HL Deb 21 May 1992 vol 537 cc688-702

11.35 a.m.

Viscount Goschen

My Lords, on behalf of my noble friend Lady Cumberlege, I beg to move that the Community Care (Residential Accommodation) Bill be now read a second time.

I stand before your Lordships' House very conscious of the fact that to deliver a maiden speech from the Dispatch Box is a double privilege, and for this I must crave your Lordships' indulgence. I am also well aware that on this day in particular, with the prospect of the Whitsun Recess before us, there is a need for the quality of brevity. So, much to your Lordships' relief, I shall turn straight to the Bill in question.

This Bill is substantially the same as a Private Member's Bill introduced late in the last Parliament by my noble friend Lady Brigstocke. That Bill gained all-party support but failed to complete all its stages in another place before the dissolution.

I am pleased, first, to pay tribute to my noble friend Lady Brigstocke for pursuing this matter so successfully in the last Parliament. After careful preparation, she steered the Bill—her first Bill—skilfully through your Lordships' House and was persuasive in putting the case on behalf of the interests affected by the Bill. I must also acknowledge the sterling attempt by my honourable friend the Member for Suffolk Central to get the Bill through in another place.

In the last Parliament, we were pleased to support a private Member in trying to get a Bill through to put minds at rest as soon as practicable. This was not to be. It is vital now that we go down the procedurally safer road of a government Bill to create the confidence of enactment, if Parliament so decides, before April next year. I know that my noble friend Lady Brigstocke shares that view. The need for the legislation has not diminished.

From April 1993 local authorities will be responsible for funding and making arrangements for domiciliary, residential and nursing home care with a range of providers in the statutory and independent sectors. This Bill will facilitate implementation of that policy by replacing Section 42(2) of the National Health Service and Community Care Act 1990 which amends Section 26 of the National Assistance Act 1948, inadvertently curtailing, from April 1993, local authority powers to make arrangements with the independent sector for residential accommodation. The Bill will ensure that local authorities continue to have those powers after April 1993.

A key objective of Caring For People is to enable the people rendered vulnerable by age or disability to live as independently as possible in their own homes or in homely settings in the community. Sometimes people need full residential or nursing home care and when this is so the local authority uses residential care homes or nursing homes. Most of these are required to be registered under the Registered Homes Act 1984 and to meet the standards laid down there, although some are specifically exempt—for example, because they are established by Royal Charter like the Royal National Institute for the Blind. But, so often, what people initially require is some form of supported housing other than full residential and nursing home care. It may well be that, while an individual can no longer be supported in his or her own home, he or she does not actually require the type of personal or nursing care provided in residential care and nursing homes.

From April 1993, when the National Health Service and Community Care Act 1990 is due to come into force, local authorities will have a duty to assess the needs of vulnerable people for social support and to design a package of care which is flexible and responsive to the individual concerned and his or her carers. Tailoring services to individual need and giving people as much choice as possible are fundamental to our community care policy. If they are to become a reality local authorities must have the flexibility to meet users' care needs taking account of their preferences, and contract with a range of organisations in both the independent and the public sector managing residential accommodation of different types and styles. Your Lordships will be aware that it is often in the independent sector that excellent, innovative and imaginative schemes tailored to the unique needs of particular people can be found. I have in mind, for example, the excellent homes managed by the Leonard Cheshire Foundation, the Autistic Society and Abbeyfield Society amongst many others.

At present local authorities provide residential care either directly or through the independent sector under the National Assistance Act 1948 or the National Health Service Act 1977. The general power for local authorities to make arrangements with the independent sector is in paragraph 2(1) (a) of Schedule 8 of the National Health Service Act. From April 1993, when the community care parts of the National Health Service and Community Care Act 1990 are fully implemented, that provision will be repealed and Section 26 of the National Assistance Act 1948 will be amended by Section 42(2) of the National Health Service and Community Care Act 1990.

However, a problem arises with Section 42(2) in its amendment of the National Assistance Act 1948 in that local authorities will no longer have powers to make arrangements with hostels and organisations like Abbeyfield, which do not provide in most of their homes the type of personal or nursing care envisaged under the Registered Homes Act 1984, and are not, therefore, either required to register or specifically exempt from registration.

