HL Deb 29 April 2003 vol 647 cc648-61

7.36 p.m.

Baroness Greengross rose to move, That an humble Address be presented to Her Majesty praying that the regulations, laid before the House on 11th March, be annulled (S.I. 2003/629).

The noble Baroness said

My Lords, I have tabled this prayer to annul this statutory instrument because I think it deserves quite serious scrutiny in this House. I do not intend to divide the House but rather I wish to seek clarification on issues raised by it.

Several organisations have raised concerns about the regulation, most notably Age Concern England, of which I am the vice-president, Help the Aged and the Alzheimer's Disease Society. It is their concerns that I wish to bring to noble Lords' attention today. But, if the impact of the regulations were more widely understood, or if the consultation had been made more public and had lasted longer after the publication of the regulations in mid-March, I am certain that we would also have heard from other organisations. This statutory instrument relates not only to older people but anyone charged for social care— although, we know that the majority are likely to be older people.

As noble Lords will know, the background to this regulation is the Health Act 1999, which gave wide powers to the Secretary of State to define functions carried out by local authorities as health-related functions. That power is being used here to delegate certain administrative functions related to charging for social care to the NHS from local authorities. At first reading, it seems straightforward and uncontroversial. But the main worry is that there could be unintended consequences of what appears to be a minor administrative change but which may take on a wider significance and may be misunderstood by the public.

Given that last month's Budget, thankfully and somewhat belatedly, abolished the very unpopular hospital down-rating rule whereby older people's state pension was docked if they were in hospital too long, I am sure that the Government do not want people to feel—even though that is very much not the case —that the NHS is charging them for something they thought would be free. If that perception takes hold, it could do great damage and confuse an already very confused picture on the still-vexed question of what is healthcare and what is social care.

I understand why the regulation is being introduced. It makes administrative sense. But in what other areas is that likely to happen? I ask the Minister whether the regulations will also be extended to charges under the Supporting People legislation. After all, many local authorities will use the home-care charging policies to charge for Supporting People services more generally.

There are also some specific concerns such as confidentiality. Many more staff will now have access to confidential financial information— people employed by the NHS and social services. I am very much in favour of greater joint working between them, which is an issue that this House debated at length when considering the Community Care (Delayed Discharges etc.) Bill before Easter. If they are to work jointly, they must share information. But, given the sensitive nature of financial information, the rules on who will handle it, and how it is handled, may need to be even stricter than they would have been if the information were available only within social services.

I wonder whether it would help to avoid confusion, particularly among older people, about who is levying the charge if all financial information gathering were done only by NHS staff within the finance section of the trust or the partnership, and not by staff who are traditionally seen as health staff, such as nurses or other medical staff. This is often considered to be best practice within social services where it has been found that the collection of information about finances is more accurately and sensibly undertaken by finance department staff. Other staff will not necessarily know, nor can they be expected to know, the full details of social security benefits and the law and guidance on charging.

That brings me to the question of training, specifically of NHS staff whether from the finance department or nurses on wards. The rules are so complicated—we all wish that they were not—but these staff are no doubt already asked by patients about care costs and perhaps may give erroneous information, quite unintentionally but because they cannot know it all. The problem may get worse if NHS staff are actually responsible for providing that information, which is why training of key staff is essential.

I was given a good example of that by Age Concern. Not very long ago, a patient asked a nurse about what would happen if she went into residential care. The nurse said that she would have to sell her house. Fortunately for this patient, the person in the opposite bed just happened to be a local welfare rights officer. Although very ill and on a drip, she was so incensed by this that she jumped out of bed to explain to the lady, who was distraught, that that advice was wrong because the value of her home would be ignored while her husband lived in it.

At Age Concern, everyone said that a PhD was needed to be poor successfully. Such information is very difficult to understand and take in. There is no reason why every nurse on a ward should have access to it. Such situations can easily arise. Luckily for that patient, everything was okay, but it might not have been.

I turn briefly to some areas that are not being delegated to the NHS by these regulations and which could be another problem. I refer first to liable relatives and to the assessment of the liable relative contribution. This was the subject of much debate in the Health and Social Care Act 2001 when I tabled various amendments. The then Minister, the noble Lord, Lord Hunt, was very sympathetic, but it was not possible to end liable relative payments at that time. With this new regulation in place, it may make it more complicated and more bureaucratic for a local authority which collects liable relative payments to work out the total amount to be paid by the family if other parts of the social care charging regime are being handled administratively by the NHS. It could be very confusing for both patients and relatives to have, in effect, one bill arriving from the NHS on behalf of the local authority for the resident and another arriving from the local authority for the liable relative contribution. That is not a fanciful situation; it could happen.

