow or other whoever employs them should be able to pay them. If they cannot be paid, they cannot be employed, and we shall not have any.
Lord Ennals: I entirely support the remarks made by the noble Lord, Lord Winstanley. He has done this Chamber a considerable service in raising this issue on three previous occasions. The noble Baroness, Lady Faithfull, has supported him. I too support him because we have had no indication from the Government as to what they will do about the fact that hospital social workers are now an endangered species. Unless they take some action soon and take a grip on the situation, before the Bill becomes enacted—that means during the course of the passage of the Bill—there will be no hospital social workers, because no one will be able to pay the bills for them.
I find it difficult to understand why the Government seem to be letting matters slide without taking any action to find a solution. However, it may
72
be that they are taking action to find a solution. If that is so, no doubt the noble Baroness will inform us. Moreover, it may be that this amendment is not the best solution. In that case, it is up to them to bring forward a better one. In my view, the Government must put matters on to a sensible footing in this Bill.
When the NHS is operating its new purchaser provider divide, it is even more likely that providers will require the services of hospital based social workers if they are to perform efficiently and effectively. The value of such social work was recognised in the Scottish Office report published in 1988. It demonstrated that not only did this form of social work give the human support required by hospital patients; it also demonstrated that it was extremely cost effective. Local authorities should be allowed to charge NHS providers for their services. If local authorities are not allowed to charge, or if they are not given the money to enable them to pay for services, then the whole project will be lost. The method and level of charging must be subject to control by the relevant Minister. The amendment proposes one way of achieving an essential reform.
In replying to this short debate, I want the Government to tell us what they propose to do about the problem. Alternatively, if they have no proposals, we shall have to return to the matter at a later stage. In moving into a new era in relations between health authorities and social services departments, with the new structures which we are setting up in the Bill, it would be quite wrong not to provide what the noble Baroness, Lady Faithfull, called the invaluable bridge between the hospital and the community, and between the health authority and the social services department.
Baroness Masham of Ilton: I too support this amendment. However, the hospital social worker of, for example, the supra-regional unit of a specialising unit—it may be a spinal unit—situated miles from the patient's home will surely also be the link with the patient's local district. I know how hard-pressed social workers are. I take Stoke Mandeville Hospital as an example. It has something like one and half social workers for the hospital patients who come from a large part of Britain. Therefore it is a most important issue.
7 p.m.
Baroness Hooper: We recognise the important role of hospital social workers. The noble Lord, Lord Winstanley, has a long and distinguished record of bringing forward his anxieties about the adequate staffing of that work. When he raised the matter previously he was worried that there was some kind of dispute between the Department of Health and the local authority associations over difficulties which had arisen over the appointment of those workers. In my famous correspondence with him on that subject, I had to point out that on the contrary the department has been doing its best to act as an honest broker.
In 1988 we put forward proposals for a system of cross-billing which we hoped would lead to a fairer distribution of the costs of providing a hospital social

73
work service. That is an especial issue of concern to those local authorities which bear the burden of large inflows of clients into their areas in major teaching hospitals, for example. Unfortunately the local authority associations were unable to agree collectively to a solution and so no agreement was forthcoming at that time. As the noble Lord said, since 1974 the provision of hospital social workers has been a local authority responsibility. I am grateful for the clarification my noble friend Lady Faithful] elicited that the noble Lord has no desire to change that system.
Part of the role of many such employees will be to be involved in the community care planning process and assessment. Many people working for or on behalf of health authorities are already involved in that way. Hospital social workers together with doctors, nurses, consultants, general practitioners, community social workers and care assistants assess their clients' needs, accounting for both their health and social care needs.
What we are planning to do in the Bill on plans and assessment is to reinforce the good practice which already exists and in which hospital social workers already play an important part. Their role is of especial value at the interface between health and social care, as has been said, where people leaving care in the acute sector may need substantial support as they return to their homes or another community setting.
Via the Social Services Inspectorate the department is collecting further information on the extent of the problems which have been mentioned by the noble Lord not merely today but on other occasions. I fear that the proposed cure contained in the new clause might be worse than the ailment, and so I urge the Committee to let us work through the potential solutions, as we shall be able to do, based on the better information that we are collecting and in a way in which the local authority associations and the NHS find workable, because it is essential to have that co-operation.
We need to keep the issues under review. There is a clear argument that looking at one element of charging will lead to debate about many others whether they are local authority provision to the NHS or vice versa. We have a large agenda for change before us, as has been pointed out from the Benches opposite from time to time. That will affect both local and health authorities. We need to set the framework for that agenda in the Bill and then review issues of detailed charging more widely in the light of the experience of general difficulties which arise from working through local arrangements for planning and assessment.
I hope that the noble Lord will feel able to withdraw his amendment. I repeat that if we can work out an agreed approach with the local authority associations, my honourable friend the Minister for Health and I are willing to look again carefully at what may be done in that area.
Lord Winstanley: I am grateful to the Minister for her reply. It is clear from what she has said that she recognises that the problem is real and serious. She then said that the department does not yet have all
74
the facts about what the problem is in different areas and that investigations are being carried out to discover them.
When the Department of Health, or indeed any other government department, embarks upon investigations, the tendency is for them to take a long time. My difficulty in agreeing to withdraw the amendment is that, although I accept it may not contain the best possible solution—I even accept that it may not be a satisfactory solution —it provides a solution. If I could be assured by the Minister that as a result of the efforts the department is making to reach some agreement with the different local authority associations we will be told the problem has been solved and how it has been solved before the Bill leaves this place, I should gladly withdraw the amendment. If she cannot say that, I must test the opinion of the Committee so that we can at least register the extent of our feeling on that problem.
Baroness Hooper: I hope to have a solution as early as possible, but I cannot promise it before the Bill leaves this place.
Lord Winstanley: I am grateful to the Minister for expressing that hope and that intent.
Lord Butterfield: Perhaps I may intervene to say that hospital social workers have an important role to play in training junior staff in the hospitals about the interface between health and social services. One of the things that I greatly regret about the disappearance of the famous lady almoner is that she helped many of us in our formative years to find a way to understand the differences between the approach of the social services and the health services.
I am sure that the noble Lord, Lord Winstanley, will agree with me when I say that in the hospitals those people are potentially important ambassadors of the social services and the other type of care. One of the problems about getting all the sides to agree may be that their role on the education and training side of the junior staff and the rising staff in the hospitals has not been fully appreciated. It may need to be a cost which is apportioned differently. A great deal of the problem always hinges on how much the cost will be. Hospital social workers should be seen as people who can build bridges in the minds of the hospital staff and the social services staff in the local authority offices. There is a great need for traffic over those bridges, especially in the shape of the service that is adumbrated by the Bill. If there is anything that I can do to encourage people to see the re-emergence of the hospital social workers as educators and bridge-builders, I shall be proud to give time and effort to that endeavour.
Baroness Faithfull: Before we proceed, would it not be wise for us to consult to see whether there is some way for the social services to pay 50 per cent. and the hospitals to pay 50 per cent.? As the noble Lord, Lord Butterfield, said, the hospital social workers are the bridges between the two departments. They work to the two departments. Rather than ask the health or social services to pay, there should be a 50/50 arrangement. I wonder

75
whether it is possible for us to discuss that proposal and bring it up again on Report.
Lord Winstanley: I am most grateful to the noble Baroness, Lady Faithfull, for making that suggestion. She has recognised, first, that there is a problem; and, secondly, she has offered another possible solution which may be an admirable one.
The noble Baroness, Lady Hooper, told us that the department would enter into discussions and that it would try to do what it could to come to an arrangement with different local authority associations. However, she has not been able to tell the Committee that the problem will have been solved by the time the Bill has passed through the House. I cannot accept this position and for that reason it might be helpful if we tested the view of the Committee on the amendment.
7. 10 p.m.
On Question, Whether the said amendment (No. 115EEA) shall be agreed to?
Their Lordships divided: Contents, 60; Not-Contents, 82.

DIVISION NO. 3

CONTENTS

Airedale, L.

Lawrence, L.

Auckland, L.

Lloyd of Kilgerran, L.

Avebury, L.

Lockwood, B.

Brooks of Tremorfa, L.

Macaulay of Bragar, L.

Butterfield, L.

Mackie of Bcnshie, L.

Carmichael of Kelvingrove,

Masham of Ilton, B.

L.

Mason of Barnsley, L.

Carter, L. [Teller.]

Molloy, L.

Cledwyn of Penrhos, L.

Morris of Castle Morris, L.

Craigavon, V.

Murray of Epping Forest, L.

Darcy (de Knayth), B.

Napier and Ettrick, L.

David, B.

Nicol, B.

Davies of Penrhys, L.

Northfield, L.

Dean of Beswick, L.

Ogmore, L.

Dormand of Easington, L.

Oram, L.

Ennals, L.

Peston, L.

Faithfull, B.

Pitt of Hampstead, L.

Falkland, V. [Teller.]

Prys-Davies, L.

Fisher of Rednal, B.

Rea, L.

Graham of Edmonton, L.

Rochester, L.

Grey, E.

Saltoun of Abernethy, Ly.

Hampton, L.

Seebohm, L.

Hanworth, V.

Taylor of Blackburn, L.

Hatch of Lusby, L.

Thurlow, L.

Hayter, L.

Turner of Camden, B.

Henderson of Brompton, L.

Underhill, L.

Hunter of Newington, L.

Walston, L.

Hylton-Foster, B.

White, B.

Jenkins of Hillhead, L.

Williams of Elvel, L.

Jenkins of Putney, L.

Winstanley, L.

Kinloss, Ly.

NOT-CONTENTS

Aldington, L.

Bridgeman, V.

Alexander of Weedon, L.

Brougham and Vaux, L.

Arran, E.

Caithness, E.

Belhaven and Stenton, L.

Campbell of Alloway, L.

Beloff, L.

Carlisle of Bucklow, L.

Belstead, L.

Carnegy of Lour, B.

Blatch, B.

Carnock, L.

Blyth, L.

Coleraine, L.

Boardman, L.

Colnbrook, L.

Borthwick, L.

Colwyn, L.

Boyd-Carpenter, L.

Cox, B.

76

Davidson, V. [Teller.]

Munster, E.

Denham, L. [Teller.]

Murton of Lindisfarne, L.

Elles, B.

Newall, L.

Fraser of Carmyllie, L.

Norrie, L.

Geddes, L.

Nugent of Guildford, L.

Glenarthur, L.

Orkney, E.

Gray of Contin, L.

Pender, L.

Greenway, L.

Penrhyn, L.

Gridley, L.

Pym, L.

Harmar-Nicholls, L.

Rankeillour, L.

Henley, L.

Reay, L.

Hesketh, L.

Renton, L.

Hives, L.

Renwick, L.

Hooper, B.

Rippon of Hexham, L.

Jenkin of Roding, L.

Saint Albans, D.

Johnston of Rockport, L.

Sanderson of Bowden, L.

Joseph, L.

Sharpies, B.

Kimball, L.

Skelmersdale, L.

Kitchener, E.

Stockton, E.

Lauderdale, E.

Strange, B.

Long, V.

Strathclyde, L.

Lothian, M.

Strathmore and Kinghorne,

Lyell, L.

E.

McColl of Dulwich, L.

Swinfen, L.

Mackay of Clashfern, L.

Thomas of Gwydir, L.

Macleod of Borve, B.

Trumpington, B.

Malmesbury, E.

Ullswater, V.

Mancroft, L.

Vaux of Harrowden, L.

Merrivale, L.

Wise, L.

Mersey, V.

Wynford, L.

Milverton, L.

Resolved in the negative, and amendment disagreed to accordingly.
Baroness Blatch: I beg to move that the House be now resumed, and, in moving the Motion, I suggest that the Committee meet again at quarter past eight.
Moved, accordingly, and, on Question, Motion agreed to.
House resumed.

Representation of the People Bill
7. 18 p.m.
Brought from the Commons; read a first time, and to be printed.

Term and Quarter Days (Scotland) Bill
Brought from the Commons; read a first time, and to be printed.

Property Services Agency and Crown Suppliers Bill
7. 19 p.m.
Report received.
Clause 1 [Transfer of Property Services Agency and Crown Suppliers]:
Lord Graham of Edmonton Lord Graham of Edmonton moved Amendment No. 1:
Page 1, line 7, leave out ("and liabilities") and insert (", liabilities and business").
The noble Lord said: My Lords, I beg to move Amendment No. 1 and it may be for the convenience

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of the House if I speak also to Amendments Nos. 2, 3 and 4. Three of these amendments are precisely the same, the fourth is tangential. I hope the Minister will take on board something which I failed to make clear in Committee and which concerns the unanimity of the various trade unions whose members are affected by the matters that we are discussing. My noble friend Lord Dean and I will be referring tonight—I referred to this at the previous stage of the Bill —to the fact that, despite the bland assurances of Ministers at times, (they have my greatest respect in other matters) the Government appear not to take fully on board not just the anxieties but also the bitterness of the members of the trade unions who are affected by this measure. Those members have said that they are not being treated with the respect to which they believe they are entitled at a time which is, individually, very traumatic for them.
The trade unions affected by the Bill are the UCATT, the TGWU, the GMB, the AEU, the EETPU, the FTAT, the MSFU—those are the industrial unions—the NUCPS, the IPMS, the CPSA and the FDA. All those trade unions have members, some of whom are certainly affected by the issues we are dealing with and some of whom are like y to be affected by them.
We have again tabled amendments which we tabled in Committee because we honestly believe that they are worthy of an attempt to get the Government to understand the dismay of the Government employees at what the Government are doing. The amendments are perfectly straightforward. We cannot see the sense or, as we say in the North, the mense, of the Government's aim of getting rid of this part of the national empire. Other amendments that we have tabled concern the lack of faith which employees have in the Goverrment's ability to protect their interests once they have been sold on, sold off, or, as I would term it, sold down the river, when this traumatic event takes place. We believe it would be sensible for these amendments to be accepted.
The noble Lord, Lord Reay, has said that the Government cannot see the need for the word "business" contained in the amendments. He said on 23rd April at column 363 of Hansard,
"We do not believe that the addition of the word "business" … would add anything of significance to the Bill".
That may be the Government's view. However, the trade unions believe that the amendments would improve the Bill from their point of view. Therefore we fail 1.0 see why the Government should not accept the amendments.
When I moved these amendments at an earlier stage of the Bill, I talked of the possibility of the establishment of mini-PSAs. I noted that the noble Lord, Lord Reay, said on 23rd April, at column 364 of Hansard,
"Clearly departments will be closely aware of the need to achieve value for money and to keep their procurement organisation to the bare minimum".
We believe that is part of the raison d'être of the Government in respect of this measure. We are not talking in terms of undue hardship but we are talking about individuals who have served the nation, their
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departments and these Ministers well. Those individuals believe they are being shabbily treated at this time. Consultations with trade union representatives have indicated that they are far from satisfied. One of the major trade unions is holding its conference at the moment. It seeks approval from its members for a ballot on industrial action. On Friday of last week the IPMS recommended official strike action to its members. That is an indication of the frustration that trade unions feel as regards persuading the Government to discuss meaningfully the impact of the Bill on their members. I shall have more to say on that on other amendments. I beg to move.
The Parliamentary Under-Secretary of State, Department of the Environment (Lord Hesketh): My Lords, as the noble Lord, Lord Graham, remarked with regard to three of the four amendments in this group, he moved three identical amendments in Committee. I recognise that fact. In moving these amendments the noble Lord appears to have confused two issues; namely, the process known as "untying", by which Government departments are no longer compelled to place orders for goods and services with the PSA and TCS, and privatisation itself.
Until recently government departments had to place their orders for the full range of services provided by the PSA and TCS with those two organisations. They were not permitted to place their orders elsewhere, even if they believed they would succeed in obtaining better value for money or improved specifications. As part of their financial management initiative, the Government have given departments the freedom to seek the best deal they can in the procurement of their goods and services. This will generally mean the placing of orders by means of competitive tenders.
This process requires departments to decide what they want, rather than relying on the PSA and TCS to tell them what they should or will have. Inevitably, therefore, they will need access to advice in specifying and then procuring the goods and services they require. Naturally departments cannot acquire this expertise for themselves without some cost. But the Government believe that these costs are outweighed by the benefits of obtaining goods and services in competition.
The result of the process of untying is that the PSA and TCS now compete directly with the private sector. Those activities which, for one reason or another need to be kept in Government have been removed from TCS, and are being removed from the PSA. Those that remain will be indistinguishable from ordinary commercial activities. We believe there can be no case therefore for retaining them in the public sector.
The noble Lord, Lord Graham, made reference to the phrase "national empire". This piece of legislation, like many others, has been initiated because the Government do not believe in national empires. That is why we resist the amendments.
Lord Dean of Beswick: My Lords, I listened with great care to what the Minister had to say in reply

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to my noble friend Lord Graham. His comments were a re-hash of what took place in Committee. However, neither in the earlier stages of this Bill nor in the reply given by the noble Lord, Lord Hesketh, tonight have the Government indicated what has failed in the past which has led them to take this view. I think it is rather sad that the Government appear to be falling back on the old idea that their political dogma must be right on all occasions. The Government are obviously not going to move on these amendments.
It is sad that in any privatisation matter, whether it concerns one of the large public utilities that have been sold off or the Property Services Agency —that is another form of public ownership—the Government appear to discount completely any progressive or objective assessments or suggestions that come from the employees involved. In the past I have been responsible at a local level for running a large building department in local government. Subsequent to that I was involved in running a large housing department in local government. I always believed in testing the market. It would be a fool who did not do so. I never believed in handing out contracts just to keep people in work. I never believed that public departments which employed people were convalescent homes. However, that is the inference that the Government appear to be drawing as regards this rather squalid exercise.
It is time that Ministers—perhaps not those in this House but their bosses in another place—realised that trade unions also have an overwhelming interest in the success of the organisations in which their members are employed. It is no comfort to members of trade unions to find that the Secretary of State for Employment suddenly has a conscience about trade unionists because there has been a series of sad accidents in the Channel Tunnel. That does not cut any ice with trade unionists. The image that comes across is that the Government are blatantly biased against trade unions and against the suggestions that sometimes emanate from their members.
We have only an hour to debate the amendments before us tonight. I fully concur with the comments of my noble friend Lord Graham. It is sad that even at this late stage the Government are not prepared to consider the amendments moved by my noble friend.
Lord Graham of Edmonton: My Lords, I acknowledge that the Minister is not prepared to recognise the concern of the trade unions. He picked me up on my use of the word "empire". The Minister knows that I referred to the public empire that is managed by the state. The employees of that empire are proud of what they do. However, they recognise that this Government no longer want to govern their particular part of the empire. That is as plain as a pikestaff.
I believe that the Government are going down the wrong road. If they want an improved, more efficient and cost-effective public service the trade unions are in the business of listening. I do not believe that the Government have listened very carefully or cleverly
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to the amendment. I intend to test the opinion of the House.
7. 32 p.m.
On Question, Whether the said amendment (No. 1) shall be agreed to?
Their Lordships divided: Contents, 23; Not-Contents, 68.

DIVISION NO. 4

CONTENTS

Barnett, L.

Jenkins of Putney, L.

Carmichael of Kelvingrove,

Lockwood, B.

L.

Macaulay of Bragar, L.

Carter, L.

Mason of Barnsley, L.

David, B.

Murray of Epping Forest, L.

Dean of Beswick, L. [Teller.]

Nicol, B.

Dormand of Easington, L.

Peston, L.

Ennals, L.

Pitt of Hampstead, L.

Fisher of Rednal, B.

Prys-Davies, L.

Graham of Edmonton, L.

Taylor of Blackburn, L.

[Teller.]

Underhill, L.

Hatch of Lusby, L.

White, B.

Houghton of Sowerby, L.

NOT-CONTENTS

Alexander of Weedon, L.

Kimball, L.

Ampthill, L.

Lauderdale, E.

Arran, E.

Long, V.

Auckland, L.

Lothian, M.

Belhaven and Stenton, L.

Lyell, L.

Beloff, L.

McColl of Dulwich, L.

Belstead, L.

Mackay of Clashfern, L.

Blatch, B.

Macleod of Borve, B.

Boardman, L.

Mancroft, L.

Borthwick, L.

Mersey, V.

Boyd-Carpenter, L.

Milverton, L.

Bridgeman, V.

