National Health Service and Community Care Bill

HL Deb 14 May 1990 vol 519 cc11-76

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 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 —

1. (a) users of community care services resident in the area of the authority;
2. (b) carers of such users;
3. (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 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". 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.

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 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—

1. (a) the setting of service standards for community care;
2. (b) the provision of advice and assistance to any local inspectors employed by local authorities and to agencies providing community care; and
3. (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, 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 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 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 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 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 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 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 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.

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: 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; 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 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.

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 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 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 —

1. (a) a voluntary organisation or other person desiring to provide care in the community, not covered by existing registration; or
33
2. (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 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 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 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.

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.

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 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 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 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—

1. (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 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 —

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

1. (a) the terms on which a person is to be employed by a local authority or National Health Service body;
2. (b) the period and continuity of a person's employment for the purposes of the Employment Protection (Consolidation) Act 1978;
3. (c) superannuation benefits; and
4. (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 —

1. (a) "local authority" and "community care services" have the same meaning as in section 44 above; and
2. (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 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 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 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 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.

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 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—

1. (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
2. (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 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 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 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 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".

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 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 (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 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 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 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 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 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 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 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—

1. (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;
2. (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;
3. (c) expenditure under the scheme to be of a capital or a revenue nature; and
4. (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 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 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 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 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 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 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 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 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 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.

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.