In short, Section 42(2) does not allow local authorities to make arrangements with the whole range of organisations within the independent sector with whom they are currently able to do so. That will affect organisations like the Abbeyfield Society, a voluntary body which has about 1,000 homes which provide residential accommodation for up to 10 elderly people in each home, in a homely setting where food and domestic help is provided but where other personal care is not required.

The Community Care (Residential Accommodation) Bill remedies the problem by replacing Section 42(2) of the 1990 Act, thus restoring to local authorities the powers which they now have to make full use of the independent sector, but which they would lose in April 1993 when the National Health Service and Community Care Act comes into force. The Bill makes only this minor but vital technical amendment to the legislation and does not herald a policy change.

The substance of Clause 1 restores to local authorities the ability to make arrangements for residential accommodation with the independent sector in premises neither registrable under the Registered Homes Act 1984 nor exempt from registration. It restores the flexibility to make arrangements with a range of independent sector organisations for residential accommodation, as well as maintaining the rest of the arrangements found in Section 42(2) of the National Health Service and Community Care Act 1990. Clause 2 provides for the short title, commencement and extent.

I hope that your Lordships will agree that the Bill will deal with a technical problem and remedy it so that the residents of hostels and societies like Abbeyfield are not put at risk. I beg to move.

Moved, That the Bill be now read a second time. —(Viscount Goschen.)

11.42 a.m.

Lord Desai

My Lords, it gives me particular pleasure to congratulate the noble Viscount, Lord Goschen, on a splendid maiden speech. As he said, it cannot be easy to have the double pleasure of having to make a maiden speech from the Dispatch Box. However, I am sure that noble Lords will agree that the way he did so will recall to all of us the famous saying in connection with the name Goschen which I think will be used again: When in trouble, send for Goschen". I hope that we shall be sending for Goschen again and again.

The Bill before the House is non-controversial and, as the noble Viscount said, we have discussed it previously. The only qualification I have in that respect is to ask the noble Viscount whether the questions raised by my noble friend Lord Carter during the previous presentation of the Bill can be answered. Such questions are: do safeguards exist to protect residents; what are the assessment procedures; what are the conditions of contracts and their monitoring; and what complaint procedure is provided by the Bill? If we can be satisfied on those issues, we shall be quite happy to support the Bill. The Bill is most welcome and, once again, I congratulate the noble Viscount on his presentation of it.

11.43 a.m.

The Viscount of Falkland

My Lords, we on these Benches would also like to join the noble Lord, Lord Desai, in congratulating the noble Viscount on his maiden speech and for so ably telling us about the provisions of the Bill. We should also like to join in the congratulations extended to the noble Baroness, Lady Brigstocke, who first introduced the Bill in the last Parliament. She brought to our attention the position which had been overlooked in some quarters where, under the arrangements in the new Bill (so ably explained by the noble Viscount), people who became eligible for community care would not have the flexibility for their individual needs which is appropriate nowadays as more and more people are likely to come within the scope of the new community care arrangements.

Having said that, I have nothing further to say from these Benches except that we wholeheartedly support the Bill and hope that it speedily reaches the statute book.

11.44 a.m.

The Countess of Mar

My Lords, I should also like to congratulate the noble Viscount, Lord Goschen, on his excellent maiden speech. I am afraid that I shall be a little longer than other speakers. I apologise for that fact, but there are things which need saying. While I welcome the provisions of the Bill, I wish to raise several points with the Minister. The Explanatory Memorandum to the Bill states that its purpose is "to remedy a lacuna" in the National Health Service and Community Care Act 1990. However, I am unsure that the whole of the gap has been filled.

It would appear that the Government have failed to comprehend the complexity and enormous variety of community care accommodation. The Bill is in relation to the powers of local authorities to make arrangements in respect of residential accommodation. All accommodation which provides both board and personal care, whether or not in a hostel, is required to be registered under Part I of the Registered Homes Act 1984, or will shortly be required to be registered as a "small home" under the same Act.

Major problems will arise for local authorities where the board is only partial; for example, the provision of some meals, or the supervision of residents cooking their own meals but with materials provided by the establishment. Is it a hostel, is it a residential care home, or is it a supported group home? The range and variety is almost infinite, depending upon the needs of the individual. The Bill has not gone far enough in helping to clarify the issues raised by those complex matters. In dealing with situations where both board and care are provided, it would have been helpful if better definitions were given—such as that in line 5 at page 2 of the Bill which ignores the question of board and relies upon the definition of personal care contained in the Registered Homes Act.

