National Health Service and Community Care Bill

HL Deb 14 May 1990 vol 519 cc92-146

8. 26 p.m.

House again in Committee.

Clause 50 [Inspection of premises providing accomodation]:

[Amendments Nos. U5EF to 115F not moved].

Clause 50 agreed to.

Clause 47 [Powers of the Secretary of State as respects social services functions of local authorities]:

Lord Allen of Abbeydale moved Amendment No. 115FB: Page 52, line 29, leave out ("social services") and insert ("community care").

The noble Lord said: In speaking to Amendment No. 11 5FB we can resume our deliberations by discussing an amendment which is entirely non-controversial, harmless and merely expresses a desire for enlightenment. Section 7 of the Local Authority Social Services Act 1970, which is referred to in the opening words of Clause 47, provides that local authorities shall, in the exercise of their social services functions including the exercise of any discretion conferred by any relevant enactment, act under the general guidance of the Secretary of State.

Clause 47 proposes that that section should be followed by a new section which will require every local authority to exercise its social services functions in accordance with the Secretary of State's directions and that those directions must be in writing.

There are two questions. First, since it is deemed necessary to have a specific requirement that those directions should be given in writing, one is left to draw the conclusion that the guidance in the existing Section 7 need not be in writing since there is no such requirement there. That point is perhaps of mild academic interest in view of the emphasis on guidance in our previous discussions.

Rather more important is the second point that the Bill is not very rich in its reference to social services functions. I believe that I am right in saying that that phrase makes its first appearance in this clause other than in the Long Title. The clause forms part of Part III of the Bill, which is headed "Community Care". The side notes to the three previous clauses all refer to "community care services'' and the explanatory note at the beginning includes the clause under the general heading, "provisions concerning community care services". However, when we reach Clause 47 the phraseology changes and in the first paragraph we find a reference to "social services functions". That form continues in later clauses, subsections and in proposed additions on the Marshalled List.

I ask whether "social services functions" are different from and wider than "community care functiors"? If they are the same, why has the phraseo ogy suddenly changed? If they are different, and if that phrase goes wider than all the other provisions in Part III, is it right that they should find a place in a Bill dealing with community care? I do not know the answers to those questions, but there must be some significance in that change of phraseology. Perhaps the Minister could tell us what it is. I beg to move.

Lord Carter

We on these Benches are very pleased to support the amendment. I am not entirely sure that I agree with the noble Lord regarding the harmless nature of the amendment. Perhaps I may give some friendly advice to the Minister. I suggest that she should beware former permanent secretaries who appear to be bearing gifts.

The noble Lord, Lord Allen of Abbeydale, very ably expressed one aspect of the amendment. I should like to spend a few moments dealing with another aspect. The amendment will help us to discover the Government's thinking. Clause 47 appears to give the Secretary of State more powers over a wide range of social services than hitherto have been envisaged. I should like to use the amendment to discover how the Secretary of State for Health intends to use those major powers.

In the notes on clauses the Government very clearly state: This clause enables the Secretary of State to issue directions to local authorities covering all" — I emphasise "all" — their social services functions". It is no exaggeration therefore to say that if that happens it will represent a major development in the relationship between the Secretary of State, his successors, the local authorities and those involved with community care in a wider sense.

It would be helpful if the Minister could give us the precise directions which she has in mind. Will she respond to the view that the clause appears to be far too wide in its implications and gives far too many powers to the Secretary of State? That is an opinion widely held by many voluntary and professional organisations and the local authority associations. They all hope that what one might discern as the grey areas of community care—where the demarcation lines are not clear between the local authorities and the Secretary of State —will be clarified by the Minister's answer.

It will be helpful to know whether the use of any of those powers are subject to parliamentary approval. I hope that the Minister will be able to satisfy the Comittee when she replies.

Lord Henderson of Brompton

Perhaps I might add a brief word appendant to the coruscating speech of the noble Lord, Lord Allen of Abbeydale. When I read the amendment and I was puzzling what it was about, it occurred to me that in sum it could be said that Lord Allen of Abbeydale pointed out that the amendment goes beyond the scope of the Bill. All I ask is whether the noble Baroness will advise me which part of the Long Title covers the clause.

In the Long Title of the Bill, there are many examples of Acts which are amended and brought within the scope of the Bill in that way; for example, the Local Government Finance Act 1982, the National Health Service Act 1977 and so on. However, there is no mention of the Act which is amended by the clause. Therefore, in a spirit of helpfulness I ask whether the Minister would agree to amend the Long Title, if she wishes the clause to remain in the Bill, otherwise it will have to be said to be outside the scope.

Baroness Hooper

It may help the Committee if I begin by explaining the reasons for seeking the general power of direction set out in the first part of this clause. In setting up the new community care arrangements we have put local authorities at the centre of the stage and given them a role as enablers of care provision. It is right —I am sure that everyone will agree—that these services should be provided by a body answerable to local people and with a fair degree of freedom and autonomy to arrange the services and to discharge its duties as it thinks fit. We have provided important controls at the local level in the community care planning and case management and assessment systems that we are setting up. But in delegating responsibility to local authorities in this way it is important that there is sufficient reserve power at the centre to ensure that all local authorities discharge their duties properly having due regard to the care needs of people in their localities. It is to ensure this that we have taken the measures in this clause to strengthen the provisions relating to the centre administration of social services in the local authority Social Services Act 1970. At present the Act only requires local authorities to discharge their functions having regard to general guidance given by the Secretary of State. As regards that point the noble Lord, Lord Allen of Abbeydale, asked whether it should be in writing.

Lord Allen of Abbeydale

The point was simply that as there was no provision about it being in writing, presumably it need not be in writing. We need a provision in the Bill as we have it, to deal with the specific directions.

Baroness Hooper

As there is no specific requirement that must be so, but it is hard to envisage how in practice it could be otherwise than in writing. The new provision goes further and enables the Secretary of State to issue directions. We see two main uses for these: first, they can be used to reinforce our guidance to ensure that important elements in it are taken into account by all local authorities; and secondly, it can be used where a local authority is failing to deliver an efficient service as a prelude to action under the new default powers which are also set out in this clause.

As the Committee is aware, we have recently undertaken a revision of the statutory provision for services for children which are now embodied in the Children Act 1989, and work is going ahead to bring that into effect towards the end of next year. We feel it is important that the general powers of direction cover not only community care legislation, but also this social services legislation and that for mentally disordered people. We have therefore put into the Bill this general provision. I think it would cause difficulties both locally and centrally if the Secretary of State was able to issue directions covering community care services but not other forms of social service. A general power would be helpful in reinforcing the Secretary of State's position across the whole field and we think it desirable to seek this at this time. I would therefore ask the noble Lord to withdraw the amendment.

The reference to "social services" therefore as opposed to "community care" simply uses the terminology of the 1970 Act and refers to "social services functions". Enactments conferring social services functions on local authorities social services committees are listed in Schedule 1 to the 1970 Act. They include Acts other than those referred to in the definition of community care services in Clause 44.

In regard to the use of direction-making powers, we have so far said that powers of direction will be used to reinforce community care guidance. We have no plans at this stage to use them in other ways. Before issuing general directions I have no doubt that the Secretary of State will consult local authority associations and other bodies in the customary way, as for guidance.

I am slightly confused by the suggestion of the noble Lord, Lord Henderson of Brompton, that the Long Title does not contain a reference to the social services functions of authorities since the penultimate line of the Long Title makes just that reference.

I hope that those comments will have assisted the Committee on the interpretation of this clause.

Lord Allen of Abbeydale

I am obliged to the Minister for her reply. The debate has turned out to be rather more interesting than I expected. I listened with care to the noble Lord, Lord Carter, who described possible motives to me which certainly were not in my mind. I took it as axiomatic that this Government, in accordance with their normal practice, would be taking greater powers for central government. That is their well-known philosophy and practice, whatever they may say in theory.

The noble Baroness said that it was hard to envisage how general guidance can be given other than in writing. That makes me wonder how directions to local authorities could be given other than in writing. I am still a little puzzled by that part of the provisions in this Bill.

The noble Baroness made it clear that social services are wider than community care. I therefore find the Explanatory Memorandum and the heading to this part of the Bill misleading. The point that the noble Lord, Lord Henderson, had in mind is that, although the Long Title lists a number of Acts which are being amended, it does not list the Local Authority Social Services Act. There are general words about social services functions, but the noble Baroness may wish to consult her experts before the next stage of the Bill. In the meantime, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Baroness Hooper moved Amendment No. 115FC: Page 52, line 36, at end insert:

("Complaints procedure.

7AA. — (1) The Secretary of State may by order require local authorities to establish a procedure for considering any representations (including any complaints) which are made to them with respect to the discharge of their social services functions made by or on behalf of—

1. (a) any person for whom, in the exercise of those functions, the local authority provides a service, either directly or by making arrangements with another person;
2. (b) any person whose request for such a service has been refused by the authority; or
3. (c) any person who, as a private carer, is providing a substantial amount of care on a regular basis to a disabled person who is living at home and for whom, in the exercise 97 of their social services functions, the local authority have a power or duty to provide a service.

(2) In subsection (1)(c) above —

1. (a) a 'private carer" means a person who is not employed to provide the care in question by any body in the exercise of its functions under any enactment; and
2. (b) "disabled person" means a person to whom section 29 of the National Assistance Act 1948 applies.

(3) A local authority shall comply with any directions given by the Secretary of State as to the procedure to be adopted in considering representations made as mentioned in subsection (1) above and as to the taking of such action as may be necessary in consequence of such representations.

(4) Local authorities shall give such publicity to any procedure established pursuant to this section as they consider appropriate.").

The roble Baroness said: This amendment was spoken to with Amendment No. 113BDA. I beg to move.

On Question, amendment agreed to.

8.45 p.m.

Lord Henderson of Brompton moved Amendment No. 115FD: Page 52, line 38, after ("held") insert:

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

The noble Lord said: Clause 47, as we have just heard, amends the Local Authorities Social Services Act 1970 by the insertion of new sections in that Act. I appreciate that the noble Baroness has just moved a new section into that Act by way of a consequential amendment which enables the Secretary of State to institute a complaints procedure for all local authorities. I must say that that is most welcome and I do not wish that my amendment should in any way detract from the welcome that we give to that addition.

However, the new complaints procedure does not enable, so far as I can see, organisations of or for disabled people to make representations, including complaints, to local authorities. I regard that as a pity. My amendment seeks to bring into the complaints procedure, so to speak, those organisations of or for disabled people by a different route. It is by a different route because the new section just introduced by the noble Baroness is concerned only with persons. The new procedure depends on the initiative of persons. It does not depend on the initiative of any relevant organisation.

I do not wish to disturb the new section which has been introduced by the noble Baroness because it might be considered anomalous to introduce relevant organisations where the initiators are persons. Therefore, as I said, my amendment brings in these organisations by a different route. There are occasions when organisations as opposed to persons should be allowed to make representations or air their grievances and I should have thought that these organisations of or for disabled people are exactly those who should be given the machinery to do so.

The amendment is therefore designed to give such organisations that opportunity so that the Secretary of State may cause an inquiry to be held where he considers it desirable to do so on representation from those organisations. The amendment is as simple as that and I commend it to the Committee. I beg to move.

Lord Mottistone

I support this amendment. With schizophrenics in particular, relatives may have ceased taking responsibility for their care. Sadly that is sometimes because they are almost forced to do so. A voluntary organisation is likely to take an interest in the general services provided for people with that illness when perhaps no one else does. It is important—given, sadly, the poor quality of many local authority services for the mentally ill—to get services looked at when they are deficient. The noble Lord, Lord Henderson, has filled a gap which even Amendment No. 115FC does not fill.

Baroness Darcy (de Knayth)

I briefly support this amendment. A project undertaken by RADAR in 1980–81 showed the importance of this right for organisations. Eleven local authorities were referred to the Secretary of State by RADAR due to their failure to meet assessed needs of community care services. In the majority of cases the service was provided to the disabled person concerned as a result of that intervention. Therefore, I believe that this is a very valuable proposal.

Lord Ennals

I should like to add a few words of support because this is an important matter. I have in mind all those organisations that represent the interests of, and often include among their memberships, those people who are disabled in one way or another. I too very much welcome the amendment moved by the Government but if it were left to individuals to make their complaints it would be very difficult for them. I refer to the mentally handicapped. Obviously MENCAP has a role in that respect. I also think of the deaf and blind where Sense and other organisations have a role. The Royal National Institute for the Blind and the Royal National Institute for the Deaf, together with a whole group of other organisations, exist not only to improve services for such people but also to represent their interests. Unless they are entitled to present complaints on behalf of the handicapped many complaints would go unheard.

Baroness Blatch

This amendment would require the Secretary of State to set up an inquiry if asked to do so by any disabled organisation which alleged that a local authority had failed to provide community care. We believe this to be wholly unrealistic and the amendment is cast in far too wide and general terms. The Secretary of State would have to respond to any request by setting up a full inquiry in accordance with this provision.

We do not feel that it would be helpful to give organisations representing disabled people such a wide ranging power. Experience in the past suggests that there is very little need to hold formal inquiries. There are two reasons for that: first, social service functions, including community care functions, are the responsibility of local authorities. The majority of investigations of failures are usually most appropriately carried out at that level.

We have no reason to suppose that a local authority is not capable of investigating failures among its own staff perfectly adequately as part of its normal management function. The proposals that we have made for inspection units will put the local authority in a much better position to exercise that function. Secondly, the reason why central inquiries are seldom necessary is that we have the social services inspectorate, which is able to carry out detailed investigations without the need to hold formal inquiries. That is often a more satisfactory way of dealing with a situation where there has been a failure of care.

There is no reason why the report on such an investigation should not be published in due course. The noble Lord, Lord Henderson of Brompton, was also concerned about individuals. Organisations or individual carers can bring a complaint or make representations on behalf of service users. I believe that the noble Lord, Lord Ennals, also made that point.

