Health and Personal Social Services (Northern Ireland) Order 1994

HL Deb 31 January 1994 vol 551 cc1139-57

4.38 p.m.

Debate resumed.

Lord Fitt

My Lords, first I should like to welcome the noble Baroness to the Dispatch Box on the Government side. This is the first occasion on which she represents and speaks on behalf of the people of Northern Ireland. I apologise immediately for not hearing the first few minutes of her speech. I was riot here because I acted on the belief that Northern Ireland business was not usually conducted at half past three in the afternoon but usually very late in the evening.

I have been very closely involved in Northern Ireland for many years, and over recent days I have been very closely involved with people in Northern. Ireland on the ground in relation to this order. We shall debate another order this afternoon in relation to Northern Ireland airports. That order contains 71 articles and a number of schedules, yet the order which the noble Baroness now presents contains only six articles and two schedules but is by far the more important of the two orders to be debated this afternoon.

When the subject of Northern Ireland is debated, it is unusual to see so many noble Lords in the House. Normally, when Northern Ireland is discussed, it is left to four or five people to speak to it. I have listened to the speech of the noble Baroness. I am quite certain that many noble Lords who have heard it will be very confused about the situation as regards health and social services in Northern Ireland and the way in which they operate at the present time.

Since the abolition of the Stormont Parliament in 1972, health and social services have been operated since 1973 as an integral body. In other parts of the United Kingdom the services have been developed in one or two areas, but they have been delegated to local authorities in Northern Ireland. I fully support that concept. These services have been given to people in constituencies where there has been local or central government. They should be given to places where there is public accountability.

In Northern Ireland we have an aversion. I believe that that aversion can be supplemented by an aversion on this side of the House to the word "trust". That word is loaded with implications for Northern Ireland. It gives rise to the spectre of quangos, to jobs for the boys and that people are only interested in their own personal and political advancement in giving service on these quangos. Therefore, one must have reservations when one talks about the creation of trusts in Northern Ireland or of giving more power to them.

I have spoken to people in Northern Ireland within recent days and hours. I have been acquainted with the facts that trusts were created in Northern Ireland in 1991 by Order in Council from both Houses of Parliament. These trusts are now in existence. I did not want them to be there. I am opposed to them and to the way in which they operate here and in many other parts of the United Kingdom.

I believe that the speech of the noble Baroness, Lady Faithfull, was very germane and compassionate. She is motivated with a great concern for events as they have transpired in Northern Ireland. But she compared Northern Ireland with Kent, which is not realistic. Northern Ireland is not like Kent. The people of Kent do not have the problems which exist in Northern Ireland. I remember at one time a former Prime Minister saying that Northern Ireland was as British as Finchley. Over many years that has proved just not so.

I have spoken to people in the trusts' section in Northern Ireland. From the observations which they made to me, I am convinced that they are not motivated by their own personal position. They have worked for the 1991 legislation and found it to be effective. From contacts which I have in Northern Ireland I believe that it has a health and social services organisation which is second to none in the United Kingdom. There are many things which Northern Ireland can do far better than they are done in other parts of the United Kingdom.

I believe that the order we are debating today is to extend to some extent the position of health service trusts in Northern Ireland. As I say, I am very reluctant to support any further powers or authority being given to the trusts. However, they have been in existence since 1991; and I have been told that, in the absence of this legislation, it may bring about a total disintegration of health and social services in Northern Ireland. One element would go one way and the other the other way, if this legislation is not put into effect.

I do not have a strong position on this. I would find it very difficult to go into one Lobby or the other today. Before bringing this order to the House, did the Government have consultations with all sectors involved in this legislation? Did the Government speak to the social workers on the ground, to the people in charge of the various homes in Northern Ireland and to the people who will be administering all the activities of the trusts? From what I have been told, I do not believe that is so on one side; yet on the other, I have been told that adequate consultation has taken place.

Northern Ireland is totally different from other parts of the United Kingdom. I hope that I live long enough in this country, or wherever it may be, to see political structures being created in Northern Ireland. Whether it is an assembly, or whatever political structure it may be, I hope that the functions of these trusts of other sorts of quangos (that awful word!) will be given into the hands of people who are elected in Northern Ireland. That is where real confidence in the operation of this order would lie.

I do not blame the Government for having to promulgate this legislation. I do not blame the Members of this House or of the other place. I would have liked this order to have come before the other place. There we could have seen and heard the remarks of people who live in Northern Ireland in the constituencies which will be affected by this legislation. I hope that the Northern Ireland representatives in this House and in the other place will endeavour to do everything they can to ensure that there will be created in Northern Ireland political structures whereby this kind of quango or trust operation can be put into the hands of elected representatives.

As I have said, I do not feel strongly one way or the other; but given the fact that the 1991 legislation created trusts in Northern Ireland, they appear to be operating. If there is any delay in the coming into being of this order which would be disadvantageous to the operation of the 1991 order, then I would find it very difficult to oppose the Government on this issue.

4.48 p.m.

Lord Skelmersdale

My Lords, it comes as some surprise to be able to follow many of the thoughts of the noble Lord, Lord Fitt, to which he has just given expression. This is the first opportunity I have had publicly to congratulate my noble friend Lady Denton on assuming her new role, to say nothing of her ambition, as Under-Secretary in the Northern Ireland Office. As she said, she succeeds my noble friend Lord Arran whom I also congratulate somewhat ironically, given my particular situation, as he is the first Minister for something like eight years to have returned from Belfast and remained on the Front Bench of your Lordships' House. All credit to him too—I believe that this answers one of the questions asked by the noble Lord, Lord Fitt—for having tramped the highways and byways of Northern Ireland, spoken with professionals within the shadow trusts and found no objection there at any rate to the proposals in the order.