The Bill appears to be saying that local authorities can provide financial support to either individuals or establishments in such a way that it will not automatically bring the establishment within the scope of being Part III accommodation. Most local authority social service departments have existing arrangements with both voluntary organisations and the private sector, as well as a variety of direct provision. In the local authority area where I live there are three hostels owned by the local authority providing rehabilitation for patients discharged from acute mental hospitals. The residents are charged a rent, apply for housing benefits and ordinary social security benefits. The philosophy is such as to re-create normal living.

Unfortunately, the Bill does not address the problems that will arise from April 1993. The local authority will then be obliged to assess and levy a Part III charge instead of rent. The former patient will no longer be able to be assisted and thus gain relevant rehabilitation experience in applying for housing benefit. Worst of all, he or she will receive only Part III pocket money, instead of being entitled to social security benefit. That is going completely against the ideas of community care that people should be rehabilitated into society. Similar problems will arise with local authority accommodation for physically disabled people who for the past four years have been treated as living independently in bed-sitters, with the local authority providing the individual with physical assistance.

The Bill does not make clear the position of group homes in both the local authority and the private sectors. There is a genuine fear that local authority provision will be deemed to fall under Part III after April 1993. A further major group, which it is not clear from the Explanatory Memorandum will be assisted, includes hostels and establishments providing assistance to the women's aid movement. If the hostel provides board and support services, the Bill appears to give power to the local authority to provide financial assistance, but is unclear whether, if the establishment provides no board but furniture and personal support, it would be lawful for the social service department to provide financial support. Moreover, if it does so, does the accommodation come within the scope of Part III?

As I have said, the Bill is to be welcomed. Many of the issues that I have raised have been discussed with civil servants on a number of occasions in the formal meetings between the local authority associations and the Department of Health. Therefore, it is somewhat disappointing that only the problems relating to the private sector have been addressed in this Bill. Is the noble Baroness able to say whether the issues I have raised will be dealt with in future legislation?

11.50 a.m.

Earl Haig

My Lords, I welcome this Bill and I hope that it will be given a swift passage by your Lordships. May I add my congratulations to the noble Viscount, Lord Goschen, on his maiden speech and on introducing the Bill with clarity and in a humane spirit. Nearly half a century divides his birthday and mine. I wish the noble Viscount many years of useful contributions in the years ahead.

The Bill enables local authorities to secure accommodation in the private sector. There are all kinds of people, many of whom are mentally ill, who are in need of housing. Some of these are cared for out of hospital in their communities and need accommodation in hostels, lodging houses and homes which are run by voluntary organisations. Through their care programme started in the wake of the closure of some of the mental hospitals, the Government have shown an awareness of the need to look after the homeless, many of whom sleep out. They have recognised the need to provide more homes, and in particular more homes for the mentally ill.

In 1990 the National Schizophrenia Fellowship published a booklet, Housing for Severely Mentally Ill People. In it it identified a range of 10 types of accommodation appropriate to their different degrees of disability, from ordinary unsupported housing to a hostel with intensive supervision. Some of this accommodation for those most severely damaged by their illness would be in registered homes provided by voluntary bodies or private owners.

The number of places in these registered homes in England has gone up from just over 2,000 in 1980 to over 7,000 in 1990—an increase of 4,000 places in private homes and nearly 3,000 in accommodation provided by voluntary bodies. Many of the residents are supported by local authorities. The costs are of course high, primarily because of the level of staffing. This expenditure on the most severely disabled and dependent mentally ill people is essential if they are to live outside hospital and be properly cared for.

Many of these cases show symptoms which need long-term treatment. For them there is so far no cure, although medication is available to relieve and to prevent regression. They need a home from which they can live as normal a life as possible within the community and where medical support can be provided. Others need supported accommodation but do not need to be in premises requiring registration or exemption from registration. They can, for example, live in independent flats or bedsitters, individual group homes or clusters of group homes, the accommodation being provided by a local authority housing association, other voluntary body or private owner. Varying levels of essential support are given by visiting social services staff, house-keepers, care assistants or people with similar skills, together with members of the psychiatric team.