I do not underestimate the very important role that organisations for or of disabled people can play in drawing the Secretary of State's attention to cases where local authorities are failing to discharge their duties. Indeed, we would want them to do so. I have no doubt that if the allegations were serious enough my right honourable friend the Secretary of State would hold an inquiry. However, I do not feel that it would be helpful to put on the face of the Bill a provision on the lines of that suggested in this amendment. Therefore, I hope that the noble Lord, Lord Henderson, will feel able to withdraw it.

Baroness Darcy (de Knayth)

Before the noble Lord decides what to do, as the Minister said that the amendment was too wide, at the next stage can we have a meeting when we might be able to devise an amendment which is not quite so wide? As all noble Lords who have spoken have said, there are special problems which some people have in representing themselves and they need the help of other organisations. It may be that their families need the support of organisations to speak on their behalf.

Baroness Blatch

Certainly, I am not against offering the possibility of talks between now and Report stage. The particular concern is that any grievances can be heard by an individual carer or an organisation. The question is whether we put on the face of the Bill a power which any organisation can simply request; namely, a full inquiry.

Lord Henderson of Brompton

Before the noble Baroness sits down, will she kindly tell the Committee what is the power under which organisations may make their representations? She has said more than once that organisations can make representations. I am wondering under what power in the Bill that can be done. We are seeking to insert that provision in the Bill because we do not find it there. Can the noble Baroness tell me where that provision is to be found?

Baroness Blatch

At this moment I cannot give the specific power. However, there is a right for people to complain. I need to come back to give details of the specific part of the Bill which gives an individual the right to bring a complaint against an authority.

Lord Ennals

Does that mean that if the Minister finds that provision is not in the Bill she will return with an amendment? It is important that organisations should know what their rights are. It is a piece of legislation in which their rights are defined. It is not enough to say that it is the custom or that it should be done. I know that this procedure has not always been followed. On a number of occasions I have put forward on behalf of MIND proposals for an inquiry but no inquiry has followed. Anyone has a right to ask for an inquiry, but that does not mean anything. Anyone may write to anyone: a cat may look at a queen, or whatever it is.

Lord Renton

There is a point that should not be overlooked. Generally mentally handicapped people cannot express themselves at all. In the nature of things they cannot make complaints. They may no longer have a parent or a guardian who can speak for them. Therefore, in the case of a mentally handicapped person it might be important that, if for no other kind of disabled person, MENCAP or a similar body is allowed the opportunity—

Lord Mottistone

That is what I said.

Lord Renton

Thank you: I am much obliged. I will not say why I am repeating the point. I think this matter can be important if further consideration is to be given to this amendment.

Baroness Blatch

I am grateful for the few moments of respite in order, I hope, to meet the very real concerns of all Members of the Committee who have spoken. I understand that the power for complaints will be a new clause contained within Amendment No. 115FC. I am also advised that organisations or carers can bring complaints or make representations on behalf of other service users. I know that my noble friend Lord Renton will be keen to make sure that that is legally correct. I am advised, legally speaking, that the term "person" includes a body of persons corporate or incorporate, so that organisations can make representations on behalf of a client. I hope that, with that assurance, the noble Lord will feel able to withdraw his amendment.

Baroness Darcy (de Knayth)

Before the noble Lord decides what course to take with this amendment I ask the Minister to consider one other matter. I am not sure that this proposal does not slightly weaken the provision to repeal Section 36 of the National Assistance Act 1948. Section 36 (1) of that Act reads: Where the Minister is of opinion, whether on representations made to him or otherwise, that a local authority have failed to discharge any of their functions". Clause 47, new section 7B (1) reads: The Secretary of State may cause an inquiry to be held in any case where he considers it advisable to do so". It takes away the duty to act on representations made to the Secretary of State; he just has a discretion to act. Has the Minister anything to say on that matter?

Baroness Blatch

My understanding is that Amendment No. 115FC will put a very proper formal complaints procedure into this Bill. Does my noble fiend feel able to absorb the impact of that amendment before deciding whether to press this one?

Lord Henderson of Brompton

I shall be very grateful if the noble Baroness can absorb the impact of the discussion that we have had and the import of it outlined from all sides of the Committee. It is clearly important that organisations should be able to make representations particularly on behalf of those who cannot speak for themselves. I am delighted to know that the intent of Amendment No. 115FC is that not only persons but also organisations shall be able to make representations. That does not appear so on the face of the Bill. Some of us know that the word "person" has a peculiar meaning in the language of the law.

When one looks at the amendment as drafted, it looks as if "person" means what you and I consider to be a person; namely, an individual. It is very hard indeed to deduce from the wording of Amendment No. 115FC that "person" has this distinctive legal meaning as well. Will the noble Baroness consider the amendment which has just been moved into the Bill and see whether it can be amended to make it quite clear that it includes organisations as well as persons? I shall be very happy if that happens and, looking around the Committee, it appears that all those who have spoken would also be happy if that were done.

I shall be very happy to withdraw this amendment which was certainly not meant to impose an obligation on the Secretary of State which he could not avoid.

Lord Ennals

Before the noble Lord withdraws his amendment, I wish to point out that in looking at the wording of the new Amendment No. 115FC, which I welcomed, none of those described as "person" in paragraphs (a), (b) and (c), would be other than individuals. Subparagraph (a) states: any person for whom, in the exercise of those functions, … (b) any person whose request for such a service has been refused… and (c) any person who, as a private carer, is providing a substantial amount of care". Those are references to individual persons. If the new amendment is to include organisations, which is what we all wish, the amendment needs to say so.

9 p.m.

Baroness Blatch

Perhaps I may point out to the noble Lord, Lord Ennals, that Section 7AA (1) ends with the words, made by or on behalf of. It then makes reference to the people he mentioned.

Lord Henderson of Brompton

I think that this matter is worth looking at again. It was not our intention to impose an unconditional obligation upon the Secretary of State. The provision was meant to apply only in a situation where he considered it advisable to set up an inquiry. Perhaps the noble Baroness will be kind enough to undertake to see that the wording is reviewed to ensure that it reflects the opinion of the Chamber.

Baroness Blatch

In the light of what has been said this evening, we shall certainly look again at the wording.

Lord Henderson of Brompton

I am most grateful to the noble Baroness. On the basis of that undertaking, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Carter moved Amendment No. 115FE: Page 53, line 7, at end insert: ("(1A) No order shall be issued under subsection (1) above in respect of community care functions unless the Secretary of State has warned them in writing not less than three months previously, specifying the grounds on which he believes the authority to be in default in the exercise of such functions.").

The noble Lord said: This amendment rather harks back to Amendment No. 115FB, which was moved by the noble Lord, Lord Allen of Abbeydale. Members of the Committee will remember that we had a very interesting mini debate about the powers in new Clause 47. It contains provisions which require the social services authorities—I use the wording "social services" because it is mentioned in the clause—to comply with directions from the Secretary of State in carrying out their functions. It provides for Sections 7A and 7D to be inserted in the Local Authority Social Services Act 1970, in so far as the Long Title of the Bill allows such insertions, as pointed out by the noble Lord, Lord Henderson of Brompton.

Under Clause 47 the Secretary of State will be able to declare an authority to be in default and to give directions so as to remedy the default. He can call for an inquiry to be set up in connection with the exercise of the social services functions by the relevant authority. As we said with regard to the previous amendment, the powers of direction contained in the clause are very comprehensive. They certainly were not contemplated by Sir Roy Griffiths in his report on community care, nor did the White Paper Caring for People contain any justification for what is a significant new power of discretion and direction.

The proposed amendment would require the Secretary of State to give in writing not less than three months' notice before the making of a direction to a particular authority regarding its community care functions. If such power were included, it would enable the local authority to discuss with the Secretary of State his judgment on a matter which it is part of the statutory duty of the local authority to continue; but if the Secretary of State is to insist on this he must surely give due warning.

Further, the proposed amendment will allow discussion about the Secretary of State's power to make an order declaring an authority to be in default. For example, it might be possible in discussion to raise the question of the nature of the inquiry. We feel that there should at least be this three months' written notice, after which time discussions would be held between the Secretary of State and the local authority before the order was made. I beg to move.

Baroness Hooper

We expect the default procedures in this clause to work in the following way. The first stage will be when it comes to the Secretary of State's attention that an authority is failing to discharge its functions. This may come from a number of directions—the work of the social services inspectorate, information received from organisations representing disabled people or by direct representations to the Secretary of State by users of services. The first thing the Secretary of State needs to do is to satisfy himself that the authority has failed without reasonable excuse to exercise its functions. This will entail some form of further investigation or inquiry and may, if the Secretary of State feels it would be useful, include using the general powers of direction to direct the authority to exercise its functions in a particular way.

It will only be after these processes have been exhausted and work with the authorities through the social services inspectorate has failed to secure any improvement in the situation that the use of the default powers will be considered. I am sure that the noble Lord, Lord Carter, is familiar with that concept. When these powers are used the Secretary of State first has to issue an order, then, if it is not complied with, he can seek an order from the court to enforce it. I think that it is clear from what I have said that the initial processes leading up the issue of a default order would in most cases take at least as long as the three months mentioned in the amendment we are now considering. It is quite right that they should. We would not want to issue orders precipitately since they are very much a measure of last resort. Nevertheless, there may be occasions when it is imperative that the Secretary of State acts more speedily.

For those reasons we do not wish to write into the Bill the time limit proposed in the amendment. I hope that in the light of that explanation and assurance the noble Lord will feel able to withdraw his amendment.

Lord Carter

Members of the Committee will be grateful for most of that explanation. However, I should like to read with care what the Minister said. I take the point that there will be occasions when it will be imperative for the Secretary of State to act with speed. With that consideration in mind, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

The Viscount of Falkland moved Amendment No. 115G: Page 53, line 20, at end insert ("and persons who are presently or recently have been dependent on alcohol or drugs.").

The noble Viscount said: This amendment is grouped with Amendments Nos. 115H, 115HA, 116B, 117C, 118B. All of these amendments relate to the discretionary powers of the Secretary of State to designate funding.

Lord Ennals

I am most grateful to the noble Viscount for giving way. I feel that I should point out at this stage that Amendment No. 115HA has been extracted from that grouping and that it will be considered separately.

The Viscount of Falkland

I am grateful to the noble Lord. I speak to Amendment No. 115G which is specifically concerned with—

Lord Mottistone

I was happy to have my amendment grouped with Amendment No. 115HA, but not with Amendment No. 115G. In the circumstances, if Amendment No. 115HA has been extracted from the grouping, I should like my amendment to be considered along with the amendment of the noble Lord, Lord Ennals. I should prefer to do that rather than become involved with this discussion.

The Viscount of Falkland

I am perfectly happy to be entirely separated from everyone. In those circumstances, perhaps I may proceed with my amendment. It concerns designated funding or specific grants for those dependent on drugs and alcohol. The aim of the amendment is to amplify and add to what is already in the Bill. When we debated the White Paper and on Second Reading the Minister was at pains—I agree with her—to point out that the problems of drug addicts and alcoholics are mentioned in the Bill. That is a welcome step.

I have had many hundreds of letters from individuals and voluntary organisations which deal with alcohol and drug abuse. They all acknowledge that the problem is mentioned in the Bill, but their anxiety springs from the history of the attitude—if I may put it that way—of local authorities towards drug and alcohol addiction and the uneven pattern of action taken by local authorities to deal with the problems which happen within their areas. It is for that reason that there is enormous concern about the alcohol and drug addiction services, whether they be the residential services, as many of them are, which are threatened at the moment by shaky funding or lesser forms of treatment. The importance of the services should be underlined in some way in the Bill. Funding should be available for those purposes.

Perhaps the Committee will allow me to go into the scale of the problem of drug and alcohol abuse for a moment. As the Committee will detect, my emphasis will be more on alcohol abuse than drug addiction although the treatment of both generally takes the same form when the crisis point is reached.

While speaking to a previous amendment on assessment, the noble Lord, Lord Mancroft, made an excellent and clear speech. He gave the whole picture of addiction in this country. The Hansard report of that debate should be recommended reading for anyone who is interested in the problem. Briefly, the costs in human and money terms are extraordinary. It is difficult to cost the problem. As the noble Lord pointed out, we have some 150,000 street drug addicts, many of whom are extremely young. There are 15,000 registered heroin addicts. Even the Department of Health acknowledges that the actual number of heroin addicts may be 10 times that number. It is calculated that about 800,000 people have severe alcohol problems—that means people whose health has deteriorated to a point where they are in danger of death —but considerably more are severely at risk. Many of them are homeless and an increasing number are young. The number of women suffering from severe alcohol problems is rising.

I draw the Committee's attention to an article which was published in a daily newspaper the other day. The article made what should be an obvious point, although it had not occurred to me. It has to do with the cultural attitude towards women's drinking. The article pointed out that 90 per cent. of male alcoholics are looked after by their wives, if they have them; but about 90 per cent. of women who become alcoholics are deserted by their husbands. That points to a curious attitude in this country towards addiction by women. The noble Lord, Lord Mancroft, gave shattering figures with respect to the number of people addicted to prescription drugs. Some 1.75 million people are addicted to drugs with well-known names such as Librium and Valium and a range of sleeping pills. Many have become addicts because they were wrongly dealt with by their general practitioners. A wrong assessment was made. That point relates also to the amendment to which the noble Lord, Lord Mancroft, made his excellent contribution.

The incalculable damage to the fabric of society must be obvious to the Committee, but there is an element of denial with the individual addict, as there is in the nation. People blinker themselves to the damage to the family structure, particularly to children and women. Violence within the home is strongly related to alcohol abuse. It is calculated that one in three cases of child abuse is connected to a severe alcohol problem. There is a high incidence of severe alcohol problems related to the repeated battering of wives. As we all know, crime often has a high alcohol or drug related content. Therefore the picture is extremely worrying.

The costs in money terms are not easy to quantify. The centre for health economics at the University of York has produced figures which are of interest and which have to do with alcohol abuse. It calculates the cost to industry for 1986 as £1. 65 million through people suffering from alcohol problems. The cost to the National Health Service is £116 million. Traffic offences account for in excess of £100 million. The cost in connection with crime—which covers the costs of courts, the police and so on —is £139 million. This all amounts to £2 billion for alcohol abuse alone in the country.