It is inevitable in any department of state, especially in the peculiar circumstances of Northern Ireland, that, on arrival, an incoming Minister will find his or her predecessor's unfinished business on the desk. It happened to me, when I arrived at Dundonald House, in the shape of competitive tendering in the health service. It happened again when I left my successor, the honourable Member for Richmond and Barnes, the legislative hurdle of the Health and Personal Social Services Order 1991 to which reference has been made today. I left all the preparatory work, I thought, completed, following what had seemed an endless series of meetings that I held over 12 or 13 months. That exactly parallels the situation in which we find ourselves today.

I fear that, like the noble Lord, Lord Fitt, I must delve briefly into history. There were two major effects of the introduction of direct rule in 1972: one good; one bad. I suspect that I take issue with my noble friend Lady Faithfull on both, although probably not with the noble Lord, Lord Fitt. Let me take the bad one first. Quite simply, local government, as we know it in Great Britain, was slaughtered. It was left essentially with the three Ls —litter, leisure and lights—and with a sadly growing need, cemeteries, as its only truly and wholly functional responsibilities. Housing went, as did education, effective planning, and health and personal services. Small wonder then that fewer and fewer able people over the past 20 years have been attracted to local government. Unless the situation is corrected, we shall find Members of Parliament being drawn more and more from other sectors of Northern Ireland society. That is not necessarily a bad thing. But it means that their political background will be the poorer. It also means—perhaps this is another answer to the noble Lord, Lord Fitt—that quangos are the only answer to providing services in Northern Ireland, and the more locally, the better. That will at least attract more people of the calibre of those who formerly served in local government.

The good result of direct rule was that the health service and personal social services came together under the DHSS and ultimately the boards. I am on record as saying something with which my noble friend Lady Faithfull profoundly disagrees: namely, that this is a step that we could—and, indeed, should—emulate this side of the water to our certain advantage. Think, my Lords, of the medical, and sometimes even surgical, hospital beds that are blocked because the social services have no impetus to provide places in the community. The likelihood of that happening in Northern Ireland is very much reduced when both services are under the same control. I challenge my noble friend Lady Denton to say that she has no intention of advising the Secretary of State to split them —otherwise I would vote against her without a qualm. In those circumstances and in her position, I should have resigned, so deeply do I feel about the issue.

In Northern Ireland, people pride themselves on doing things a little better and a little later than we in Great Britain. The pace of life is a little slower but is none the worse for that. It does not prevent immediate and often forceful debate on how a particular matter should be pursued. As my noble friend said, the need for the order has come about because, in the words of the DHSS proposal, while the current legislation enables hoards to contract with health and social services trusts, it does not commit them to delegate the discharge of certain functions which by law are conferred on boards or delegated to them by the department. That does not matter where hospitals are concerned, but it does matter when we are considering personal social services trusts. That is an admitted weakness of the 1991 order. In effect, the existing legislation does not allow the latter at all, so the order provides in Article 3 for a board (with, and only with, the approval of the department for a trust) to provide for such relevant functions of the board as are specified in a scheme to be exercisable by a trust. My noble friend will correct me if I am wrong, but if it is not in the scheme, it simply will not be done. It cannot be done. Some trusts are already up and running in a shadow form, as we have heard. That is allowed, as I understand it, as they are still units under the direct control of the boards. But they were formed and, indeed, acquired members on the understanding that they would become fully fledged on 1st April this year.

Given the peculiar circumstances of health and social services in Northern Ireland, to which both the noble Lord, Lord Fitt, and I have referred, and given the need to involve local people at all levels in them, there has to be an extension of trust status to personal social services. I have not heard—and clearly, the noble Lord, Lord Fitt, has not heard—any complaints of hospital trusts in Northern Ireland. Not one. It seems natural that a logical extension of the same modus operandi to social services is desirable and necessary. It was, after all, the primary reason for the health service reforms that boards should purchase care and that others should provide it —not only statutory services, but charities as well.

I have recently become chairman of the Stroke Association, a medium-sized medical charity confined to England and Wales, and it is my experience that the health service reforms have meant that more and more health authorities are buying the services that we provide. It therefore surprised me to receive a letter from the chief executive of Child Care (NI), commenting adversely on the order as long ago as 2nd June last year. Those comments led in due course to a meeting, organised by my noble friend Lady Faithful, within this building. Concerns were expressed and later addressed to my noble friend Lord Arran, to which he listened carefully as one would expect. The net result was his decision announced on 22nd July to extend the consultation period and thereby the introduction of the order which we could realistically have expected in late November or early December. Instead, as we heard from my noble friend Lady Denton, the order was not laid until December.

The legislation has already been delayed once. Why again? I was alerted by Child Care to the problems that it saw. If it remains worried, I am surprised that it has not contacted me again, seeking to persuade me to speak against the order. It has not. What I find most mysterious of all is why the Government are being asked to delay for only one more month. I know that my noble friend Lady Denton has tried to explain and I hope that she will do so in slightly more detail when she replies. Does she really expect that the problems that she foresees can be addressed in that time? How real are my noble friend's concerns? As we know, the boards will, with, and only with, the approval of the department, arrange a scheme for the discharge of functions by a particular trust. It seems to me that that covers everything that needs to be covered. It will set out the functions that are to be discharged, how the trust will discharge them and, most importantly, the accountability arrangements between the two. Nor is that all. The department will have to approve the scheme before it is put into effect. The same people will be doing the same jobs for the same client groups. There will even be a trained social services person among the trustees. That was not a requirement of board membership under the 1991 order.