Monk Bretton, L.

Caithness, E.

Mottistone, L.

Carlisle of Bucklow, L.

Napier and Ettrick, L.

Carnegy of Lour, B.

Orkney, E.

Carnock, L.

Pender, L.

Colnbrook, L.

Pym, L.

Colwyn, L.

Rankeillour, L.

Craigavon, V.

Reay, L.

Davidson, V. [Teller.]

Renton, L.

Denham, L. [Teller.]

Renwick, L.

Elles, B.

Saltoun of Abernethy, Ly.

Faithfull, B.

Sanderson of Bowden, L.

Fraser of Carmyllie, L.

Sharples, B.

Glenarthur, L.

Skelmersdale, L.

Gray of Contin, L.

Stockton, E.

Gridley, L.

Strange, B.

Harmar-Nicholls, L.

Strathclyde, L.

Henley, L.

Strathmore and Kinghorne,

Hesketh, L.

E.

Hives, L.

Thomas of Gwydir, L.

Hooper, B.

Trumpington, B.

Jenkin of Roding, L.

Ullswater, V.

Johnston of Rockport, L.

Wise, L.

Joseph, L.

Resolved in the negative, and amendment disagreed to accordingly.
7. 39 p.m.
[Amendments Nos. 2 and 3 not moved.]
Clause 2 [Transferred staff]:
[Amendment No. 4 not moved.]
Lord Graham of Edmonton Lord Graham of Edmonton moved Amendment No. 5:
Page 2, line 20, leave out paragraph (a) and insert:
("(a) nothing in this section shall prejudice any rights or entitlements of any person arising in connection with any scheme under section 1 of the Superannuation Act 1972;").
The noble Lord said: My Lords, this amendment is crucial and sensitive as it affects the members of whom I spoke earlier. It falls under Clause 2, which deals with the terms under which transfers and redundancies take place and with superannuation, so Clause 2 is crucial.
The employees are unhappy and uneasy at the way in which the Government have explained what they intend to do. For instance, the Government have said that the terms under which the transfers will take place will be comparable. They have used such terms as, "They will mirror". One of the disturbing features is the employees' inability to relate the Government's intentions under this Bill to their intentions under previous Bills. The Minister must understand that the employees are realistic. They realise that some of them will continue to enjoy their present terms and conditions in respect of pay, work, pensions and redundancy. They will not be disturbed when the dust settles, but, sadly, other employees will be t ransferred out —I prefer to say sold on —with that part of the business to a new management buy-ouf team or whatever it may be and they are obviously anxious.
Ministers in another place, Mr. Chris Patten and Mr. Christopher Chope, are well aware, as I am sure are the two Ministers who speak here tonight, of the deep unease about the fact that the trade unions have failed to take advantage of the way in which questions have been handled by Ministers. Perhaps I may read out a paragraph from the ballot paper issued by the Institution of Professionals, Managers and Specialists with regard to the ballot to which I referred earlier. It states:
"No adequate guarantees have been received that pensions and severance entitlements comparable with and as secure as those in the PCSPS will be provided in the private sector following privatisation despite repeated requests for such guarantees".
I am certain that the Minister will say that there are on-going negotiations, that matters have not yet been resolved and that there are no purchasers in sight. He could put at rest the worries of 20,000 people if he accepted Amendment No. 5 and the other amendments that we propose. The sad fact is that, if the employees whom we are discussing continue to be employed in government, they will feel aggrieved at the way in which they have been treated. If some of them become employees in a new business, they will carry into that business a sense of bitterness towards the Government. If they are neither one thing nor the other—if they are made properly redundant —the terms that they enjoy will not be those that they have enjoyed as civil servants.
I am not here to argue whether those terms are right or wrong, save to say that trade unions negotiate the best terms possible for their members and the Government, as the employer, agree to the best terms as regards the employer. I do not listen to people who talk about generous or cushioned terms because the potential benefits regarding redundancy or retirement are reflected in the modest salaries that are carried in order to enjoy those benefits.
Under the terms of the amendment we want the Government to consider the scheme in as generous a way as possible. The employees' fears can be assuaged and the Government's lot in progressing the matter
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can be made a great deal easier if they realise that the employees are asking not for an advantage or a benefit but for fair treatment from their employer. I beg to move.
7.45 p.m.
Lord Dean of Beswick: My Lords, perhaps I may intervene briefly at this stage. I understand that under the rules of procedure of the House, apart from the mover of the amendment, no one is supposed to rise in support of it at Report stage. However, I believe that my noble friend Lord Graham has made the case for the amendment.
My mind goes back some two or three years when another privatisation Bill was going through the House. At that time we were graced by the regular presence of the noble and learned Lord, Lord Denning. My noble friend tells me that it was the Dockyard Services Bill. The noble and Learned Lord, Lord Denning, dealt forcefully with the attempt by the Government to alter the terms of engagement which employees had enjoyed over a long period as employees of the dockyards so that they could be varied by a new employer. I believe that I am correct in saying that on that occasion, with the persuasive and forceful powers of the noble and learned Lord, the House indicated clearly that his point, made on behalf of trade unionists, was correct. The basis of the argument was that people employed under a contract should not be sold and traded on the open market without having any say in their future.
My noble friend Lord Graham moved the amendment reasonably. It makes sense and the Government will do themselves no disservice to heed the amendment and perhaps look upon it with more favour than has hitherto been the case this evening.
Lord Hesketh: My Lords, the effect of the amendment would be to delete the existing paragraph (a) of subsection (2) and to substitute a provision whereby staff would effectively be regarded as having been compulsorily retired at the point of transfer. They would therefore be entitled to the benefits that flow from this under the PCSPS, even though they will have retained their jobs and will in no sense be redundant.
As the Government have repeatedly made clear, staff terms and conditions of employment are safeguarded. They will, therefore, be entitled to redundancy compensation if in fact they are made redundant after the transfer. The compensation to which they will be entitled after the transfer will be identical, as far as possible, to that which would have been payable to them under the PCSPS.
Normally, when undertakings in the public or private sector are transferred, there is no question of transferring staff receiving redundancy compensation whilst keeping their jobs. The payment of redundancy compensation in those circumstances would be quite unjustifiable and, as I have explained, it is this anomaly that Subsection (2) (a) seeks to rectify. That paragraph contains standard provisions which have appeared in all recent legislation concerned with the privatisation

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of organisations whose employees are members of the Principal Civil Service Pension Scheme, and this amendment, if adopted, would introduce into the legislation the unjustifiable situation which I have described previously. That is why we resist this amendment.
Lord Graham of Edmonton: My Lords, the Government rest their case on producing pieces of legislation to eliminate what they consider to be lacunae and anomalies in existing legislation. But it is that existing legislation which forms part of the contract between the Government and the employees. The burden of the employees' argument is that there will be no meaningful consultations. In general, when the Government speak of negotiation they do not mean negotiation with employees but with future employers. Once that has been done there exists a fait accompli and the Government say to the employees, "We have negotiated a very satisfactory deal".
The employees may come to the conclusion that it is a satisfactory deal. The removal of this benefit or part of the contract, for example, may very well be seen by the employees as in totality not unreasonable. But they have not had a chance to look at the total package. They are continually inhibited from reaching what fair-minded trade union negotiators would recognise as a fair deal.
Quite frankly there is an objection. The Minister will move the next amendment. We have a shrewd suspicion as to why the Government are taking advantage of the large majority that they have in the House while the trade unions outside are powerless to intervene. The Minister has given an unsatisfactory answer but I am not in a position to challenge it. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Lord Hesketh Lord Hesketh moved Amendment No. 6:
Page 2, line 23, leave out paragraph (b) and insert—
("(b) his ceasing to be employed in that service shall not be regarded as an occasion of redundancy for the purpose of the agreed redundancy procedures applicable to persons employed in that service.").
The noble Lord said: My Lords, I am rather surprised by the noble Lord's last remarks with regard to the amendment that I propose to move. I had hoped very much that it was in answer to a clarion call that he made at an earlier stage of the Bill. In Committee the noble Lord, Lord Graham, said that he believed that Clause 2 (2) (b) of the Bill would be in contravention of the Government's obligations under the acquired rights directive. At that time I undertook to consider the issue.
The first point that I should make is that it was never the Government's intention that this Bill should prevent the transfer of any collective agreements affecting the staff of the PSA and TCS. It was designed to ensure that redundancy procedures were disapplied at the point of transfer. We have looked again at the drafting of Clause 2 (2) (b), and we do not believe that it would have the effect suggested at Committee stage by the noble Lord, Lord Graham. Nevertheless, we accept that some
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clarification is desirable to avoid any suggestion that the paragraph inadvertently goes wider than we intended.
The proposed amendment therefore will put beyond doubt that the redundancy procedures are disapplied only at the moment of transfer. As I said in Committee they need to be disapplied in order to ensure that no confusion is caused by the operation of the redundancy procedures at the point of sale. After the sales the relevant redundancy agreement will continue to apply to the staff of the PSA and TCS in so far as the agreement is capable of operation in the private sector.
I hope that the noble Lord, Lord Graham, will accept that this amendment meets the point that he made in Committee. I hope also that it will be acceptable to the House. I beg to move.
Lord Graham of Edmonton: My Lords, I am grateful to the Minister. At Committee stage he spoke to Amendment No. 14, which sought to:
"leave out lines 23 and 24 and insert … Article 3 (2) of the Business Transfer Directive (No. 77/187) shall have effect in relation to the agreed redundancy procedures applicable to a person employed in that service". — [Official Report, 23/4/90; col. 384.]
I took great care to be clear about this matter and at the end the Minister said that he would take note of it and undertake to consider it before the Bill completed its passage.
I do not mean any disrespect to the Minister and indeed for my edification I ask whether he is telling me that, in response to the point that I raised, he and his advisers consider that this amendment is helpful to the thrust of my intention. This amendment was tabled only last Friday and I was made privy to it only today. Because of its lateness I have had no opportunity to seek advice or guidance. Certainly I shall do nothing to stop the passage of the amendment but I shall need to have some guidance from outside the House in order to confirm whether it is indeed helpful or not helpful to the point.
Will the Minister confirm that this is that undertaking; that is to say, the response to the point that I raised?
Lord Hesketh: My Lords, I went to rather a lot of trouble over this matter. This is the response to the point that the noble Lord made.
Lord Graham of Edmonton: My Lords, the Minister says that this is the response. I tell him that I do not recognise it in terms of the point which I made. I am not an expert in these matters. The Minister is expert in reading a brief that he has helped to prepare which, he said, takes him to the point. Perhaps I may again ask the Minister whether what he said he took a great deal of time to prepare is helpful to the point that I made or whether it is anodyne or even benign.
Lord Hesketh: My Lords, the simple answer to that is as follows. The noble Lord, Lord Graham, raises a good point; namely, that he wishes to discuss this matter outside the House. I can reassure him again. I responded at Committee stage, saying that

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I very much hoped to be able to respond to the point that he made. Following discussion, I and my advisers believe that this amendment answers the point that he raised. Clearly he may wish to consider this matter further
Lord Graham of Edmonton: My Lords, I accept the sense of those remarks. The Minister is aware that between now and the Third Reading of the Bill on Friday there is not a long period during which it will be in order to table amendments. I think it would be helpful to the Minister if our discussions were to take place as quickly as possible in order to avoid a protracted Third Reading stage of the Bill on Friday. That could very well happen if those whom I shall consult outside the House tell me that his response is not helpful. However, I accept that the Minister sought to be helpful and I am grateful for that.
On Question, amendment agreed to.
Lord Graham of Edmonton Lord Graham of Edmonton moved Amendment No. 7:
Page 2, line 24, at end insert:
("() no person shall be transferred by this section other than by mutual consent").
The noble Lord said: My Lords, in essence this is a simple amendment. Quite frankly, although I have a brief I do not need to refer to it. This is a heartfelt cry from the trade unions to the effect that before there is a transfer there needs to be mutual consent on the part of the Government, the new employer and the individual.
We know that in the discussions that took place during the previous stage of the Bill the point was raised—and we recognise it—that there will be circumstances in which an employee declines to be transferred. In such a case there are certain benefits —in this case, redundancy —which can flow from that. We do not wish an employee to be told, "Take it or leave it. You transfer, and if you don't transfer you have in effect made yourself redundant, or you have refused an offer, which denies you redundancy". If the Minister is prepared to accept the amendment, I invite him to tell the House and the employees under what circumstances the Government would acquiesce to and be a party to the transfer of employees against their consent. I beg to move.
8 p.m.
Lord Hesketh: My Lords, your Lordships will recall that we dealt with an identical amendment in Committee. Such an amendment, if passed, would give the staff the opportunity to veto both privatisations. Clearly this would not be acceptable to the Government.
I explained in Committee the extensive measures which the Government were taking to meet the preferences of staff who wish to remain in the Civil Service. I cannot of course give a cast-iron guarantee that all preferences will be met. To do so might mean that the viability of the PSA and TCS would be threatened in the private sector. That would clearly not be in the interests of the organisations themselves, those employees who go with them into the private sector or their customers. The availability
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of alternative posts in the Civil Service is also a constraint. But the staff have been given an undertaking that the management will use their best endeavours to meet staff preferences.
The PSA preference exercise, covering all staff, has been completed and is being evaluated. With arrangements for the sale of TCS so far advanced, it is more sensible now to wait until the identification of the purchasers is known before asking TCS staff what they want to do.
I should perhaps remind your Lordships that not only will staff have the protection of TUPE in relation to their terms and conditions of employment, but they will also have the protection of the general law in relation to unfair dismissals. In the Government's view, therefore, satisfactory protection is being given to the staff's terms and conditions of service, and as much as possible is being done to meet the staffs preferences. I hope therefore that your Lordships will be able to resist the amendment.
Lord Graham of Edmonton: My Lords, it is interesting that the Government and the Minister have indicated that employees can rest assured that they have the protection of TUPE 81. Perhaps I may read a letter to the House from a body called the Training Business Group of 141 Great Charles Street, Birmingham. It is addressed to a Mr. Gallagher, who is the national officer of the National Union of Civil and Public Servants. It is in connection with the Lambeth Skillcentre. That is one of a number of bodies that are being sold under a management buy-out. The Lambeth Skillcentre is being sold to the Training Business Group. The letter is dated 1st May, and the first paragraph states:
"As I indicated in my previous letter, we have taken very full legal advice regarding our obligations under the Transfer of Undertakings Regulations. It was on the basis of this advice, alongside all other relevant considerations, that I advised you that we did not consider it appropriate to recognise NUCPS. This is still our position".
All too eagerly those who are being prevailed upon by the Government to take the Government's hands off aspects of what I continue to call the public empire are acting in a very provocative, unfair, unjust and, I would say, immoral way. The people about whom we are talking have been members of a trade union. It is sometimes the only protection that they have had. This letter gives an illustration. The other paragraph that I believe is worthy of quoting states:
"I reiterate again that, faced with a very substantial loss making situation at Lambeth, our objective and commitment is to work with the people at Lambeth to do everything we possibly can to look after their interests".
At the end of the day if it is in the interest of the new business to make people redundant it will do so because it is the viability of the business with which it is concerned and not the protection under TUPE or anything else.
That is another illustration where employees in my view will be bitter. The Government can do a great deal to recognise that. One of a series of amendments moved either here or in another place provided that businesses that were not viable and making a profit should not be transferred out of the

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public domain into the private domain. I believe that I am right in saying that it is probably the first privatisation where the Government have not wished to make sure that it was a good buy. They are just anxious to get rid of it.
The people who will suffer are the employees. No one will buy a business that is not profitable or where he will be denied the restraints which will allow the business to make a profit rather than a loss by taking action against the employees. Before I withdraw the amendment has the Minister anything further to say?
Lord Hesketh: My Lords, the noble Lord, Lord Graham, tries to insinuate that the Government have a policy of creating what he calls a good buy. That is not true. We have a policy of producing a viable and successful future. Part of that policy involves ensuring that the employees who go into the new undertaking are properly protected. That has created cost with both these proposed privatisations. It is purely a matter of good business sense to make sure that they are profitable in the future because they have the right level of morale. The noble Lord cannot have his cake and eat it. The Government and the taxpayer may make less money, possibly because we wish to preserve those standards, but the noble Lord cannot at the same time say, "This is not a good buy". He can have one thing or another but not both.
Lord Graham of Edmonton: My Lords, I would settle for a sweetener. I think that £38 million would be attractive.
When the Minister and his colleagues make their policy decisions on how to get out of running these two highly successful public concerns, there is a range of ways in which they can make a business which may not have looked so attractive on the surface look attractive to the potential buyer.
The Minister and his colleagues are storing up trouble. If matters turn out to be as sour and sad as I am told that they will be, we shall return to the House and make Ministers' lives a little less comfortable than they might otherwise have been. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Lord Graham of Edmonton Lord Graham of Edmonton moved Amendment No. 8:
Page 2, line 24, at end insert:
("() Persons transferring by virtue of subsection (2) above shall be entitled to benefits for retirement on grounds of redundancy, inefficiency or limited efficiency which are comparable to those benefits provided by the principal civil service pension scheme which cover retirement on grounds of redundancy, inefficiency or limited efficiency; and for the avoidance of doubt a benefit or benefits shall be regarded as comparable if, but only if, that benefit or benefits is—

(a) Fully protected by transfer to a trust or fund specially designated and financed so as to secure accrued entitlements to retirement benefits on grounds of redundancy, inefficiency or limited efficiency arising under the terms of the principal civil service pension scheme; or

(b) guaranteed to be met out of Treasury Funds.").