The need for services is acute and is growing greater daily. People with alcohol and drug problems need a wide range of assistance. At one end some perhaps need only a small amount of advice.

Counselling sessions may help to deal with the stresses and causes of abuse, particularly heavy drinking. At the other end of the spectrum, treatment centres deal with people who are at a crisis level in relation to their addiction. This is where I come again to the problems with the new set-up as outlined by the Bill. These people need immediate access to detoxification and care after detoxification in an environment supervised by professionals. It should be followed by rehabilitation in a residential setting. This is all costly. These measures often lead to a halfway house and to eventual re-emergence into the community, with perhaps counselling for periods.

I am trustee of a treatment centre which deals with the sad cases of people in an advanced state of addiction. Unfortunately relapse is a common feature. Patients habitually leave and then return and it is a difficult process. The professionals who are trained in this field have invaluable experience in dealing with it.

It is not only the people who suffer directly as addicts. The effects extend to families, friends, business colleagues and so on. The current assistance—before I come to the Bill—is provided mostly by voluntary agencies although one or two are run by the statutory sector. There is easy access to individual counselling. Residential services are provided mainly by the voluntary sector in regard to alcohol addiction in conjunction with housing associations. Sadly, these are few and far between when one considers the scope of the problem. They provide immediate assessment and admission for periods ranging from one week to sometimes as much as a year.

Current funding is from a variety of sources, which reflects the nature of the problem we face as to where the responsibility for these people should lie. In some areas health authorities take responsibility for the funding of the services, in others the social services do it, and in some areas there is joint financial support.

However, overall it is generally accepted that there is a higher commitment from health authorities than from social services. Residential services are maintained through supplementary benefit paid by the Department of Social Security. There are regional variations but the benefit normally amounts to a rental payment of about £40 a week and a care payment of £103 per person per week. That goes towards the cost of the social work that is involved in treating these people.

Under the new proposals of the Bill the care payment will be transferred to the local authority to be used in response to the assessed needs of the patient. There is however the uncertainty of whether funds will be used for these purposes, given the priorities and financial pressures on local authorities. Other Members of the Committee have referred to that point in connection with other amendments.

What are the implications for the future? Generally speaking the many hundreds of letters that I have received suggest that voluntary agencies are not sanguine about the future. The arrangement after April 1991 is that local authorities will agree a contractual fee arrangement with agencies. However, certainly those who are involved directly with these problems on a day to day basis in the voluntary alcohol services feel that potential patients are unlikely to approach a local authority directly. As regards both drug addicts and alcoholics, the relationship with a local authority is extremely difficult. Perhaps because of stigma attached to drug and alcohol abuse, those who suffer from these problems are wary of dealing with the authorities at all.

Members of the Committee have referred to my next point in connection with other matters. The number of local authorities which most agencies would have to cope with would be extremely high, as referrals come from a wide area. Those are the problems which are being faced. Many residential projects are under threat at this time. The situation is becoming graver daily. Funding is extremely short and any delay or hiatus in funding would undoubtedly lead to further closures and to more people being at risk. Trained and able people who have a vast experience in this field would be put out of work and would be unable to practise their skills. That would be a great loss to the community.

The noble Baroness has on many occasions outlined the Government's intention, which is clearly to take care of this problem in our community. But how is that to be done and what is the reality of the position? How will the funding be made available? How are we to ensure that local authorities will use the funds available? How will they be able to use those funds under the scope of the Bill?

I should like to end by saying that all is not gloom so far as concerns local authorities. I received a letter today which indicated that in the North East there is a successful and productive relationship between the local health authority and sufferers in that area. However, the writer of the letter, who runs a treatment centre in the North East, said that he doubted whether the same co-operation existed elsewhere in the North. It is that unevenness of attitudes which is causing the problem. I beg to move.

Baroness Masham of Ilton

I shall be very brief. I have put my name to the amendment. I should like to ask the Minister whether she can give assurances on three points: that services will continue for clients with drug and alcohol problems; that services will be easily accessible for clients; and that choice will be maintained with the flexible use of treatment options. Treatment is wide and varied.

Drug and alcohol abuse destroys families and disrupts communities. It is worrying that an organisation such as Turning Point has already decided that projects which after 1991 will become dependent on individual funding arrangements will close. That will be a very serious situation.

Lord Mancroft

I shall be even more brief. I am not an expert on local authority finance, even after having listened in the debate last week to the noble Lord, Lord Carter, and to the reply of my noble friend. I can safely say that I still do not know anything about local authority finance. That is no judgment on their ability to explain but rather on my ability to comprehend. One of the points that worries me most is that it seems to me from the short time in which I have had dealings with local authorities and health authorities that their own comprehension of their financing is also a little dusty.

Therefore I would not presume to advise the Committee whether it should approve of ring fencing, earmarking or blank cheques (which are probably not a good idea). However, the principle behind the amendment of the noble Viscount, Lord Falkland, is important. This is a very unpopular group of patients which is at the bottom of the list of priorities. It would be very helpful if my noble friend would in some way underline in the Bill the importance of these patients, if not by ring fencing perhaps in the regulations governing the publishing of the policies of the local authorities. If those dependent on drugs and alcohol were included in such policies there would be no need to underline their financing requirements. The Government must put a microscope on this group of patients who will otherwise be left out.

Lord Ennals

I shall speak very briefly. I shall try to confine myself to three sentences. First, it is quite clear that alcohol services have received very low priority for funding from social services departments. Secondly, Alcohol Concern says that the proposed changes in the funding of residential care will result in the wholesale closure of residential drug and alcohol projects unless specific measures are taken. Thirdly, when one asks why those services have received such low priority, a variety of answers are given. I shall give only one; namely, that there is no statutory responsibility on local authorities to provide those services. That is the overwhelming reason for the amendment. It should be a statutory responsibility. If it is not, there is no reason to expect that local authorities will automatically pay.

9.30 p.m.

Baroness Faithfull

Even if the local authority has overriding responsibility, there is nothing one can do if the patient does not respond. The Committee will remember that some time ago I recommended that there should be a new court order and that people should be found to be in need of treatment. My noble friend Lord Ferrers said that he thought it was a good idea; but nothing has happened.

Baroness Hooper

As the Committee will remember, the Government originally decided that the best way to ensure that adequate resources were directed to care-in-the-community policies was to provide those resources through the revenue support grant. I shall not repeat all the arguments in favour of that proposal, particularly if they are not comprehensible to my noble friend Lord Mancroft. However, we believe that it goes against the grain of our policies to offer local authorities new responsibilities and to ask them to be more fully accountable to their electorate on the one hand and then, on the other hand, determine from the centre how resources should be deployed. That is the general argument, and the Government are now carefully considering the position following the Committee's decision to support Amendments Nos. 108AE and 108AEB, which bear on that point.

I remind the Committee that all the evidence thus far shows that expenditure on personal social services does well out of non-ring-fenced funding and has risen substantially in real terms vis-à-vis other areas of expenditure. Over the past 10 years, it has risen by 37 per cent. in real terms. We have made an exception to that general policy for those who are mentally ill because this is an area where we well know that resources have been inadequately applied and services have in some cases been less than we would wish. Basically, that appears to be because local authorities generally have not been able to give as much priority to providing services to people with a mental illness as to services for other vulnerable groups.

However, no one should assume that, because we propose only to make grants to support the development of services for the mentally ill, we believe that other client groups are less important. Those with relatively rare conditions such as motor neuron disease, to name but one, also need adequate social care. We believe that those groups are catered for by existing legislation, such as the Chronically Sick and Disabled Persons Act 1970 and the Disabled Persons (Services, Consultation and Representation) Act 1986. Resources for those Acts have already been taken into account in the levels of support given to local authorities.

The provisions that we make in the Bill for assessment of need and for community care plans are designed to encourage and require authorities to make provision for those whom they serve on a customer need basis. We are requiring consultation in drawing up care plans with health authorities, the new family health services authorities, housing authorities and voluntary and other bodies providing services. That is deliberately designed to improve the scope for developing relevant services to all client groups, including alcohol and drug misusers, as well as multi-handicapped people.

The noble Baroness, Lady Masham, asked whether services would continue. They will of course continue. Those services will be in a better position than they are now simply because of the consultation process undertaken by local authorities and the publication of their plans. The provision will be much more visible.

On the point raised by my noble friend Lord Mancroft, priority on spending should be decided by local authorities. There are many ways in which central government can help in those important areas—and we recognise how important they are —so central government expenditure on drug and alcohol misuse will continue.

Furthermore, I can inform the Committee that the Secretary of State intends to direct local authorities to include drug and alcohol misuse in their community care plans. I believe that that covers many of the anxieties felt by people operating in that area. With that explanation I trust that the noble Viscount and noble Lords who intended to move the other amendments still included in this group will feel able to withdraw their amendments.

Baroness Masham of Ilton

Before the noble Viscount rises, I should like to say that I wish I had the faith and trust possessed by the Minister. I know that there are no votes in drug and alcohol abuse. It is a most unpopular issue. We tried to set up a Phoenix House on the south coast. We have had great opposition, led by the local mayor, to setting up a home or treatment centre. I could show the Minister letters that I have received on this matter, as have the organisation.

That is why there is fear that this form of treatment will fall through the net. I hope that the Minister will be able to ensure that it does not do so; but I do not have her faith.

The Viscount of Falkland

I thank the noble Baroness, Lady Masham. I do not share the faith expressed by the Minister either. I only hope that, in a rather typically British way, we are not just waiting for a disaster to occur in much the same way as happened in the prisons. I hope that we do not find that there is an enormous explosion of crack or some other substance and that we have to take very fast action at extraordinary cost in order to deal with it.

Obviously I shall not divide the Committee on the amendment at this hour of the night. I am not at all happy with the noble Baroness's brief on this subject, which has been consistent throughout. I do not feel that local authorities will act in the way that we hope. I reserve the right to come back at a later stage and I sit down, rather heavy in my heart at the response that I have received. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Mottistone moved Amendment No. 115H: Page 53, line 20, at end insert ("or substantially handicapped as a result of a previous mental illness").

The noble Lord said: I do not see this amendment as part of a grouping with Amendment No. 115G because the charities with which I am associated have a problem over this point.

The passage that it is proposed to alter is the new Section 7D of the other Act, which concerns grants to local authorities in respect of social services for the mentally ill. That is fine. The previous amendment sought to latch other issues on to the mentally ill provision, which I thoroughly welcome. Indeed, I am grateful to the Government for including this special clause relating to the mentally ill for the reasons that my noble friend the Minister so clearly explained.

The only point in the new Section 7D which is not clear to me is the mention of: persons suffering from mental illness".

What does that mean? Does it refer to people who have been mentally ill at some stage in their life? Of all the people diagnosed as having schizophrenia, about 20 per cent. are perfectly well but the remaining 80 per cent. go through life with schizophrenia returning to them from time to time. The object of this amendment is to make sure that the provisions included in the new Section 7D apply to those people just as well as those who are in hospital.

We are talking about care. If for some legal reason in the Bill the phrase "suffering from mental illness" means something that covers a person's lifetime, whether or not he or she is in a sane state at a particular time, nevertheless the point is that that person requires care. The chief medical officer pointed out in 1988: It remains an unpalatable fact that many mentally ill people require support and treatment on a long term basis".

He also states: Over half those admitted to hospital with a diagnosis of schizophrenia will be left with significant residual symptoms and seriously impaired social functioning".

It is those people, even if they are able to get a job, who need to be covered by the Bill as it stands. If they are, my amendment is unnecessary. If they are not, it is necessary.

Lord Ennals

Perhaps I may both support the noble Lord in the amendment that he has proposed and say a few words about it. I also speak to Amendment No. 115HA.

I know that the noble Lord's amendment is a probing amendment. The answer is very important. He is right that many people who suffer mental illness have a residual handicap which is with them probably all their lives. But that does not apply to everyone. Many people who have had bouts of mental illness may be under treatment for the remainder of their lives but that treatment can operate very effectively. I know plenty who operate very effectively. Schizophenia is one good example. But those who have suffered severe bouts of manic depression have sometimes had electro-convulsive therapy and have been left quite disabled. They find it difficult to return to work again. If one includes those who have spent a long time in psychiatric hospitals, their principal illness is probably institutionalisation. Those are all people who should be included in this definition.

One reason for tabling Amendment No. 115HA is to try to find out from the Government what they intend to do. I very much welcome the indication given in July that mental illness would be dealt with by a specific grant. That was stated by Mr. Freeman and repeated in the White Paper. I am very sorry that Mr. Freeman has moved. People are not allowed to stay long enough in jobs under this Government. He learnt his job very well. He was very constructive, thoughtful and caring. But before we know where we are, he has had to learn the transport game. I am sure that his successor in a few months' time may also be quite good. He is a bright young fellow. But I do not believe that people should be shuffled around like that. It is not right for the service.

However, very little has been said since Mr. Freeman's statement about what the Government have in mind. What is the grant? Will it be a 100 per cent. grant, a 75 per cent. grant, a 50 per cent. grant or what? What are the criteria for eligibility?

Initially Roger Freeman seemed to indicate a very broad range of eligibility among patients discharged from hospital, but later he seemed to be corrected by indications suggesting that the Government wished to restrict the category to those under the supervision of a psychiatrist. That narrows it down considerably.

I do not know whether the proposal still stands or whether it may be dropped. I hope that the Minister will tell us. What level of expenditure in broad terms do the Government have in mind? How will it be distributed? Are they talking about £1 million, £30 million or £1 billion? What are the Government talking about?

Eventually local authorities must submit their proposals. Therefore, they need carefully to develop plans, consult about them and know the size of the projects that they can submit. What help will there be for patients living in the community whom social workers, community psychiatric nurses and other hard-pressed services are struggling to keep out of hospital? Will financial assistance be available for effective crisis intervention? That is sometimes carried out by health and local authorities and sometimes by voluntary organisations. Will the services cover the homeless mentally ill? Will they include those with senile dementia?

It is less than 11 months until the scheme will come into operation. The time has now come for the Government to state what local authorities should expect from the initiative.

9.45 p.m.