There is, however, one question that my noble friend must answer. It concerns the worst forebodings of my noble friend Lady Faithfull. I note that Article 3(5) refers to any amendment or revocation of an authorisation. My question is: who by? Perhaps I may be permitted a supplementary question. If the answer to the original question is, "The board and the trust acting together", does it again have to be approved by the department? If the answer to the second question is, "Yes", I shall have no hesitation in supporting the Government this evening.

4.58 p.m.

Lord Hylton

My Lords, I apologise for having been late for the beginning of our consideration of this order. I did take the trouble to consult the Government Whips' Office and I am sorry to have to say that in the end the forecast that I was given proved to be about three-quarters of an hour, if not a whole hour, out. It was incorrect.

I should like to join all noble Lords in welcoming the noble Baroness, Lady Denton of Wakefield, to her new responsibilities. I am sure that she will find—if she has not found this already—that the people of Northern Ireland are probably the most warm-hearted in the whole world.

I should also like to congratulate the noble Baroness, Lady Faithfull, on moving what I believe is known technically as an "O'Hagan amendment" to a statutory instrument, after our mutual friend, the noble Lord, Lord O'Hagan.

The Northern Ireland voluntary groups which are concerned with child care are, I know, disturbed about two things. They are disturbed, first, about continuity; and, secondly, about future accountability for certain statutory services. NIACRO, an association of which I have the honour to be president, while less directly involved in those matters, is in general agreement with the child care practitioners. We all wish to see the closest possible links between health and social services for the sick, the handicapped and the infirm so that community care can become a living reality. It does not, however, necessarily follow that services for the protection, adoption and fostering of children should have to follow the same pattern of organisation. I think that most people would agree that there is a difference in kind between those whose health needs therapy and those who are well but require social protection.

Ministers or elected councillors should be responsible directly for decisions arising on the protection of children. They should not be allowed to shelter behind appointed quangos. I understand, too, that a new children's order is in preparation. Is it not therefore right to introduce that into a stable administrative structure rather than into an untried system of trusts? Her Majesty's Government have a major duty to explain why they think that 13 trusts are likely to work better than four area boards. Does the unlucky number of 13 relate in some way to the number and distribution of hospitals, or, on the other hand, is it conceivably based upon 26 local government districts at two per trust?

If the Government are seeking to discover for England and Wales whether the trust model is appropriate for social services, we would all agree with the noble Lord, Lord Fitt, when he pointed out that Northern Ireland has its own special problems of sectarianism and intimidation and is not a suitable experimental area for the whole of the United Kingdom. If, on the other hand, the Government wish to find out what will work best in practice in Northern Ireland, then they should mount one or two carefully monitored pilot projects within that jurisdiction. On those grounds, I support the amendment and strongly urge Her Majesty's Government to think again.

5.2 p.m.

Lord Holme of Cheltenham

My Lords, perhaps I, too, may thank the Minister for her statement. I must apologise for not having been in my place, but the flexi-management of business this afternoon caught me on the hop. Perhaps I may say also how much Members on all sides of the House welcome her to her new responsibilities. She has certainly been thrown in at the deep end this afternoon, but I imagine that it is some measure of her colleagues' confidence in her that she starts with the most difficult task of all, which is to do what we rarely see in this House, and to talk about an amendment putting back an order.

Perhaps I may also welcome the noble Lord, Lord Williams of Mostyn, to this small club of Northern Ireland regulars. As the noble Lord, Lord Fitt, said, this is not the time of day at which we normally meet. We are not usually at peak time. We usually lurk in the twilight shadows of the dinner hour, late at night, or at some time approaching the weekend. We should not be spoilt by this, with such a well-attended House, but it gives us a chance to air some of the problems of legislating for Northern Ireland, as we in this House do.

There is a duty on Parliament, and therefore on this House, when we govern Northern Ireland, as we do (at arm's length) to ensure that legislation is appropriate and that it is based upon local consultation and consent. One could argue that that should be true of all legislation, but it is especially true of Northern Ireland legislation, nearly all of which is by Order in Council. That is why we, on all sides of the House, should thank the noble Baroness, Lady Faithfull, for having brought forward the amendment this afternoon and for having made us think hard about whether the order accurately represents local opinion, which the noble Lord, Lord Skelmersdale, believes that it does.

There is a regrettable tendency, which we have seen in relation to Northern Ireland legislation over recent years, to apply GB legislation to Northern Ireland willy-nilly. Of course if we were to emerge from strand one of the talks, which we all hope will be resumed shortly, with proposals for devolved government in Northern Ireland, and with power sharing between the communities, many matters, including, I hope, the way in which health and social services are organised, should be matters for that devolved government. Therefore there is a responsibility on us when considering this order to think whether, were there such devolved government, this is what the people of Northern Ireland would wish to decide for themselves.