The noble Lord said: My Lords, by this amendment we seek an undertaking from the I
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Government. When the transfers take place the Government, with the best of intentions, will have settled on the best set of terms and undertakings from the potential purchaser. Nevertheless the worry of the employees is that an employer may well be intent on asset-stripping an aspect of the business. Employees are transferred into the private sector with all the protections that are available. There are not many. They then find that in superannuation, redundancy, sickness and a great many matters, the new employer finds a way of reducing his costs by making changes.
If the Minister sees so much advantage to the public in selling on the business, he can do so more easily by giving the employees the guarantees that we ask for. They are simple. If the terms under which the transfer takes place turn out to be blemished—the Minister may say that there should be a timescale, I am prepared to accept that —by the actions of the new employers, in order to give the new employees the guarantees that they currently enjoy, the amendment asks that Treasury funds make up any shortfall that results. I beg to move.
Lord Hesketh: My Lords, the amendment relates to the redundancy terms for staff who are transferred to the new PSA and TCS companies. It seeks to provide the transferred staff with the same benefits as they have at present and also to provide for the protection of those benefits by means of a trust, a fund or a Treasury guarantee. I dealt at length in Committee with the redundancy terms and assured your Lordships that arrangements will be made to ensure that, after privatisation, redundancy terms will be identical, so far as possible, to those which the staff have at present.
The amendment refers specifically to comparability, but I have already made clear that, on redundancy, transferred staff will be entitled so far as possible to identical terms. All previous privatisations ensured that proper protection was given to staff interests. I and my colleagues in another place are entirely satisfied that this Bill is no exception.
The amendment also raises the question of the security of any redundancy payments made after the privatisations requiring some form of guarantee that, if the new owner defaults on his obligations, the payments will be made from public funds. The giving of a guarantee is under consideration but such a guarantee would be unprecedented in a privatisation of this kind and it is unlikely that the Government will accede to the idea. We believe that, in relation to redundancy, the interests of the staff will be properly safeguarded by the measures outlined during Committee stage.
Finally, it is important to remember that the price that will be achieved reflects the fact that the purchaser accepts the conditions on which he will have to employ the staff. Therefore, the taxpayer will have contributed already to that security in that assessment as the transfer takes place.
Lord Graham of Edmonton: My Lords, I accept the fact that the Government and the new employer will act in good faith. I accept that the new terms struck

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by the Government and in which the employer acquiesces are agreed in good faith. However, subsequently there may be rotten luck, mismanagement, a change in policy or a thousand things which will force the new employer, or in which he will connive, to change the terms of the transfer. The employees who are transferred do not want to be transferred. At present, subject to keeping their noses clean and being efficient and competent, they will enjoy their present terms until normal retirement.
The Minister used the phrase "shall as far as possible". We are asking whether, in the case of an individual tragedy, the Government will be prepared to accept their responsibilities and underwrite such cases. I am familiar with a Royal Ordnance factory in respect of which the Government gave all kinds of assurances about what would happen to the employees. The local Member of Parliament, who was a Minister of State, was told by the Government what would happen. The factory was bought by British Aerospace, which within a short time decided to close it. The Minister might say that that was the business of British Aerospace. However, previously it had been the Government's business.
The factory having closed, the Enfield council stepped in and assisted in making provisions for the establishment of small businesses. Then, lo and behold, some of the employees of the Royal Ordnance factory who had started small businesses found that their factories were no longer available. They had first enjoyed the terms of employment of the Royal Ordnance factory but were transferred to the employment of British Aerospace. They then started their own small businesses but suddenly found that they had been wiped off the map. That was the history at Enfield during five years.
I do not believe that the Minister is naive but he refuses to acknowledge that circumstances can lead to individuals suffering badly. I hope that those employees will take notice of the fact that, as regards this series of crucial, individual and personal circumstances, the Government have proved to be unthinking and uncaring. They may mean well but that is not good enough. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
8.15 p.m.
Lord Graham of Edmonton Lord Graham of Edmonton moved Amendment No. 9:
Page 2. line 24, at end insert:
("() The person or persons to whom anything is transferred at any lime as a consequence of any scheme made under section 1 above shall provide pensions for persons transferring by virtue of subsection (2) of this section which replicate the provisions of the Principal Civil Service Pension Scheme; and no changes shall be made to those pensions except by agreement.").
The noble Lord said: This is a simple amendment. We ask that the terms under which a transfer takes place shall:
"replicate the provisions of the Principal Civil Service Pension Scheme; and no changes shall be made to those pensions except by agreement".
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That is a modest proposal. The Minister has spoken about negotiations and reaching settlements. However, that was not with the employees but with the future employers. Why can the Minister not tell the House that he will insist upon such a condition being carried over? Earlier he said that the price that the Government received for the business would reflect the obligations laid upon the new purchaser. Why do the conditions laid upon the new purchaser not include such reasonable measures? If I were an employer in that situation I should wish to have a copper-bottomed undertaking from a respectable source—as are the Government and the public purse—in order to provide protection. During the next few years there will be an unhappy atmosphere about all such little bits of business. In my view, that will be eased if the Government are sympathetic; not generous or reasonable but merely sympathetic, I beg to move.
Lord Hesketh: My Lords, perhaps I should begin by reminding your Lordships that I made a lengthy and detailed statement in Committee explaining the Government's proposals for pensions in relation to these two privatisations. I do not believe there is anything I can usefully add to what I said then.
The amendment would require purchasers to provide pension schemes which replicate the Civil Service scheme. The Government do not accept the case for doing this. The Acquired Rights Directive and TUPE provide for the transfer of all the staffs terms and conditions of service, except pensions. It would be impracticable to insist that, when undertakings are sold, pension arrangements should remain unchanged. I do not see what justification there can be for treating these two organisations differently from other privatisations involving transferred civil servants or, indeed, from transfers in the private sector.
Of course, the Government recognise the importance of pensions. I explained in Committee the measures which are being taken in order to achieve pensions provisions which are broadly comparable with those in the PCSPS. The staff will, of course, be fully consulted through their trade union representatives about these measures.
In Committee I gave detailed reasons for resisting the noble Lord's amendment. I am sure that he and other noble Lords will forgive me for not repeating them now on Report.
Lord Graham of Edmonton: My Lords, as the Minister knows, I do not wish to be offensive. In Committee he took a great deal of care to present cogent arguments against the amendment. However, even if he repeats them I shall still find them unacceptable. I agree that there is no purpose in doing so.
The argument is comparatively simple; that employees are fearful that they will be disadvantaged in the future. The Government are not guaranteeing that they will not be disadvantaged but are simply saying, "We intend to do our best for you". Employees and trade unions are telling us that their knowledge of some of the potential employers leads them to want stronger guarantees than the

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Government have seen fit to spatchcock into the Bill.
I certainly agree with the Minister that much information has been put into the Bill. Because of and despite what he said, my trade union friends have asked me to raise this matter again. That is an indication of their unease. I am grateful to the Minister and I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 3 [Transferee companies]:
Lord Graham of Edmonton Lord Graham of Edmonton: moved Amendment No. 10:
Page 3, line 3, leave out from ("company") to end of line 4, and insert:

("(a) until the value of those shares or securities is finally established by the National Audit Office on the basis of properly audited accounts; and

(b) without the consent of the Treasury, and the Treasury shall not consent except that six years' audited accounts are available.").

The noble Lord said: My Lords, this amendment suggests the attitude which the Government should take to the stability, viability and credibility of the manner in which the transfers will take place.
When I raise the issue of the true worth of the sale of a public asset, I need say little to make the House understand that this is a sensitive area. Despite the best intentions—and I say that sincerely—of this Minister and others, recent history is riddled with public assets being disposed of to the disadvantage of the public and to the advantage of the purchaser, and very often to the advantage of one individual.
The Minister can satisfy the public by saying that time is not of the essence and that there is no timescale other than that laid down by the Government. We wish to make sure that the value of assets sold out of the public sector are seen to be fair and reasonable by what I accept is a proper body. I beg to move.
Lord Hesketh: My Lords, I may be naive but I believe that the effect of Amendment No. 10 is to delay the sale of the PSA or TCS companies until the value of the shares has been established by the National Audit Office on the basis of audited accounts. Further, it prevents the sales until the Treasury's consent has been obtained, and requires that their consent be subject to six years' audited accounts being available.
Dealing first with paragraph (a) on the role of the National Audit Office, I have already explained to your Lordships during Committee stage that TCS has full commercial accounts capable of meeting the requirements of the Companies Acts and statements of standard accounting practice issued by the main accountancy bodies, and that PSA is in the process of introducing them. Those accounting systems will of course be subject to proper audit. They will be perfectly adequate for the Government as vendor, and for prospective purchasers, in valuing the business activities of both PSA and TCS.
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The value of both these organisations will be based on bidders' assessments of their future profitability when they are freed from public sector constraints. It would be wrong for the National Audit Office to publish their own assessment of the value of the businesses as a going concern before the sales took place, as that would effectively set a ceiling on the purchase price and would clearly not be in the interests of the taxpayer. It is for bidders to make up their own minds on this point.
To delay the sales until six years' audited accounts for the companies were available would mean that neither PSA nor TCS could be sold until at least 1996, which would benefit nobody except their competitors and could cause serious damage both to the interests of the organisations and, more importantly, their staff. I must, therefore, ask your Lordships to resist the blandishments of the noble Lord, Lord Graham, and to reject this amendment.
Lord Graham of Edmonton: My Lords, the Minister denies us this amendment on the basis that it would delay the sale. That is absolutely right. We want that sale to be delayed in order to establish a proper price for the assets sold and a proper price for the viability of the company. What a terrible condition to be laid on a vendor.
The Government want to sell this quick rather than sell it right. They have a proven track record in doing that. We shall find that the time of the Public Accounts Committee and the Select Committees of both Houses will be taken up when, in the fullness of time—and that will not be in six years' time but in the very near future—it is seen that the assets which the Government have sold are sold on for twice the price and that they are divided and again sold for twice the price.
Questions will then be asked. In the future it may be that the Minister will ask from this side of the House a Labour Minister to explain why he was party to such a disgraceful process. The government of the day will be able to say, "It was not our fault. It was your fault". However, it will then be too late because the purchaser will have made the killing and employees will have suffered. Therefore, the public will lose the benefit of the services of reliable men and women who want nothing more than to provide their families with a decent wage and the country with a good, well-run public service.
When I say that the Minister has done his best, that is not very much. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.

National Health Service and Community Care Bill
8. 26 p.m.
House again in Committee.
Clause 50 [Inspection of premises providing accomodation]:
[Amendments Nos. U5EF to 115F not moved].
Clause 50 agreed to.
Clause 47 [Powers of the Secretary of State as respects social services functions of local authorities]:
Lord Allen of Abbeydale Lord Allen of Abbeydale moved Amendment No. 115FB:
Page 52, line 29, leave out ("social services") and insert ("community care").
The noble Lord said: In speaking to Amendment No. 11 5FB we can resume our deliberations by discussing an amendment which is entirely non-controversial, harmless and merely expresses a desire for enlightenment. Section 7 of the Local Authority Social Services Act 1970, which is referred to in the opening words of Clause 47, provides that local authorities shall, in the exercise of their social services functions including the exercise of any discretion conferred by any relevant enactment, act under the general guidance of the Secretary of State.
Clause 47 proposes that that section should be followed by a new section which will require every local authority to exercise its social services functions in accordance with the Secretary of State's directions and that those directions must be in writing.
There are two questions. First, since it is deemed necessary to have a specific requirement that those directions should be given in writing, one is left to draw the conclusion that the guidance in the existing Section 7 need not be in writing since there is no such requirement there. That point is perhaps of mild academic interest in view of the emphasis on guidance in our previous discussions.
Rather more important is the second point that the Bill is not very rich in its reference to social services functions. I believe that I am right in saying that that phrase makes its first appearance in this clause other than in the Long Title. The clause forms part of Part III of the Bill, which is headed "Community Care". The side notes to the three previous clauses all refer to "community care services'' and the explanatory note at the beginning includes the clause under the general heading, "provisions concerning community care services". However, when we reach Clause 47 the phraseology changes and in the first paragraph we find a reference to "social services functions". That form continues in later clauses, subsections and in proposed additions on the Marshalled List.
I ask whether "social services functions" are different from and wider than "community care functiors"? If they are the same, why has the phraseo ogy suddenly changed? If they are different, and if that phrase goes wider than all the other provisions in Part III, is it right that they should find a place in a Bill dealing with community care? I do not know the answers to those questions, but there must be some significance in that change of phraseology. Perhaps the Minister could tell us what it is. I beg to move.
Lord Carter: We on these Benches are very pleased to support the amendment. I am not entirely sure that I agree with the noble Lord regarding the harmless nature of the amendment. Perhaps I may give some friendly advice to the Minister. I suggest
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that she should beware former permanent secretaries who appear to be bearing gifts.
The noble Lord, Lord Allen of Abbeydale, very ably expressed one aspect of the amendment. I should like to spend a few moments dealing with another aspect. The amendment will help us to discover the Government's thinking. Clause 47 appears to give the Secretary of State more powers over a wide range of social services than hitherto have been envisaged. I should like to use the amendment to discover how the Secretary of State for Health intends to use those major powers.
In the notes on clauses the Government very clearly state:
"This clause enables the Secretary of State to issue directions to local authorities covering all" —
I emphasise "all" —
"their social services functions".
It is no exaggeration therefore to say that if that happens it will represent a major development in the relationship between the Secretary of State, his successors, the local authorities and those involved with community care in a wider sense.
It would be helpful if the Minister could give us the precise directions which she has in mind. Will she respond to the view that the clause appears to be far too wide in its implications and gives far too many powers to the Secretary of State? That is an opinion widely held by many voluntary and professional organisations and the local authority associations. They all hope that what one might discern as the grey areas of community care—where the demarcation lines are not clear between the local authorities and the Secretary of State —will be clarified by the Minister's answer.
It will be helpful to know whether the use of any of those powers are subject to parliamentary approval. I hope that the Minister will be able to satisfy the Comittee when she replies.
Lord Henderson of Brompton: Perhaps I might add a brief word appendant to the coruscating speech of the noble Lord, Lord Allen of Abbeydale. When I read the amendment and I was puzzling what it was about, it occurred to me that in sum it could be said that Lord Allen of Abbeydale pointed out that the amendment goes beyond the scope of the Bill. All I ask is whether the noble Baroness will advise me which part of the Long Title covers the clause.
In the Long Title of the Bill, there are many examples of Acts which are amended and brought within the scope of the Bill in that way; for example, the Local Government Finance Act 1982, the National Health Service Act 1977 and so on. However, there is no mention of the Act which is amended by the clause. Therefore, in a spirit of helpfulness I ask whether the Minister would agree to amend the Long Title, if she wishes the clause to remain in the Bill, otherwise it will have to be said to be outside the scope.
Baroness Hooper: It may help the Committee if I begin by explaining the reasons for seeking the general power of direction set out in the first part of this clause. In setting up the new community care

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arrangements we have put local authorities at the centre of the stage and given them a role as enablers of care provision. It is right —I am sure that everyone will agree—that these services should be provided by a body answerable to local people and with a fair degree of freedom and autonomy to arrange the services and to discharge its duties as it thinks fit. We have provided important controls at the local level in the community care planning and case management and assessment systems that we are setting up. But in delegating responsibility to local authorities in this way it is important that there is sufficient reserve power at the centre to ensure that all local authorities discharge their duties properly having due regard to the care needs of people in their localities. It is to ensure this that we have taken the measures in this clause to strengthen the provisions relating to the centre administration of social services in the local authority Social Services Act 1970. At present the Act only requires local authorities to discharge their functions having regard to general guidance given by the Secretary of State. As regards that point the noble Lord, Lord Allen of Abbeydale, asked whether it should be in writing.
Lord Allen of Abbeydale: The point was simply that as there was no provision about it being in writing, presumably it need not be in writing. We need a provision in the Bill as we have it, to deal with the specific directions.
Baroness Hooper: As there is no specific requirement that must be so, but it is hard to envisage how in practice it could be otherwise than in writing. The new provision goes further and enables the Secretary of State to issue directions. We see two main uses for these: first, they can be used to reinforce our guidance to ensure that important elements in it are taken into account by all local authorities; and secondly, it can be used where a local authority is failing to deliver an efficient service as a prelude to action under the new default powers which are also set out in this clause.
As the Committee is aware, we have recently undertaken a revision of the statutory provision for services for children which are now embodied in the Children Act 1989, and work is going ahead to bring that into effect towards the end of next year. We feel it is important that the general powers of direction cover not only community care legislation, but also this social services legislation and that for mentally disordered people. We have therefore put into the Bill this general provision. I think it would cause difficulties both locally and centrally if the Secretary of State was able to issue directions covering community care services but not other forms of social service. A general power would be helpful in reinforcing the Secretary of State's position across the whole field and we think it desirable to seek this at this time. I would therefore ask the noble Lord to withdraw the amendment.
The reference to "social services" therefore as opposed to "community care" simply uses the terminology of the 1970 Act and refers to "social services functions". Enactments conferring social
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services functions on local authorities social services committees are listed in Schedule 1 to the 1970 Act. They include Acts other than those referred to in the definition of community care services in Clause 44.
In regard to the use of direction-making powers, we have so far said that powers of direction will be used to reinforce community care guidance. We have no plans at this stage to use them in other ways. Before issuing general directions I have no doubt that the Secretary of State will consult local authority associations and other bodies in the customary way, as for guidance.
I am slightly confused by the suggestion of the noble Lord, Lord Henderson of Brompton, that the Long Title does not contain a reference to the social services functions of authorities since the penultimate line of the Long Title makes just that reference.
I hope that those comments will have assisted the Committee on the interpretation of this clause.
Lord Allen of Abbeydale: I am obliged to the Minister for her reply. The debate has turned out to be rather more interesting than I expected. I listened with care to the noble Lord, Lord Carter, who described possible motives to me which certainly were not in my mind. I took it as axiomatic that this Government, in accordance with their normal practice, would be taking greater powers for central government. That is their well-known philosophy and practice, whatever they may say in theory.
The noble Baroness said that it was hard to envisage how general guidance can be given other than in writing. That makes me wonder how directions to local authorities could be given other than in writing. I am still a little puzzled by that part of the provisions in this Bill.
The noble Baroness made it clear that social services are wider than community care. I therefore find the Explanatory Memorandum and the heading to this part of the Bill misleading. The point that the noble Lord, Lord Henderson, had in mind is that, although the Long Title lists a number of Acts which are being amended, it does not list the Local Authority Social Services Act. There are general words about social services functions, but the noble Baroness may wish to consult her experts before the next stage of the Bill. In the meantime, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Baroness Hooper Baroness Hooper moved Amendment No. 115FC:
Page 52, line 36, at end insert:
("Complaints procedure.
7AA. — (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 social services functions made by or on behalf of—

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

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

(c) any person who, as a private carer, is providing a substantial amount of care on a regular basis to a disabled person who is living at home and for whom, in the exercise

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of their social services functions, the local authority have a power or duty to provide a service.

(2) In subsection (1)(c) above —

(a) a '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; and

(b) "disabled person" means a person to whom section 29 of the National Assistance Act 1948 applies.

(3) 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) above and as to the taking of such action as may be necessary in consequence of such representations.
(4) Local authorities shall give such publicity to any procedure established pursuant to this section as they consider appropriate.").
The roble Baroness said: This amendment was spoken to with Amendment No. 113BDA. I beg to move.
On Question, amendment agreed to.
8.45 p.m.
Lord Henderson of Brompton Lord Henderson of Brompton moved Amendment No. 115FD:
Page 52, line 38, after ("held") insert:

("(a) if requested to do so by an organisation of or for disabled people which alleges that a local authority has failed to fulfil their duties to provide community care services under any of the enactments specified in section 44 above or

(b)")

The noble Lord said: Clause 47, as we have just heard, amends the Local Authorities Social Services Act 1970 by the insertion of new sections in that Act. I appreciate that the noble Baroness has just moved a new section into that Act by way of a consequential amendment which enables the Secretary of State to institute a complaints procedure for all local authorities. I must say that that is most welcome and I do not wish that my amendment should in any way detract from the welcome that we give to that addition.
However, the new complaints procedure does not enable, so far as I can see, organisations of or for disabled people to make representations, including complaints, to local authorities. I regard that as a pity. My amendment seeks to bring into the complaints procedure, so to speak, those organisations of or for disabled people by a different route. It is by a different route because the new section just introduced by the noble Baroness is concerned only with persons. The new procedure depends on the initiative of persons. It does not depend on the initiative of any relevant organisation.
I do not wish to disturb the new section which has been introduced by the noble Baroness because it might be considered anomalous to introduce relevant organisations where the initiators are persons. Therefore, as I said, my amendment brings in these organisations by a different route. There are occasions when organisations as opposed to persons should be allowed to make representations or air their grievances and I should have thought that these organisations of or for disabled people are exactly those who should be given the machinery to do so.
The amendment is therefore designed to give such organisations that opportunity so that the Secretary of State may cause an inquiry to be held where he
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considers it desirable to do so on representation from those organisations. The amendment is as simple as that and I commend it to the Committee. I beg to move.
Lord Mottistone: I support this amendment. With schizophrenics in particular, relatives may have ceased taking responsibility for their care. Sadly that is sometimes because they are almost forced to do so. A voluntary organisation is likely to take an interest in the general services provided for people with that illness when perhaps no one else does. It is important—given, sadly, the poor quality of many local authority services for the mentally ill—to get services looked at when they are deficient. The noble Lord, Lord Henderson, has filled a gap which even Amendment No. 115FC does not fill.
Baroness Darcy (de Knayth): I briefly support this amendment. A project undertaken by RADAR in 1980–81 showed the importance of this right for organisations. Eleven local authorities were referred to the Secretary of State by RADAR due to their failure to meet assessed needs of community care services. In the majority of cases the service was provided to the disabled person concerned as a result of that intervention. Therefore, I believe that this is a very valuable proposal.
Lord Ennals: I should like to add a few words of support because this is an important matter. I have in mind all those organisations that represent the interests of, and often include among their memberships, those people who are disabled in one way or another. I too very much welcome the amendment moved by the Government but if it were left to individuals to make their complaints it would be very difficult for them. I refer to the mentally handicapped. Obviously MENCAP has a role in that respect. I also think of the deaf and blind where Sense and other organisations have a role. The Royal National Institute for the Blind and the Royal National Institute for the Deaf, together with a whole group of other organisations, exist not only to improve services for such people but also to represent their interests. Unless they are entitled to present complaints on behalf of the handicapped many complaints would go unheard.
Baroness Blatch: This amendment would require the Secretary of State to set up an inquiry if asked to do so by any disabled organisation which alleged that a local authority had failed to provide community care. We believe this to be wholly unrealistic and the amendment is cast in far too wide and general terms. The Secretary of State would have to respond to any request by setting up a full inquiry in accordance with this provision.
We do not feel that it would be helpful to give organisations representing disabled people such a wide ranging power. Experience in the past suggests that there is very little need to hold formal inquiries. There are two reasons for that: first, social service functions, including community care functions, are the responsibility of local authorities. The majority of investigations of failures are usually most appropriately carried out at that level.