Lady Kinloss

I support the amendment tabled by the noble Lord, Lord Mottistone. People with a recurring mental illness, and in particular severe schizophrenia, are unable to cope with the ordinary, everyday practicalities of life such as paying bills. They will need the help of the local authority social services, especially if they have no caring relatives or friends to help them.

Lord Henley

I thank the noble Lord, Lord Ennals, for his kind remarks about my honourable friend Mr. Freeman.—

Lord Ennals

When you go I will say the same!

Lord Henley

That is most kind of the noble Lord. I hope that he will be able to make the same remarks at that time. There is no need to say exactly why we need a specific grant for the mentally ill because we dealt with that matter earlier.

I turn to the amendment standing in the name of my noble friend Lord Mottistone. I can offer him reassurance because at present there is no legal definition of the term "mental illness". Therefore, it bears its normal meaning, which encompasses all stages of mental illness; not only acute episodes but any continuing or persistent disabilities. Those whom my noble friend seeks to include in his amendment are included in the basic definition of mental illness and local authorities will be able to use the specific grant to provide services for them. I hope that my noble friend will accept the fact that his amendment is unnecessary.

I turn to the amendment of the noble Lord, Lord Ennals. Draft guidance just issued on specific grant for menial health care provides, at paragraph 6 (a), that the grant will be available for those whose mental illness is so severe that they have been accepted for treatment by the specialist psychiatric services. Paragraph 6 (b) helps homeless people who could benefit by being in touch with specialist psychiatric services.

I entirely accept that the provision of accommodation, to which the amendment refers, is an essential part of services for the mentally ill in the community. Local authorities will be able to provide or secure a wide range of supported accommodation for people with a mental illness under the terms of the specific grant. We shall take steps to ensure that social services authorities work closely with housing authorities to enable those who are capable of doing so to move into mainstream housing. Leisure facilities are also important and many are provided within personal social services.

However, the most pressing need is to improve social care for the more seriously mentally ill and that is where we intend to target out support. I should also point out that the specific grant which we have in mind about which the noble Lord was asking—I shall not give any figures now and I am sure that the noble Lord would not expect me to—will and can only be a small proportion of the total expenditure which may be needed by both local and health authorities in order to offer a range of adequate provision for the mentally ill. The specific grant is not designed to support the totality of the provision required. I do not believe that the noble Lord would expect me to go any further.

Lord Ennals

I do not expect the Minister to start giving a review of the public expenditure White Paper to be published later this year. However, it is important that local authorities should know what is the per centage of the grant, whether it be 65 per cent., 75 per cent. and so on. The local authorities need to know that.

Lord Henley

I go no further than saying that it will be a small proportion. We do not have in mind that it will meet anything like the totality. To some extent the grant is designed to encourage that provision. As we said earlier, it needs encouragement because it has always been treated very much as a poor relation.

Lord Mottistone

I thank my noble friend for his response to my Amendment No. 115H. That reassures me and I am most grateful.

I should have said that I very much support the sense of Amendment No. 115HA in the name of the noble Lord, Lord Ennals. I am sorry that he did not get a little more from my noble friend, but he did fairly well.

Lord Ennals

Before the noble Lord withdraws his amendment, I am very disappointed in the Minister's response. It is the first time that I have heard any Minister say that this grant will be only a "small proportion". I have heard so many speeches by Roger Freeman and have seen Written Answers given in another place. At no stage did I gain the impression that this would be a small proportion of local authority expenditure or any expenditure on the mentally ill. I was very disturbed to hear what the Minister said, not so much in relation to the amendment, but my probing produced a very unsatisfactory answer.

Lord Mottistone

I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 115HA not moved.]

Lord Seebohm had given notice of his intention to move Amendment No. 116: Page 53, line 20, at end insert: ("() The Secretary of State for Health shall lay before Parliament an annual report setting out the resources available to each local authority in connection with the exercise of their Social Services functions under Part III of the National Health Service and Community Care Act 1990. ()The Secretary of State for Wales shall lay before Parliament an annual report setting out the resources available to each local authority in connection with the exercise of their Social Services functions under Part III of the National Health Service and Community Care Act 1990.").

The noble Lord said: I apologise to the Committee for underrating its intelligence because I implied that the ring-fencing amendment had not been passed. However, in view of the fact that it was passed, I shall not move my amendment.

[Amendment No. 116 not moved.]

[Amendments Nos. 116A to 116C not moved.]

Clause 47, as amended, agreed to.

Lord Seebohm moved Amendment No. 117:

After Clause 47, insert the following new clause:

("Role of Director of Social Services

In section 6 of the Local Authority Social Services Act 1970 (which requires a local authority to appoint a Director of Social Services) the following subsections shall be substituted for subsections (2) to (8):—

"(2) The Director of Social Services of a local authority shall not, without the approval of the Secretary of State (which may be given either generally or in relation to a particular authority), be employed by that authority in connection with the discharge of any of the authority's functions other than social services functions.

(3) A local authority shall secure the provision of adequate staff to assist the Director of Social Services appointed by them in the discharge of his functions.

(4) A local authority shall not, without the approval of the Secretary of State (which may be given either generally or in relation to a particular authority), arrange for the discharge of any of the authority's social services functions by any officer who has not been appointed by, or is not under the direction of, the Director of Social Services for that authority.

(5) For the purposes of subsection (4) above, an officer appointed by or under the supervision of a person subordinate to the Director of Social Services shall be deemed to have been appointed by or, as the case may be, to be under the direction of the Director of Social Services.").

The noble Lord said: This amendment is important. The Association of Directors of Social Services likes this amendment and I have a personal interest which will become clear in a moment. It concerns the duties and authority of the directors of social services.

I must return to what has been called the Seebohm report, which engendered the Local Authority Social Services Act 1970. In the summary recommendations it stated: The head of the social services department should be able to give his whole mind and time to the work of the department and should not be subordinate to the head of another department. His post should be statutory and this should be an obligation on the local authority to provide him with sufficient supporting staff. He along with the other principal officers should work as a team under the leadership of the clerk in the manner in which the Maud Committee have indicated".

That was picked up in the Bill and appears in the Act as follows: A local authority shall appoint an officer, to be known as the director of social services, for the purposes of their social services functions".

The Act continues: (5) The director of social services of a local authority shall not, without the approval of the Secretary of State (which may be given either generally or in relation to a particular authority) be employed by that authority in connection with the discharge of any of the authority's functions other than their social services functions. (6) A local authority which has appointed, or concurred in the appointment of, a director of social services, shall secure the provision of adequate staff for assisting him in the exercise of his functions".

That almost completely picked up the recommendations of the committee, and so far as I am aware that Act stands and has not been amended. It is for each local authority to decide how they will implement the requirement. The approval of the Secretary of State is only needed for a major extension of the director's role; for example, if he or she takes on the role of director of housing, as has happened in a handful of authorities including the London Borough of Harrow.

Twenty years ago no one could have predicted the restructuring of local authorities that is now taking place in some areas. That in turn had an impact on the role of the director of social services. The Association of Directors of Social Services believes that amendment is required to the 1970 Act which will clarify the current position. The new clause therefore is intended to strengthen the powers of the Secretary of State where authorities are introducing management restructures which separate the legal post of the director from his day-to-day functions.

In Tower Hamlets the management structure has been decentralised to a number of neighbourhood offices. Although the nominal director of social services has legal responsibility for social services decisions, the actual responsibility lies with neighbourhood chief executives. The post of director is now vacant. The most recent occupant found that he had no powers to reorganise or co-ordinate policies across the borough.

The Metropolitan District of Rochdale is proposing a different structure which collects together a number of statutory functions in a single post of director of corporate services. Day-to-day responsibility for social services functions will be devolved in neighbourhood executives, once again separating the legal responsibility from line management.

The Association of Directors of Social Services respects the right of each local authority to determine its own structure. Its chief concern regarding the substantial changes to the role of a director is where his ultimate responsibility for social services functions lies; in other words, where does the buck stop? That is particularly pertinent given the new responsibilities of the Children Act 1989 and the National Health Service and Community Care Bill.

Unless a clear line of accountability is introduced through legislation, future inquiries into tragedies such as the death of a child in care or the abuse of elderly people in a local authority home will begin to find that the buck stops somewhere between local management and the nominal director. I am not so bigoted as to think that a recommendation made over 20 years ago is good for all time; but serious deviation from the intentions of the 1970 Act must not be allowed without the approval of the Secretary of State. What is happening in Tower Hamlets and Rochdale does not make managerial sense. In my view they are seriously in breach of the 1970 Act.

Finally, financial responsibility has been transferred from social security to social services. That is something quite new to social services departments, and the authority of the director of social services must be made clear. By this amendment we do not obstruct change. We hope that at least the 1970 Act will abide unless the Secretary of State alters it, which he will be allowed to do under the amendment.

Amendment No. 117 is very important, and I know that the directors of social services will be hanging on to the Government's every word in this regard. I beg to move.

10 p.m.

Baroness Faithfull

I support the noble Lord, Lord Seebohm, in his amendment. I shall not repeat all that he said but I ask the Committee to look at the matter from the point of view of the staffs. If you are working for a director of social services who also has wide responsibilities for housing or other departments, you do not feel secure or that you are working for someone who is fully acquainted with the details of the situation.

I do not believe that it is possible for any one man or woman who is a director of social services to know the Children Act through and through, to know this Bill through and through, and at the same time to be completely responsible for them and also to take on other responsibilities such as housing. That is beyord the capacity of any one person.

I also reinforce the point about training. Either one is trained to be a housing manager or trained to be a social worker. One cannot do both jobs unless one is fortunate enough to be trained in both areas, which is most unlikely.

Finally, I refer to a personal experience. Last summer I dealt with a most distressing case in an authority which shall be nameless. The director of social services had responsibility for housing and for social services. I must say, with all due respect, that he was unable to give a suitable service in that particular distressing case. The local authority was proved to be wrong. That case may not have happened if the director had not carried responsibility for housing as well as for social services. I support the amendment in the strongest possible terms.

Lord Winstanley

I too support the amendment. I do so as briefly as I can. The amendment was admirably and clearly moved by the noble Lord, Lord Seebohm, and I absolutely agree with what he said. I am sure that the whole Committee does so. The noble Lord, Lord Seebohm, quoted the words regarding the relevant functions of directors of social services. The words in the Bill are ambiguous, to say the least. If they do not mean what is stated in the amendment, they ought to mean that. Surely that is the purpose of the amendment.

Many of us are aware of the pressures and difficulties, including financing, that local authorities are experiencing. There are also staff difficulties. There must have been pressures which led to the manoeuvres mentioned by the noble Lord in Rochdale, Tower Hamlets and many other places. It is possible that occasionally the reorganisation of functions would work. For special cases the amendment allows for that to happen with the approval of the Secretary of State, but not gradually and unseen or in that kind of way.

In essence, therefore, what does the amendment do? We have already decided to ring fence certain parts of local government rate support grant. The amendment ring fences the directors of social services. I agree with that.

Lord Peston

In supporting the amendment on behalf of the Official Opposition I take the opportunity of congratulating the noble Lord, Lord Seebohm, on not merely his introduction to this amendment but on his own major contribution in this area. I do not say that to him because we expect to pension him off in the immediate future but simply because the area of social services will be forever indebted to him for his contribution.

The noble Lord was right—even though we are debating the amendment at ten o'clock at night—to emphasise the importance of the amendment. It is concerned with management and it lays down simple principles of management as they should be applied to this area—that there should be a clear line of responsibility and that someone should be ultimately responsible, but that that person should also be the person who, so to speak, acts.

I agree with the noble Lord, Lord Winstanley, that there should be no ambiguity. The great benefit of this amendment is that there is no ambiguity. There is no way round the amendment. The Local Authority Social Services Act may well be ambiguous. Perhaps I may add that I would be happier to have the amendment accepted than to be told that the Local Authority Social Services Act is correctly interpreted in that way. If that is correctly interpreted, we have the slight problem of why it is not being acted on in that way. I hope that the Government, either in the form of these exact words which seem perfectly satisfactory to me or in their own words, take this opportunity and accept the amendment. I do not see that this matter is remotely party political or undermining the Bill. It reinforces what the Government very much want to do. It is with a plea for sweet reasonableness on the part of the Government that for the Opposition I strongly support this amendment.

Baroness Blatch

I understand and sympathise with the objective underlying this amendment, which, as I understand it, is that the director of social services shall have the necessary authority and accountability for the discharge of his responsibilities. I entirely endorse the objective. The question is whether it can be achieved by statute.

It is essentially a matter for the local authority which should, we suggest, be allowed scope to organise the management of its services in ways best suited to its local circumstances in accordance with up-to-date best practice and, above all, to promote the government objectives for community care as set out in the White Paper Caring for People.

Here I am thinking particularly of the need to make services more flexible and accessible to those who need them. Authorities that wish to reorganise their community services so as to simplify access to a range of services and to make access more local, should not be unnecessarily impeded by legislation. As the Committee will know, the Bill incorporates a new general power for the Secretary of State to give directions to local authorities and also new default powers.

Together these provisions will make it easier for the Government to intervene effectively if things start to go wrong, to protect the interests of users and carers and to see that the community care policies are given effect. The Local Authority Social Services Act 1970 provides, as I believe the noble Lord, Lord Seebohm, reminded us, that the director of social services be given adequate staff to enable him to fulfil his statutory duties. We would expect the director or his staff to be involved in the appointment of professional staff.

The Secretary of State's approval is already required for other than social services functions to be laid on the director of social services. We do not think that it would be right to involve the Secretary of State to a greater degree in the administrative arrangements of individual local authorities.

The amendment would also remove the possibility of two or more authorities employing the same person to carry out the social services functions where they consider that one person can efficiently discharge those functions. I do not know whether any authorities may wish to make such an arrangement, but I would be reluctant to see that choice denied them.

The noble Lord, Lord Seebohm, was concerned about the line of accountability. It is possible to have clear lines of accountability in several different organisational structures. We accept that clear accountability must exist. I believe that sufficient safeguards exist to investigate and to take action where there is cause for concern. The noble Lord also asked where the buck stopped. That is a very real question in management terms.