The amount of psychiatric treatment and support to be provided depends on the degree of illness. In lesser cases of incapacity some patients may manage without treatment. Some of these may have to face a situation where some unscrupulous landlords extract housing benefit in return for shoddy accommodation. That problem reminds us of the constant need for control and supervision in order to provide more and better housing, both in the public and private sector.

Local authorities need to retain the flexibility to make arrangements for the use of a wide variety of accommodation for mentally ill people managed by voluntary bodies and private owners. To have their general powers limited to premises registered (or exempt) under the Registered Homes Act 1984 would rule out the possibility of using a range of accommodation suitable for those who are less dependent after April 1993—a system which local authorities currently support.

The Bill seems to me to be uncontroversial and I hope your Lordships will also find it so

11.54 a.m.

Lord Rea

My Lords, before I continue with my prepared remarks perhaps I could follow up the anxieties expressed by the noble Earl, Lord Haig. It concerns a problem which is happening in my own practice area with regard to a small nursing home which is being built to accommodate discharged mentally infirm elderly patients from Friern Hospital.

The local general practitioners are being asked to provide a service looking after these patients but no special payment is being given other than the normal capitation fees. These quite severely disabled elderly patients are almost certainly going to need a great deal more care than we can expect from a normal fit member of the population. Will the noble Baroness look into this matter at some future date, not necessarily now, and give me an answer about what is proposed?

While I fully accept the need for this short Bill, this Second Reading provides us with an opportunity to put some questions to the noble Baroness in her new post about the provision of suitable homes for old or disabled people and the funding that will be available for them. My first question concerns just this—funding. The noble Baroness has been very much concerned with community care, even before her recent appointment, so she will be aware that there is in many areas an increasing shortfall between the income support levels which residents receive and the costs of private nursing home fees.

When local authorities are allocated funds to cover the costs of supporting residents in private homes under the National Health Service and Community Care Act 1990 in April next year, will they receive an amount which will cover the actual costs, or will they receive a sum equivalent only to the income support that residents are now receiving? The costs of the new assessment procedures will also have to be taken into account. Both the British Medical Association and the Association of Directors of Social Services are anxious that these on-costs will not be included in calculations to determine allocations to individuals.

These shortfalls, as they occur, would reduce the amount available to social services departments to organise care and might reduce the number of places that local authorities can offer to needy, old and disabled people. Can the noble Baroness assure us that these facts are taken fully into consideration when estimates of funding are being calculated? If funds are insufficient there is a danger that care will be chosen according to its cost rather than to its suitability. I repeat, fewer places may well be available.

My second question concerns the access of community nurses and other health authority professionals to private nursing homes. At present in some areas district nurses are not allowed to provide services to residents, even though the residents are registered with a local general practitioner who may feel that these services are needed. I gather that in Scotland guidance has been issued stating that the services of specialist community nurses and other National Health Service professionals should be available when requested by a GP. Can the noble Baroness assure me that the same guidance will apply to England and Wales?

My third question, relevant to the Bill, concerns standards and inspection units. The Social Services Select Committee in another place and the British Medical Association are concerned about the impartiality and effectiveness of the proposed arm's length inspection units under local authority control which are proposed. Will the noble Baroness give further consideration to the establishment of independent inspection units with the mandatory involvement of the medical and nursing professions? Will the additional homes now included in the Bill under consideration also be subject to full inspection procedures?

The questions I have put are relevant although not strictly concerned with the detail of the Bill before us. But I should like to take this opportunity to fire a shot across the bows of the noble Baroness to warn her —as if she did not know—that we shall be watching very closely how the Government implement the whole of the community care legislation in the run-up to April next year.

The reforms cut across the responsibilities of various government departments—Health, Social Security, Environment and Education, not to mention the Treasury. Will the Minister assure me that one Secretary of State will take responsibility in Cabinet for co-ordinating and implementing the Government's proposals?

Finally, can the Minister explain how the funds for community care, which will be transferred from central government to local authorities, will be protected from leaking into the almost bottomless pit of local authority expenditure when many, if not all, local authorities find it hard to fulfil their existing obligations under current financial restrictions?

11.59 a.m.

Lord Butterfield

My Lords, I too want to introduce some medical reflections on the Bill; but before I do I wonder whether I could find a phrase which the noble Viscount, Lord Goschen, can take back to his wife to assure her of the success of his maiden speech. Sir, it was a magnificent innings. I do not know whether you played much cricket at Eton, but it was great. You tell your wife that we are very proud to have you among us.

