§ 3.35 p.m
§ The Parliamentary Under-Secretary of State, Northern Ireland Office (Baroness Denton of Wakefield)
rose to move, That the draft order laid before the House on 9th December be approved.
The noble Baroness said: My Lords, I bring to the House today an order which plays an important role in the development of health and social services Northern Ireland. The purpose of the draft Health arid Personal Social Services (Northern Ireland) Order 1994 is to enable health and social services trusts in Northern Ireland to carry out certain statutory functions which at the moment are the legal responsibility of the health and social services boards there.
The order is a local solution to a local problem. It may be helpful to the House if I comment briefly on the background to it and the present organisation of the services in the Province. In Northern Ireland health and personal social services were integrated into one structure in 1973. We have therefore had an integrated service for over 20 years. During that period the services have been provided by four health and social services boards. This integrated system has served Northern Ireland well through 20 turbulent years, and the people of the Province are quite justifiably proud of this unique 1125 service. The draft order seeks to preserve this integration and to enable services to continue more or less in their present form. It is needed only to remedy a weakness in the existing law and not because the present services are deficient in any way.
The Government's reforms for health and social services provide for the separation of the purchase and provision of services. The Health and Personal Social Services (Northern Ireland) Order 1991 redefined the role of the four boards as being responsible primarily for assessing the needs of their populations and commissioning services to meet those needs. Their direct management role in the services was removed and general management was introduced at unit level. The order provided for units to be established as health and social services trusts, fully independent of board management but wholly—I stress the word "wholly" —within the statutory sector.
However, although the 1991 order enabled trusts to be established and allowed boards to contract with them for services, it did not permit trusts to carry out certain functions associated with those services except for mental health functions, for which specific provision was made. These functions flow from a range of existing legislation such as the Children and Young Person's Act 1968 and the Disabled Persons (Northern Ireland) Act 1989. Some are sensitive powers involving the restriction of civil liberties, for example taking a child into care. This legislative weakness prevents some units such as those providing personal and social services from becoming fully operational as trusts and the order is concerned with putting that right.
In bringing forward the order we aim to provide a legal framework for the discharge of functions by trusts which ensures clarity about where responsibility lies and secures full accountability for the work undertaken by trusts. Within that framework the order enables boards, with the approval of the Department of Health and Social Services in Northern Ireland, to delegate certain statutory functions, which will be specified by the department, to health and social services trusts. The functions involved were set out in the explanatory document published with the proposal last summer and a draft copy of the regulations dealing with them was placed in the Library when the order was laid on 9th December. The order allows trusts to carry out those functions and makes provision for schemes to be agreed between trusts and boards on how the functions are to be carried out.
Since the proposal for legislation was published last June many people have voiced anxieties about its effect on services, particularly in relation to those for children. Some have expressed doubts about the accountability of trusts within the new arrangements. Questions about fragmentation and inequality of provision have been raised. My noble friend and predecessor and, more recently, I have considered very carefully the anxieties raised and have devoted much time and effort to listening and then explaining the issues. I think it is fair to say that many of the anxieties expressed stemmed from a misunderstanding of the role of trusts, and perhaps I can clarify that point.
1126 Health and social services trusts are state bodies, established firmly within the health and personal social services in Northern Ireland. They are fully accountable for all that they do and are closely monitored both by the department and by the boards. They are not independent companies and are bound by the same guidance and directions that govern the operation of health and social services boards at present. Like my noble predecessor, I recognise that people have anxieties and I appreciate their concerns. They are genuinely held, but they have not been ignored. Regardless of which side of the debate we are on, we have one interest in common—the welfare of children and other vulnerable groups in our society. For that reason the shadow trusts and boards concerned have been working very hard to establish procedures which will ensure that those who are entrusted with the discharge of statutory responsibilities at local level will be clear about their role and fully accountable for all that they do.
For my part I have been concerned to get to grips with the issues involved since I took up my new post. I have met with representatives from the British Association of Social Workers to hear at first hand its concerns. I have visited units which are preparing for trust status and talked with people who are directly involved in providing services and who are preparing the ground. From my conversations with managers and professionals alike, and on the evidence that I have seen, I have no doubt that the schemes being developed between boards and trusts will address clearly and comprehensively the key issues that have been raised. Under the terms of the draft order they will have to be approved by my department.
There are two other important issues which, although not technically part of this legislation, are intended to underpin it. First, those trusts which will be providing personal social services will need to have access to expert advice and guidance in providing those services and carrying out the functions I have mentioned. To ensure that they have we are making it a legal requirement for any trust providing these services to appoint a qualified social worker as an executive director. At the same time the department will be asking all health and social services boards to appoint a director of social services if they have not already done so. Guidance on the roles and responsibilities of both posts will be issued.
Those changes, taken together, represent a significant strengthening of the structures involved in personal social services in Northern Ireland. Perhaps I should point out also that chief executives of trusts have gone to great pains to build in safeguards for existing social work structures, both organisationally and professionally, within trusts.
Perhaps I may briefly say a word or two about three other changes to Northern Ireland health and social services legislation which are contained in the order. First, the order amends existing law on the audit of health and social service bodies. The law in that area is no more than adequate at present and the order is designed to modernise and strengthen it. Secondly, it amends the law on the registration of pharmaceutical chemists by requiring people seeking registration to 1127 satisfy prescribed conditions as to character, health and other matters. This will bring Northern Ireland legislation into line with that in other countries. Thirdly, the order repeals an existing provision in relation to the employment of nurses which is no longer needed because of the changes in the way nurses are recruited and trained.