It is for each authority to determine the precise pattern of accountability for its officers. Ultimately the legal responsibility rests with the authority itself. It will need to make sure that its internal arrangements allow its accountability to be discharged. The noble Lord, Lord Seebohm, again questioned the management structure at Tower Hamlets. I do not feel that it would be appropriate or helpful for us to get immersed in the arrangements of that authority. Authorities are free to decide how to organise their social service departments. If they want the director to carry out any other functions.—

Lord Winstanley

I may be confused by what the noble Baroness is saying as against what she said earlier. She appeared to say earlier that the Secretary of State's approval is required before additional functions other than social services functions are laid on the director of social services. Are we to assume from that that the Secretary of State has given approval for what is happening in the authority which has just been quoted?

Baroness Blatch

I am not sure that I can comment specifically on Tower Hamlets. I can confirm to the noble Lord that the Secretary of State's approval is required where the social services take on functions other than those contained in the Act. They require the permission of the Secretary of State.

I must leave as an open question the accusation made by the noble Lord, Lord Seebohm. He felt that a particular authority was in breach of the Act. If that is so, then I believe that it should be dealt with, though at this moment I do not wish to comment upon the situation. Nevertheless, it is a question that must be answered.

Lord Peston

I think that we should clarify a point which seems to me to be quite fundamental. It concerns the first part of the amendment moved by the noble Lord, Lord Seebohm; namely, subsection (2), which starts with the words, the Director of Social Services", and so on. Is the noble Baroness saying that what is contained in that part of the amendment is not needed because the situation cannot arise? It seemed to me that the noble Lord was saying that the situation he is trying to prevent is, unfortunately, already happening. Is she quite clear in her mind that the problems that have been identified simply cannot be happening legally, so to speak? That is the issue which is bothering us.

The remarks made by the noble Lord, Lord Seebohm, have been somewhat interpreted by the noble Lord, Lord Winstanley. We all thought that that provision was contained in the Local Authority Social Services Act 1970. However, in practice that does not seem to be the case. To put it hypothetically, if the noble Baroness can say that what is happening in these boroughs is different from that situation and that she is convinced it is illegal and can be dealt with under the earlier legislation, one might be satisfied. However, it has certainly happened.

Baroness Blatch

I was trying hard not to become embroiled in the instances concerning this particular authority. I shall repeat what I said earlier: if the director of social services is to carry out other functions the authority must have the approval of the Secretary of State. If an authority embarked upon any unorthodox activity I am sure that the social services inspectorate would wish to watch closely to ensure that services were delivered effectively. I have recently been advised that approval has so far been withheld by the Secretary of State in Tower Hamlets.

I believe that enough has been said in this short debate, which has raised many questions. I should like to take the amendment away and discuss it with the department in view of the number of questions which have been left in the air.

Baroness Seear

I am most grateful to the noble Baroness for giving way. In my view we are discussing two different points. There is the point where a director of social services is given a quite different job to do. As I understand it, that is against the provisions of the initial Act. I think that all of us would agree that that is an unsatisfactory situation.

There is another situation which is perfectly possible. In some circumstances it can be desirable that within the framework of operating the social services in a local authority a director of services may decide that it is a good idea to delegate some of that work to smaller groups in the authority. I can see no objection to that course of action. It can be done while maintaining the line of authority; it is simply delegating. It is done in so many organisations. You simply delegate and you maintain the responsibility. The director would put in controls to ensure that the work is being carried out properly. He would delegate this power to certain groups because in his authority he believes that that is the way it will work. As I said, we are discussing two different issues. I should be glad if the noble Baroness could comment upon the matter. If she cannot do so now, perhaps she will undertake to think about it.

Baroness Blatch

I am grateful to the noble Baroness. I think that we are indeed discussing two different matters. I think that I made clear in my first answer that social services directors must be free to organise their departments either on a patch basis or by some other arrangement, so long as the structure is understood and the services are delivered effectively into the community.

The other issue to which the noble Baroness rightly referred is the assuming of new functions which are not contained within the Act. There is sufficient of a question mark in this respect to suggest that that may well be an issue. As I said, I have been advised that thus far the Secretary of State's approval has been withheld in this particular instance. I believe that we are talking about the additional function of housing.

The third point is the one about which the noble Lord, Lord Seebohm, and other noble Lords are worried. It relates to where the management lines go, who is accountable and where the buck stops. There are sufficient question-marks to cause me to read the debate, discuss the matter with the department and return to the amendment on Report if the noble Lord feels able to withdraw the amendment.

10.15 p.m.

Lord Seebohm

I must say that I was glad to hear what the Minister said. It is clear that apart from Tower Hamlets some other local authorities are in breach of the Act which clearly states: The director of social services of a local authority shall not, without the approval of the Secretary of State (which may be given either generally or in relation to a particular authority), be employed by that authority in connection with the discharge of any of the authority's functions other than their social services functions". That is clear. It is not just Tower Hamlets because several local authorities are doing the same. It is an insult to the directors of social services. Of course I shall not press the amendment. I shall bring it back on Report. I hope that the Government will be able to produce an amendment which covers all the points that we require. If they do that, it will be magnificent.

If not, we shall fight the matter to the end. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Carmichael of Kelvingrove moved Amendment No. 117ZA: Before Clause 48, insert the following new clause:

("Health Board Plans

.— (1) After section 13 of the National Health Service (Scotland) Act 1978 there shall be inserted the following section:—

"Health Board Plans for Community Care Services.

1. 13A. — (1) Within such period after the day appointed for the coming into force of this section as the Secretary of State shall direct, and in accordance with the provisions of this section, each Health Board shall prepare and publish a plan for the provision of health care for the users of community care services in their area.
2. (2) Each Health Board shall from time to time review any plan prepared by them under subsection (1) above, and shall, in the light of any review, prepare and publish —
1. (a) any modifications to the plan under review; or
2. (b) if the case requires, a new plan.
3. (3) In preparing any plan or carrying out any review under subsection (I) or, as the case may be, subsection (2) above the authority shall consult—
1. (a) any local authority having responsibilities under Part II of the Social Work (Scotland) Act 1968 in their area;
2. (b) insofar as the plan or, as the case may be, the review may affect or be affected by the provision or availability of housing, every district or island council in the area of the Board;
3. (c) such voluntary housing agencies and other bodies as appear to the authority to provide housing or community care services in their area;
4. (d) such voluntary organisations as are representative of the users of community care services and their families and informal carers in the area of the Board; and
5. (e) such other persons as the Secretary of State may direct.
4. (4) Plans prepared under this section shall incorporate, so far as is relevant, any community care plans prepared under section 5A of the Social Work (Scotland) Act 1968 currently in force in their area.'.").

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

Baroness Carnegy of Lour

Scottish local authorities have pointed out to me that they are required to prepare and publish plans and consult the health boards, but that although the health boards are required to draw up plans for the Secretary of State's approval, they are not required to do so in relation to the Act. The Act does not require it. The health boards are not required to consult the local authorities when so doing. In view of what was said in the White Paper about planning agreements, this provision seems to local authorities to set about the matter in the wrong way. The amendment is an attempt to put that matter right. I shall be interested to hear what my noble friend has to say.

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

The noble Lord, Lord Carmichael, is quite right to stress the importance of health boards making community care plans which tie in with those which local authorities will be required to make under Clause 49. Planning for community care requires the close collaboration of all agencies concerned, and that is a matter fully recognised by the Government.

As Chapter 6 of the White Paper Caring for People makes clear, our current reforms place a strong emphasis on the need for health boards and local authorities to work together; for example, in ensuring that there is an effective primary and community health contribution to the development of individual community care packages.

Local authorities will be required to consult health boards and other bodies before drawing up their plans. The White Paper specifically states that local authorities must specify how they will co-ordinate their plans and activities with those of health authorities and other bodies. We shall require health boards to draw up their own community care plans. It might be helpful to the noble Lord and my noble friend if I read the appropriate extract from the White Paper: Health boards will be asked to draw up their own plans which will be agreed with the local authorities and other interested parties for the development of community care in their area. These plans will require to be submitted to the Scottish Office and progress will be monitored as part of the accountability review (part of the monitoring arrangements of the Scottish Home and Health Department) to ensure that adequate funds are being devoted to this". Paragraph 10.17 goes on to say: There will be a need for planning agreements between local authorities and health boards setting out shared assumptions and objectives as the basis of the community care plans of the health boards and the local authorities. The details will be the subject of further consultations". Given the Secretary of State's general powers to direct health boards under the National Health Service (Scotland) Act 1978, we are not convinced that it is appropriate to write the requirement for health boards to draw up community care plans onto the face of the Bill.

I am particularly unhappy with subsection (4) of the noble Lord's amendment which would require health boards to incorporate so far as is relevant the community care plans prepared by local authorities. I think that this could be unnecessarily prescriptive. It is one thing for different bodies to agree shared assumptions and objectives, as we intend, but quite another to incorporate one body's plans wholesale into those of another. I fear that this would undermine the flexibility which is essential to ensure the best possible collaboration between local authorities and health boards.

I do not believe that there is inconsistency in the approach that we are adopting because it allows for the fact—and this is very important—that the Secretary of State's relationship with health boards is quite different from his relationship with local authorities. I am sure that the noble Lord understands what I mean by that. I hope that with that explanation he will be able to study what I have said and conclude that what we intend is probably in line with what he seeks.

Lord Carmichael of Kelvingrove

Of course I shall study what the Minister said and I hope that he also will do me the courtesy of looking closely at my amendment proposing the new clause. Obviously my wording is more likely to be flawed than a provision drawn up by the Minister's experts, but even in the noble Lord's explanation he kept emphasising what the White Paper said. All things being equal, we take the provisions at their face value, but at the end of the day what worries us is that the provision could be challenged.

There could be a difference of opinion between the health board and the local authorities. According to my reading of the Bill and my information, the local authorities would have all the powers and would only need to consult the health boards. They have only to say that they have consulted the health boards.

Lord Sanderson of Bowden

Perhaps the noble Lord will permit me to intervene. That may seem so, but if our intentions are not fulfilled, then Clause 48 and the powers of the Secretary of State come into play.

Lord Carmichael of Kelvingrove

I accept the noble Lord's words and will examine them with great care. In the meantime, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 48 [Power of Secretary of State to give directions]:

Lord Carmichael of Kelvingrove moved Amendment No. 117ZB: Page 53, line 27, leave out ("directions") and insert ("general guidance").

The noble Lord said: In moving Amendment No. 117ZB it may be for the convenience of the Committee if I speak also to Amendment No. 117ABA. The purpose of Amendment No. 117ZB is that the clause unamended gives the Secretary of State very wide-ranging powers to issue specific directions to local authorities which hitherto they have not enjoyed.

Under Clause 48 the Secretary of State would have power to issue directions on all the social work functions of local authorities, including child care and assessment and not just community care as dealt with in Part IV of the Bill. There is the fear that a Secretary of State could privatise the health service simply by issuing directions under the terms of this clause. I am not of course suggesting that the present Secretary of State would do so, but the effects of legislation last for a long time. We believe that the present powers of the Secretary of State to issue general guidelines are adequate and that any extra power is unnecessary. I beg to move.

Baroness Carnegy of Lour

I am glad that the noble Lord has raised this matter because it is of concern to the Law Society of Scotland and to local authorities. It will be interesting to hear whether my noble friend considers that the new subsection to be inserted into the Social Work (Scotland) Act 1968 implies the wide powers that have been suggested. It is surely not the intention that the Secretary of State should be involved in, for example, child care, assessments and other social work services. That is not stated in the Bill. I look forward to hearing my noble friend's comments on that.

Lord Carmichael of Kelvingrove

I am grateful to the noble Baroness for her comments. When I introduced this amendment I linked it up with Amendment No. 117ABA. I should stress that the latter amendment is linked with this amendment. We believe that the Bill as it stands goes further down the road of promoting vague, enabling powers which concentrate powers in the hands of the Secretary of State without much chance of parliamentary review. The director of the King's Fund feels that that will be the case. I am sure the Minister is well aware of that body. The two amendments seem to me to address a good point. Like the noble Baroness, I am anxious to hear the Minister's reply.

Lord Sanderson of Bowden

I shall deal first with Amendment No. 117ZB. Throughout this Bill we have tried to strike a balance between delegation at local level and retention of necessary central controls By asking us to water down a direction-making power, the noble Lord, Lord Carmichael, seems to be suggesting that the Bill is too biased towards the centre.

Under the Bill and the White Paper Caring for People we are transferring major new responsibilities to local authorities for the development and operation of community care. It seems prudent to balance this shift of responsibility with the minimum necessary powers at central level to ensure that local authorities carry out their community care functions properly. It is for this reason that we are giving the Secretary of State general powers to direct local authorities on duties they carry out under the Social Work (Scotland) Act 1968 (which of course include the community care provisions that this Bill inserts into the 1968 Act).

The noble Lord said that directions could result in the privatisation of the health service. However, directions cannot override the principal legislation which imposes on the Secretary of State the duty of running the health service. The replacement of the word "directions" with the words "general guidance" and the removal of a local authority's duty to comply with directions would water down the general powers to the point that they would no longer be effective. I think that that would be wrong.

For a start the Secretary of State already has a power under Section 5 of the 1968 Social Work (Scotland) Act to issue local authorities with general guidance on their social work functions, and we will be using this power to give local authorities a wealth of guidance on the performance of their new community care responsibilities under this Bill. But general guidance, by definition, cannot be too specific. The great advantage of directions is that they can be tailor-made to individual circumstances and in particular allow the Secretary of State to step in when an individual authority appears to be falling down on very specific aspects of its duties; and of course directions, whether general or specific, carry a good deal more authority than guidance.

I see nothing unreasonable in giving the Secretary of State a power to direct local authorities in their community care functions. When we are dealing with the provision of services to the most vulnerable people in our society it surely makes sense to build in some statutory, central safeguards. Indeed, there is nothing new in what we are doing since the 1968 Act and related legislation, such as the Mental Health (Scotland) Act 1984, already contain direction-making powers as well as powers to make orders and regulations.

It was suggested that the directions under Clause 48 of the Bill could be used to privatise social work. That is not the case. The 1968 Act gives local authorities statutory social work duties and directions cannot override those.