I am anxious to pick up one or two medical points about the Bill which may not be as pointed as those made by the noble Lord, Lord Rea. I wish to draw attention to the fact that subsection (1D) states: Subsection (1C) above does not apply to the making by an authority of temporary arrangements for the accommodation of any person as a matter of urgency". I hope that when regulations stem from the Bill the word "temporary" in that context will mean brief. I see the noble Lord, Lord McColl, in his place. I am sure that he will agree with me that one of the problems involved in the care of elderly people in any residential situation is that they become parked there. One of the problems with the Health Service is that people are sadly dispersed throughout a hospital. It is hard to get to see them all, as one should. There are no clamping or any other organisations to pick up elderly people who have been parked in some place to take them to a pound where one can ensure they are being taken care of properly. They become lost. That is the point the noble Lord, Lord Rea, was making when he was talking about standards.

I had the temerity to raise the matter because I noticed that the Bill referred to community care. Line 22 on page 1 and line 5 on page 2 refer to personal care for the elderly in residential homes, a point mentioned by the noble Viscount. They refer especially to homes registered under Part II of the Registered Homes Act 1984, which, by reason only of being maintained or controlled by an exempt body, do not fall within the definition of a nursing home in Section 21 of that Act". In such circumstances, the frail elderly, about whom I am especially concerned, may in the urgent situation to which I have referred suddenly find themselves being cared for by—I trust caring, well-meaning but not necessarily well-informed—helpers. Many of us are anxious that we do not allow bricks and mortar arrangements to blind us to the terrific burden that will come with caring for the 1 million people now aged over 85. That number is expected to rise to 1.7 million by 2030. They are an enormous burden, and we must find ways of looking after them properly.

I have been to some of the homes. I do not want anyone to think that I speak harshly about the people —many of them young—who take care of such people in the homes. Most of them come straight from school. They cannot be blamed for not knowing much when they are first recruited. As far as I am aware there are no statutory short training courses. We need those people to be almost like the old-fashioned medical student—someone who cares about people. They do not need to be highly scientific but they need to know how to look after emergencies and other cases. It is important to train them, because so many things in medical, clinical affairs are paradoxical.

I say that because not many people would think that the best way to guard against urinary incontinence—one of the big problems in the homes —is to encourage people to hold on to their water for as long as they possibly can. It is an extraordinary subject to be talking about in the House just before lunch, but it is an example of one of the methods of prevention which will be important in the care of the frail elderly—those over 85—in the future. If one encourages people to hold on a little longer, they gradually stretch the walls of their bladders. That was discovered by a scientist not so long ago. It is what we are disseminating, as valuable information, through the Health Promotion Research Trust.

I have the privilege to chair that trust. My deputy chairman, whom I have seen take her place recently, was also appointed by the Secretary of State for Health. She is the noble Baroness, Lady Birk. We have previously had from the other place Sir Ian Munro from the Conservative side to keep an eye on what we are doing. I am sure that the noble Baroness will confirm with a nod that over 100,000 people have now written in for the little pamphlet called The Misbehaving Bladder that the trust has put out. It is important that old people are not incontinent. Nothing is worse for bed sores than a wet bed. I hope that your Lordships will not think that I am on a ridiculous tack. All I am trying to do is to remind people that we must plead with the Department of Health to ensure that the latest information is in the hands of the carers. That will be an important part of community care.

I have said how worried I am about the over 85 year-olds. One matter that has been borne in on me recently is how terribly their savings have been evaporated by inflation. I looked up the figures. They are terrifying. Your Lordships are all aware of them. One can work out what it means to someone who had £1,000 in a Post Office savings account when he or she retired in about 1970. The inflation figures have risen year on year. I do not think I should give the details because it is late. In five years, £1,000 had shrunk to £630 in purchasing power; to £350 in 10 years; and, sadly, to £250 in 15 years. We must all realise that when those people retired they expected some respect from society, but I find that their morale is low. As they have become progressively less wealthy and less able to tip the school child for doing their shopping or whatever, their morale has withered away. These are the kinds of things that I trust the noble Baroness, Lady Cumberlege, who knows so much more about them than I through her career and personal devotion to community care, will watch carefully in her responsibilities in the Department of Health.