I must say that, although I hear what other noble Lords have said, I have heard some of the widespread misgiving and opposition in Northern Ireland that the noble Lord, Lord Fitt, mentioned. That has come not just from the public service unions, and one might expect them to have a particular position to argue, but from some other health and community care professionals. We must bear in mind that the Northern Ireland integrated system, as it was in the past, has been admired widely. Many people in Europe have studied it, and want to imitate it. But there is an obligation upon us to remember the old maxim: If it ain't broke, don't fix it". Perhaps I may ask the Minister four questions. I understand that there are shadow trusts in existence waiting to operate from 1st April. Is it part of the Government's argument that we should legislate to give power to such bodies? If it is, it seems to me to be a chicken and egg justification. Before we legislate for them, we must be persuaded that there is a good reason for their existence. My second question is: how much will the members of the trusts be paid, and how, given the report of the PAC last week, will they be appointed? It is of the greatest importance that the appointments reflect the community in Northern Ireland in a broad way, rather than be of those who are likely to agree with the thrust of the Government's policies.

Thirdly, there is the question to which other noble Lords, including the noble Baroness, Lady Faithfull, have referred. It is the question of accountability. There are provisions for accountability for health boards to the department's management executive and to the courts in the last resort. But am I right in thinking that the trusts are in fact a sub sub-agent of the Minister? To whom should the client or patient complain? In the last resort, how is accountability to the people of Northern Ireland taken into account? It seems to me that this legislation takes executive powers two steps further away from them.

The final point upon which the Government could, and should, reassure us is that Northern Ireland is not being used in any way as a testing ground for radical new organisational theories. There is a good case for testing. I wish the Government were as keen on test marketing as they are on market testing. There is a need in government for pilot tests. But the one place to which they should not be applied willy-nilly is to the whole of the Province of Northern Ireland. That is the last place where new organisational theories should be tested by the Government.

I shall listen with great care to the Minister's reply. I am bound to say from these Benches, where we have great misgivings, that, unless the Minister can be especially reassuring, we are inclined to support the amendment tabled by the noble Baroness, Lady Faithfull. It is relevant that the order has come here first rather than to the Commons where there are elected representatives from Northern Ireland. That should weigh with us all when we decide what attitude to take.

5.8 p.m.

Lord Williams of Mostyn

My Lords, perhaps I too may welcome the Minister to her hot seat. It is not a seat of responsibility that anyone envies her at this time, but she knows, as well as I do, that she is always a special favourite in your Lordships' House because of the courtesy and candour with which she responds to questions.

Noble Lords

Hear, hear!

Lord Williams of Mostyn

My Lords, perhaps I may add a word about the work that her predecessor the noble Earl, Lord Arran, carried out. In our brief acquaintance in this area he treated me with every courtesy. I think that I can betray a personal confidence on this occasion. He enjoyed his time in Northern Ireland enormously and left with a great deal of personal regret, and many in Northern Ireland regretted his going to different pastures. I also thank the noble Lord, Lord Holme of Cheltenham, for his generosity in welcoming me to the Dispatch Box.

Having listened with care to the gentle way in which the amendment was introduced, I believe that it is a devastating critique of the order. Many of the questions asked by the noble Baroness, Lady Faithfull, are extremely important and if the response to them is not fully to our satisfaction we intend to support her amendment.

The powers which are to be given to trusts are extensive and deal with mental health, child protection and community care assessment. The fact that the services are administered by boards which are not fully accountable in the way in which we would hope is a great loss.

I agree with what was said by the noble Lord, Lord Skelmersdale; that it is a significant blot on the Northern Ireland political landscape that the local authorities ties have so few significant powers that they are virtually derisory. I agree with his analysis of the consequences, which are both adverse. The first is that there is a feeling of remoteness and non-accountability in daily affairs, which is important as a component of social and political public life. The second is that, as the powers and duties which the local authorities have are virtually derisory, those who should be drawn to public service for altruistic purposes and people of high quality turn their minds away from serving on those authorities. Again, that is to the detriment of the public body and of the public bodies.

I agree with the noble Lord, Lord Hylton, that not every service which is provided by government, quangos or statutory creatures is alike. If one is dealing with something as fundamental as the civil liberties of children, who during the past 25 years in England and Wales have not been well served, there should be a more direct line of accountability than a trust, a board and eventually a Secretary of State. It is deeply troubling that a part of the United Kingdom is intended to have its affairs regulated in such an "unlocally" accountable way.

Furthermore, is it appropriate to contemplate that as many as 13 trusts—I agree with the noble Lord, Lord Hylton, that there are 13 but there may be 12—shall serve a population a little in excess of 1.5 million? That appears to us to be a classic recipe for further bureaucracy, further possible inefficiencies and certainly a non-productive spending of public money. We on this side of the House question whether this is an experimental model for England and Wales as well as for Northern Ireland. It may be that the Minister will give us assurances which put our suspicions at rest.

I realise that my knowledge of Northern Ireland is limited and I hope that what I say will be taken on the basis that I recognise my ignorance. We have received a substantial number of representations from different organisations which are deeply anxious about the effect of the order. UNISON, for instance, has a large number of employees—approximately 24,000—whom it represents in Northern Ireland. It is entitled at least to our respectful attention if not necessarily to our automatic acquiescence. The organisation is deeply worried. The Northern Ireland Public Service Alliance is also worried and objects to the order. After all, the order deals with the civil liberties of children and we have not served them well. One has only to think for a moment or two of events in Cleveland, the Orkneys and Staffordshire. Children are desperately vulnerable and often their vulnerability is neither expressed nor recognised.

As was indicated by the noble Lord, Lord Holme, we must bear in mind what, on a hopeful view, may be the future governance of Northern Ireland. It would be a shame if so many powers were given away to trusts when many Members of your Lordships' House believe that a degree of democratic accountability and its return to Northern Ireland is long overdue.