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We have no reason to suppose that a local authority is not capable of investigating failures among its own staff perfectly adequately as part of its normal management function. The proposals that we have made for inspection units will put the local authority in a much better position to exercise that function. Secondly, the reason why central inquiries are seldom necessary is that we have the social services inspectorate, which is able to carry out detailed investigations without the need to hold formal inquiries. That is often a more satisfactory way of dealing with a situation where there has been a failure of care.
There is no reason why the report on such an investigation should not be published in due course. The noble Lord, Lord Henderson of Brompton, was also concerned about individuals. Organisations or individual carers can bring a complaint or make representations on behalf of service users. I believe that the noble Lord, Lord Ennals, also made that point.
I do not underestimate the very important role that organisations for or of disabled people can play in drawing the Secretary of State's attention to cases where local authorities are failing to discharge their duties. Indeed, we would want them to do so. I have no doubt that if the allegations were serious enough my right honourable friend the Secretary of State would hold an inquiry. However, I do not feel that it would be helpful to put on the face of the Bill a provision on the lines of that suggested in this amendment. Therefore, I hope that the noble Lord, Lord Henderson, will feel able to withdraw it.
Baroness Darcy (de Knayth): Before the noble Lord decides what to do, as the Minister said that the amendment was too wide, at the next stage can we have a meeting when we might be able to devise an amendment which is not quite so wide? As all noble Lords who have spoken have said, there are special problems which some people have in representing themselves and they need the help of other organisations. It may be that their families need the support of organisations to speak on their behalf.
Baroness Blatch: Certainly, I am not against offering the possibility of talks between now and Report stage. The particular concern is that any grievances can be heard by an individual carer or an organisation. The question is whether we put on the face of the Bill a power which any organisation can simply request; namely, a full inquiry.
Lord Henderson of Brompton: Before the noble Baroness sits down, will she kindly tell the Committee what is the power under which organisations may make their representations? She has said more than once that organisations can make representations. I am wondering under what power in the Bill that can be done. We are seeking to insert that provision in the Bill because we do not find it there. Can the noble Baroness tell me where that provision is to be found?
Baroness Blatch: At this moment I cannot give the specific power. However, there is a right for people to complain. I need to come back to give details of the specific part of the Bill which gives an individual the right to bring a complaint against an authority.
Lord Ennals: Does that mean that if the Minister finds that provision is not in the Bill she will return with an amendment? It is important that organisations should know what their rights are. It is a piece of legislation in which their rights are defined. It is not enough to say that it is the custom or that it should be done. I know that this procedure has not always been followed. On a number of occasions I have put forward on behalf of MIND proposals for an inquiry but no inquiry has followed. Anyone has a right to ask for an inquiry, but that does not mean anything. Anyone may write to anyone: a cat may look at a queen, or whatever it is.
Lord Renton: There is a point that should not be overlooked. Generally mentally handicapped people cannot express themselves at all. In the nature of things they cannot make complaints. They may no longer have a parent or a guardian who can speak for them. Therefore, in the case of a mentally handicapped person it might be important that, if for no other kind of disabled person, MENCAP or a similar body is allowed the opportunity—
Lord Mottistone: That is what I said.
Lord Renton: Thank you: I am much obliged. I will not say why I am repeating the point. I think this matter can be important if further consideration is to be given to this amendment.
Baroness Blatch: I am grateful for the few moments of respite in order, I hope, to meet the very real concerns of all Members of the Committee who have spoken. I understand that the power for complaints will be a new clause contained within Amendment No. 115FC. I am also advised that organisations or carers can bring complaints or make representations on behalf of other service users. I know that my noble friend Lord Renton will be keen to make sure that that is legally correct. I am advised, legally speaking, that the term "person" includes a body of persons corporate or incorporate, so that organisations can make representations on behalf of a client. I hope that, with that assurance, the noble Lord will feel able to withdraw his amendment.
Baroness Darcy (de Knayth): Before the noble Lord decides what course to take with this amendment I ask the Minister to consider one other matter. I am not sure that this proposal does not slightly weaken the provision to repeal Section 36 of the National Assistance Act 1948. Section 36 (1) of that Act reads:
"Where the Minister is of opinion, whether on representations made to him or otherwise, that a local authority have failed to discharge any of their functions".
Clause 47, new section 7B (1) reads:
"The Secretary of State may cause an inquiry to be held in any case where he considers it advisable to do so".

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It takes away the duty to act on representations made to the Secretary of State; he just has a discretion to act. Has the Minister anything to say on that matter?
Baroness Blatch: My understanding is that Amendment No. 115FC will put a very proper formal complaints procedure into this Bill. Does my noble fiend feel able to absorb the impact of that amendment before deciding whether to press this one?
Lord Henderson of Brompton: I shall be very grateful if the noble Baroness can absorb the impact of the discussion that we have had and the import of it outlined from all sides of the Committee. It is clearly important that organisations should be able to make representations particularly on behalf of those who cannot speak for themselves. I am delighted to know that the intent of Amendment No. 115FC is that not only persons but also organisations shall be able to make representations. That does not appear so on the face of the Bill. Some of us know that the word "person" has a peculiar meaning in the language of the law.
When one looks at the amendment as drafted, it looks as if "person" means what you and I consider to be a person; namely, an individual. It is very hard indeed to deduce from the wording of Amendment No. 115FC that "person" has this distinctive legal meaning as well. Will the noble Baroness consider the amendment which has just been moved into the Bill and see whether it can be amended to make it quite clear that it includes organisations as well as persons? I shall be very happy if that happens and, looking around the Committee, it appears that all those who have spoken would also be happy if that were done.
I shall be very happy to withdraw this amendment which was certainly not meant to impose an obligation on the Secretary of State which he could not avoid.
Lord Ennals: Before the noble Lord withdraws his amendment, I wish to point out that in looking at the wording of the new Amendment No. 115FC, which I welcomed, none of those described as "person" in paragraphs (a), (b) and (c), would be other than individuals. Subparagraph (a) states:
"any person for whom, in the exercise of those functions, …"
"(b) any person whose request for such a service has been refused…"
and
"(c) any person who, as a private carer, is providing a substantial amount of care".
Those are references to individual persons. If the new amendment is to include organisations, which is what we all wish, the amendment needs to say so.
9 p.m.
Baroness Blatch: Perhaps I may point out to the noble Lord, Lord Ennals, that Section 7AA (1) ends with the words,
"made by or on behalf of.
It then makes reference to the people he mentioned.
Lord Henderson of Brompton: I think that this matter is worth looking at again. It was not our intention to impose an unconditional obligation upon the Secretary of State. The provision was meant to apply only in a situation where he considered it advisable to set up an inquiry. Perhaps the noble Baroness will be kind enough to undertake to see that the wording is reviewed to ensure that it reflects the opinion of the Chamber.
Baroness Blatch: In the light of what has been said this evening, we shall certainly look again at the wording.
Lord Henderson of Brompton: I am most grateful to the noble Baroness. On the basis of that undertaking, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Lord Carter Lord Carter moved Amendment No. 115FE:
Page 53, line 7, at end insert:
("(1A) No order shall be issued under subsection (1) above in respect of community care functions unless the Secretary of State has warned them in writing not less than three months previously, specifying the grounds on which he believes the authority to be in default in the exercise of such functions.").
The noble Lord said: This amendment rather harks back to Amendment No. 115FB, which was moved by the noble Lord, Lord Allen of Abbeydale. Members of the Committee will remember that we had a very interesting mini debate about the powers in new Clause 47. It contains provisions which require the social services authorities—I use the wording "social services" because it is mentioned in the clause—to comply with directions from the Secretary of State in carrying out their functions. It provides for Sections 7A and 7D to be inserted in the Local Authority Social Services Act 1970, in so far as the Long Title of the Bill allows such insertions, as pointed out by the noble Lord, Lord Henderson of Brompton.
Under Clause 47 the Secretary of State will be able to declare an authority to be in default and to give directions so as to remedy the default. He can call for an inquiry to be set up in connection with the exercise of the social services functions by the relevant authority. As we said with regard to the previous amendment, the powers of direction contained in the clause are very comprehensive. They certainly were not contemplated by Sir Roy Griffiths in his report on community care, nor did the White Paper Caring for People contain any justification for what is a significant new power of discretion and direction.
The proposed amendment would require the Secretary of State to give in writing not less than three months' notice before the making of a direction to a particular authority regarding its community care functions. If such power were included, it would enable the local authority to discuss with the Secretary of State his judgment on a matter which it is part of the statutory duty of the local authority to continue; but if the Secretary of State is to insist on this he must surely give due warning.
Further, the proposed amendment will allow discussion about the Secretary of State's power to make an order declaring an authority to be in default. For example, it might be possible in discussion to raise the question of the nature of the inquiry. We feel that there should at least be this three months' written notice, after which time discussions would be held between the Secretary of State and the local authority before the order was made. I beg to move.
Baroness Hooper: We expect the default procedures in this clause to work in the following way. The first stage will be when it comes to the Secretary of State's attention that an authority is failing to discharge its functions. This may come from a number of directions—the work of the social services inspectorate, information received from organisations representing disabled people or by direct representations to the Secretary of State by users of services. The first thing the Secretary of State needs to do is to satisfy himself that the authority has failed without reasonable excuse to exercise its functions. This will entail some form of further investigation or inquiry and may, if the Secretary of State feels it would be useful, include using the general powers of direction to direct the authority to exercise its functions in a particular way.
It will only be after these processes have been exhausted and work with the authorities through the social services inspectorate has failed to secure any improvement in the situation that the use of the default powers will be considered. I am sure that the noble Lord, Lord Carter, is familiar with that concept. When these powers are used the Secretary of State first has to issue an order, then, if it is not complied with, he can seek an order from the court to enforce it. I think that it is clear from what I have said that the initial processes leading up the issue of a default order would in most cases take at least as long as the three months mentioned in the amendment we are now considering. It is quite right that they should. We would not want to issue orders precipitately since they are very much a measure of last resort. Nevertheless, there may be occasions when it is imperative that the Secretary of State acts more speedily.
For those reasons we do not wish to write into the Bill the time limit proposed in the amendment. I hope that in the light of that explanation and assurance the noble Lord will feel able to withdraw his amendment.
Lord Carter: Members of the Committee will be grateful for most of that explanation. However, I should like to read with care what the Minister said. I take the point that there will be occasions when it will be imperative for the Secretary of State to act with speed. With that consideration in mind, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
The Viscount of Falkland The Viscount of Falkland moved Amendment No. 115G:
Page 53, line 20, at end insert ("and persons who are presently or recently have been dependent on alcohol or drugs.").
The noble Viscount said: This amendment is grouped with Amendments Nos. 115H, 115HA, 116B, 117C, 118B. All of these amendments relate to the discretionary powers of the Secretary of State to designate funding.
Lord Ennals: I am most grateful to the noble Viscount for giving way. I feel that I should point out at this stage that Amendment No. 115HA has been extracted from that grouping and that it will be considered separately.
The Viscount of Falkland: I am grateful to the noble Lord. I speak to Amendment No. 115G which is specifically concerned with—
Lord Mottistone: I was happy to have my amendment grouped with Amendment No. 115HA, but not with Amendment No. 115G. In the circumstances, if Amendment No. 115HA has been extracted from the grouping, I should like my amendment to be considered along with the amendment of the noble Lord, Lord Ennals. I should prefer to do that rather than become involved with this discussion.
The Viscount of Falkland: I am perfectly happy to be entirely separated from everyone. In those circumstances, perhaps I may proceed with my amendment. It concerns designated funding or specific grants for those dependent on drugs and alcohol. The aim of the amendment is to amplify and add to what is already in the Bill. When we debated the White Paper and on Second Reading the Minister was at pains—I agree with her—to point out that the problems of drug addicts and alcoholics are mentioned in the Bill. That is a welcome step.
I have had many hundreds of letters from individuals and voluntary organisations which deal with alcohol and drug abuse. They all acknowledge that the problem is mentioned in the Bill, but their anxiety springs from the history of the attitude—if I may put it that way—of local authorities towards drug and alcohol addiction and the uneven pattern of action taken by local authorities to deal with the problems which happen within their areas. It is for that reason that there is enormous concern about the alcohol and drug addiction services, whether they be the residential services, as many of them are, which are threatened at the moment by shaky funding or lesser forms of treatment. The importance of the services should be underlined in some way in the Bill. Funding should be available for those purposes.
Perhaps the Committee will allow me to go into the scale of the problem of drug and alcohol abuse for a moment. As the Committee will detect, my emphasis will be more on alcohol abuse than drug addiction although the treatment of both generally takes the same form when the crisis point is reached.
While speaking to a previous amendment on assessment, the noble Lord, Lord Mancroft, made an excellent and clear speech. He gave the whole picture of addiction in this country. The Hansard report of that debate should be recommended

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reading for anyone who is interested in the problem. Briefly, the costs in human and money terms are extraordinary. It is difficult to cost the problem. As the noble Lord pointed out, we have some 150,000 street drug addicts, many of whom are extremely young. There are 15,000 registered heroin addicts. Even the Department of Health acknowledges that the actual number of heroin addicts may be 10 times that number. It is calculated that about 800,000 people have severe alcohol problems—that means people whose health has deteriorated to a point where they are in danger of death —but considerably more are severely at risk. Many of them are homeless and an increasing number are young. The number of women suffering from severe alcohol problems is rising.
I draw the Committee's attention to an article which was published in a daily newspaper the other day. The article made what should be an obvious point, although it had not occurred to me. It has to do with the cultural attitude towards women's drinking. The article pointed out that 90 per cent. of male alcoholics are looked after by their wives, if they have them; but about 90 per cent. of women who become alcoholics are deserted by their husbands. That points to a curious attitude in this country towards addiction by women. The noble Lord, Lord Mancroft, gave shattering figures with respect to the number of people addicted to prescription drugs. Some 1.75 million people are addicted to drugs with well-known names such as Librium and Valium and a range of sleeping pills. Many have become addicts because they were wrongly dealt with by their general practitioners. A wrong assessment was made. That point relates also to the amendment to which the noble Lord, Lord Mancroft, made his excellent contribution.
The incalculable damage to the fabric of society must be obvious to the Committee, but there is an element of denial with the individual addict, as there is in the nation. People blinker themselves to the damage to the family structure, particularly to children and women. Violence within the home is strongly related to alcohol abuse. It is calculated that one in three cases of child abuse is connected to a severe alcohol problem. There is a high incidence of severe alcohol problems related to the repeated battering of wives. As we all know, crime often has a high alcohol or drug related content. Therefore the picture is extremely worrying.
The costs in money terms are not easy to quantify. The centre for health economics at the University of York has produced figures which are of interest and which have to do with alcohol abuse. It calculates the cost to industry for 1986 as £1. 65 million through people suffering from alcohol problems. The cost to the National Health Service is £116 million. Traffic offences account for in excess of £100 million. The cost in connection with crime—which covers the costs of courts, the police and so on —is £139 million. This all amounts to £2 billion for alcohol abuse alone in the country.
The need for services is acute and is growing greater daily. People with alcohol and drug problems need a wide range of assistance. At one end some perhaps need only a small amount of advice.
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Counselling sessions may help to deal with the stresses and causes of abuse, particularly heavy drinking. At the other end of the spectrum, treatment centres deal with people who are at a crisis level in relation to their addiction. This is where I come again to the problems with the new set-up as outlined by the Bill. These people need immediate access to detoxification and care after detoxification in an environment supervised by professionals. It should be followed by rehabilitation in a residential setting. This is all costly. These measures often lead to a halfway house and to eventual re-emergence into the community, with perhaps counselling for periods.
I am trustee of a treatment centre which deals with the sad cases of people in an advanced state of addiction. Unfortunately relapse is a common feature. Patients habitually leave and then return and it is a difficult process. The professionals who are trained in this field have invaluable experience in dealing with it.
It is not only the people who suffer directly as addicts. The effects extend to families, friends, business colleagues and so on. The current assistance—before I come to the Bill—is provided mostly by voluntary agencies although one or two are run by the statutory sector. There is easy access to individual counselling. Residential services are provided mainly by the voluntary sector in regard to alcohol addiction in conjunction with housing associations. Sadly, these are few and far between when one considers the scope of the problem. They provide immediate assessment and admission for periods ranging from one week to sometimes as much as a year.
Current funding is from a variety of sources, which reflects the nature of the problem we face as to where the responsibility for these people should lie. In some areas health authorities take responsibility for the funding of the services, in others the social services do it, and in some areas there is joint financial support.
However, overall it is generally accepted that there is a higher commitment from health authorities than from social services. Residential services are maintained through supplementary benefit paid by the Department of Social Security. There are regional variations but the benefit normally amounts to a rental payment of about £40 a week and a care payment of £103 per person per week. That goes towards the cost of the social work that is involved in treating these people.
Under the new proposals of the Bill the care payment will be transferred to the local authority to be used in response to the assessed needs of the patient. There is however the uncertainty of whether funds will be used for these purposes, given the priorities and financial pressures on local authorities. Other Members of the Committee have referred to that point in connection with other amendments.
What are the implications for the future? Generally speaking the many hundreds of letters that I have received suggest that voluntary agencies are not sanguine about the future. The arrangement after April 1991 is that local authorities will agree a contractual fee arrangement with agencies. However,

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certainly those who are involved directly with these problems on a day to day basis in the voluntary alcohol services feel that potential patients are unlikely to approach a local authority directly. As regards both drug addicts and alcoholics, the relationship with a local authority is extremely difficult. Perhaps because of stigma attached to drug and alcohol abuse, those who suffer from these problems are wary of dealing with the authorities at all.
Members of the Committee have referred to my next point in connection with other matters. The number of local authorities which most agencies would have to cope with would be extremely high, as referrals come from a wide area. Those are the problems which are being faced. Many residential projects are under threat at this time. The situation is becoming graver daily. Funding is extremely short and any delay or hiatus in funding would undoubtedly lead to further closures and to more people being at risk. Trained and able people who have a vast experience in this field would be put out of work and would be unable to practise their skills. That would be a great loss to the community.
The noble Baroness has on many occasions outlined the Government's intention, which is clearly to take care of this problem in our community. But how is that to be done and what is the reality of the position? How will the funding be made available? How are we to ensure that local authorities will use the funds available? How will they be able to use those funds under the scope of the Bill?
I should like to end by saying that all is not gloom so far as concerns local authorities. I received a letter today which indicated that in the North East there is a successful and productive relationship between the local health authority and sufferers in that area. However, the writer of the letter, who runs a treatment centre in the North East, said that he doubted whether the same co-operation existed elsewhere in the North. It is that unevenness of attitudes which is causing the problem. I beg to move.
Baroness Masham of Ilton: I shall be very brief. I have put my name to the amendment. I should like to ask the Minister whether she can give assurances on three points: that services will continue for clients with drug and alcohol problems; that services will be easily accessible for clients; and that choice will be maintained with the flexible use of treatment options. Treatment is wide and varied.
Drug and alcohol abuse destroys families and disrupts communities. It is worrying that an organisation such as Turning Point has already decided that projects which after 1991 will become dependent on individual funding arrangements will close. That will be a very serious situation.
Lord Mancroft: I shall be even more brief. I am not an expert on local authority finance, even after having listened in the debate last week to the noble Lord, Lord Carter, and to the reply of my noble friend. I can safely say that I still do not know
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anything about local authority finance. That is no judgment on their ability to explain but rather on my ability to comprehend. One of the points that worries me most is that it seems to me from the short time in which I have had dealings with local authorities and health authorities that their own comprehension of their financing is also a little dusty.
Therefore I would not presume to advise the Committee whether it should approve of ring fencing, earmarking or blank cheques (which are probably not a good idea). However, the principle behind the amendment of the noble Viscount, Lord Falkland, is important. This is a very unpopular group of patients which is at the bottom of the list of priorities. It would be very helpful if my noble friend would in some way underline in the Bill the importance of these patients, if not by ring fencing perhaps in the regulations governing the publishing of the policies of the local authorities. If those dependent on drugs and alcohol were included in such policies there would be no need to underline their financing requirements. The Government must put a microscope on this group of patients who will otherwise be left out.
Lord Ennals: I shall speak very briefly. I shall try to confine myself to three sentences. First, it is quite clear that alcohol services have received very low priority for funding from social services departments. Secondly, Alcohol Concern says that the proposed changes in the funding of residential care will result in the wholesale closure of residential drug and alcohol projects unless specific measures are taken. Thirdly, when one asks why those services have received such low priority, a variety of answers are given. I shall give only one; namely, that there is no statutory responsibility on local authorities to provide those services. That is the overwhelming reason for the amendment. It should be a statutory responsibility. If it is not, there is no reason to expect that local authorities will automatically pay.
9.30 p.m.
Baroness Faithfull: Even if the local authority has overriding responsibility, there is nothing one can do if the patient does not respond. The Committee will remember that some time ago I recommended that there should be a new court order and that people should be found to be in need of treatment. My noble friend Lord Ferrers said that he thought it was a good idea; but nothing has happened.
Baroness Hooper: As the Committee will remember, the Government originally decided that the best way to ensure that adequate resources were directed to care-in-the-community policies was to provide those resources through the revenue support grant. I shall not repeat all the arguments in favour of that proposal, particularly if they are not comprehensible to my noble friend Lord Mancroft. However, we believe that it goes against the grain of our policies to offer local authorities new responsibilities and to ask them to be more fully accountable to their electorate on the one hand and then, on the other hand, determine from the centre