12.10 p.m.

The Duke of Buccleuch

My Lords, I shall only detain your Lordships briefly. First, I wish to add my congratulations to the noble Viscount on the excellent way in which he introduced the Bill. I also wish to say what a pleasure it is to follow someone who speaks with the wisdom, knowledge and understanding of the noble Lord, Lord Butterfield. His valuable contribution is one which we shall look forward to reading with care.

Perhaps I should declare an interest. I am closely involved in the Scottish National Institute for the War Blinded, and also the Thistle Foundation.

I wish to say how much I welcome the Bill because it is very much a part of what I see as a great success story. It is one of the greatest success stories of social progress during the latter part of the 21st century; that is, the great increase in the number of suitable places providing residential accommodation for those who need it in what the noble Lord, Lord Butterfield, rightly points out is an increasingly ageing society.

My noble friend Lord Haig mentioned the enormous increase in homes, from 2,000 to 9,000, in a short time. That reflects the great progress being made and one wonders how on earth families managed before all these homes were provided. From time to time we should remind ourselves not to take it all for granted. So many people are involved in providing suitable accommodation that frequent tribute should be paid to them.

We welcome the Bill because it enables local authorities to have that degree of flexibility which they need in negotiating and making arrangements with the independent sector. Obviously there is a great variation in the standards which are found in various homes. I do not know whether anyone has yet thought that it might be a good idea to introduce hotel style classifications, by means of one, two, three, four or five stars. That is something which no doubt local authorities should bear in mind when scrutinising the premises which are being built. We hope that the figure of 9,000 will increase rapidly in order to take account of the increasing age of the population.

Finally, I wish to add my plea that when buildings are being converted or constructed those who provide accommodation should remember the people suffering from physical disabilities. When appropriate action is taken at the beginning, in the planning stages, it does not necessarily cost more money but can cater for situations where there is a shortage of suitable accommodation. I congratulate the Government on bringing forward the measure.

12.14 p.m.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)

My Lords, I wish to thank noble Lords for the interesting debate today. This is the first occasion on which I have been at the Dispatch Box, other than answering a Starred Question, and I thank noble Lords for the welcome they have given me.

This is a good opportunity for me to pay a brief tribute to my predecessor in this post, my noble friend Lady Hooper. With grace, charm, diligence and immense skill she played a key role on behalf of Her Majesty's Government in a wide range of complicated Bills. However, I think she will be particularly remembered for the way in which she skilfully steered the National Health Service and Community Care Bill through your Lordships' House to its successful enactment. With equal skill she deflected well the shafts and arrows from noble Lords opposite and I know that she established excellent working relationships with all sides of the House. Her presence on the Front Bench will be much missed.

I wish to echo the remarks about my noble friend Lady Brigstocke. She took up the matter in the last Parliament and convinced your Lordships of the importance of the measure for the interests concerned. It is thanks to her work that we now deal expeditiously, though with proper consideration, with the revived Bill. I am also pleased to support my noble friend's acknowledgment of the part played in another place by my honourable friend the Member for Suffolk Central.

I congratulate my noble friend Lord Goschen on his maiden speech and am pleased to welcome him warmly to the Government Front Bench. I join your Lordships in looking forward to his future contributions on behalf of the Government. I am grateful for his help and support today and for the lucid and precise way in which he introduced the Second Reading of the Bill.

A number of points have been made and I shall cover them as quickly as I can. I start with those made by the noble Lord, Lord Desai. He was concerned about safeguards and ensuring that we protect residents in non-registrable homes. Consumers will be involved in the assessment of their needs. That is a major plank of the new Act. They will be involved not only with their needs but with the planning and the management of their care. In addition, as part of the new contracting process, local authorities will set and monitor quality standards. It is important that they do so and I know that at present they are taking on a great deal of training to ensure that they do it well. As a fallback, there is a full local authority complaints procedure which will be available not only to individuals but also to their families and carers.

The noble Viscount, Lord Falkland, gave support to the Bill and I wish to thank him for that and for his words about my noble friend Lady Brigstocke. The noble Countess, Lady Mar, introduced many interesting technical points. If I am unable to answer some this morning, I shall write to her in due course. Work is under way to revise the whole charging system—a point which she raised—for people placed in residential accommodation. We are aware of the need to ensure that adequate sums are made available to people catering partly for themselves. This will be taken into account in the new system.