Some anxieties have been expressed about this part of the Bill. I repeat to my noble friend Lady Carnegy of Lour—who expressed some concern about the powers of the Secretary of State —that as regards the Long Title of the Bill one of the objectives is to make further provision concerning the provision of accommodation and other welfare services by local authorities and the powers of the Secretary of State as respects the social services functions of such authorities. That puts the matter in perspective. I hope that the noble Lord will consider withdrawing his amendment.

10.30 p.m.

Baroness Carnegy of Lour

Perhaps I may advise my noble friend what the Law Society said and he can tell me whether he thinks it is right. The Law Society said that the clause is worded in such a way that the giving of directions by the Secretary of State applies to all the social work functions of the local authorities, including those not related to the provision of community care. Is he saying that there is nothing new in that because of the 1968 Act?

Lord Sanderson of Bowden

I did not say that. I repeated what my noble friend Lady Hooper said earlier regarding the English provisions and pointed out that the Bill makes it clear that there are powers in the Long Title to do such things as my noble friend has mentioned. The power exists on a wider scale than would have been the case previously.

Lord Carmichael of Kelvingrove

Again I am grateful to the noble Baroness, Lady Carnegy of Lour, for her questions. I had been convinced that the Minister was correct until the noble Baroness raised that point. I do not for a moment suggest that he was wrong, but perhaps it is a matter of interpretation. Our amendments originated largely with the Law Society. I shall withdraw the amendment but I hope that the Minister will accept that we may bring it back at a later date. In the meantime I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 117A, 117B and 117ABA not moved.]

Lord Carmichael of Kelvingrove moved Amendment No. 117BBA: Page 53, line 31, at end insert ("having regard to the national strategy for Scotland prepared under section (National strategy for local authority provision of communtiy care).").

The noble Lord said: It may be for the convenience of the Committee if Amendments Nos. 117BBA and 117CBA are taken together.

Lord Sanderson of Bowden

And also Amendment No. 118XA?

Lord Carmichael of Kelvingrove

Yes. In Clause 48 the Bill gives draconian new powers to the Secretary of State. In the past one of the greatest obstacles to the development of high quality community care in Scotland has been the failure of the Scottish Office to use the power of guidance which it already has. It could have used that power to guide social work and community care in Scotland much better than it has. For example, there are no national guidelines in existence for the registration of day care establishments. That means that local authorities work in a vacuum trying to set their own standards for such establishments.

In Wales the all-Wales strategy on mental health has given impetus to community care, but Scotland has not chosen to follow that example. The problem will become even more acute because developments such as case management, assessment of needs and so on will require monitoring and the propagation of good practice.

In the English context, Ministers have repeatedly assured Parliament that the proposal will not require additional legislative safeguards because of the role of the Social Services Inspectorate. In Scotland there is no Social Services Inspectorate. The Government must explain what they propose as an alternative.

The precedents for the requirement in Amendment No. 118XA are Sections 17 (2) and 18 (3) of the Chronically Sick and Disabled Persons Act 1970 and Section 11 of the Disabled Persons (Services, Consultation and Representation) Act 1986 about which we spoke last week. In England and Northern Ireland, there are social services inspectorates and in Wales the social workers' service has recently been renamed the Social Services Inspectorate to reflect the strengthening of commitment to quality assurance.

If the clause is accepted, it will provide an opportunity to ask the Scottish Office Minister why there appear to be no proposals to strengthen the role of the social work services group in view of the powers provided by Clause 48 and developments in the rest of the UK.

My suggestions are self-explanatory and I hope that the Minister will be able to help me. I beg to move.

Lord Sanderson of Bowden

We already have a national strategy and statement of objectives for the provision of community care in Scotland and it is detailed in the White Paper Caring for People, much of which is now being enacted through this Bill. As the noble Lord knows, the key part of our strategy, as recommended by Sir Roy Griffiths, is to place the responsibility for community care with local authorities. It is clearly they who are best placed to determine the needs and priorities for community care in their own areas and they will be required to produce detailed community care plans in consultation with health boards and other interested parties. Thus all over Scotland plans will be developed for meeting the care needs of vulnerable people which are fully adapted to local circumstances.

I see no need for the kind of national community care strategy proposed in Amendment No. 117CBA. At best, it would be a wasteful duplication by central government of work already being done at local level. At worst it would represent an inappropriate degree of central control and involvement in community care planning which could serve merely to undermine and frustrate the efforts of local authorities.

I am not suggesting there should be no central control in that important field. We are already providing for that. The Scottish Office will be monitoring community care plans and the progress made in implementing them and wherever it appears that local authorities are falling down on their community care duties the Secretary of State will be able to step in with his direction-making powers under Clause 48 to which we have referred on many occasions.

I see similar objections to Amendment No. 118XA which calls for the Secretary of State to produce an annual statement of objectives for the development of community care. Community care plans will be public documents and it will be quite clear how services are being developed to address assessed needs. The Scottish Office will monitor the plans and the progress in implementing them. The noble Lord believes that the Secretary of State should state specific objectives because, if the objectives were too general, they would be of limited value. However, I believe that specific objectives would represent a derogation from the local authorities' responsibilities.

The second part of Amendment No. 118XA calls' for annual reports on progress. Numerous statistical bulletins are already produced giving a wide range of information. That includes the numbers of people discharged from hospital, the number of mentally handicapped, mentally ill and elderly persons in residential care in the community and the availability of day services.

I am sure that further reports are not the answer, although I believe that it should be possible to look again at the way in which the statistics are collected and published with the objective of making improvements. Such work is already in hand within the Scottish Office. I want to have a look and see what is happening south of the Border, particularly as the noble Lord mentioned Wales. But I do not feel that the answer lies in what he suggests.

Lord Carmichael of Kelvingrove

I am very grateful that the Minister will look south of the Border. Having been very active in many ways during the passage of the 1968 Social Work (Scotland) Act, I firmly believe that we set a standard which was copied, or was attempted to be copied, down south. But as always happens, people leap ahead. The more one looks around the world, and in particular at our own country of Britain, the more one realises that there is never one group which makes smooth progress all the time.

The Minister suggested that he did not like the idea that the Secretary of State should have specific objectives. There is probably something in that. The idea of having too rigid a framework is bad, but there would certainly be no harm in having guidelines, as we discussed earlier. However, I am grateful to the Minister for the care that he has taken and beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 48 agreed to.

[Amendment No. 117CBA not moved.]

Clause 51 agreed to.

Clause 55 [Power of Secretary of State to make grants]:

Lord Carmichael of Kelvingrove moved Amendment No. 117 BA: Page 57, line 44, leave out ("may") and insert ("shall").

The noble Lord said: It may be for the convenience of the Committee if we discuss Amendments Nos. 117BA, 117BB and 117BC together. Amendment No. 117BA ensures that it is the duty of the Secretary of State to make grants to local authorities in respect of their functions under Part II of the National Health Service and Community Care Act, Section 27 of the National Health Service (Scotland) Act 1947 and Sections 7 and 8 of the Mental Health (Scotland) Act 1984.

As has been said, Amendment No. 117BB requires that a role is identified for the Scottish Office ensuring the transfer of funds from health boards to local authorities. Officials from the social work services group have stated that these grants will be top sliced—an interesting term—from the local authorities' revenue support grants. Therefore, the financial incentive for local authorities to develop community care services for mentally ill people will only be at the expense of other local authority services. No role is identified for the Scottish Office in ensuring the transfer of funds from health boards to local authorities. Indeed, it seems that the Scottish Office may be giving up some control to the Treasury. It has been suggested that in the past the Scottish Office could allocate its own budget as it saw fit and could have made significant grants to mental health projects without the need for new legislation.

The final amendment in this group calls for: after ('Parliament') insert ('in addition to that made available under the Revenue Support Grant').

Unlike for England, in Chapter Four, at page 35 of the White Paper, the contribution of resources transfer from the health boards to local authorities receives no mention in the Scottish chapter. Yet it remains fundamental to the achievement of this aspect of community care. The National Health Service changes proposed in the Bill may exert greater pressure for the resources released from long-stay hospitals to be retained and diverted elsewhere within the health boards. There is no legal obstacle to having an English equivalent of the dowries in Scotland.

Without resources transfer, the burden of paying for care will have to be shouldered by local authorities and communities. Long stay hospital discharge programmes should not be subsidised out of the care element except on a temporary bridging basis. There is concern that the specific grant for mental health will be top sliced from existing local authority expenditure and will be project led and that unlike England it will be eligible in cases of hospital discharge but without contribution from the National Health Service.

The Minister will realise that it is an extremely important group of amendments about which CoSLA and other bodies in Scotland are very concerned. His reply will be awaited with very great interest. I beg to move.

10.45 p.m.

Lord Sanderson of Bowden

On the first amendment, the Government are firmly committed to giving grants towards local authorities' expenses on developing services for mentally ill people. The White Paper Caring for People, in paragraph 7.15 makes it quite clear that specific grants will be available for this group. There is no question whatsoever of this Government resiling from that commitment, subject to parliamentary approval of the Bill. But that does not mean that these grants will necessarily be a permanent feature. The White Paper makes it clear that the reason why grant aid is proposed for services for mentally ill people but not for other groups is that local authorities generally have not been able to give as much priority to providing services to those with mental illness as to other vulnerable groups.

I am sure that we all hope that, with the help of this grant scheme, local authorities will find it possible to increase the resources that they devote to this important group of people. When that aim is achieved and services for mentally ill people are brought up to a suitable standard, we would, as our consultation paper about the grant has made clear, consult local authorities on how the newly created facilities could be funded in the same way as other parts of the social work programme.

That is why I cannot agree this amendment, not because the noble Lord's approach differs from ours in the foreseeable future but because I believe that the amendment would fossilise the system for all time by removing the Secretary of State's discretion.

On Amendment No. 117BB, I do not think I need take too long in talking to somebody who has been a Minister in government about the powers of the Treasury. There are sound and important reasons of financial management why the Treasury must act as a central controller of the Government's purse strings; otherwise the important economic objectives of any government would be jeopardised.

However, the very important amendment, Amendment No. 117BC—I am not at all surprised that the noble Lord emphasised its importance—raises the most interesting question. I hope that he will forgive me if I deal with it at some length.

I can well understand the noble Lord's concern that grants made under Clause 55 should be new money rather than being diverted from existing resources. That is not, however, the kind of matter that is properly dealt with in primary legislation. Nor does the proposed amendment fairly reflect the arrangements for providing support to local authorities. It may be helpful if I explain to the Committee how these operate.

From this financial year a wide range of specific grants come within an umbrella of central government support for local authorities. This is known as aggregate external finance and in addition to specific grants of the kind envisaged by Clause 55 it includes revenue support grant and non-domestic rate income. The Government obviously have to reach a view each year on the size of the aggregate Exchequer finance. That assessment takes due account of any changes in policy and responsibilities. It is then a matter of deciding how much of that total amount is to be available to authorities in the various ways through the mechanism of specific grants and support of particular policies or through the revenue support grant or non-domestic rate income.

In the way the system operates the more that is to be provided through specific grants the less there is available for revenue support grant. But the choice between specific grant or revenue support grant as a mechanism for payment is less important than making sure that the total settlement responds fairly to new policies and responsibilities. I am sure the noble Lord knows what I mean by that.

The Committee should also bear in mind that at present the revenue support grant already takes account of local authority expenditure on services for mentally ill people. A new specific grant will provide a better means of targeting available resources.

Central government support for local authorities is a matter on which my right honourable friend the Secretary of State for Scotland holds regular discussions with CoSLA. Members of the Committee can therefore be assured that the local authorities' new responsibilities are being borne in mind and that due account will be taken of them when we decide on the total size of the aggregate external finance settlement. This will include the arrangements for the mental illness specific grant.

I hope that, in the light of that explanation, the noble Lord will understand the difficulties I have, particularly with his last amendment. He said that the Scottish Office could formerly have made grants and that the Treasury is now shackling us. No, the Secretary of State needs specific powers to make grants. The Treasury is simply there as the final arbiter in the totality of the public expenditure round. I am sure that the noble Lord has had experience of that as have I.

As regards the transfer of funds from health boards to local authorities, the Secretary of State can do that within his block if he thinks fit. Nothing in the Bill alters that. As the noble Lord has recognised, Scottish health boards can pay dowries when patients are discharged from hospital. We believe that there is enough flexibility within the system.

The subject of dowries was raised earlier by the noble and learned Lord, Lord McCluskey. There is nothing to prevent them being paid. However, we do not claim that the system is used universally in England and Wales. It is a possible solution to some problems but it is not ruled out in a Scottish context.

Finally, as regards the development of community care specific grant on mental illness, the consultation period has recently concluded. We have received a considerable number of replies and we are satisfied with them. We shall be studying the document closely and hope to present the Government's views on it during the summer. We hope that it will be well in place for implementation by 1st April, 1991.

Lord Carmichael of Kelvingrove

The Minister gave a most helpful reply. I was pleased that he realised that the points I raised are causing considerable anxiety in certain areas in Scotland. I shall take care in reading his reply and obtaining advice. Bearing in mind that his was the nicest and most innocuous description of the Treasury I have heard, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 117BB and 117BC not moved.]

Lord Sanderson of Bowden moved Amendment No. 117BD: Page 58, leave out from beginning of line 1 to ("and") in line 2.

The noble Lord said: This is a small technical amendment. As originally introduced in another place, the clause dealing with community care plans—now Clause 49—contains a definition of community care services. It included a reference to part of Section 27 of the National Health Service (Scotland) Act 1947. The provision deals with the aftercare duties of local authorities and health boards in relation to persons who have been discharged from hospital. Most of the rest of the 1947 Act has long since been repealed.

In order to simplify the statutory provisions on social work services generally, the draftsmen of the present Bill decided to provide for the repeal of the residual social work provisions of the 1947 Act and their re-enactment within the Social Work (Scotland) Act 1968 along with the other provisions relating to community care. That is achieved in the second half of Clause 53, which includes the relevant part of Section 27 as a new Section 13 (b) in the 1968 Act. Section 27 having thus been dispensed with in its original form, the reference to it in the definition of community care services is redundant and requires to be removed. I beg to move.