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how resources should be deployed. That is the general argument, and the Government are now carefully considering the position following the Committee's decision to support Amendments Nos. 108AE and 108AEB, which bear on that point.
I remind the Committee that all the evidence thus far shows that expenditure on personal social services does well out of non-ring-fenced funding and has risen substantially in real terms vis-à-vis other areas of expenditure. Over the past 10 years, it has risen by 37 per cent. in real terms. We have made an exception to that general policy for those who are mentally ill because this is an area where we well know that resources have been inadequately applied and services have in some cases been less than we would wish. Basically, that appears to be because local authorities generally have not been able to give as much priority to providing services to people with a mental illness as to services for other vulnerable groups.
However, no one should assume that, because we propose only to make grants to support the development of services for the mentally ill, we believe that other client groups are less important. Those with relatively rare conditions such as motor neuron disease, to name but one, also need adequate social care. We believe that those groups are catered for by existing legislation, such as the Chronically Sick and Disabled Persons Act 1970 and the Disabled Persons (Services, Consultation and Representation) Act 1986. Resources for those Acts have already been taken into account in the levels of support given to local authorities.
The provisions that we make in the Bill for assessment of need and for community care plans are designed to encourage and require authorities to make provision for those whom they serve on a customer need basis. We are requiring consultation in drawing up care plans with health authorities, the new family health services authorities, housing authorities and voluntary and other bodies providing services. That is deliberately designed to improve the scope for developing relevant services to all client groups, including alcohol and drug misusers, as well as multi-handicapped people.
The noble Baroness, Lady Masham, asked whether services would continue. They will of course continue. Those services will be in a better position than they are now simply because of the consultation process undertaken by local authorities and the publication of their plans. The provision will be much more visible.
On the point raised by my noble friend Lord Mancroft, priority on spending should be decided by local authorities. There are many ways in which central government can help in those important areas—and we recognise how important they are —so central government expenditure on drug and alcohol misuse will continue.
Furthermore, I can inform the Committee that the Secretary of State intends to direct local authorities to include drug and alcohol misuse in their community care plans. I believe that that covers many of the anxieties felt by people operating in that area. With that explanation I trust that the noble
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Viscount and noble Lords who intended to move the other amendments still included in this group will feel able to withdraw their amendments.
Baroness Masham of Ilton: Before the noble Viscount rises, I should like to say that I wish I had the faith and trust possessed by the Minister. I know that there are no votes in drug and alcohol abuse. It is a most unpopular issue. We tried to set up a Phoenix House on the south coast. We have had great opposition, led by the local mayor, to setting up a home or treatment centre. I could show the Minister letters that I have received on this matter, as have the organisation.
That is why there is fear that this form of treatment will fall through the net. I hope that the Minister will be able to ensure that it does not do so; but I do not have her faith.
The Viscount of Falkland: I thank the noble Baroness, Lady Masham. I do not share the faith expressed by the Minister either. I only hope that, in a rather typically British way, we are not just waiting for a disaster to occur in much the same way as happened in the prisons. I hope that we do not find that there is an enormous explosion of crack or some other substance and that we have to take very fast action at extraordinary cost in order to deal with it.
Obviously I shall not divide the Committee on the amendment at this hour of the night. I am not at all happy with the noble Baroness's brief on this subject, which has been consistent throughout. I do not feel that local authorities will act in the way that we hope. I reserve the right to come back at a later stage and I sit down, rather heavy in my heart at the response that I have received. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Lord Mottistone Lord Mottistone moved Amendment No. 115H:
Page 53, line 20, at end insert ("or substantially handicapped as a result of a previous mental illness").
The noble Lord said: I do not see this amendment as part of a grouping with Amendment No. 115G because the charities with which I am associated have a problem over this point.
The passage that it is proposed to alter is the new Section 7D of the other Act, which concerns grants to local authorities in respect of social services for the mentally ill. That is fine. The previous amendment sought to latch other issues on to the mentally ill provision, which I thoroughly welcome. Indeed, I am grateful to the Government for including this special clause relating to the mentally ill for the reasons that my noble friend the Minister so clearly explained.
The only point in the new Section 7D which is not clear to me is the mention of:
"persons suffering from mental illness".
What does that mean? Does it refer to people who have been mentally ill at some stage in their life? Of all the people diagnosed as having schizophrenia, about 20 per cent. are perfectly well but the remaining 80 per cent. go through life with

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schizophrenia returning to them from time to time. The object of this amendment is to make sure that the provisions included in the new Section 7D apply to those people just as well as those who are in hospital.
We are talking about care. If for some legal reason in the Bill the phrase "suffering from mental illness" means something that covers a person's lifetime, whether or not he or she is in a sane state at a particular time, nevertheless the point is that that person requires care. The chief medical officer pointed out in 1988:
"It remains an unpalatable fact that many mentally ill people require support and treatment on a long term basis".
He also states:
"Over half those admitted to hospital with a diagnosis of schizophrenia will be left with significant residual symptoms and seriously impaired social functioning".
It is those people, even if they are able to get a job, who need to be covered by the Bill as it stands. If they are, my amendment is unnecessary. If they are not, it is necessary.
Lord Ennals: Perhaps I may both support the noble Lord in the amendment that he has proposed and say a few words about it. I also speak to Amendment No. 115HA.
I know that the noble Lord's amendment is a probing amendment. The answer is very important. He is right that many people who suffer mental illness have a residual handicap which is with them probably all their lives. But that does not apply to everyone. Many people who have had bouts of mental illness may be under treatment for the remainder of their lives but that treatment can operate very effectively. I know plenty who operate very effectively. Schizophenia is one good example. But those who have suffered severe bouts of manic depression have sometimes had electro-convulsive therapy and have been left quite disabled. They find it difficult to return to work again. If one includes those who have spent a long time in psychiatric hospitals, their principal illness is probably institutionalisation. Those are all people who should be included in this definition.
One reason for tabling Amendment No. 115HA is to try to find out from the Government what they intend to do. I very much welcome the indication given in July that mental illness would be dealt with by a specific grant. That was stated by Mr. Freeman and repeated in the White Paper. I am very sorry that Mr. Freeman has moved. People are not allowed to stay long enough in jobs under this Government. He learnt his job very well. He was very constructive, thoughtful and caring. But before we know where we are, he has had to learn the transport game. I am sure that his successor in a few months' time may also be quite good. He is a bright young fellow. But I do not believe that people should be shuffled around like that. It is not right for the service.
However, very little has been said since Mr. Freeman's statement about what the Government have in mind. What is the grant? Will it be a 100 per cent. grant, a 75 per cent. grant, a 50 per cent. grant or what? What are the criteria for eligibility?
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Initially Roger Freeman seemed to indicate a very broad range of eligibility among patients discharged from hospital, but later he seemed to be corrected by indications suggesting that the Government wished to restrict the category to those under the supervision of a psychiatrist. That narrows it down considerably.
I do not know whether the proposal still stands or whether it may be dropped. I hope that the Minister will tell us. What level of expenditure in broad terms do the Government have in mind? How will it be distributed? Are they talking about £1 million, £30 million or £1 billion? What are the Government talking about?
Eventually local authorities must submit their proposals. Therefore, they need carefully to develop plans, consult about them and know the size of the projects that they can submit. What help will there be for patients living in the community whom social workers, community psychiatric nurses and other hard-pressed services are struggling to keep out of hospital? Will financial assistance be available for effective crisis intervention? That is sometimes carried out by health and local authorities and sometimes by voluntary organisations. Will the services cover the homeless mentally ill? Will they include those with senile dementia?
It is less than 11 months until the scheme will come into operation. The time has now come for the Government to state what local authorities should expect from the initiative.
9.45 p.m.
Lady Kinloss: I support the amendment tabled by the noble Lord, Lord Mottistone. People with a recurring mental illness, and in particular severe schizophrenia, are unable to cope with the ordinary, everyday practicalities of life such as paying bills. They will need the help of the local authority social services, especially if they have no caring relatives or friends to help them.
Lord Henley: I thank the noble Lord, Lord Ennals, for his kind remarks about my honourable friend Mr. Freeman.—
Lord Ennals: When you go I will say the same!
Lord Henley: That is most kind of the noble Lord. I hope that he will be able to make the same remarks at that time. There is no need to say exactly why we need a specific grant for the mentally ill because we dealt with that matter earlier.
I turn to the amendment standing in the name of my noble friend Lord Mottistone. I can offer him reassurance because at present there is no legal definition of the term "mental illness". Therefore, it bears its normal meaning, which encompasses all stages of mental illness; not only acute episodes but any continuing or persistent disabilities. Those whom my noble friend seeks to include in his amendment are included in the basic definition of mental illness and local authorities will be able to use the specific grant to provide services for them. I hope that my noble friend will accept the fact that his amendment is unnecessary.

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I turn to the amendment of the noble Lord, Lord Ennals. Draft guidance just issued on specific grant for menial health care provides, at paragraph 6 (a), that the grant will be available for those whose mental illness is so severe that they have been accepted for treatment by the specialist psychiatric services. Paragraph 6 (b) helps homeless people who could benefit by being in touch with specialist psychiatric services.
I entirely accept that the provision of accommodation, to which the amendment refers, is an essential part of services for the mentally ill in the community. Local authorities will be able to provide or secure a wide range of supported accommodation for people with a mental illness under the terms of the specific grant. We shall take steps to ensure that social services authorities work closely with housing authorities to enable those who are capable of doing so to move into mainstream housing. Leisure facilities are also important and many are provided within personal social services.
However, the most pressing need is to improve social care for the more seriously mentally ill and that is where we intend to target out support. I should also point out that the specific grant which we have in mind about which the noble Lord was asking—I shall not give any figures now and I am sure that the noble Lord would not expect me to—will and can only be a small proportion of the total expenditure which may be needed by both local and health authorities in order to offer a range of adequate provision for the mentally ill. The specific grant is not designed to support the totality of the provision required. I do not believe that the noble Lord would expect me to go any further.
Lord Ennals: I do not expect the Minister to start giving a review of the public expenditure White Paper to be published later this year. However, it is important that local authorities should know what is the per centage of the grant, whether it be 65 per cent., 75 per cent. and so on. The local authorities need to know that.
Lord Henley: I go no further than saying that it will be a small proportion. We do not have in mind that it will meet anything like the totality. To some extent the grant is designed to encourage that provision. As we said earlier, it needs encouragement because it has always been treated very much as a poor relation.
Lord Mottistone: I thank my noble friend for his response to my Amendment No. 115H. That reassures me and I am most grateful.
I should have said that I very much support the sense of Amendment No. 115HA in the name of the noble Lord, Lord Ennals. I am sorry that he did not get a little more from my noble friend, but he did fairly well.
Lord Ennals: Before the noble Lord withdraws his amendment, I am very disappointed in the Minister's response. It is the first time that I have heard any Minister say that this grant will be only a "small proportion". I have heard so many speeches by Roger Freeman and have seen Written Answers given in another place. At no stage did I gain the impression that this would be a small proportion of local authority expenditure or any expenditure on the mentally ill. I was very disturbed to hear what the Minister said, not so much in relation to the amendment, but my probing produced a very unsatisfactory answer.
Lord Mottistone: I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendment No. 115HA not moved.]
Lord Seebohm Lord Seebohm had given notice of his intention to move Amendment No. 116:
Page 53, line 20, at end insert:
("() The Secretary of State for Health shall lay before Parliament an annual report setting out the resources available to each local authority in connection with the exercise of their Social Services functions under Part III of the National Health Service and Community Care Act 1990.
()The Secretary of State for Wales shall lay before Parliament an annual report setting out the resources available to each local authority in connection with the exercise of their Social Services functions under Part III of the National Health Service and Community Care Act 1990.").
The noble Lord said: I apologise to the Committee for underrating its intelligence because I implied that the ring-fencing amendment had not been passed. However, in view of the fact that it was passed, I shall not move my amendment.
[Amendment No. 116 not moved.]
[Amendments Nos. 116A to 116C not moved.]
Clause 47, as amended, agreed to.
Lord Seebohm Lord Seebohm moved Amendment No. 117:
After Clause 47, insert the following new clause:
("Role of Director of Social Services
In section 6 of the Local Authority Social Services Act 1970 (which requires a local authority to appoint a Director of Social Services) the following subsections shall be substituted for subsections (2) to (8):—
"(2) The Director of Social Services of a local authority shall not, without the approval of the Secretary of State (which may be given either generally or in relation to a particular authority), be employed by that authority in connection with the discharge of any of the authority's functions other than social services functions.
(3) A local authority shall secure the provision of adequate staff to assist the Director of Social Services appointed by them in the discharge of his functions.
(4) A local authority shall not, without the approval of the Secretary of State (which may be given either generally or in relation to a particular authority), arrange for the discharge of any of the authority's social services functions by any officer who has not been appointed by, or is not under the direction of, the Director of Social Services for that authority.
(5) For the purposes of subsection (4) above, an officer appointed by or under the supervision of a person subordinate to the Director of Social Services shall be deemed to have been appointed by or, as the case may be, to be under the direction of the Director of Social Services.").
The noble Lord said: This amendment is important. The Association of Directors of Social Services likes this amendment and I have a personal interest which will become clear in a moment. It concerns the duties and authority of the directors of social services.
I must return to what has been called the Seebohm report, which engendered the Local Authority Social Services Act 1970. In the summary recommendations it stated:
"The head of the social services department should be able to give his whole mind and time to the work of the department and should not be subordinate to the head of another department. His post should be statutory and this should be an obligation on the local authority to provide him with sufficient supporting staff.
He along with the other principal officers should work as a team under the leadership of the clerk in the manner in which the Maud Committee have indicated".
That was picked up in the Bill and appears in the Act as follows:
"A local authority shall appoint an officer, to be known as the director of social services, for the purposes of their social services functions".
The Act continues:
"(5) The director of social services of a local authority shall not, without the approval of the Secretary of State (which may be given either generally or in relation to a particular authority) be employed by that authority in connection with the discharge of any of the authority's functions other than their social services functions.
(6) A local authority which has appointed, or concurred in the appointment of, a director of social services, shall secure the provision of adequate staff for assisting him in the exercise of his functions".
That almost completely picked up the recommendations of the committee, and so far as I am aware that Act stands and has not been amended. It is for each local authority to decide how they will implement the requirement. The approval of the Secretary of State is only needed for a major extension of the director's role; for example, if he or
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she takes on the role of director of housing, as has happened in a handful of authorities including the London Borough of Harrow.
Twenty years ago no one could have predicted the restructuring of local authorities that is now taking place in some areas. That in turn had an impact on the role of the director of social services. The Association of Directors of Social Services believes that amendment is required to the 1970 Act which will clarify the current position. The new clause therefore is intended to strengthen the powers of the Secretary of State where authorities are introducing management restructures which separate the legal post of the director from his day-to-day functions.
In Tower Hamlets the management structure has been decentralised to a number of neighbourhood offices. Although the nominal director of social services has legal responsibility for social services decisions, the actual responsibility lies with neighbourhood chief executives. The post of director is now vacant. The most recent occupant found that he had no powers to reorganise or co-ordinate policies across the borough.
The Metropolitan District of Rochdale is proposing a different structure which collects together a number of statutory functions in a single post of director of corporate services. Day-to-day responsibility for social services functions will be devolved in neighbourhood executives, once again separating the legal responsibility from line management.
The Association of Directors of Social Services respects the right of each local authority to determine its own structure. Its chief concern regarding the substantial changes to the role of a director is where his ultimate responsibility for social services functions lies; in other words, where does the buck stop? That is particularly pertinent given the new responsibilities of the Children Act 1989 and the National Health Service and Community Care Bill.
Unless a clear line of accountability is introduced through legislation, future inquiries into tragedies such as the death of a child in care or the abuse of elderly people in a local authority home will begin to find that the buck stops somewhere between local management and the nominal director. I am not so bigoted as to think that a recommendation made over 20 years ago is good for all time; but serious deviation from the intentions of the 1970 Act must not be allowed without the approval of the Secretary of State. What is happening in Tower Hamlets and Rochdale does not make managerial sense. In my view they are seriously in breach of the 1970 Act.
Finally, financial responsibility has been transferred from social security to social services. That is something quite new to social services departments, and the authority of the director of social services must be made clear. By this amendment we do not obstruct change. We hope that at least the 1970 Act will abide unless the Secretary of State alters it, which he will be allowed to do under the amendment.
Amendment No. 117 is very important, and I know that the directors of social services will be hanging on to the Government's every word in this regard. I beg to move.
10 p.m.
Baroness Faithfull: I support the noble Lord, Lord Seebohm, in his amendment. I shall not repeat all that he said but I ask the Committee to look at the matter from the point of view of the staffs. If you are working for a director of social services who also has wide responsibilities for housing or other departments, you do not feel secure or that you are working for someone who is fully acquainted with the details of the situation.
I do not believe that it is possible for any one man or woman who is a director of social services to know the Children Act through and through, to know this Bill through and through, and at the same time to be completely responsible for them and also to take on other responsibilities such as housing. That is beyord the capacity of any one person.
I also reinforce the point about training. Either one is trained to be a housing manager or trained to be a social worker. One cannot do both jobs unless one is fortunate enough to be trained in both areas, which is most unlikely.
Finally, I refer to a personal experience. Last summer I dealt with a most distressing case in an authority which shall be nameless. The director of social services had responsibility for housing and for social services. I must say, with all due respect, that he was unable to give a suitable service in that particular distressing case. The local authority was proved to be wrong. That case may not have happened if the director had not carried responsibility for housing as well as for social services. I support the amendment in the strongest possible terms.
Lord Winstanley: I too support the amendment. I do so as briefly as I can. The amendment was admirably and clearly moved by the noble Lord, Lord Seebohm, and I absolutely agree with what he said. I am sure that the whole Committee does so. The noble Lord, Lord Seebohm, quoted the words regarding the relevant functions of directors of social services. The words in the Bill are ambiguous, to say the least. If they do not mean what is stated in the amendment, they ought to mean that. Surely that is the purpose of the amendment.
Many of us are aware of the pressures and difficulties, including financing, that local authorities are experiencing. There are also staff difficulties. There must have been pressures which led to the manoeuvres mentioned by the noble Lord in Rochdale, Tower Hamlets and many other places. It is possible that occasionally the reorganisation of functions would work. For special cases the amendment allows for that to happen with the approval of the Secretary of State, but not gradually and unseen or in that kind of way.
In essence, therefore, what does the amendment do? We have already decided to ring fence certain
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parts of local government rate support grant. The amendment ring fences the directors of social services. I agree with that.
Lord Peston: In supporting the amendment on behalf of the Official Opposition I take the opportunity of congratulating the noble Lord, Lord Seebohm, on not merely his introduction to this amendment but on his own major contribution in this area. I do not say that to him because we expect to pension him off in the immediate future but simply because the area of social services will be forever indebted to him for his contribution.
The noble Lord was right—even though we are debating the amendment at ten o'clock at night—to emphasise the importance of the amendment. It is concerned with management and it lays down simple principles of management as they should be applied to this area—that there should be a clear line of responsibility and that someone should be ultimately responsible, but that that person should also be the person who, so to speak, acts.
I agree with the noble Lord, Lord Winstanley, that there should be no ambiguity. The great benefit of this amendment is that there is no ambiguity. There is no way round the amendment. The Local Authority Social Services Act may well be ambiguous. Perhaps I may add that I would be happier to have the amendment accepted than to be told that the Local Authority Social Services Act is correctly interpreted in that way. If that is correctly interpreted, we have the slight problem of why it is not being acted on in that way. I hope that the Government, either in the form of these exact words which seem perfectly satisfactory to me or in their own words, take this opportunity and accept the amendment. I do not see that this matter is remotely party political or undermining the Bill. It reinforces what the Government very much want to do. It is with a plea for sweet reasonableness on the part of the Government that for the Opposition I strongly support this amendment.
Baroness Blatch: I understand and sympathise with the objective underlying this amendment, which, as I understand it, is that the director of social services shall have the necessary authority and accountability for the discharge of his responsibilities. I entirely endorse the objective. The question is whether it can be achieved by statute.
It is essentially a matter for the local authority which should, we suggest, be allowed scope to organise the management of its services in ways best suited to its local circumstances in accordance with up-to-date best practice and, above all, to promote the government objectives for community care as set out in the White Paper Caring for People.
Here I am thinking particularly of the need to make services more flexible and accessible to those who need them. Authorities that wish to reorganise their community services so as to simplify access to a range of services and to make access more local, should not be unnecessarily impeded by legislation. As the Committee will know, the Bill incorporates a