Serious doubts have been expressed by a number of Members of another place. They were expressed as recently as 20th January in the deliberations of the Northern Ireland Committee. They come from all parts of the political spectrum and I hope that nothing will be heard from us tonight that will apply any partisan approach to the problems. They are far too serious for that.

At page 14 of the committee's report the Reverend McCrea stated: There is a genuine and general anxiety that the Government have been and are carrying out a systematic dismantling of the health service". At page 13 the Reverend Smyth stated: We believe that the scheme will add unnecessary costs and take money from the care of patients and clients". At page 26 Sir James Kilfedder stated: What has happened to the accountability of the bureaucrats to the people? Accountability is what democracy is about". At page 11 Mr. O'Brien stated: It is improper for powers under mental health, child protection and community care legislation to be handed over to" — and for the accuracy of your Lordships' record I include my words—to be handed over to non-locally accountable trusts. At page 17 of the report the Reverend McCrea stated: Accountability will be totally lacking". If there is no significant, explained, rational defence of the order Members on this side of the House are minded to vote for the amendment. Deep questions of accountability are involved. I well understand the historical imperative that has caused Northern Ireland to be governed in a certain way since 1973 and no one overlooks that. No one overlooks the difficulties referred to by my noble friend Lord Fitt. However, we must not attend too much to difficulties which may be overcome. We must not overlook our responsibilities to children, whose care and protection will be devolved to bodies which are not locally accountable. They will be accountable at the end of the long chain, as described by the noble Lord, Lord Hylton.

Having troubled your Lordships for a while on these issues —and they are deep issues—perhaps I may give an example. I understand that the chairman of a trust will be nominated by the Secretary of State and will have a contract for one year only, which will be terminable in effect at one week's notice. That is no recipe for proper accountability and it is no recipe for the independent functioning of bodies as important at these.

Whatever one's political views, one notes that the Public Accounts Committee and all the headlines that we have recently read point to the question of whether, despite the deficiencies of locally-accountable bodies, they are much better stewards of public money and public trust than anonymous, unelected and unaccountable quangos.

5.19 p.m.

Baroness Denton of Wakefield

My Lords, I thank all noble Lords who welcomed me to my new position. I regard the appointment as a privilege, even this afternoon. I thank in particular the noble Lord, Lord Williams of Mostyn, for his kind remarks and look forward to working with him in the coming months. I also thank the noble Lord for his remarks about my predecessor. My noble friend Lord Arran has left footsteps which are comforting but difficult to follow. He greatly enjoyed his time in the department. The warmth of my welcome by the people of Northern Ireland has been second to none.

This order is important and we have had a comprehensive and wide-ranging discussion on it. The quality of the contributions is a credit to your Lordships. It reflects the concern for those at risk in our society. I assure your Lordships that I share that concern. As the Minister responsible I am confident that the order and the changes that it will facilitate will be to the benefit of the people in Northern Ireland. I should not bring the order before your Lordships unless that were so.

I hope that your Lordships will forgive me if I take a little time to answer the debate. Many questions have been asked and I know that noble Lords are looking for answers. I thank my noble friend Lord Skelmersdale for giving the House the benefit of his considerable experience in this area. I hope that in due course I may follow in the footsteps of my noble friend Lord Arran and return to another office on the Front Bench, but not for many years.

I know that I can count on my noble friend's support because I can assure him that I do not intend to undo the valuable work and achievements of the past 20 years by splitting health and social services in Northern Ireland. I assure my noble friend also that any amendments or revocations of authorisations must be approved by the department.

I was pleased that the noble Lord, Lord Fitt, took part in our discussions. I agree with the noble Lord that it is nice to see Northern Ireland business coming before the House at an early hour. I hope that I am setting a precedent today which can be followed in the future. I agree also with the noble Lord that the health and social services in Northern Ireland can be described rightly as second to none. We should be extremely proud of them. That is something that I have inherited.

The noble Lord expressed reservations about trusts. Many of the questions and concerns which arose during consultations were not about the integration of health and social services but about reservations in connection with trusts. Having met the people concerned working in the shadow trusts, I share the noble Lord's impression that those people are of a high calibre and are committed to providing services at a local level.

The consultation, which is so important in Northern Ireland because of the system of orders, has been wide, extensive and extended. We have reacted in many ways to what we have learnt. I agree with the noble Lord, Lord Fitt, that we should have preferred the order to go first before the other place. However, perhaps I may suggest that the noble Lord's colleagues in the other place have prevented that. But I am delighted to confirm that the debate on health services in the Northern Ireland Committee on 20th January, as the noble Lord, Lord Williams, pointed out, gave the Northern Ireland Members of Parliament the opportunity to express their anxieties and views about this issue. Therefore, we have direct input from those Members of Parliament who are most concerned.

The noble Lord, Lord Hylton, is looking for continuity. Of course that is vital when dealing with vulnerable groups. I propose this order because it guarantees continuity. The weakness of the present legislation is that it prevents it. I fear that lack of continuity is all that the amendment offers us. That worries me greatly. I assure noble Lords that we do not seek to be innovative as regards the order. We are merely bringing forward an order which allows the practice of the past 20 years to continue. To those noble Lords who suggest that there should be a pilot scheme, I would say that the integration of health and social services has been piloted for 20 years. That cannot be put forward as a future problem.