The proposals before the House present no threat to the welfare of patients or clients. They are no threat to standards. They are no threat to vulnerable groups. Rather, they are concerned with ensuring that our services are structured and organised in such a way as to maximise their capacity to respond to people's needs quickly and effectively. I am confident that the trusts which the legislation will affect by focusing on the needs of local people will be best placed to make that response in meeting both health and social welfare needs. I beg to move.
Moved, That the draft order laid before the House on 9th December be approved.—(Baroness Denton of Wakefield.)
§ 3.47 p.m.
§ Baroness Faithfull rose to move, as an amendment to the above Motion, to leave out from ("That") to the end arid insert ("this House calls on Her Majesty's Government to withdraw the draft order laid before the House on 9th December 1993; and to re-lay it in a month, having considered whether it should extend to social services.")
§ The noble Baroness said: My Lords, in moving the amendment standing in my name on the Order Paper perhaps I may, first. thank my noble friend the Minister for explaining the order. Perhaps I may also welcome her to her post as Minister for Northern Ireland.
§ I should like to thank my noble friend and her predecessor, my noble friend Lord Arran, for the time that they have given to explaining the Order in Council to me. Alas, I have been unable to agree with their explanations, particularly as they have not accorded with the views of social workers working in the statutory sector who are members of the British Association of Social Workers. Nor have they accorded with the views of social workers in the voluntary sector, which consists of some outstanding voluntary organisations, among them Barnardo's, which I know well.
§ I have moved the amendment in this form because an Order in Council must be accepted in total or totally rejected. That is different from the position relating to primary legislation when Bills before your Lordships' House can he debated, discussed and amendments moved to improve the Bill. The amendment therefore takes the form of providing a month for further consultation and discussion. The amendment is in accordance with standing rules and orders and has been approved by the Clerk of the Parliaments.
§ My noble friend the Minister has done much to explain the order. At present the social work service is covered by four health and personal social services boards. The health and social services were amalgamated some years ago, as the Minister said. I have to say that at that time I disagreed with the amalgamation. The 1128 social work service is responsible for carrying out the implementation of the children Acts dealing with delinquency, care and protection, and the prevention of suffering, the chronically sick and disabled persons Acts, the mental health Acts, adoption Acts, and work with the education service. Within each of the health and social services boards at present there is a director of social services and a staff of social workers divided into units.
§ Under the Order in Council before your Lordships' House today, the health and social services board will continue with a director of social services. However, as the Minister said, 12 trusts will be formed to carry out the work which at present is the duty of the four health and personal social services boards. The grass roots social workers will be given the opportunity of moving to the trusts.
§ What is the exact ethos and purpose of this change? The Minister has stated that it is to provide a mechanism for purchasing and providing, but she has given no other reason. She said that the work at present being undertaken is being done well. If it is being done well, why change the system? Why move the service in particular as that will be costly? If the work is not being done well, can the Minister give examples of malpractice? Can she give examples of where the work is not being done well which would justify a change? Am I right in thinking that the present four health and social services boards will continue in their present form?
§ In her opening address the Minister spoke of accountability. I am still not quite sure exactly to whom the trusts will be accountable. Will it be to the four personal and social services boards, the Department's executive board, and then the Minister? Should there be a mishandling of a case—for instance, the death of a child; a sexual abuse case not properly dealt with; people in an old people's home not cared for—who would be responsible? Would it be the trusts, which are non-statutory bodies? Would it be the hoard which is not doing the work? Would it then be the Minister who is two steps away, divorced from the work? Even in the Minister's outstanding speech the position has not been made clear.
§ I understand that the members of the 12 trusts will be appointed by Her Majesty's Government. As has been stated, the trusts are non-statutory bodies. Am I right in thinking that the chairman of each of the 12 trusts will be paid £15,000 a year, and each of the five board members £5,000 a year? Will an experienced and qualified social worker, a director of social services as the Minister stated in her speech, be paid a salary as an executive member? There will then be the clerical and administrative staff. I estimate that the trusts will be far more costly than the present system. Is that riot so? Has the new system been costed against the present system? Do we know the extra costs and whether the change will be worth them?
§ I am not clear how non-statutory community trusts can carry out work under Acts and orders. The Minister has referred to that aspect; and I look to the noble Lord, Lord Williams of Mostyn, to clarify the legal position.1129
§ Roughly speaking, the 12 trusts will cover an area the size of Kent, with approximately the same population. How is consistency of work between the 12 trusts to be carried out? From a social worker's point of view, consistency is important. If you have a child wanting to be adopted and do not have an adopter for that child, you ask another area for help with adopters. If there is no consistency of practice, there will be difficulties.
§ If the purpose is to give a better service to the vulnerable of the Province, it must be proved that the present system is not efficient and effective. Are we wise to agree to a new, bureaucratic and expensive machine without clear answers to those questions?
§ I have kept my speech short; I hope that I have made it clear. I believe that the people of Northern Ireland are entitled to a first class service for the vulnerable in their society. I do not believe that the present system has failed. I do not understand how the new system will give a better service. The only reason given by the Minister is the introduction of the purchaser-provider principle. I suspect that that does not give a better service. I beg to move.
§ Moved, as an amendment to the above Motion, to leave out from ("That") to the end and insert ("this House calls on Her Majesty's Government to withdraw the draft order laid before the House on 9th December 1993; and to re-lay it in a month, having considered whether it should extend to social services.")—(Baroness Faithfull.)