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new general power for the Secretary of State to give directions to local authorities and also new default powers.
Together these provisions will make it easier for the Government to intervene effectively if things start to go wrong, to protect the interests of users and carers and to see that the community care policies are given effect. The Local Authority Social Services Act 1970 provides, as I believe the noble Lord, Lord Seebohm, reminded us, that the director of social services be given adequate staff to enable him to fulfil his statutory duties. We would expect the director or his staff to be involved in the appointment of professional staff.
The Secretary of State's approval is already required for other than social services functions to be laid on the director of social services. We do not think that it would be right to involve the Secretary of State to a greater degree in the administrative arrangements of individual local authorities.
The amendment would also remove the possibility of two or more authorities employing the same person to carry out the social services functions where they consider that one person can efficiently discharge those functions. I do not know whether any authorities may wish to make such an arrangement, but I would be reluctant to see that choice denied them.
The noble Lord, Lord Seebohm, was concerned about the line of accountability. It is possible to have clear lines of accountability in several different organisational structures. We accept that clear accountability must exist. I believe that sufficient safeguards exist to investigate and to take action where there is cause for concern. The noble Lord also asked where the buck stopped. That is a very real question in management terms.
It is for each authority to determine the precise pattern of accountability for its officers. Ultimately the legal responsibility rests with the authority itself. It will need to make sure that its internal arrangements allow its accountability to be discharged. The noble Lord, Lord Seebohm, again questioned the management structure at Tower Hamlets. I do not feel that it would be appropriate or helpful for us to get immersed in the arrangements of that authority. Authorities are free to decide how to organise their social service departments. If they want the director to carry out any other functions.—
Lord Winstanley: I may be confused by what the noble Baroness is saying as against what she said earlier. She appeared to say earlier that the Secretary of State's approval is required before additional functions other than social services functions are laid on the director of social services. Are we to assume from that that the Secretary of State has given approval for what is happening in the authority which has just been quoted?
Baroness Blatch: I am not sure that I can comment specifically on Tower Hamlets. I can confirm to the noble Lord that the Secretary of State's approval is required where the social services take on functions
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other than those contained in the Act. They require the permission of the Secretary of State.
I must leave as an open question the accusation made by the noble Lord, Lord Seebohm. He felt that a particular authority was in breach of the Act. If that is so, then I believe that it should be dealt with, though at this moment I do not wish to comment upon the situation. Nevertheless, it is a question that must be answered.
Lord Peston: I think that we should clarify a point which seems to me to be quite fundamental. It concerns the first part of the amendment moved by the noble Lord, Lord Seebohm; namely, subsection (2), which starts with the words,
"the Director of Social Services",
and so on. Is the noble Baroness saying that what is contained in that part of the amendment is not needed because the situation cannot arise? It seemed to me that the noble Lord was saying that the situation he is trying to prevent is, unfortunately, already happening. Is she quite clear in her mind that the problems that have been identified simply cannot be happening legally, so to speak? That is the issue which is bothering us.
The remarks made by the noble Lord, Lord Seebohm, have been somewhat interpreted by the noble Lord, Lord Winstanley. We all thought that that provision was contained in the Local Authority Social Services Act 1970. However, in practice that does not seem to be the case. To put it hypothetically, if the noble Baroness can say that what is happening in these boroughs is different from that situation and that she is convinced it is illegal and can be dealt with under the earlier legislation, one might be satisfied. However, it has certainly happened.
Baroness Blatch: I was trying hard not to become embroiled in the instances concerning this particular authority. I shall repeat what I said earlier: if the director of social services is to carry out other functions the authority must have the approval of the Secretary of State. If an authority embarked upon any unorthodox activity I am sure that the social services inspectorate would wish to watch closely to ensure that services were delivered effectively. I have recently been advised that approval has so far been withheld by the Secretary of State in Tower Hamlets.
I believe that enough has been said in this short debate, which has raised many questions. I should like to take the amendment away and discuss it with the department in view of the number of questions which have been left in the air.
Baroness Seear: I am most grateful to the noble Baroness for giving way. In my view we are discussing two different points. There is the point where a director of social services is given a quite different job to do. As I understand it, that is against the provisions of the initial Act. I think that all of us would agree that that is an unsatisfactory situation.
There is another situation which is perfectly possible. In some circumstances it can be desirable

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that within the framework of operating the social services in a local authority a director of services may decide that it is a good idea to delegate some of that work to smaller groups in the authority. I can see no objection to that course of action. It can be done while maintaining the line of authority; it is simply delegating. It is done in so many organisations. You simply delegate and you maintain the responsibility. The director would put in controls to ensure that the work is being carried out properly. He would delegate this power to certain groups because in his authority he believes that that is the way it will work. As I said, we are discussing two different issues. I should be glad if the noble Baroness could comment upon the matter. If she cannot do so now, perhaps she will undertake to think about it.
Baroness Blatch: I am grateful to the noble Baroness. I think that we are indeed discussing two different matters. I think that I made clear in my first answer that social services directors must be free to organise their departments either on a patch basis or by some other arrangement, so long as the structure is understood and the services are delivered effectively into the community.
The other issue to which the noble Baroness rightly referred is the assuming of new functions which are not contained within the Act. There is sufficient of a question mark in this respect to suggest that that may well be an issue. As I said, I have been advised that thus far the Secretary of State's approval has been withheld in this particular instance. I believe that we are talking about the additional function of housing.
The third point is the one about which the noble Lord, Lord Seebohm, and other noble Lords are worried. It relates to where the management lines go, who is accountable and where the buck stops. There are sufficient question-marks to cause me to read the debate, discuss the matter with the department and return to the amendment on Report if the noble Lord feels able to withdraw the amendment.
10.15 p.m.
Lord Seebohm: I must say that I was glad to hear what the Minister said. It is clear that apart from Tower Hamlets some other local authorities are in breach of the Act which clearly states:
"The director of social services of a local authority shall not, without the approval of the Secretary of State (which may be given either generally or in relation to a particular authority), be employed by that authority in connection with the discharge of any of the authority's functions other than their social services functions".
That is clear. It is not just Tower Hamlets because several local authorities are doing the same. It is an insult to the directors of social services. Of course I shall not press the amendment. I shall bring it back on Report. I hope that the Government will be able to produce an amendment which covers all the points that we require. If they do that, it will be magnificent.
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If not, we shall fight the matter to the end. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Lord Carmichael of Kelvingrove Lord Carmichael of Kelvingrove moved Amendment No. 117ZA:
Before Clause 48, insert the following new clause:
("Health Board Plans
.— (1) After section 13 of the National Health Service (Scotland) Act 1978 there shall be inserted the following section:—
"Health Board Plans for Community Care Services.

13A. — (1) Within such period after the day appointed for the coming into force of this section as the Secretary of State shall direct, and in accordance with the provisions of this section, each Health Board shall prepare and publish a plan for the provision of health care for the users of community care services in their area.

(2) Each Health Board shall from time to time review any plan prepared by them under subsection (1) above, and shall, in the light of any review, prepare and publish —

(a) any modifications to the plan under review; or

(b) if the case requires, a new plan.

(3) In preparing any plan or carrying out any review under subsection (I) or, as the case may be, subsection (2) above the authority shall consult—

(a) any local authority having responsibilities under Part II of the Social Work (Scotland) Act 1968 in their area;

(b) insofar as the plan or, as the case may be, the review may affect or be affected by the provision or availability of housing, every district or island council in the area of the Board;

(c) such voluntary housing agencies and other bodies as appear to the authority to provide housing or community care services in their area;

(d) such voluntary organisations as are representative of the users of community care services and their families and informal carers in the area of the Board; and

(e) such other persons as the Secretary of State may direct.

(4) Plans prepared under this section shall incorporate, so far as is relevant, any community care plans prepared under section 5A of the Social Work (Scotland) Act 1968 currently in force in their area.'.").

The noble Lord said: I have a long justification for the amendment which I have abbreviated because of the lateness of the hour. I am sure that the Minister's answer will be based on a rather more exhaustive examination than I am prepared to give at this time. The new clause seeks to reflect the proposals contained in the White Paper which make it clear that health boards have responsibilities for community care planning. It states that health boards will be asked to draw up their own plans which will be agreed with the local authorities and other interested parties. However, the Bill gives all community care planning obligations to local authorities. None of the planning is given to the health boards. Local authorities have merely to consult health boards. In addition, the Bill makes no mention of the planning agreements between local authorities and health boards which are proposed in the White Paper. The amendment would rectify those faults. I beg to move.
Baroness Carnegy of Lour: Scottish local authorities have pointed out to me that they are required to prepare and publish plans and consult the health boards, but that although the health boards are required to draw up plans for the

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Secretary of State's approval, they are not required to do so in relation to the Act. The Act does not require it. The health boards are not required to consult the local authorities when so doing. In view of what was said in the White Paper about planning agreements, this provision seems to local authorities to set about the matter in the wrong way. The amendment is an attempt to put that matter right. I shall be interested to hear what my noble friend has to say.
The Minister of State, Scottish Office (Lord Sanderson of Bowden): The noble Lord, Lord Carmichael, is quite right to stress the importance of health boards making community care plans which tie in with those which local authorities will be required to make under Clause 49. Planning for community care requires the close collaboration of all agencies concerned, and that is a matter fully recognised by the Government.
As Chapter 6 of the White Paper Caring for People makes clear, our current reforms place a strong emphasis on the need for health boards and local authorities to work together; for example, in ensuring that there is an effective primary and community health contribution to the development of individual community care packages.
Local authorities will be required to consult health boards and other bodies before drawing up their plans. The White Paper specifically states that local authorities must specify how they will co-ordinate their plans and activities with those of health authorities and other bodies. We shall require health boards to draw up their own community care plans. It might be helpful to the noble Lord and my noble friend if I read the appropriate extract from the White Paper:
"Health boards will be asked to draw up their own plans which will be agreed with the local authorities and other interested parties for the development of community care in their area. These plans will require to be submitted to the Scottish Office and progress will be monitored as part of the accountability review (part of the monitoring arrangements of the Scottish Home and Health Department) to ensure that adequate funds are being devoted to this".
Paragraph 10.17 goes on to say:
"There will be a need for planning agreements between local authorities and health boards setting out shared assumptions and objectives as the basis of the community care plans of the health boards and the local authorities. The details will be the subject of further consultations".
Given the Secretary of State's general powers to direct health boards under the National Health Service (Scotland) Act 1978, we are not convinced that it is appropriate to write the requirement for health boards to draw up community care plans onto the face of the Bill.
I am particularly unhappy with subsection (4) of the noble Lord's amendment which would require health boards to incorporate so far as is relevant the community care plans prepared by local authorities. I think that this could be unnecessarily prescriptive. It is one thing for different bodies to agree shared assumptions and objectives, as we intend, but quite another to incorporate one body's plans wholesale into those of another. I fear that this would undermine the flexibility which is essential to ensure
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the best possible collaboration between local authorities and health boards.
I do not believe that there is inconsistency in the approach that we are adopting because it allows for the fact—and this is very important—that the Secretary of State's relationship with health boards is quite different from his relationship with local authorities. I am sure that the noble Lord understands what I mean by that. I hope that with that explanation he will be able to study what I have said and conclude that what we intend is probably in line with what he seeks.
Lord Carmichael of Kelvingrove: Of course I shall study what the Minister said and I hope that he also will do me the courtesy of looking closely at my amendment proposing the new clause. Obviously my wording is more likely to be flawed than a provision drawn up by the Minister's experts, but even in the noble Lord's explanation he kept emphasising what the White Paper said. All things being equal, we take the provisions at their face value, but at the end of the day what worries us is that the provision could be challenged.
There could be a difference of opinion between the health board and the local authorities. According to my reading of the Bill and my information, the local authorities would have all the powers and would only need to consult the health boards. They have only to say that they have consulted the health boards.
Lord Sanderson of Bowden: Perhaps the noble Lord will permit me to intervene. That may seem so, but if our intentions are not fulfilled, then Clause 48 and the powers of the Secretary of State come into play.
Lord Carmichael of Kelvingrove: I accept the noble Lord's words and will examine them with great care. In the meantime, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 48 [Power of Secretary of State to give directions]:
Lord Carmichael of Kelvingrove Lord Carmichael of Kelvingrove moved Amendment No. 117ZB:
Page 53, line 27, leave out ("directions") and insert ("general guidance").
The noble Lord said: In moving Amendment No. 117ZB it may be for the convenience of the Committee if I speak also to Amendment No. 117ABA. The purpose of Amendment No. 117ZB is that the clause unamended gives the Secretary of State very wide-ranging powers to issue specific directions to local authorities which hitherto they have not enjoyed.
Under Clause 48 the Secretary of State would have power to issue directions on all the social work functions of local authorities, including child care and assessment and not just community care as dealt with in Part IV of the Bill. There is the fear that a Secretary of State could privatise the health service simply by issuing directions under the terms of this clause. I am not of course suggesting that the present

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Secretary of State would do so, but the effects of legislation last for a long time. We believe that the present powers of the Secretary of State to issue general guidelines are adequate and that any extra power is unnecessary. I beg to move.
Baroness Carnegy of Lour: I am glad that the noble Lord has raised this matter because it is of concern to the Law Society of Scotland and to local authorities. It will be interesting to hear whether my noble friend considers that the new subsection to be inserted into the Social Work (Scotland) Act 1968 implies the wide powers that have been suggested. It is surely not the intention that the Secretary of State should be involved in, for example, child care, assessments and other social work services. That is not stated in the Bill. I look forward to hearing my noble friend's comments on that.
Lord Carmichael of Kelvingrove: I am grateful to the noble Baroness for her comments. When I introduced this amendment I linked it up with Amendment No. 117ABA. I should stress that the latter amendment is linked with this amendment. We believe that the Bill as it stands goes further down the road of promoting vague, enabling powers which concentrate powers in the hands of the Secretary of State without much chance of parliamentary review. The director of the King's Fund feels that that will be the case. I am sure the Minister is well aware of that body. The two amendments seem to me to address a good point. Like the noble Baroness, I am anxious to hear the Minister's reply.
Lord Sanderson of Bowden: I shall deal first with Amendment No. 117ZB. Throughout this Bill we have tried to strike a balance between delegation at local level and retention of necessary central controls By asking us to water down a direction-making power, the noble Lord, Lord Carmichael, seems to be suggesting that the Bill is too biased towards the centre.
Under the Bill and the White Paper Caring for People we are transferring major new responsibilities to local authorities for the development and operation of community care. It seems prudent to balance this shift of responsibility with the minimum necessary powers at central level to ensure that local authorities carry out their community care functions properly. It is for this reason that we are giving the Secretary of State general powers to direct local authorities on duties they carry out under the Social Work (Scotland) Act 1968 (which of course include the community care provisions that this Bill inserts into the 1968 Act).
The noble Lord said that directions could result in the privatisation of the health service. However, directions cannot override the principal legislation which imposes on the Secretary of State the duty of running the health service. The replacement of the word "directions" with the words "general guidance" and the removal of a local authority's duty to comply with directions would water down
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the general powers to the point that they would no longer be effective. I think that that would be wrong.
For a start the Secretary of State already has a power under Section 5 of the 1968 Social Work (Scotland) Act to issue local authorities with general guidance on their social work functions, and we will be using this power to give local authorities a wealth of guidance on the performance of their new community care responsibilities under this Bill. But general guidance, by definition, cannot be too specific. The great advantage of directions is that they can be tailor-made to individual circumstances and in particular allow the Secretary of State to step in when an individual authority appears to be falling down on very specific aspects of its duties; and of course directions, whether general or specific, carry a good deal more authority than guidance.
I see nothing unreasonable in giving the Secretary of State a power to direct local authorities in their community care functions. When we are dealing with the provision of services to the most vulnerable people in our society it surely makes sense to build in some statutory, central safeguards. Indeed, there is nothing new in what we are doing since the 1968 Act and related legislation, such as the Mental Health (Scotland) Act 1984, already contain direction-making powers as well as powers to make orders and regulations.
It was suggested that the directions under Clause 48 of the Bill could be used to privatise social work. That is not the case. The 1968 Act gives local authorities statutory social work duties and directions cannot override those.
Some anxieties have been expressed about this part of the Bill. I repeat to my noble friend Lady Carnegy of Lour—who expressed some concern about the powers of the Secretary of State —that as regards the Long Title of the Bill one of the objectives is to make further provision concerning the provision of accommodation and other welfare services by local authorities and the powers of the Secretary of State as respects the social services functions of such authorities. That puts the matter in perspective. I hope that the noble Lord will consider withdrawing his amendment.
10.30 p.m.
Baroness Carnegy of Lour: Perhaps I may advise my noble friend what the Law Society said and he can tell me whether he thinks it is right. The Law Society said that the clause is worded in such a way that the giving of directions by the Secretary of State applies to all the social work functions of the local authorities, including those not related to the provision of community care. Is he saying that there is nothing new in that because of the 1968 Act?
Lord Sanderson of Bowden: I did not say that. I repeated what my noble friend Lady Hooper said earlier regarding the English provisions and pointed out that the Bill makes it clear that there are powers in the Long Title to do such things as my noble friend has mentioned. The power exists on a wider scale than would have been the case previously.
Lord Carmichael of Kelvingrove: Again I am grateful to the noble Baroness, Lady Carnegy of Lour, for her questions. I had been convinced that the Minister was correct until the noble Baroness raised that point. I do not for a moment suggest that he was wrong, but perhaps it is a matter of interpretation. Our amendments originated largely with the Law Society. I shall withdraw the amendment but I hope that the Minister will accept that we may bring it back at a later date. In the meantime I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendments Nos. 117A, 117B and 117ABA not moved.]
Lord Carmichael of Kelvingrove Lord Carmichael of Kelvingrove moved Amendment No. 117BBA:
Page 53, line 31, at end insert ("having regard to the national strategy for Scotland prepared under section (National strategy for local authority provision of communtiy care).").
The noble Lord said: It may be for the convenience of the Committee if Amendments Nos. 117BBA and 117CBA are taken together.
Lord Sanderson of Bowden: And also Amendment No. 118XA?
Lord Carmichael of Kelvingrove: Yes. In Clause 48 the Bill gives draconian new powers to the Secretary of State. In the past one of the greatest obstacles to the development of high quality community care in Scotland has been the failure of the Scottish Office to use the power of guidance which it already has. It could have used that power to guide social work and community care in Scotland much better than it has. For example, there are no national guidelines in existence for the registration of day care establishments. That means that local authorities work in a vacuum trying to set their own standards for such establishments.
In Wales the all-Wales strategy on mental health has given impetus to community care, but Scotland has not chosen to follow that example. The problem will become even more acute because developments such as case management, assessment of needs and so on will require monitoring and the propagation of good practice.
In the English context, Ministers have repeatedly assured Parliament that the proposal will not require additional legislative safeguards because of the role of the Social Services Inspectorate. In Scotland there is no Social Services Inspectorate. The Government must explain what they propose as an alternative.
The precedents for the requirement in Amendment No. 118XA are Sections 17 (2) and 18 (3) of the Chronically Sick and Disabled Persons Act 1970 and Section 11 of the Disabled Persons (Services, Consultation and Representation) Act 1986 about which we spoke last week. In England and Northern Ireland, there are social services inspectorates and in Wales the social workers' service has recently been renamed the Social Services Inspectorate to reflect the strengthening of commitment to quality assurance.
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If the clause is accepted, it will provide an opportunity to ask the Scottish Office Minister why there appear to be no proposals to strengthen the role of the social work services group in view of the powers provided by Clause 48 and developments in the rest of the UK.
My suggestions are self-explanatory and I hope that the Minister will be able to help me. I beg to move.
Lord Sanderson of Bowden: We already have a national strategy and statement of objectives for the provision of community care in Scotland and it is detailed in the White Paper Caring for People, much of which is now being enacted through this Bill. As the noble Lord knows, the key part of our strategy, as recommended by Sir Roy Griffiths, is to place the responsibility for community care with local authorities. It is clearly they who are best placed to determine the needs and priorities for community care in their own areas and they will be required to produce detailed community care plans in consultation with health boards and other interested parties. Thus all over Scotland plans will be developed for meeting the care needs of vulnerable people which are fully adapted to local circumstances.
I see no need for the kind of national community care strategy proposed in Amendment No. 117CBA. At best, it would be a wasteful duplication by central government of work already being done at local level. At worst it would represent an inappropriate degree of central control and involvement in community care planning which could serve merely to undermine and frustrate the efforts of local authorities.
I am not suggesting there should be no central control in that important field. We are already providing for that. The Scottish Office will be monitoring community care plans and the progress made in implementing them and wherever it appears that local authorities are falling down on their community care duties the Secretary of State will be able to step in with his direction-making powers under Clause 48 to which we have referred on many occasions.
I see similar objections to Amendment No. 118XA which calls for the Secretary of State to produce an annual statement of objectives for the development of community care. Community care plans will be public documents and it will be quite clear how services are being developed to address assessed needs. The Scottish Office will monitor the plans and the progress in implementing them. The noble Lord believes that the Secretary of State should state specific objectives because, if the objectives were too general, they would be of limited value. However, I believe that specific objectives would represent a derogation from the local authorities' responsibilities.
The second part of Amendment No. 118XA calls' for annual reports on progress. Numerous statistical bulletins are already produced giving a wide range of information. That includes the numbers of people discharged from hospital, the number of mentally handicapped, mentally ill and elderly persons in