The scope of the Bill is to remedy a technical lacuna in Section 42(2) of the National Health Service and Community Care Act 1990 so that former powers of local authorities can be restored. Therefore, there is no change of policy in it. On a previous occasion your Lordships accepted the principle and supported the Bill, as I hope they will today.

My noble friend Lord Haig spoke about mentally ill people and the closure of mental hospitals. In my view, the Bill will enhance the ability of health authorities and local authorities to use a whole range of different care to meet individual needs. I very much support the words of my noble friend on the contributions made by the private and voluntary sector. It is important that those who are discharged from hospital receive enough supervision. With the regular assessment that is outlined in the National Health Service and Community Care Act, we hope that this will happen. It is certainly the intention to have a regular assessment for people who are discharged from hospital.

The noble Lord, Lord Rea, raised a number of interesting points, particularly on funding. It is important that when the new Act comes into force and the social security money is transferred to local authorities it is made transparent exactly how much money is being transferred and how it is spent. The amount of money involved is a matter for discussion with the Treasury and announcements will be made in the autumn after the public expenditure survey takes place.

I now turn to the role of district nurses and whether they have access to all the patients on a GP's list. The noble Lord may know that at the moment a review of community nursing is taking place. I have been charged by my right honourable friend the Secretary of State to undertake that review. I have given a commitment that we shall report in September. An additional review is taking place on community psychiatric nursing. Noble Lords will hear the results of that in due course.

I know that many people in the country are concerned about standards. As has been said, local authority inspection units operate on an arm's length principle. I have visited one or two of those units and I am impressed by the work they are carrying out. However, if the noble Lord has particular anxieties I hope he will raise them with me and I shall look into them.

The noble Lord, Lord Butterfield, was anxious about patients who, in his words, get "parked" in hospitals. I share that concern. When I visit hospitals and talk to patients the question they most frequently ask is, "When can I go home?" The assessment process will help those people to be discharged because the assessments will be mandatory and will be carried out with care. Social services departments will then have the duty to ensure that if patients can go home services are available to meet their needs.

As regards those working in homes, I share the view that that work is difficult. We need people who are skilled and who have training to carry it out. The national vocational qualification scheme that is being introduced will go some way towards solving that problem. Incontinence is a real problem for many elderly people. There are more and more incontinence advisers working in the community. They see part of their role as imparting knowledge and skills to carers and families. I hope their presence will mitigate the problem of incontinence.

I wish to pay tribute to noble Lords who supported the Nurse Prescribing Bill in the previous Session. That helps in the provision of nursing aids including incontinence pads. The measure also helps carers at home to look after their dependent relatives. My noble friend the Duke of Buccleuch and Queensberry paid tribute to those working in homes. I endorse his words. I agree that standards vary and it is important that local authorities inspect care homes every six months and that the contracts that are drawn up consider quality as well as cost.

Finally, I believe the case for this Bill is clear-cut. It makes a simple change in the law to preserve the flexibility of local authorities to arrange for care which best meets people's individual needs. It also protects the position of well respected organisations that provide valuable and high quality service in the community. The Bill received your Lordships' support in the previous Parliament and I believe that that will be repeated today.

Lord Rea

My Lords, before the noble Baroness sits down, I hope she will have a stab at answering the final question I put to her. I suggested that one Cabinet Minister should be appointed to give overall supervision to the passage and the enactment of this measure.

Baroness Cumberlege

My Lords, I apologise to the noble Lord for not picking up that point. Noble Lords may know that the ministerial team has been strengthened. We now have an additional parliamentary Under-Secretary of State, my honourable friend Tim Yeo, whose special responsibility is community care. In addition the Minister for Health covers that matter, as does the Secretary of State. We are fortunate that we have a Secretary of State who knows this subject better than almost anyone in the land. We know she is making a powerful impact on her Cabinet colleagues. I have every confidence that she will carry her duties through with good effect.

On Question, Bill read a second time; Committee negatived.

Then, Standing Order No. 44 having been dispensed with (pursuant to Resolution of 14th May), Bill read a third time and passed, and sent to the Commons.

House adjourned for the Spring Bank Holiday Recess at twenty-five minutes past midday.