There are a couple of other areas where the regulations have left not delegated powers, such as recovery—I mean financial recovery, not personal recovery where the nurse and doctor are far better qualified than anyone else—where a person misrepresents or fails to disclose income or capital and the fees owed to social services for taking on receivership. For receivership cases, perhaps I may ask the Minister whether she expects one impact of the regulations to be that the NHS takes on receivership cases as, in effect, all the people involved in caring for that person will be within the NHS. That could happen.

I know that the Department of Health has sought to ensure that those interested in these regulations are consulted and well informed. However, I seek reassurance from the Minister that her department will require local authorities to consult with the wider community of service users and their local representative groups about the impact of these regulations. That is very important if partnership working is to be a reality. It may also be important in helping to ensure that the unintended consequences I referred to earlier do not occur.

Finally, I seek clarification on how "local authority discretion" will work in the light of this regulation. The domiciliary charging system is wholly based on discretion. Even following the implementation of the Fairer Charging Framework, there are many areas where discretion is used on an individual basis, such as when something is accepted as a disability-related cost or whether to disregard some capital that has been earmarked for a large item.

In summary, while the regulations appear uncontroversial, they raise some concerns—some of which I covered in my remarks—on which I hope that I can be reassured. I beg to move the humble Address and I hope that it has the support of noble Lords from all sides of the House.

Moved, That an humble Address be presented to Her Majesty praying that the regulations, laid before the House on 11th March, be annulled (S.I. 2003/629).—(Baroness Greengross.)

7.45 p.m.

Baroness Barker

My Lords, in supporting the noble Baroness, I declare my interest as an employee of Age Concern England. I thank the noble Baroness for introducing this Prayer today. She has brought to the attention of the House a matter of very fundamental importance and not just in the particular terms that we shall discuss it this evening.

She has hit upon a theme which has been ever-present in health policy during all the time that I have been in your Lordships' House. That theme can be expressed in one of two ways. Beneficially, it can be described as breaking down the barriers between health and social care. Conversely, it can be viewed as bringing in charging policies by stealth. That arises from the fact that health and social care are covered by two different sets of legislation and that the process to which we turn time and time again is about finding out where the barriers of those two sets of legislation collide.

I thank the noble Baroness, Lady Greengross, for this because of the nature of the consultation. She said that the nature of the consultation on this matter was somewhat odd: it hit the Department of Health website on 19th December and had a closing date of 31st January. To the best of my knowledge that is the only format in which the consultation was held. During that period I did not pay a great deal of attention to the matter and I am not sure how many others paid attention either. I was somewhat preoccupied with figuring out how the Community Care (Delayed Discharges etc.) Bill would work. What was the level of response? What was the nature of the response to the consultation? I think that the noble Baroness, Lady Greengross, is right. This looks like a simple administrative function but actually there is a huge underlying question as to what exactly are health-related functions.

I shall concentrate on a couple of areas which are unclear and on which it would be very helpful to have clarification from the Minister. One issue is disputes, a matter about which we have talked a great deal in your Lordships' House in relation to the establishment of care trusts. When someone has a dispute on this matter—where a health body is discharging the charging functions of a social services department—first, as the noble Baroness said, there is scope for confusion that the NHS is charging for NHS services. I agree with everything that she said about the need for clarity on that. But if a person has a dispute about the nature of a charge for a social care service, to whom do they complain? Which complaints procedure do they use? My big fear is that the answer will be that they use the NHS complaints procedure. But, frankly, the NHS complaints procedures are not set up for this. They are primarily geared towards clinical matters. They are not about financial matters. Moreover, as I have said on many occasions in your Lordships' House, NHS complaints procedures take for ever. So that is a very big concern.

My second question relates to the issue of legal enforcement. If a person refuses to pay, will the NHS be responsible for the legal enforcement of a social services charge? If so, will the money obtained be social services or health service money? Will the NHS end up taking people to court over a matter with which it has nothing to do, essentially, because it is a social services matter?

Like the noble Baroness, Lady Greengross, I have many doubts about confidentiality. I have no wish to rehearse the many arguments we had during the passage of the Community Care (Delayed Discharges etc.) Bill but, for a glorious period of about 10 days, when the issue of consent was contained in a piece of legislation, we spent many happy hours talking about the principles of the confidentiality of patient information.