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residential care in the community and the availability of day services.
I am sure that further reports are not the answer, although I believe that it should be possible to look again at the way in which the statistics are collected and published with the objective of making improvements. Such work is already in hand within the Scottish Office. I want to have a look and see what is happening south of the Border, particularly as the noble Lord mentioned Wales. But I do not feel that the answer lies in what he suggests.
Lord Carmichael of Kelvingrove: I am very grateful that the Minister will look south of the Border. Having been very active in many ways during the passage of the 1968 Social Work (Scotland) Act, I firmly believe that we set a standard which was copied, or was attempted to be copied, down south. But as always happens, people leap ahead. The more one looks around the world, and in particular at our own country of Britain, the more one realises that there is never one group which makes smooth progress all the time.
The Minister suggested that he did not like the idea that the Secretary of State should have specific objectives. There is probably something in that. The idea of having too rigid a framework is bad, but there would certainly be no harm in having guidelines, as we discussed earlier. However, I am grateful to the Minister for the care that he has taken and beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 48 agreed to.
[Amendment No. 117CBA not moved.]
Clause 51 agreed to.
Clause 55 [Power of Secretary of State to make grants]:
Lord Carmichael of Kelvingrove Lord Carmichael of Kelvingrove moved Amendment No. 117 BA:
Page 57, line 44, leave out ("may") and insert ("shall").
The noble Lord said: It may be for the convenience of the Committee if we discuss Amendments Nos. 117BA, 117BB and 117BC together. Amendment No. 117BA ensures that it is the duty of the Secretary of State to make grants to local authorities in respect of their functions under Part II of the National Health Service and Community Care Act, Section 27 of the National Health Service (Scotland) Act 1947 and Sections 7 and 8 of the Mental Health (Scotland) Act 1984.
As has been said, Amendment No. 117BB requires that a role is identified for the Scottish Office ensuring the transfer of funds from health boards to local authorities. Officials from the social work services group have stated that these grants will be top sliced—an interesting term—from the local authorities' revenue support grants. Therefore, the financial incentive for local authorities to develop community care services for mentally ill people will only be at the expense of other local authority services. No role is identified for the Scottish Office
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in ensuring the transfer of funds from health boards to local authorities. Indeed, it seems that the Scottish Office may be giving up some control to the Treasury. It has been suggested that in the past the Scottish Office could allocate its own budget as it saw fit and could have made significant grants to mental health projects without the need for new legislation.
The final amendment in this group calls for:
"after ('Parliament') insert ('in addition to that made available under the Revenue Support Grant').
Unlike for England, in Chapter Four, at page 35 of the White Paper, the contribution of resources transfer from the health boards to local authorities receives no mention in the Scottish chapter. Yet it remains fundamental to the achievement of this aspect of community care. The National Health Service changes proposed in the Bill may exert greater pressure for the resources released from long-stay hospitals to be retained and diverted elsewhere within the health boards. There is no legal obstacle to having an English equivalent of the dowries in Scotland.
Without resources transfer, the burden of paying for care will have to be shouldered by local authorities and communities. Long stay hospital discharge programmes should not be subsidised out of the care element except on a temporary bridging basis. There is concern that the specific grant for mental health will be top sliced from existing local authority expenditure and will be project led and that unlike England it will be eligible in cases of hospital discharge but without contribution from the National Health Service.
The Minister will realise that it is an extremely important group of amendments about which CoSLA and other bodies in Scotland are very concerned. His reply will be awaited with very great interest. I beg to move.
10.45 p.m.
Lord Sanderson of Bowden: On the first amendment, the Government are firmly committed to giving grants towards local authorities' expenses on developing services for mentally ill people. The White Paper Caring for People, in paragraph 7.15 makes it quite clear that specific grants will be available for this group. There is no question whatsoever of this Government resiling from that commitment, subject to parliamentary approval of the Bill. But that does not mean that these grants will necessarily be a permanent feature. The White Paper makes it clear that the reason why grant aid is proposed for services for mentally ill people but not for other groups is that local authorities generally have not been able to give as much priority to providing services to those with mental illness as to other vulnerable groups.
I am sure that we all hope that, with the help of this grant scheme, local authorities will find it possible to increase the resources that they devote to this important group of people. When that aim is achieved and services for mentally ill people are brought up to a suitable standard, we would, as our consultation paper about the grant has made clear,

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consult local authorities on how the newly created facilities could be funded in the same way as other parts of the social work programme.
That is why I cannot agree this amendment, not because the noble Lord's approach differs from ours in the foreseeable future but because I believe that the amendment would fossilise the system for all time by removing the Secretary of State's discretion.
On Amendment No. 117BB, I do not think I need take too long in talking to somebody who has been a Minister in government about the powers of the Treasury. There are sound and important reasons of financial management why the Treasury must act as a central controller of the Government's purse strings; otherwise the important economic objectives of any government would be jeopardised.
However, the very important amendment, Amendment No. 117BC—I am not at all surprised that the noble Lord emphasised its importance—raises the most interesting question. I hope that he will forgive me if I deal with it at some length.
I can well understand the noble Lord's concern that grants made under Clause 55 should be new money rather than being diverted from existing resources. That is not, however, the kind of matter that is properly dealt with in primary legislation. Nor does the proposed amendment fairly reflect the arrangements for providing support to local authorities. It may be helpful if I explain to the Committee how these operate.
From this financial year a wide range of specific grants come within an umbrella of central government support for local authorities. This is known as aggregate external finance and in addition to specific grants of the kind envisaged by Clause 55 it includes revenue support grant and non-domestic rate income. The Government obviously have to reach a view each year on the size of the aggregate Exchequer finance. That assessment takes due account of any changes in policy and responsibilities. It is then a matter of deciding how much of that total amount is to be available to authorities in the various ways through the mechanism of specific grants and support of particular policies or through the revenue support grant or non-domestic rate income.
In the way the system operates the more that is to be provided through specific grants the less there is available for revenue support grant. But the choice between specific grant or revenue support grant as a mechanism for payment is less important than making sure that the total settlement responds fairly to new policies and responsibilities. I am sure the noble Lord knows what I mean by that.
The Committee should also bear in mind that at present the revenue support grant already takes account of local authority expenditure on services for mentally ill people. A new specific grant will provide a better means of targeting available resources.
Central government support for local authorities is a matter on which my right honourable friend the Secretary of State for Scotland holds regular
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discussions with CoSLA. Members of the Committee can therefore be assured that the local authorities' new responsibilities are being borne in mind and that due account will be taken of them when we decide on the total size of the aggregate external finance settlement. This will include the arrangements for the mental illness specific grant.
I hope that, in the light of that explanation, the noble Lord will understand the difficulties I have, particularly with his last amendment. He said that the Scottish Office could formerly have made grants and that the Treasury is now shackling us. No, the Secretary of State needs specific powers to make grants. The Treasury is simply there as the final arbiter in the totality of the public expenditure round. I am sure that the noble Lord has had experience of that as have I.
As regards the transfer of funds from health boards to local authorities, the Secretary of State can do that within his block if he thinks fit. Nothing in the Bill alters that. As the noble Lord has recognised, Scottish health boards can pay dowries when patients are discharged from hospital. We believe that there is enough flexibility within the system.
The subject of dowries was raised earlier by the noble and learned Lord, Lord McCluskey. There is nothing to prevent them being paid. However, we do not claim that the system is used universally in England and Wales. It is a possible solution to some problems but it is not ruled out in a Scottish context.
Finally, as regards the development of community care specific grant on mental illness, the consultation period has recently concluded. We have received a considerable number of replies and we are satisfied with them. We shall be studying the document closely and hope to present the Government's views on it during the summer. We hope that it will be well in place for implementation by 1st April, 1991.
Lord Carmichael of Kelvingrove: The Minister gave a most helpful reply. I was pleased that he realised that the points I raised are causing considerable anxiety in certain areas in Scotland. I shall take care in reading his reply and obtaining advice. Bearing in mind that his was the nicest and most innocuous description of the Treasury I have heard, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendments Nos. 117BB and 117BC not moved.]
Lord Sanderson of Bowden Lord Sanderson of Bowden moved Amendment No. 117BD:
Page 58, leave out from beginning of line 1 to ("and") in line 2.
The noble Lord said: This is a small technical amendment. As originally introduced in another place, the clause dealing with community care plans—now Clause 49—contains a definition of community care services. It included a reference to part of Section 27 of the National Health Service (Scotland) Act 1947. The provision deals with the aftercare duties of local authorities and health boards in relation to persons who have been discharged from hospital. Most of the rest of the 1947 Act has long since been repealed.
In order to simplify the statutory provisions on social work services generally, the draftsmen of the present Bill decided to provide for the repeal of the residual social work provisions of the 1947 Act and their re-enactment within the Social Work (Scotland) Act 1968 along with the other provisions relating to community care. That is achieved in the second half of Clause 53, which includes the relevant part of Section 27 as a new Section 13 (b) in the 1968 Act. Section 27 having thus been dispensed with in its original form, the reference to it in the definition of community care services is redundant and requires to be removed. I beg to move.
On Question, amendment agreed to.
[Amendment No. 117C not moved]
Clause 55, as amended, agreed to.
Baroness Faithfull Baroness Faithfull moved Amendment No. 118:
After Clause 55, insert the following new clause—
("Specific needs of elderly and disabled persons.
In exercising their functions under sections 40 to 55 of this Act, local authorities shall take special measures to attend to the needs of any person who is suffering from grave chronic disease and who, by reason of age, illness or disability, is living in conditions which in the opinion of a court give rise to an immediate and serious risk to the life and safety of that person.")
The noble Baroness said: All amendments are important but I am sad that this very important amendment is being discussed at 11 o'clock in the evening. I move it on behalf of Age Concern and, in doing so, I pay tribute to the work of Age Concern, which does outstanding work with regard to the care and welfare of the elderly.
There are three points to stress in speaking to this amendment. First, existing legislative provision to protect vulnerable adults is inadequate. The mental health Acts do not cover everyone who can be described as vulnerable. For example, they do not extend to those suffering from early signs of dementia. The only other provision—namely, Section 47 of the National Assistance Act —is highly unsatisfactory.
Secondly, at present the Bill contains no measures which will ensure that local authorities step in in emergency cases when people are at grave risk. Thirdly, the amendment should not place an undue burden on local authorities as it leaves them free to develop their own procedures.
As I said earlier, there is a gap not covered by the mental health Acts or Section 47 of the National Assistance Act. I quote from personal experience. When I was a director of social services I arrived home one evening and opened the evening paper to see an article entitled, "Director of Social Services allows old lady to die". I immediately looked into the matter. I found that the old lady had not been out for weeks, she would not allow anybody into the house and no one had right of entry. Gradually she became weaker and weaker. Health visitors, doctors and social workers were not admitted and ultimately the old lady died.
I quote a second case. A doctor telephoned me about an old man suffering from hypothermia. We sent in a social worker who lit the gas fire, took him
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hot soup and stayed with him for an hour or two. She went away and returned two hours later. The moment she went out of the door, he hopped out of bed, switched off the gas fire and refused to drink the soup. The doctor telephoned again to say that he was suffering from hypothermia. Those are two cases of vulnerable people who are not covered by mental health legislation. However, at the same time they deteriorate and eventually they die. There is no way in which the social services, medical people or health visitors can help.
Therefore, in this amendment we recommend that there should be a general power to promote the welfare of old people. Also, we recommend that there should be a new duty. At present local authorities have no specific duty to investigate complaints, to respond to requests for help, to support elderly people or their carers or to conduct assessments.
An assessment of the needs of a particular person followed by a notification to the individual concerned of the steps to be taken to meet those needs and the obtaining of his or her consent is essential. However, there also needs to be the introduction of the concept of an intervention order if the local authority refuses to consider needs or to act upon the assessment. That would provide a means of appealing against a local authority which has failed to fulfil its duties. There should be emergency powers, including the replacement or repeal of Section 47 of the National Assistance Act.
There was a report entitled The Law and Vulnerable Elderly People and those recommendations were made in that report. I press my noble friend to consider this amendment carefully. It is of vital importance to the people concerned, to the social workers dealing with the case and to the community. It could be said that, if someone will not co-operate and he does not fall under the mental health or national assistance Acts, he has a death wish and we must leave people to live the lives which they wish to lead. However, when it has been possible to enter premises, perhaps with a relative, or possible to support the person concerned, there have been cases where such people have lived afterwards and have been happy and supported.
The amendment concerns a very serious problem.
I beg to move.
11 p.m.
Lord Carter: I am extremely pleased from these Benches to support this important amendment. It is a shame that it had to come on so late at night. I also endorse the words of the noble Baroness, Lady Faithfull, concerning the work done by Age Concern.
I agree with the noble Baroness regarding the operation of Section 47 of the National Assistance Act 1948. My wife, as a magistrate, has been involved in a number of those cases. I was struck by the clumsiness of the procedure and the way that it does not meet all the requirements, particularly the requirements for an emergency procedure when there is an old, vulnerable or disabled person at risk. The Government should either accept this amendment, or bring forward their own amendment to deal with this serious situation.
Baroness Hooper: I recognise that similar powers already exist in Section 47 of the National Assistance Act 1948, and also in the provisions of the Mental Health (Scotland) Act 1984. My noble friend Lady Faithfull considers that the power to remove to another place on the order of a court is not sufficient. However, there are a number of difficulties regarding the proposal before us.
In the first place, the local authority's duty would be to attend to the person's needs, irrespective of whether the person is able or willing to consent to the meeting of those needs. It may well be that the local authority will decide that the needs in question can only be met by removal of the person from the place where he is living. But the local authority's power to remove the person would be dependent on the order of a court on application under the 1948 provisions referred to. The local authority's duty under the amendment (as distinct from its power under the existing 1948 Act provision) could therefore only relate to the provision of services which the person could receive in the place where he or she was already living.
Given that limitation, it is hard to see what purpose the clause would serve, beyond that of the assessment provision already contained in Clause 52 of the Bill. Under that provision the local authority, finding a person living in a situation of the kind described so ably by my noble friend and which gives rise to concern, would be under a duty to assess the needs of the person for any community care services. It would be under a further duty to decide what services it should provide. One consideration in that connection would clearly be the willingness of the person to accept any offer of residential accommodation that might be made available to him.
The only advance which the amendment would provide on the position provided by Clause 52 would be to require the local authority to provide a service on the premises whether or not the person wanted it. However, there seems to be no benefit in giving the local authority a duty to provide such services unless the nature of the particular service can be specified in advance.
If, contrary to the effect of the new clause as drafted, the objective is to provide local authorities with a power to remove individuals from their homes for their protection from risk to life or safety, then I have to say that the clause could not readily be re-drafted to secure that result. Certification of risk to a person's life or health by a medical practitioner under the existing 1948 Act provision continues to provide, in our view, the most appropriate way of enforcing what amounts to eviction of a person from his or her home in order to be treated in the way that the statutory authorities perceive to be necessary in his or her interests. We do not consider that it is necessary or desirable to give local authorities powers of removal at their own hand in order to provide services which they feel the person requires but cannot or will not receive in his or her home.
This is a difficult situation and we must all recognise that. However, I can give a clear assurance that the Government are very much alive to the need to ensure safeguards for the protection of people,
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whether or not of mature years, who are plainly unable to look after themselves, but we see great difficulty in dealing with this by going further than existing legislation or the provisions in the Bill.
My noble friend referred to the suggestion in Age Concern's report on law and vulnerable elderly people. As my noble friend will know, we have given careful consideration to the proposals in the report, but we do not feel that legalistic devices such as the intervention order proposed are the right way to tackle these problems. Social services are needed which are more sensitive to individual needs. That is the thrust of the community care proposals and what we aim to achieve. On that basis, and recognising the importance of this subject, I hope that my noble friend will feel able to withdraw her amendment.
Baroness Faithfull: I thank my noble friend the Minister for her reply. Clearly the social services departments will attempt to give every possible service to the person concerned in his or her own home. The forcible removal of a person would be only a last resort.
However, the practical outcome of my noble friend's reply is that social services ultimately will let someone die. While that has to be faced, it is nevertheless unpalatable. Equally, dealing with such a situation is also unpalatable. Therefore, which of the two unpalatable lines does one take? It is hard for a director of social services to see in a local paper that she has allowed someone to die. I realise that if someone wants to die it is fair to say, I suppose, that he or she should be allowed to do so. However, the fact is that many people are assisted and subsequently live a happy life for several years.
I recognise the difficulty of my noble friend the Minister in making legislation to cover such cases, but I still feel that something could be done. It should be possible to have a right of entry in extreme cases—and only in extreme cases—to remove a person to a place of care. However, at this time of night I should like to consider what has been said by my noble friend, to discuss the matter with Age Concern and come back at Report stage. In the meantime, I withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendment No. 118XA not moved.]
[Amendment No. 118YA had been withdrawn from the Marshalled List.]
Clause 56 agreed to.
Clause 57 [Removal of Crown immunities]:
Lord Henley Lord Henley moved Amendment No. 118YB:
Page 59, line 24, at end isnert—
("(3A) Nothing in subsection (1) above affects the extent of the expression "the services of Crown" where it appears in —

(a) Schedule 1 to the Registered Designs Act 1949 (provisions as to the use of registered designs for the services of the Crown etc.); and

(b) sections 55 to 59 of the Patents Act 1977 (use of patented inventions for services of the Crown);

and, accordingly, services provided in pursuance of any power or duty of the Secretary of State under Part I of the National Health Service Act 1977 or Part I or Part III of the National