The noble Lord, Lord Holme, spoke of the importance of consultation, which we all recognise. He expressed the fear also that we might be following Great Britain, willy-nilly. I have not received that impression, even in my first few weeks. Integration has been well placed, well practised and much admired for many years.

The opposition has arisen partly because of the issue of trusts. We need to progress and build. I assure the noble Lord, Lord Williams, that members of the shadow trusts have been appointed from the community based on their skills and involvement with that community. We have discussed the limitations on local authorities and we believe that it is beneficial for the trusts to devolve, as nearly as possible, to the local communities. That is what the trusts do.

One of the benefits in Northern Ireland is that because of its size, communication is easier, both up and down. I hope that that gives us opportunities to explain what we are doing. I hope also that it means that we are able to listen to anxieties which are raised. It is important—and I believe that the order achieves it—that these matters are dealt with locally.

My noble friend Lady Faithfull made comparisons with Kent. She asked why we need 11 trusts concerned with personal social services in such a small area. I was pleased by the answer that the noble Lord, Lord Fitt, gave because the problems in Northern Ireland are special and different. We should react not to what is taking place in Great Britain but to the needs of the Province. That is the aim of the order.

The noble Lord, Lord Williams, asked how we intend to ensure that there is no repetition of the tragedies that occurred to children in Cleveland, Staffordshire and the Orkneys. I should not wish to argue that now, but a possible suggestion is that the integration of the health and social services may prove to be a benefit in that regard. I am sure that it helps when people are closer to the community. We are well aware of the risks which may be involved in Northern Ireland but I believe that experience has shown that social workers and other employees in the health service carry out. their duties according to the needs of their clients—children, old. people and all who are less fortunate than ourselves.

The non-executives on the trusts receive £5,000 per annum. The chairmen receive between £15,000 and £20,000 depending upon the responsibility, size and nature of the budgets. I am sure that the noble Lord, Lord Williams, will be delighted to hear that the appointments of chairmen are for four years.

Lord Williams of Mostyn

My Lords, my question related to the chief executive rather than the chairmen.

Baroness Denton of Wakefield

My Lords, I apologise. I shall return to that. The noble Lord, Lord Hylton, asked whether the order should be postponed until the proposed children's order is implemented. That order is concerned with children's welfare and protection and not with how health services for children should be organised. The schemes now being developed will clarify and formalise existing procedures and relationships between boards and trusts. I believe that that will help rather than hinder the implementation of the children's order because the canvas will be in place, honed and practised for the benefit of this order.

I turn now to the speech made by my noble friend Lady Faithfull. Perhaps I may first acknowledge her great experience in the field. I also understand why people with concerns should turn to her for comment and assistance. But my noble friend asked what was the ethos and purpose of the change. It is to preserve the unique and integrated structure of the health and personal social services in Northern Ireland. My noble friend asked why, if there are no problems, we are changing the system. It is because we have had no cases of problems and because we want to continue with what is already in place that we are bringing forward the order. As I said in my opening remarks, the order is not about improving things which are wrong; it is about continuing and ensuring that services can continue more or less as they are. The boards will be able to concentrate on what they are responsible for—that is, assessing need and ensuring that there are services available to meet it.

My noble friend is worried about accountability. Accountability is to boards, to the department and then to me. That position does not change. There is another line in the structure. There is a line to the social work person on the board of the trust; a dotted professional line, which is of benefit in this case. If something should go wrong, the trust as the statutory body—and I stress the words "statutory body"—at the grass roots will be fully accountable and responsible. I accept that my noble friend has concerns in that area. In her speech she linked them to the so-called "non- statutory" nature of trusts. However, I must say, with respect, that she is wrong in that view. Trusts are wholly statutory bodies established under the Health and Personal Social Services (Northern Ireland) Order 1991. That is a fact which should cause no confusion in your Lordships' House.

My noble friend also frequently mentioned the costly nature of trusts. Such costs are common whether for hospital or community trusts. Moreover, chairmen and board members are remunerated at levels which I have already identified. We believe—and there is evidence to show this—that the benefits and the greater cost effectiveness flowing from trust status will far outweigh the question of compensation to those who take on the responsibilities. Perhaps I may also point out that if the compensation was worked out at an hourly rate it would certainly not justify anyone applying for the job on account of the money. It is visibly commitment which drives such people. The order is not about introducing a purchaser-provider split. That was introduced in 1991.

My noble friend perhaps overlooked the key role of the purchaser. Each board will be responsible for ensuring equity of provision and common standards in key areas. The Government's regional strategy sets objectives and targets for the HPSS as a whole. The boards are charged with securing them and trusts with providing them in a locally sensitive manner. They do not set the agenda, they respond to it.

I can tell the noble Lord, Lord Williams of Mostyn, that the terms of an executive contract are a matter for the trust involved. The tradition in Northern Ireland is not to adopt aggressive management approaches. Too much should not be read into individual contracts. Nevertheless, I shall register the fact that I have heard what the noble Lord said.

My noble friend Lady Faithfull has tabled an amendment to the Motion which seeks to defeat the purpose of the order as it was laid before the House. The amendment proposes that we spend another month considering whether we should enable trusts to discharge a range of statutory duties and responsibilities and to provide or secure personal social services associated with them. There is no value in deferring consideration of the matter for a further month. Since the number of units of management delivering community care and childcare services expressed an interest in moving to trust status over two years ago, the administrative and professional staff from my department have worked closely with staff from boards and trusts to devise arrangements which will safeguard and facilitate the development of personal social services in the future.