On Question, amendment agreed to.

[Amendment No. 117C not moved]

Clause 55, as amended, agreed to.

Baroness Faithfull moved Amendment No. 118:

After Clause 55, insert the following new clause—

("Specific needs of elderly and disabled persons.

In exercising their functions under sections 40 to 55 of this Act, local authorities shall take special measures to attend to the needs of any person who is suffering from grave chronic disease and who, by reason of age, illness or disability, is living in conditions which in the opinion of a court give rise to an immediate and serious risk to the life and safety of that person.")

The noble Baroness said: All amendments are important but I am sad that this very important amendment is being discussed at 11 o'clock in the evening. I move it on behalf of Age Concern and, in doing so, I pay tribute to the work of Age Concern, which does outstanding work with regard to the care and welfare of the elderly.

There are three points to stress in speaking to this amendment. First, existing legislative provision to protect vulnerable adults is inadequate. The mental health Acts do not cover everyone who can be described as vulnerable. For example, they do not extend to those suffering from early signs of dementia. The only other provision—namely, Section 47 of the National Assistance Act —is highly unsatisfactory.

Secondly, at present the Bill contains no measures which will ensure that local authorities step in in emergency cases when people are at grave risk. Thirdly, the amendment should not place an undue burden on local authorities as it leaves them free to develop their own procedures.

As I said earlier, there is a gap not covered by the mental health Acts or Section 47 of the National Assistance Act. I quote from personal experience. When I was a director of social services I arrived home one evening and opened the evening paper to see an article entitled, "Director of Social Services allows old lady to die". I immediately looked into the matter. I found that the old lady had not been out for weeks, she would not allow anybody into the house and no one had right of entry. Gradually she became weaker and weaker. Health visitors, doctors and social workers were not admitted and ultimately the old lady died.

I quote a second case. A doctor telephoned me about an old man suffering from hypothermia. We sent in a social worker who lit the gas fire, took him hot soup and stayed with him for an hour or two. She went away and returned two hours later. The moment she went out of the door, he hopped out of bed, switched off the gas fire and refused to drink the soup. The doctor telephoned again to say that he was suffering from hypothermia. Those are two cases of vulnerable people who are not covered by mental health legislation. However, at the same time they deteriorate and eventually they die. There is no way in which the social services, medical people or health visitors can help.

Therefore, in this amendment we recommend that there should be a general power to promote the welfare of old people. Also, we recommend that there should be a new duty. At present local authorities have no specific duty to investigate complaints, to respond to requests for help, to support elderly people or their carers or to conduct assessments.

An assessment of the needs of a particular person followed by a notification to the individual concerned of the steps to be taken to meet those needs and the obtaining of his or her consent is essential. However, there also needs to be the introduction of the concept of an intervention order if the local authority refuses to consider needs or to act upon the assessment. That would provide a means of appealing against a local authority which has failed to fulfil its duties. There should be emergency powers, including the replacement or repeal of Section 47 of the National Assistance Act.

There was a report entitled The Law and Vulnerable Elderly People and those recommendations were made in that report. I press my noble friend to consider this amendment carefully. It is of vital importance to the people concerned, to the social workers dealing with the case and to the community. It could be said that, if someone will not co-operate and he does not fall under the mental health or national assistance Acts, he has a death wish and we must leave people to live the lives which they wish to lead. However, when it has been possible to enter premises, perhaps with a relative, or possible to support the person concerned, there have been cases where such people have lived afterwards and have been happy and supported.

The amendment concerns a very serious problem.

I beg to move.

11 p.m.

Lord Carter

I am extremely pleased from these Benches to support this important amendment. It is a shame that it had to come on so late at night. I also endorse the words of the noble Baroness, Lady Faithfull, concerning the work done by Age Concern.

I agree with the noble Baroness regarding the operation of Section 47 of the National Assistance Act 1948. My wife, as a magistrate, has been involved in a number of those cases. I was struck by the clumsiness of the procedure and the way that it does not meet all the requirements, particularly the requirements for an emergency procedure when there is an old, vulnerable or disabled person at risk. The Government should either accept this amendment, or bring forward their own amendment to deal with this serious situation.

Baroness Hooper

I recognise that similar powers already exist in Section 47 of the National Assistance Act 1948, and also in the provisions of the Mental Health (Scotland) Act 1984. My noble friend Lady Faithfull considers that the power to remove to another place on the order of a court is not sufficient. However, there are a number of difficulties regarding the proposal before us.

In the first place, the local authority's duty would be to attend to the person's needs, irrespective of whether the person is able or willing to consent to the meeting of those needs. It may well be that the local authority will decide that the needs in question can only be met by removal of the person from the place where he is living. But the local authority's power to remove the person would be dependent on the order of a court on application under the 1948 provisions referred to. The local authority's duty under the amendment (as distinct from its power under the existing 1948 Act provision) could therefore only relate to the provision of services which the person could receive in the place where he or she was already living.

Given that limitation, it is hard to see what purpose the clause would serve, beyond that of the assessment provision already contained in Clause 52 of the Bill. Under that provision the local authority, finding a person living in a situation of the kind described so ably by my noble friend and which gives rise to concern, would be under a duty to assess the needs of the person for any community care services. It would be under a further duty to decide what services it should provide. One consideration in that connection would clearly be the willingness of the person to accept any offer of residential accommodation that might be made available to him.

The only advance which the amendment would provide on the position provided by Clause 52 would be to require the local authority to provide a service on the premises whether or not the person wanted it. However, there seems to be no benefit in giving the local authority a duty to provide such services unless the nature of the particular service can be specified in advance.

If, contrary to the effect of the new clause as drafted, the objective is to provide local authorities with a power to remove individuals from their homes for their protection from risk to life or safety, then I have to say that the clause could not readily be re-drafted to secure that result. Certification of risk to a person's life or health by a medical practitioner under the existing 1948 Act provision continues to provide, in our view, the most appropriate way of enforcing what amounts to eviction of a person from his or her home in order to be treated in the way that the statutory authorities perceive to be necessary in his or her interests. We do not consider that it is necessary or desirable to give local authorities powers of removal at their own hand in order to provide services which they feel the person requires but cannot or will not receive in his or her home.

This is a difficult situation and we must all recognise that. However, I can give a clear assurance that the Government are very much alive to the need to ensure safeguards for the protection of people, whether or not of mature years, who are plainly unable to look after themselves, but we see great difficulty in dealing with this by going further than existing legislation or the provisions in the Bill.

My noble friend referred to the suggestion in Age Concern's report on law and vulnerable elderly people. As my noble friend will know, we have given careful consideration to the proposals in the report, but we do not feel that legalistic devices such as the intervention order proposed are the right way to tackle these problems. Social services are needed which are more sensitive to individual needs. That is the thrust of the community care proposals and what we aim to achieve. On that basis, and recognising the importance of this subject, I hope that my noble friend will feel able to withdraw her amendment.

Baroness Faithfull

I thank my noble friend the Minister for her reply. Clearly the social services departments will attempt to give every possible service to the person concerned in his or her own home. The forcible removal of a person would be only a last resort.

However, the practical outcome of my noble friend's reply is that social services ultimately will let someone die. While that has to be faced, it is nevertheless unpalatable. Equally, dealing with such a situation is also unpalatable. Therefore, which of the two unpalatable lines does one take? It is hard for a director of social services to see in a local paper that she has allowed someone to die. I realise that if someone wants to die it is fair to say, I suppose, that he or she should be allowed to do so. However, the fact is that many people are assisted and subsequently live a happy life for several years.

I recognise the difficulty of my noble friend the Minister in making legislation to cover such cases, but I still feel that something could be done. It should be possible to have a right of entry in extreme cases—and only in extreme cases—to remove a person to a place of care. However, at this time of night I should like to consider what has been said by my noble friend, to discuss the matter with Age Concern and come back at Report stage. In the meantime, I withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 118XA not moved.]

[Amendment No. 118YA had been withdrawn from the Marshalled List.]

Clause 56 agreed to.

Clause 57 [Removal of Crown immunities]:

Lord Henley moved Amendment No. 118YB: Page 59, line 24, at end isnert— ("(3A) Nothing in subsection (1) above affects the extent of the expression "the services of Crown" where it appears in —

1. (a) Schedule 1 to the Registered Designs Act 1949 (provisions as to the use of registered designs for the services of the Crown etc.); and
2. (b) sections 55 to 59 of the Patents Act 1977 (use of patented inventions for services of the Crown);

and, accordingly, services provided in pursuance of any power or duty of the Secretary of State under Part I of the National Health Service Act 1977 or Part I or Part III of the National Health Service (Scotland) Act 1978 shall continue to be regarded as included in that expression, whether the services are in fact provided by a health service body, a National Health Service trust or any other person.")

The noble Lord said: In moving this amendment I shall also speak to Amendment No. 118ZAA. The removal of Crown immunity from the NHS has been widely welcomed as a positive move designed to enhance patient care by ensuring that statutory standards are clearly applicable and enforceable across the NHS. It is standards of patient care and staff welfare which are the essential object of this clause. However, Crown immunity is a complex subject, the removal of which has thrown up a number of unintended consequences which might for one reason or another work against the provision of better patient care. The clause has therefore been drafted to cover a number of areas where simple abolition would or could cost the NHS money without bringing any benefits to patients or staff.

One such area is the use of registered designs copyright or patent material. Legislation covering these areas has consistently recognised the value to the general public of maintaining a Crown or public service exemption for use of such material without the permission of the owner of the intellectual property in the material. These provisions are used sparingly. But on occasions the public interest in patient care is best served by invoking them. There was, for example, a recent case relating to lithotripter machines, where, without use of these powers, NHS patients, would have been deprived of the benefit of this equipment pending the outcome of litigation relating to the patents in the equipment.

These provisions do not allow the Crown simply to use others' ideas without payment. When these powers in relation to the use of patents and registered designs are invoked there is provision for compensation of the owner of the intellectual property. In the case of copyright the power is not a wide one and is indeed one of many cases where use can be made of copyright material without infringement.

Any diversion of effort or funds from patient care which does not bring an offsetting benefit in the form of higher standards is to be avoided. The public interest in patient care will remain even when Crown immunity has in general been removed from the NHS. I commend this amendment to the Committee. I beg to move.

On Question, amendment agreed to.

Lord Sanderson of Bowden moved Amendment No. 118ZA: Page 59, line 35, after ("Board") insert ("or Special Health Board").

The noble Lord said: In moving this amendment I shall also speak to Amendment No. 118AA. The two amendments insert the new special health boards in the list of health service bodies in Clauses 57 and 58. This means that special health boards will be treated in exactly the same way as ordinary health boards; they will not generally benefit from Crown immunity but they will be exempt from certain taxation. I beg to move.

On Question, amendment agreed to.

Clause 57, as amended, agreed to.

Schedule 8 [Provisions arising out of removal of Crown immunities from health service bodies]:

Lord Henley moved Amendment No. 118ZAA: Page 89, line 34, at end insert —

("The Copyright, Designs and Patents Act 1988

. At the end of section 48 of the Copyright, Designs and Patents Act 1988 (material communicated to the Crown in the course of public business) there shall be added the following subsection —

"(6) In this section "the Crown" includes a health service body, as defined in section 57 (6) of the National Health Service and Community Care Act 1990, and a National Health Service trust established under Part 1 of that Act or the National Health Service (Scotland) Act 1978; and the reference in subsection (1) above to public business shall be construed accordingly. "").

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

On Question, amendment agreed to.

Lord Sanderson of Bowden moved Amendment No. 118ZB: Page 90, line 2, at end insert—

("The Acquisition of Land (Authorisation Procedure) (Scotland) Act 1947

. In the First Schedule to the Acquisition of Land (Authorisation Procedure) (Scotland) Act 1947 (procedure for authorising compulsory purchases), after paragraph 10 there shall be inserted the following paragraph—

"10A. In paragraphs 9 and 10 of this Schedule "statutory undertakers" include —

1. (a) a health service body, as defined in section 57 (6) of the National Health Service and Community Care Act 1990; and
2. (b) a National Health Service trust established under Part I of that Act or the National Health Service (Scotland) Act 1978;

but in relation to a health service body, as so defined, any reference in those paragraphs to land acquired or available for acquisition by the statutory undertakers shall be construed as a reference to land acquired or available for use by the Secretary of State for use or occupation by that body. ".")

The noble Lord said: In moving this amendment I shall speak also to Amendment No. 118A. Schedule 8 to the Bill deals with the removal of Crown immunity from the health service. There is widespread support for this move designed to make it a statutory requirement that the highest standards are maintained within the NHS for the benefit of patients and staff. The removal of Crown immunity has, however, other consequences less beneficial to the NHS. These amendments seek to deal with one such consequence.

Present National Health Service land is Crown property and no-one can compulsorily purchase it. Any acquisition of National Health Service land must be with the consent of the owner, normally the Secretary of State, who will consider carefully the impact of the proposal on the services for patients and the welfare of staff.

However, removing Crown immunity removes this protection. Therefore, the amendment ensures that the land of health service bodies including health authorities, health boards and National Health Service trusts gets the same protection against compulsory purchase as the land of statutory undertakers such as British Telecom and British Gas. I beg to move.

On Question, amendment agreed to.

11.15 p.m.

Lord Sanderson of Bowden moved Amendment No. 118A: Page 90, line 29, at end insert:

("The Acquisition of Land Act 1981.

—(1) At the end of section 16 of the Acquisition of Land Act 1981 (statutory undertakers' land excluded from compulsory purchase) there shall be added the following subsection —"

(3) In the preceding provisions of this section "statutory undertakers" include —

1. (a) a health service body, as defined in section 57 (6) of the National Health Service and Community Care Act 1990; and
2. (b) a National Health Service trust established under Part 1 of that Act or the National Health Service (Scotland) Act 1978

but in relation to a health service body, as so defined, any reference in those provisions to land acquired or available for acquisition by the statutory undertakers shall be construed as a reference to land acquired or available for acquisition by the Secretary of State for use or occupation by that body".