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Health Service (Scotland) Act 1978 shall continue to be regarded as included in that expression, whether the services are in fact provided by a health service body, a National Health Service trust or any other person.")
The noble Lord said: In moving this amendment I shall also speak to Amendment No. 118ZAA. The removal of Crown immunity from the NHS has been widely welcomed as a positive move designed to enhance patient care by ensuring that statutory standards are clearly applicable and enforceable across the NHS. It is standards of patient care and staff welfare which are the essential object of this clause. However, Crown immunity is a complex subject, the removal of which has thrown up a number of unintended consequences which might for one reason or another work against the provision of better patient care. The clause has therefore been drafted to cover a number of areas where simple abolition would or could cost the NHS money without bringing any benefits to patients or staff.
One such area is the use of registered designs copyright or patent material. Legislation covering these areas has consistently recognised the value to the general public of maintaining a Crown or public service exemption for use of such material without the permission of the owner of the intellectual property in the material. These provisions are used sparingly. But on occasions the public interest in patient care is best served by invoking them. There was, for example, a recent case relating to lithotripter machines, where, without use of these powers, NHS patients, would have been deprived of the benefit of this equipment pending the outcome of litigation relating to the patents in the equipment.
These provisions do not allow the Crown simply to use others' ideas without payment. When these powers in relation to the use of patents and registered designs are invoked there is provision for compensation of the owner of the intellectual property. In the case of copyright the power is not a wide one and is indeed one of many cases where use can be made of copyright material without infringement.
Any diversion of effort or funds from patient care which does not bring an offsetting benefit in the form of higher standards is to be avoided. The public interest in patient care will remain even when Crown immunity has in general been removed from the NHS. I commend this amendment to the Committee. I beg to move.
On Question, amendment agreed to.
Lord Sanderson of Bowden Lord Sanderson of Bowden moved Amendment No. 118ZA:
Page 59, line 35, after ("Board") insert ("or Special Health Board").
The noble Lord said: In moving this amendment I shall also speak to Amendment No. 118AA. The two amendments insert the new special health boards in the list of health service bodies in Clauses 57 and 58. This means that special health boards will be treated in exactly the same way as ordinary health boards; they will not generally benefit from Crown immunity but they will be exempt from certain taxation. I beg to move.
On Question, amendment agreed to.
Clause 57, as amended, agreed to.
Schedule 8 [Provisions arising out of removal of Crown immunities from health service bodies]:
Lord Henley Lord Henley moved Amendment No. 118ZAA:
Page 89, line 34, at end insert —
("The Copyright, Designs and Patents Act 1988
. At the end of section 48 of the Copyright, Designs and Patents Act 1988 (material communicated to the Crown in the course of public business) there shall be added the following subsection —
"(6) In this section "the Crown" includes a health service body, as defined in section 57 (6) of the National Health Service and Community Care Act 1990, and a National Health Service trust established under Part 1 of that Act or the National Health Service (Scotland) Act 1978; and the reference in subsection (1) above to public business shall be construed accordingly. "").
The noble Lord said: I have already spoken to this amendment. I beg to move.
On Question, amendment agreed to.
Lord Sanderson of Bowden Lord Sanderson of Bowden moved Amendment No. 118ZB:
Page 90, line 2, at end insert—
("The Acquisition of Land (Authorisation Procedure) (Scotland) Act 1947
. In the First Schedule to the Acquisition of Land (Authorisation Procedure) (Scotland) Act 1947 (procedure for authorising compulsory purchases), after paragraph 10 there shall be inserted the following paragraph—
"10A. In paragraphs 9 and 10 of this Schedule "statutory undertakers" include —

(a) a health service body, as defined in section 57 (6) of the National Health Service and Community Care Act 1990; and

(b) a National Health Service trust established under Part I of that Act or the National Health Service (Scotland) Act 1978;

but in relation to a health service body, as so defined, any reference in those paragraphs to land acquired or available for acquisition by the statutory undertakers shall be construed as a reference to land acquired or available for use by the Secretary of State for use or occupation by that body. ".")
The noble Lord said: In moving this amendment I shall speak also to Amendment No. 118A. Schedule 8 to the Bill deals with the removal of Crown immunity from the health service. There is widespread support for this move designed to make it a statutory requirement that the highest standards are maintained within the NHS for the benefit of patients and staff. The removal of Crown immunity has, however, other consequences less beneficial to the NHS. These amendments seek to deal with one such consequence.
Present National Health Service land is Crown property and no-one can compulsorily purchase it. Any acquisition of National Health Service land must be with the consent of the owner, normally the Secretary of State, who will consider carefully the impact of the proposal on the services for patients and the welfare of staff.
However, removing Crown immunity removes this protection. Therefore, the amendment ensures that the land of health service bodies including health authorities, health boards and National Health

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Service trusts gets the same protection against compulsory purchase as the land of statutory undertakers such as British Telecom and British Gas. I beg to move.
On Question, amendment agreed to.
11.15 p.m.
Lord Sanderson of Bowden Lord Sanderson of Bowden moved Amendment No. 118A:
Page 90, line 29, at end insert:
("The Acquisition of Land Act 1981.
—(1) At the end of section 16 of the Acquisition of Land Act 1981 (statutory undertakers' land excluded from compulsory purchase) there shall be added the following subsection —"
(3) In the preceding provisions of this section "statutory undertakers" include —

(a) a health service body, as defined in section 57 (6) of the National Health Service and Community Care Act 1990; and

(b) a National Health Service trust established under Part 1 of that Act or the National Health Service (Scotland) Act 1978

but in relation to a health service body, as so defined, any reference in those provisions to land acquired or available for acquisition by the statutory undertakers shall be construed as a reference to land acquired or available for acquisition by the Secretary of State for use or occupation by that body".
(2) In section 17 of that Act (local authority and statutory undertakers' land) at the end of subsection (2) there shall be inserted the following subsection—
" (2A) Subsection (3) of section 16 above applies in relation to subsections (1) and (2) above as it applies in relation to the preceding provisions of that section. "").
On Question, amendment agreed to.
Schedule 8, as amended, agreed to.
Clause 58 [Health service bodies: taxation):
Lord Sanderson of Bowden Lord Sanderson of Bowden moved Amendment No. 118AA:
Page 60, line 18, after ("Board") insert ("or Special Health Board").
The noble Lord said: This amendment has already been spoken to. I beg to move.
On Question, amendment agreed to.
Clause 58, as amended, agreed to.
Clauses 59 and 60 agreed to.
Clause 61 [Regulations, orders and directions:
Lord Carter Lord Carter moved Amendment No. 118AB:
Page 61, line 35, after ("and") insert ("subject to subsection (A2) below").
The noble Lord said: In moving this amendment I should like, with leave of the Committee, to speak also to Amendment No. 118BA. These amendments deal with a specific concern relating to the very wide enabling powers in the Bill. As the Bill stands, it would confer these wide powers on the Secretary of State once the legislation is enacted. In debates on previous amendments we have discussed the various aspects of these powers.
As we know, it would be possible for the Secretary of State to bring in new orders and regulations which would be subject only to the negative resolution procedure. Thus they could escape the full scrutiny of Parliament. Therefore, we feel strongly that Clause 61 of the Bill should be amended to ensure
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that wherever appropriate, especially where patient care may be affected, new regulations should be subject to the affirmative resolution procedure.
We have had this discussion on many occasions regarding previous enactments. I hope that when the Minister replies there will be something better than the usual government arguments, which, however well phrased, always amount to an attempt to convince the Committee that a diktat by any other name smells as sweet. I beg to move.
Baroness Hooper: The clauses on fund-holding practices and indicative prescribing budgets to which these amendments relate lay down the principles of these two new schemes and put in place a clear-cut framework for their implementation. It is only right that this should be so. Parliament must have an opportunity to debate and approve the principles, and the people who will have to carry through these proposals want to see the framework properly spelt out.
The noble Lord, Lord Carter, pointed out that the clauses already contain a number of regulation-making powers. They provide the flexibility which is needed for the schemes to develop in an evolutionary way—by responding to new circumstances and learning from experience. It is also consistent with the legislative basis of the National Health Service since its inception; for example, on the GP services where regulations spell out all the detailed arrangements. Over the years this has been accepted as the right approach. It has prevented primary legislation in this area from growing into a labyrinth which is especially inappropriate for a national service for which a Secretary of State is fully accountable to Parliament.
I believe that Parliament should concentrate on the principles, clearly define the scope of any delegation and hold Ministers to account for the exercise of their powers. I am sure that it will continue to do so. It should keep its eye on the ball and not become bogged down in a morass of legislative detail.
It is for similar reasons that I cannot agree to the noble Lord's proposition that we should use the affirmative resolution procedure for these regulations.
Essentially the regulations concern the implementation and administration of the schemes founded on the primary legislation. It is hardly sensible to delegate those detailed matters to Ministers on the one hand and on the other to pull them back into the parliamentary arena by requiring debates and resolutions, not just at the outset but on each and every occasion on which adjustments are made. The principles will already have been subject to the full debate and approval of Parliament. I doubt whether a repeat performance each and every time that regulations are made would necessarily be of great benefit to anyone.
Of course I recognise that Members of this place will take a keen interest in the development of fund-holding and prescribing budgets and may on occasion want to challenge what is proposed. That would not be out of character. There is already

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provision for that to be done in a way which is more clearly focused than the way suggested by the amendments. Each statutory instrument will be laid before both Houses of Parliament and be subject to the negative procedure. I suspect that noble Lords opposite will not hesitate to press for a debate if they want to question any of our regulations and consider the matter of sufficient importance to occupy the attention of this place.
In addition, the Committee will be aware that the procedures of this place provide a number of other ways in which the Government can be held to account The joint committee will, as ever, take care to ensure that we have made proper use of the powers that Parliament has given us. I hope that the noble Lord understands our views and will feel able to withdraw his amendment.
Lord Peston: I should perhaps preface my question by saying that I am not against indicative drug budgets because they seem to be a broadly sensible way of approaching the problem of prescribing. Is the Minister saying that in the Government's view we have debated the matter sufficiently and that no case can be made for having the affirmative procedure? As I understand it—I remain a tyro in these matters—whether it is the affirmative or negative procedure does not affect what happens in this place, but it may affect what happens in the other place. Is the Minister saying that we have explored these drug budgets in so much detail, and that the remaining details are so uncontroversial that the affirmative procedure would not be relevant to the other place? I am sure that my noble friend Lord Carter has the same view: I am not seeking to undermine or wreck the Bill with this proposal, but there are certain matters about which people who are affected—the pharmaceutical companies are a good example—are to say the least a trifle doubtful. Does the Minister intend to be as definite in her answer as she sounded?
I well understand what the Minister is saying. Will she indicate the possibility at least of some flexibility? I am not intervening because I am against some of the things that the Government want to do. On a subsequent occasion there might be more to be said and so the affirmative procedure might be appropriate. I merely ask the question.
Baroness Hooper: The principles of the matters will have been subject to full debate by the time the Bill, eventually as we hope, receives Royal Assent. I am informed that there has been ample opportunity to debate these procedures, because over 1,000 amendments have so far been debated in both places. My point is that the negative procedure permits a debate in both places. However, to require this in each and every case as the amendment suggests would be a little too much.
Lord Carter: When I moved the amendment, I said that I expected the Minister to produce the usual arguments. She did not disappoint me.
Baroness Hooper: If the noble Lord will give way, I have to say that if the same amendments are tabled, then he is bound to receive the same answers.
Lord Carter: Exactly. At this stage of proceedings we shall reserve the right to come back because it is an important matter. However, for the time being I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendments Nos. 118B and 118BA not moved.]
Clauses 61 and 62 agreed to.
Schedule 9 [Minor and Consequential Amendments]:
Baroness Blatch Baroness Blatch moved Amendment No. 118BB:
Page 99, line 3, after ("committee)") insert ("(a)").
The noble Baroness said: In approving Amendment No. 115FC and agreeing that Clause 47 as amended by the Committee should stand part of the Bill, your Lordships added to the additions to the Local Authority Social Services Act 1970 set out in that clause a new section requiring local authorities if so ordered by the Secretary of State to establish a complaints procedure. The effect of these amendments, Nos. 118BB, 118BC and 118BD, is to add that procedure to Schedule 1 to the 1970 Act. Not only will this make it a function of the local authority's social services committee, it will also mean that in exercising its functions the authority will have to have regard to any general guidance issued by the Secretary of State under Section 7 to the 1970 Act. When Clause 47 becomes law, the local authority will have to observe any directions given by the Secretary of State under Section 7A of the same Act, and the Secretary of State's powers to hold enquiries (Section 7B) and to take special action in cases of default (Section 7C) will also apply to it. I so move.
On Question, amendment agreed to.
Baroness Blatch Baroness Blatch moved Amendments Nos. 118BC and 118BD en bloc:
Page 99, line 5, after ("trusts"") insert:
("(b) in the first column, for the words "Section 6 of this Act" there shall be substituted "Sections 6 and 7AA of this Act"").
Page 99, line 5, after ("and") insert ("(c)").
On Question, amendments agreed to.
Lord Sanderson of Bowden Lord Sanderson of Bowden moved Amendment No. 118C:
Page 99, line 28, at end insert:
("The Criminal Procedure (Scotland) Act 1975
13A. In section 462 (interpretation) of the Criminal Procedure (Scotland) Act 1975, in paragraph (a) of the definition of "hospital", after the words "Secretary of State" there shall be inserted the words "or in a National Health Service trust".").
The noble Lord said: I beg to move Amendment No. 118C and speak to Amendment No. 118E. These two amendments make minor changes to existing legislation consequential on the setting up of National Health Service trusts. I beg to move.
On Question, amendment agreed to.
Baroness Blatch Baroness Blatch moved Amendment No. 118CA:
Page 100, line 39, at end insert:
("(8A) At the end of section 103 of that Act (special arrangement as to payment of remuneration) there shall be inserted the following subsection —
"(3) If the Secretary of State by order so provides with respect to remuneration in respect of such pharmaceutical services as may be specified in the order, —

(a) an NHS trust determined in accordance with the order shall have the function of paying sums so determined to the Family Health Services Authority which, under Part II of this Act, has the function of paying that remuneration; and

(b) nothing in subsection (2) above shall apply with respect to that remuneration. "").

The noble Baroness said: It is not uncommon for a hospital doctor to issue a prescription to a patient when he or she leaves hospital and for that prescription to be dispensed by the patient's local pharmacist rather than by the hospital pharmacy. In such cases, at present, the pharmacist recovers the cost of dispensing the prescription from the Family Practitioner Committee and the health authority reimburses the Family Practitioner Committee for the cost. Health authorities have been given the function of meeting these costs by an order made under Section 103 of the 1977 Act.
In future it is likely that doctors working in NHS trusts will similarly issue prescriptions which are dispensed by a local pharmacist and this amendment will allow the Secretary of State to make an order giving relevant trusts the function of reimbursing the FHSA, as it will then be, for the costs of dispensing such prescriptions. The trust itself will recover the costs incurred from health authorities through National Health Service contracts. With that explanation I commend these amendments to the Committee. I beg to move.
On Question, amendment agreed to.
Lord Henley Lord Henley moved Amendment No. 118CB:
Page 100, line 45, at end insert:
("() In section 122 of that Act (recovery of charges), in subsection (1) after the words "this Act", in the second place where they occur, there shall be inserted "or Part I of the National Health Service and Community Care Act 1990".").
The noble Lord said: This technical amendment will ensure that National Health Service trusts, like health authorities, will be able to recover any sums they are owed in respect of such charges summarily as a civil debt. I commend the amendment to the Committee and beg to move.
On Question, amendment agreed to.
Lord Sanderson of Bowden Lord Sanderson of Bowden moved Amendment No. 118D:
Page 101, line 24, at end insert —
("(1A) In subsection (5) of section 11 (Scottish Hospital Trust) of that Act, after the words "and shall cause" there shall be inserted the words "such accounts to be audited and".").
The noble Lord said: This amendment has already been spoken to. I beg to move.
On Question, amendment agreed to.
Lord Sanderson of Bowden Lord Sanderson of Bowden moved Amendment No. 118DZA:
Page 103, line 49, at end insert:
("(19A) In section 110 of that Act (citation, extent and commencement)—

(a) in subsection (2), for the words "subsection (3) " there shall be substituted "subsections (2A) and (3)"; and

(b) after subsection (2) there shall be inserted—

("(2A) Section 87B (3) extends also to England and Wales. ".").
The noble Lord said: I am indebted to my noble friend Lord Balfour for drawing this matter to our attention. The amendment amends the extent section of the National Health Service (Scotland) Act 1978 to allow new Section 87B (3) which is inserted into the 1978 Act by Clause 33 of the Bill to extend to England and Wales. The 1978 Act generally extends only to Scotland. I beg to move.
On Question, amendment agreed to.
[Amendment No. 118DA had been withdrawn from the Marshalled List.]
Baroness Hooper Baroness Hooper moved Amendment No. 118DAA:
Page 105, line 20, after ("(4)") insert ("after the word "exercised" there shall be inserted "subject to subsection (5) below" and").
The noble Baroness said: In moving this amendment I wish to speak also to Amendment No. 118DAB. These amendments simply preserve the existing provision for appeals to the hospital managers by patients detained under the Mental Health Act 1983 to be considered by people who have not been involved in their care and treatment.
The Act provides for these appeals to be heard by members. With the advent of executive members and directors we need to make it clear that employees should not be involved whether or not they have been directly involved in the case. This is an important safeguard which I hope will commend itself to the Committee. I beg to move.
On Question, amendment agreed to.
Baroness Hooper Baroness Hooper moved Amendment No. 118DAB:
Page 105, line 21, at end insert ("and
(c) after subsection (4) there shall be inserted the following subsection —
"(5) The reference in subsection (4) above to the members of an authority, trust or body or the members of a committee or sub-committee of an authority, trust or body, —

(a) in the case of a District or Special health authority or a committee or sub-committee of such an authority, is a reference only to the chairman of the authority and such members (of the authority, committee or sub-committee, as the case may be) as are not also officers of the authority, within the meaning of the National Health Service Act 1977; and

(b) in the case of a National Health Service trust or a committee or sub-committee of such a trust, is a reference only to the chairman of the trust and such directors or (in the case of a committee or sub-committee) members as are not also employees of the trust."").

On Question, amendment agreed to.
Lord Sanderson of Bowden Lord Sanderson of Bowden moved Amendment No. 118DB:
Page 105, line 29, at end insert:
("(5A) In section 117 of that Act (after-care) in subsection (3) for the words "the District Health Authority for the district" there shall be substituted "such District Health Authority as may te determined in accordance with regulations made by the Secretary of State".").
The noble Lord said: This amendment has already been spoken to. I beg to move.
On Question, amendment agreed to.
Lord Sanderson of Bowden Lord Sanderson of Bowden moved Amendment No. 118E:
Page 07, line 14, leave out ("managers of that hospital") and insert ("directors of the trust").
The noble Lord said: This amendment has already been spoken to. I beg to move.
On Question, amendment agreed to.
Schedule 9, as amended, agreed to.
Schedule 10 [Enactments Repealed]:
Baroness Blatch Baroness Blatch moved Amendment No. 118EZA:
Page 13, line 8, column 3, at end insert:
("In section 111(1)(a) the words "or paragraph (c)".")
The noble Baroness said: In moving this amencment I wish to speak also to Amendment No. 1 8EZB. These amendments repeal two small subsections of the Employment Protection (Consolidation) Act. They are consequential on the repeal of Section 99 of that Act in Schedule 10 of the Bill. The repeal of Section 99 is in turn consequential on the provisions in Clause 54 which remove outstanding Crown immunities from the National Health Service. I am sure the Committee will support these minor measures to tidy up the statute book. I beg to move.
On Question, amendment agreed to.
Baroness Blatch Baroness Blatch moved Amendment No. 118EZB:
Page 113, line 9, column 3, at end insert:
("Section 149(1)(d).").
On Question, amendment agreed to.
Lord Sanderson of Bowden Lord Sanderson of Bowden moved Amendment No. 118EA:
Page 113, line 16, column 3, at beginning insert:
("Section 124.").
The noble Lord said: This amendment has already been spoken to. I beg to move.
On Question, amendment agreed to.
Schedule 10, as amended, agreed to.
Clause 63 [Short title, commencement and extent];
[Amendment No. 119 not moved.]
[Amendment No. 120 had been withdrawn from the Marshalled List.]
[Amendment No. 121 not moved.]
[Amendments Nos. 121A and 121B had been withdrawn from the Marshalled List.]
Clause 63 agreed to.
House resumed: Bill reported with amendments.
House adjourned at twenty-five minutes before midnight.