I have discussed those arrangements fully with the staff involved and have had an opportunity to speak to managerial and professional staff in the trusts about them. As a result of those discussions, I am satisfied that the arrangements that have been devised are sound and enjoy the support of the staff at trust, board and departmental level. Delay for another month would not lead to any change in the situation. It would be impossible for us to consult further and deeper than we have. On the contrary, perhaps I may suggest that delay would only serve to undermine the morale of those many staff who have worked so hard to reach this stage and would, perhaps, cast some doubt over the continued integration of our health and social services. That would be undesirable and, indeed, could jeopardise the implementation of the community care reforms and possibly the forthcoming children's order.

I know that there are social workers in statutory voluntary bodies who have expressed concerns about the proposals. However, I also know from my discussions since I arrived in this post that they do not wish to see the disintegration of the service and the separate administration of personal social services. The integrated service which we have in Northern Ireland has been in existence for over 20 years and has brought great benefit. We should not consider any measure which could damage it. I suggest that the amendment would do so. The order that I am asking the House to approve will facilitate the continuing development of the integrated services by freeing the boards fully from their direct management responsibilities and enabling them to concentrate on their role as commissioners of services for their populations.

I hope that noble Lords will forgive me for taking a considerable amount of time to cover the points that have been raised. The order is an important one. In the interests of the people of Northern Ireland—that is, the vulnerable, the professionals who help them and those of us with the responsibility for seeing that our services are of the very best—I hope that I have been able to convince my noble friend Lady Faithfull, and others, that pressing the amendment will not bring benefit but will increase and extend uncertainty. It will offer rejection to the many committed people in Northern Ireland working continuously to build and improve our services. I hope that my noble friend will allow us to go forward. I commend the order to the House.

5.38 p.m.

Baroness Faithfull

My Lords, I thank my noble friend the Minister for giving the House a full explanation of the order. I hope that noble Lords will forgive me if I stray a little outside the matter and touch on a wider issue which was brought forward by the noble Lord, Lord Williams of Mostyn. He said that accountability is what democracy is all about. Perhaps I may just say at this stage that we hope the time will come when the political situation in Northern Ireland will be such that there will be more accountability on the part of the ordinary people of Northern Ireland. I hope that I shall be forgiven for saying so.

My noble friend the Minister gave a very clear picture of what she believes is in the order. However, I found it very difficult to follow. It seems to me that she has two conflicting statements which do not accord with one another. On the one hand, she said that the work done under the present system is good. She congratulated the social workers and the people in Northern Ireland who are responsible for giving a good service. But, on the other hand, she said that this order will help them to continue to provide a good service. If they are already providing a good service, and my noble friend hopes that will continue, why not leave the situation as it is instead of altering the position?

Baroness Denton of Wakefield

My Lords, I thank my noble friend for allowing me to return to this subject. The work that is being done is first-class because everyone is working together. Without this order, they cannot continue to work together.

Baroness Faithfull

My Lords, I thank my noble friend the Minister for those comments. However, I should point out that the people who will have to work under the provisions of this order are the grass-roots social workers. I have been to Belfast and I greatly enjoyed myself there. I have met social workers from both the statutory and the voluntary sectors in Northern Ireland as well as in this country. They do not feel happy about this order. They do not feel they will give of their best under this order. My noble friend has asked why we should delay the order for a month. My noble friend has taken up her new office just when this order is being introduced. She has met the social workers, but with all her persuasive ability she has not been able to persuade them that the order is the right thing for them. Yet they are the people who do the work. I consider that by delaying the order for a month it would be possible to help the people who do the work on the ground to understand the position.

My noble friend the Minister has said that the trusts are keen to do this work, and they have been put in a position to do it. However, they will not actually do the work. They will oversee the work and they will be responsible for the work but they will not actually do the work. I consider there is a juxtaposition of feelings and thoughts here which do not accord with our going forward with this order.

I still cannot see how the purchaser/provider system will make for better social work. I do not understand that matter. Perhaps if the order had been delayed for a month I could have understood the position. I may be slow, and perhaps if I had had a little more time I would have understood the position. However, I do not understand it. I believe the noble Lord, Lord Skelmersdale, approves of the trusts—we shall have to disagree on that matter—but, equally, he approves of public accountability.

The noble Lord, Lord Holme of Cheltenham, put the case very well. I believe he has understood the order and the feeling of discontent about it. Of course the trusts are content as their staff will have jobs and they will be paid. However, I must return to the matter of costs. In this country we are constantly being told that we must cut costs. These trusts will cost a lot more than the existing provision. Yet the social workers on the ground are seeing their services cut in terms of what they can do for the vulnerable people in their areas. They then see that trusts will be set up which will be costly. The social workers cannot understand how that system will give a better service. I could go through every comment made by every speaker in this debate but I shall not do so.

Noble Lords

Hear, hear!

Baroness Faithfull

My Lords, I am sorry noble Lords do not want me to comment on what they have said. I was in close touch with social workers last night and I cannot see how the order will improve the present service which my noble friend the Minister acknowledges is a good one. I wish to test the opinion of the House.

The Deputy Speaker (Lord Murton of Lindisfarne)

My Lords, the original Motion was, That the draft Health and Personal Social Services (Northern Ireland) Order 1994 laid before the House on 9th December be approved; since when an amendment to the Motion has been moved 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.") The Question is, That this amendment be agreed to.

5.45 p.m.

On Question, Whether the said amendment shall be agreed to?

Their Lordships divided: Contents. 88; Not-Contents, 111.