(2) In section 17 of that Act (local authority and statutory undertakers' land) at the end of subsection (2) there shall be inserted the following subsection—

" (2A) Subsection (3) of section 16 above applies in relation to subsections (1) and (2) above as it applies in relation to the preceding provisions of that section. "").

On Question, amendment agreed to.

Schedule 8, as amended, agreed to.

Clause 58 [Health service bodies: taxation):

Lord Sanderson of Bowden moved Amendment No. 118AA: Page 60, line 18, after ("Board") insert ("or Special Health Board").

The noble Lord said: This amendment has already been spoken to. I beg to move.

On Question, amendment agreed to.

Clause 58, as amended, agreed to.

Clauses 59 and 60 agreed to.

Clause 61 [Regulations, orders and directions:

Lord Carter moved Amendment No. 118AB: Page 61, line 35, after ("and") insert ("subject to subsection (A2) below").

The noble Lord said: In moving this amendment I should like, with leave of the Committee, to speak also to Amendment No. 118BA. These amendments deal with a specific concern relating to the very wide enabling powers in the Bill. As the Bill stands, it would confer these wide powers on the Secretary of State once the legislation is enacted. In debates on previous amendments we have discussed the various aspects of these powers.

As we know, it would be possible for the Secretary of State to bring in new orders and regulations which would be subject only to the negative resolution procedure. Thus they could escape the full scrutiny of Parliament. Therefore, we feel strongly that Clause 61 of the Bill should be amended to ensure that wherever appropriate, especially where patient care may be affected, new regulations should be subject to the affirmative resolution procedure.

We have had this discussion on many occasions regarding previous enactments. I hope that when the Minister replies there will be something better than the usual government arguments, which, however well phrased, always amount to an attempt to convince the Committee that a diktat by any other name smells as sweet. I beg to move.

Baroness Hooper

The clauses on fund-holding practices and indicative prescribing budgets to which these amendments relate lay down the principles of these two new schemes and put in place a clear-cut framework for their implementation. It is only right that this should be so. Parliament must have an opportunity to debate and approve the principles, and the people who will have to carry through these proposals want to see the framework properly spelt out.

The noble Lord, Lord Carter, pointed out that the clauses already contain a number of regulation-making powers. They provide the flexibility which is needed for the schemes to develop in an evolutionary way—by responding to new circumstances and learning from experience. It is also consistent with the legislative basis of the National Health Service since its inception; for example, on the GP services where regulations spell out all the detailed arrangements. Over the years this has been accepted as the right approach. It has prevented primary legislation in this area from growing into a labyrinth which is especially inappropriate for a national service for which a Secretary of State is fully accountable to Parliament.

I believe that Parliament should concentrate on the principles, clearly define the scope of any delegation and hold Ministers to account for the exercise of their powers. I am sure that it will continue to do so. It should keep its eye on the ball and not become bogged down in a morass of legislative detail.

It is for similar reasons that I cannot agree to the noble Lord's proposition that we should use the affirmative resolution procedure for these regulations.

Essentially the regulations concern the implementation and administration of the schemes founded on the primary legislation. It is hardly sensible to delegate those detailed matters to Ministers on the one hand and on the other to pull them back into the parliamentary arena by requiring debates and resolutions, not just at the outset but on each and every occasion on which adjustments are made. The principles will already have been subject to the full debate and approval of Parliament. I doubt whether a repeat performance each and every time that regulations are made would necessarily be of great benefit to anyone.

Of course I recognise that Members of this place will take a keen interest in the development of fund-holding and prescribing budgets and may on occasion want to challenge what is proposed. That would not be out of character. There is already provision for that to be done in a way which is more clearly focused than the way suggested by the amendments. Each statutory instrument will be laid before both Houses of Parliament and be subject to the negative procedure. I suspect that noble Lords opposite will not hesitate to press for a debate if they want to question any of our regulations and consider the matter of sufficient importance to occupy the attention of this place.

In addition, the Committee will be aware that the procedures of this place provide a number of other ways in which the Government can be held to account The joint committee will, as ever, take care to ensure that we have made proper use of the powers that Parliament has given us. I hope that the noble Lord understands our views and will feel able to withdraw his amendment.

Lord Peston

I should perhaps preface my question by saying that I am not against indicative drug budgets because they seem to be a broadly sensible way of approaching the problem of prescribing. Is the Minister saying that in the Government's view we have debated the matter sufficiently and that no case can be made for having the affirmative procedure? As I understand it—I remain a tyro in these matters—whether it is the affirmative or negative procedure does not affect what happens in this place, but it may affect what happens in the other place. Is the Minister saying that we have explored these drug budgets in so much detail, and that the remaining details are so uncontroversial that the affirmative procedure would not be relevant to the other place? I am sure that my noble friend Lord Carter has the same view: I am not seeking to undermine or wreck the Bill with this proposal, but there are certain matters about which people who are affected—the pharmaceutical companies are a good example—are to say the least a trifle doubtful. Does the Minister intend to be as definite in her answer as she sounded?

I well understand what the Minister is saying. Will she indicate the possibility at least of some flexibility? I am not intervening because I am against some of the things that the Government want to do. On a subsequent occasion there might be more to be said and so the affirmative procedure might be appropriate. I merely ask the question.

Baroness Hooper

The principles of the matters will have been subject to full debate by the time the Bill, eventually as we hope, receives Royal Assent. I am informed that there has been ample opportunity to debate these procedures, because over 1,000 amendments have so far been debated in both places. My point is that the negative procedure permits a debate in both places. However, to require this in each and every case as the amendment suggests would be a little too much.

Lord Carter

When I moved the amendment, I said that I expected the Minister to produce the usual arguments. She did not disappoint me.

Baroness Hooper

If the noble Lord will give way, I have to say that if the same amendments are tabled, then he is bound to receive the same answers.

Lord Carter

Exactly. At this stage of proceedings we shall reserve the right to come back because it is an important matter. However, for the time being I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 118B and 118BA not moved.]

Clauses 61 and 62 agreed to.

Schedule 9 [Minor and Consequential Amendments]:

Baroness Blatch moved Amendment No. 118BB: Page 99, line 3, after ("committee)") insert ("(a)").

The noble Baroness said: In approving Amendment No. 115FC and agreeing that Clause 47 as amended by the Committee should stand part of the Bill, your Lordships added to the additions to the Local Authority Social Services Act 1970 set out in that clause a new section requiring local authorities if so ordered by the Secretary of State to establish a complaints procedure. The effect of these amendments, Nos. 118BB, 118BC and 118BD, is to add that procedure to Schedule 1 to the 1970 Act. Not only will this make it a function of the local authority's social services committee, it will also mean that in exercising its functions the authority will have to have regard to any general guidance issued by the Secretary of State under Section 7 to the 1970 Act. When Clause 47 becomes law, the local authority will have to observe any directions given by the Secretary of State under Section 7A of the same Act, and the Secretary of State's powers to hold enquiries (Section 7B) and to take special action in cases of default (Section 7C) will also apply to it. I so move.

On Question, amendment agreed to.

Baroness Blatch moved Amendments Nos. 118BC and 118BD en bloc: Page 99, line 5, after ("trusts"") insert: ("(b) in the first column, for the words "Section 6 of this Act" there shall be substituted "Sections 6 and 7AA of this Act""). Page 99, line 5, after ("and") insert ("(c)").

On Question, amendments agreed to.

Lord Sanderson of Bowden moved Amendment No. 118C: Page 99, line 28, at end insert:

("The Criminal Procedure (Scotland) Act 1975

13A. In section 462 (interpretation) of the Criminal Procedure (Scotland) Act 1975, in paragraph (a) of the definition of "hospital", after the words "Secretary of State" there shall be inserted the words "or in a National Health Service trust".").

The noble Lord said: I beg to move Amendment No. 118C and speak to Amendment No. 118E. These two amendments make minor changes to existing legislation consequential on the setting up of National Health Service trusts. I beg to move.

On Question, amendment agreed to.

Baroness Blatch moved Amendment No. 118CA: Page 100, line 39, at end insert: ("(8A) At the end of section 103 of that Act (special arrangement as to payment of remuneration) there shall be inserted the following subsection — (3) If the Secretary of State by order so provides with respect to remuneration in respect of such pharmaceutical services as may be specified in the order, —

1. (a) an NHS trust determined in accordance with the order shall have the function of paying sums so determined to the Family Health Services Authority which, under Part II of this Act, has the function of paying that remuneration; and
2. (b) nothing in subsection (2) above shall apply with respect to that remuneration. "").

The noble Baroness said: It is not uncommon for a hospital doctor to issue a prescription to a patient when he or she leaves hospital and for that prescription to be dispensed by the patient's local pharmacist rather than by the hospital pharmacy. In such cases, at present, the pharmacist recovers the cost of dispensing the prescription from the Family Practitioner Committee and the health authority reimburses the Family Practitioner Committee for the cost. Health authorities have been given the function of meeting these costs by an order made under Section 103 of the 1977 Act.

In future it is likely that doctors working in NHS trusts will similarly issue prescriptions which are dispensed by a local pharmacist and this amendment will allow the Secretary of State to make an order giving relevant trusts the function of reimbursing the FHSA, as it will then be, for the costs of dispensing such prescriptions. The trust itself will recover the costs incurred from health authorities through National Health Service contracts. With that explanation I commend these amendments to the Committee. I beg to move.

On Question, amendment agreed to.

Lord Henley moved Amendment No. 118CB: Page 100, line 45, at end insert: ("() In section 122 of that Act (recovery of charges), in subsection (1) after the words "this Act", in the second place where they occur, there shall be inserted "or Part I of the National Health Service and Community Care Act 1990".").

The noble Lord said: This technical amendment will ensure that National Health Service trusts, like health authorities, will be able to recover any sums they are owed in respect of such charges summarily as a civil debt. I commend the amendment to the Committee and beg to move.

On Question, amendment agreed to.

Lord Sanderson of Bowden moved Amendment No. 118D: Page 101, line 24, at end insert — ("(1A) In subsection (5) of section 11 (Scottish Hospital Trust) of that Act, after the words "and shall cause" there shall be inserted the words "such accounts to be audited and".").

The noble Lord said: This amendment has already been spoken to. I beg to move.

On Question, amendment agreed to.

Lord Sanderson of Bowden moved Amendment No. 118DZA: Page 103, line 49, at end insert: ("(19A) In section 110 of that Act (citation, extent and commencement)—

1. (a) in subsection (2), for the words "subsection (3) " there shall be substituted "subsections (2A) and (3)"; and
2. (b) after subsection (2) there shall be inserted—

("(2A) Section 87B (3) extends also to England and Wales. ".").

The noble Lord said: I am indebted to my noble friend Lord Balfour for drawing this matter to our attention. The amendment amends the extent section of the National Health Service (Scotland) Act 1978 to allow new Section 87B (3) which is inserted into the 1978 Act by Clause 33 of the Bill to extend to England and Wales. The 1978 Act generally extends only to Scotland. I beg to move.

On Question, amendment agreed to.

[Amendment No. 118DA had been withdrawn from the Marshalled List.]

Baroness Hooper moved Amendment No. 118DAA: Page 105, line 20, after ("(4)") insert ("after the word "exercised" there shall be inserted "subject to subsection (5) below" and").

The noble Baroness said: In moving this amendment I wish to speak also to Amendment No. 118DAB. These amendments simply preserve the existing provision for appeals to the hospital managers by patients detained under the Mental Health Act 1983 to be considered by people who have not been involved in their care and treatment.

The Act provides for these appeals to be heard by members. With the advent of executive members and directors we need to make it clear that employees should not be involved whether or not they have been directly involved in the case. This is an important safeguard which I hope will commend itself to the Committee. I beg to move.

On Question, amendment agreed to.

Baroness Hooper moved Amendment No. 118DAB: Page 105, line 21, at end insert ("and (c) after subsection (4) there shall be inserted the following subsection — (5) The reference in subsection (4) above to the members of an authority, trust or body or the members of a committee or sub-committee of an authority, trust or body, —

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

On Question, amendment agreed to.

Lord Sanderson of Bowden moved Amendment No. 118DB: Page 105, line 29, at end insert: ("(5A) In section 117 of that Act (after-care) in subsection (3) for the words "the District Health Authority for the district" there shall be substituted "such District Health Authority as may te determined in accordance with regulations made by the Secretary of State".").

The noble Lord said: This amendment has already been spoken to. I beg to move.

On Question, amendment agreed to.

Lord Sanderson of Bowden moved Amendment No. 118E: Page 07, line 14, leave out ("managers of that hospital") and insert ("directors of the trust").

The noble Lord said: This amendment has already been spoken to. I beg to move.

On Question, amendment agreed to.

Schedule 9, as amended, agreed to.

Schedule 10 [Enactments Repealed]:

Baroness Blatch moved Amendment No. 118EZA: Page 13, line 8, column 3, at end insert:

("In section 111(1)(a) the words "or paragraph (c)".")

The noble Baroness said: In moving this amencment I wish to speak also to Amendment No. 1 8EZB. These amendments repeal two small subsections of the Employment Protection (Consolidation) Act. They are consequential on the repeal of Section 99 of that Act in Schedule 10 of the Bill. The repeal of Section 99 is in turn consequential on the provisions in Clause 54 which remove outstanding Crown immunities from the National Health Service. I am sure the Committee will support these minor measures to tidy up the statute book. I beg to move.

On Question, amendment agreed to.

Baroness Blatch moved Amendment No. 118EZB: Page 113, line 9, column 3, at end insert:

("Section 149(1)(d).").

On Question, amendment agreed to.

Lord Sanderson of Bowden moved Amendment No. 118EA: Page 113, line 16, column 3, at beginning insert:

("Section 124.").

The noble Lord said: This amendment has already been spoken to. I beg to move.

On Question, amendment agreed to.

Schedule 10, as amended, agreed to.

Clause 63 [Short title, commencement and extent];

[Amendment No. 119 not moved.]

[Amendment No. 120 had been withdrawn from the Marshalled List.]

[Amendment No. 121 not moved.]

[Amendments Nos. 121A and 121B had been withdrawn from the Marshalled List.]

Clause 63 agreed to.

House resumed: Bill reported with amendments.

House adjourned at twenty-five minutes before midnight.