The noble Baroness is right. There is a great deal of potential for people to be resistant to passing information to the NHS, particularly to people such as nurses with whom they do not associate financial matters. Unless there is a clear explanation, I question whether the process might compromise the integrity of healthcare.

Let me take your Lordships back to one of my favourite documents, Delivering the NHS Plan. Noble Lords will remember that that document contains a proposal that the NHS should be free to set up joint companies with the independent sector to deliver services—for example, nursing homes. If that is to be the case, will the NHS become the body setting the charges, making individual assessments and providing care? If so, what safeguards will there be for individuals? That is not clear from the information before us.

I do not wish to take your Lordship too far down the road of reconsidering the ombudsman's report—we have discussed it at considerable length but the noble Baroness, Lady Greengross, is right: there is still a great deal of confusion about what kind of social care is ancillary to health needs and it would be dangerous to put on top of that confused legislation such as this.

I acknowledge the excellent briefing we have received from the Alzheimer's Society, which sets out in great detail the fears that people have. They already start from a point of confusion. They have expectations that services for people who are severely demented will be regarded as healthcare, but they are not; they are regarded as social care. There is a great fear that charging for those services— and the charging being carried out by the NHS—will put people off.

I agree with the noble Baroness, Lady Greengross, and the Government that there is a need to break down the barriers between social services and health and that it should be done in an up-front and transparent manner. That cause is not helped by actions that can be perceived as being at best confused and at worst an attempt to alter policy by stealth. If the Minister can assure the House that front-line staff such as nurses will not be sidelined into doing this kind of work, we will have achieved a great deal today.

Earl Howe

My Lords, I congratulate the noble Baroness, Lady Greengross, on initiating the debate and for drawing our attention to some issues of considerable interest and importance. I confess that I sat down and read these regulations and the Explanatory Note which accompanies them and felt little the wiser at the end. It is fairly impenetrable. Having listened to the noble Baroness today, I feel that I am now a good deal wiser. But it will, I am sure, be of considerable assistance to all of us to hear in the Minister's own words what she regards as being the sense and purport of the regulations and the reasons why they have been introduced.

We are all familiar with the idea of partnerships between the NHS and local government. On the whole I believe that we regard such partnerships as a good thing. The Health Act 1999 ushered in the legal powers to enable such joint working to occur, not least in the form of pooled budgets. The regulations in front of us flow at least in part from that Act. Broadly speaking, where local authorities perform functions which affect people's health, then the Secretary of State has the power to define and influence those functions.

My first question to the Minister is whether collecting information about people, issuing invoices to them and making sure that they pay those invoices constitute a set of activities that can be said to have an effect on those people's health. At first sight, I am not at all convinced that they do. None of those activities is a service delivered to individuals; they are a series of administrative processes. So I question whether the wording of the Act was meant to cover the kind of function that these regulations encompasses.

That is my first, rather technical, observation. My second one is that for a local authority to delegate certain functions to the NHS carries with it two kinds of risk. The first kind of risk is that the barrier between local government and the health service will be bridged too easily. The second kind of risk is the opposite, which is that important issues will not get properly across the bridge but will instead fall between the cracks.

In the first camp lies the noble Baroness's concern about confidentiality. It is all very well to envisage local government passing some of its functions to the NHS for reasons of convenience or expediency, but what kind of say does the patient have about who can have access to the information collected? I do not know how I would feel if I were quizzed by NHS staff about how much money I had or what my house was worth. I might see the need to divulge this kind of information to a local government official in certain circumstances, but would I feel comfortable disclosing it to a nurse or to a hospital manager? I doubt it—which is why I agree with the noble Baroness, Lady Greengross, that there need to be strict, tightly-defined procedures for dealing with this kind of process, where informed patient consent plays a central role.

The second camp contains most of the other points so cogently put by the noble Baronesses, Lady Greengross and Lady Barker. Breaking down the barriers between local government and the NHS should not leave any room for either ambiguity or unprofessionalism. Local government staff who have to perform the sensitive job of explaining the charging rules to service users and exercising discretion where that is required—as it often is—about what charges are appropriate to someone's domicilary care, are experienced and trained in those roles. If NHS staff are to be asked to take over those roles, then they have to know what they are doing. That is not meant to sound disrespectful to NHS staff, but the fact is that none of us could perform those tasks without being suitably trained, any more than a nurse or a hospital administrator can be expected to do them. It would be most helpful to hear from the Minister how the delegation of tasks by local authorities to the NHS is to be accompanied by the necessary propagation of skills.