Division No. 1
CONTENTS
Acton, L.	Jenkins of Hillhead, L.
Addington, L.	Lauderdale, E.
Airedale, L.	Lawrence, L.
Archer of Sandwell, L.	Longford, E.
Barnett, L.	Lovell-Davis, L.
Beaumont of Whitley, L.	McIntosh of Haringey, L.
Belhaven and Stenton, L.	Mackie of Benshie, L.
Blackstone, B.	McNair, L.
Bonham-Carter, L.	Mar, C.
Boston of Faversham, L.	Mason of Barnsley, L.
Brightman, L.	Mayhew, L.
Butterfield, L.	Mishcon, L.
Carmichael of Kelvingrove, L.	Monkswell, L.
Cocks of Hartcliffe, L.	Moran, L.
Craigavon, V.	Morris of Castle Morris., L.
David, B.	Newall, L.
Dean of Thornton-le-Fylde, B.	Nicol, B.
Donoughue, L.	Palmer, L.
Dormand of Easington, L.	Park of Monmouth, B.
Ennals, L.	Pitt of Hampstead, L.
Faithfull, B. [Teller.]	Plant of Highfield, L.
Falkland, V.	Prys-Davies, L.
Foot, L.	Redesdale, L.
Gladwyn, L.	Richard, L.
Gould of Potternewton, B.	Rochester, L.
Graham of Edmonton, L.	St. John of Bletso, L.
Greene of Harrow Weald, L.	Sefton of Garston, L.
Grey, E.	Serota, B.
Halsbury, E.	Shannon, E.
Hamwee, B.	Shaughnessy, L.
Hanworth, V.	Shepherd, L.
Harris of Greenwich, L.	Stoddart of Swindon, L.
Haskel, L.	Taylor of Blackburn, L.
Henderson of Brompton, L.	Taylor of Gryfe, L.
Hilton of Eggardon, B.	Thomson of Monifieth, L.
Hollis of Heigham, B.	Tordoff, L.
Holme of Cheltenham, L.	Turner of Camden, B.
Hooson, L.	Waverley, V.
Howell, L.	Wharton, B.
Hughes, L.	White, B.
Hylton, L. [Teller.]	Williams of Elvel, L.
Hylton-Foster, B.	Williams of Mostyn, L.
Jay of Paddington, B.	Winchilsea and Nottingham, E.
Jeger, B.	Wise, L.
NOT-CONTENTS
Addison, V.	Boardman, L.
Alexander of Tunis, E.	Borthwick, L.
Archer of Weston-Super-Mare, L.	Boyd-Carpenter, L.
Arran, E.	Braine of Wheatley,
Astor, V.	Brougham and Vaux, L
Astor of Hever, L.	Butterworth, L.
Birdwood, L.	Cadman, L.
Blatch, B.	Campbell of Alloway, L.
Blyth, L.	Carnegy of Lour, B.

Carnock, L.	Marlesford, L.
Chalker of Wallasey, B.	Merrivale, L.
Chelmsford, V.	Mersey, V.
Chesham, L.	Middleton, L.
Clanwilliam, E.	Miller of Hendon, B.
Clark of Kempston, L	Milverton, L.
Colwyn, L.	Morris, L.
Courtown, E.	Mottistone, L.
Cranborne, V.	Mountevans, L.
Crickhowell, L.	Moyne, L.
Cumberlege, B.	Munster, E.
Davidson, V.	Murton of Lindisfarne, L.
Dean of Harptree, L.	Norfolk, D.
Denham, L.	Norrie, L.
Denton of Wakefield, B.	O'Cathain, B.
Dixon-Smith, L.	Orr-Ewing, L.
Dundonald, E.	Oxfuird, V.
Elibank, L.	Pearson of Rannoch, L.
Elles, B.	Pender, L.
Elliott of Morpeth, L.	Perry of Southwark, B.
Elton, L.	Rankeillour, L.
Ferrers, E.	Rees, L.
Fraser of Carmyllie, L.	Renwick, L.
Gardner of Parkes, B.	Rippon of Hexham, L.
Glenarthur, L.	Rodger of Earlsferry, L.
Goschen, V.	Rodney, L.
Gridley, L.	Romney, E.
Haddington, E.	St. Davids, V.
Hailsham of Saint Marylebone, L.	Skelmersdale, L.
Harmsworth, L.	Southwark, Bp.
Haslam, L.	Stewartby, L.
Henley, L.	Strathclyde, L.
Holderness, L.	Strathmore and Kinghorne, E. [Teller.]
HolmPatrick, L.
Hood, V.	Sudeley, L.
Jenkin of Roding, L.	Swansea, L.
Johnston of Rockport, L.	Tebbit, L.
Kenyon, L.	Thomas of Gwydir, L.
Lane of Horsell, L.	Torrington, V.
Leigh, L.	Trefgarne, L.
Liverpool, E.	Trumpington, B.
Long, V.	Ullswater, V. [Teller.]
McColl of Dulwich, L.	Vivian, L.
Mackay of Ardbrecknish, L.	Wade of Chorlton, L.
Mackay of Clashfern, L. [Lord Chancellor.]	Wakeham, L. [Lord Privy Seal.]
Macleod of Borve, B.	Westbury, L.
Mancroft, L.	Whitelaw, V.

Resolved in the negative, and amendment disagreed to accordingly.

5.53 p.m.

The Lord Chancellor (Lord Mackay of Clashfern)

My Lords, the Question is, That the original Motion be agreed to.

On Question, Motion agreed to.