We also need clarity about where the buck stops. When local government functions are performed by local government there is no ambiguity on that score. When local government functions are delegated to another public body, where does the responsibility lie in both practical and legal terms? The noble Baroness, Lady Barker, made the point very well. If the NHS sends a bill to someone and that person does not pay, whose responsibility is it to take enforcement action? Who is the arbiter of disputes? Everyone involved in a partnership arrangement needs to be absolutely clear about where responsibilities ultimately rest, not just legally but practically.

I share the noble Baroness's view that we can talk positively about partnership arrangements and wish those arrangements well when they happen. But when they do happen, people have got to know what the full implications are; and that means consulting beforehand those directly affected. I hope that such consultation will be automatic in each instance, because these are not necessarily straightforward matters. It is very helpful that the Minister has an opportunity to allay the concerns that the noble Baroness, Lady Greengross, has identified, for I believe that they are concerns that are shared around the whole House.

8 p.m.

Baroness Andrews

My Lords, I am very grateful to the noble Baroness, Lady Greengross, for creating an opportunity for the House to discuss these regulations in terms of the Prayer that she has laid. I am even more grateful that she has not only advised me of some of her concerns, but also that she has said that she will not be praying against the regulations this evening. However, it is a useful opportunity that has been taken by noble Lords to explore some of the issues that are raised in the regulations, and we should be grateful for that. I will try to deal with as many of the questions that have been raised as possible. There is a consensus among noble Lords about some of those issues, and I hope that I can give fairly full answers.

I will start by explaining what the original legislation was intended to do. I will also start by saying something about the consultation period, because I know that the noble Baroness, Lady Barker, was concerned about the short period of time. We did notify the local authorities and the voluntary organisations and we did actually use e-mail. So it was not quite as slow as she implied. We did not just put it on the website, we did actually invite a positive response. But she is right, the responses were low and we had only approximately 15 responses. They were from a mixture of local authorities and voluntary organisations and so on. We opted for a six-week consultation period because two of the three amendments were uncontroversial, and I shall explain at the end of my speech why they were so uncontroversial.

The third option, the controversial one which we are discussing, Regulation 5, is in fact a voluntary choice, but even so, it was something that we certainly wanted to consult on. We did want responses and we received very well-informed responses from the people who replied. The original legislation was essentially designed to address the issues that were covered by the original regulations. The focus of the original partnership arrangements were set out in the NHS Bodies and Local Authority Partnerships (England) Regulations 2002. As noble Lords know, that was designed to encourage joint working between the NHS and local authorities; and it has been warmly welcomed, because to be against joint working is like being against sin. We cannot be anything other than in favour of it.

These regulations introduce new ways for agencies to work together to provide the best possible service for local people. Using the powers of Section 31 of the Health Act 1999, local authority and health partners can now pool different pots of money. They can make better use of resources. They can try better and more ambitious projects and essentially they can put their staff teams together under the same managers so that social workers, district nurses and care assistants can work from day to day in the same teams. I am pleased to say that since those powers were introduced we have seen a flourishing of over 200 new projects notified to the department, ranging from the very straightforward such as integrated community equipment to multimillion pound joint ventures.

The amendments before us are essentially designed to make some necessary changes and clarification; and I hope that that the noble Baroness will be pleased with the clarification. First, in relation to Regulation 5, which primarily concerns us, I wish to reassure noble Lords that the changes proposed are for a very specific purpose and will only be needed and used by a very small number of care trusts and large-scale NHS-led partnerships which are transferring substantial sections of their administrative arrangements from local authorities to the NHS. The proposed amendment ensures that councils can only delegate charging for the particular care services which the partnership is delivering. They are very specific and they can only do that under the conditions set out in these amendments and the forthcoming guidance, which I want to spend a little time describing.

The noble Earl, Lord Howe, asked whether the collection of administrative tasks that he identified really do affect health. Section 31(a) to the Health Act 1999 defines health-related functions, not only in terms of the effect on health, but whether they are connected with any functions of NHS bodies. So the technical answer is yes. However, I add from a more personal point of view, that the collection of this kind of financial information can be stressful, and can have an impact on health. So in the broader context I would say yes to that, too.

Let me deal with some of the concerns that have been raised. One of them is obviously that, because this involves a transfer to an NHS-led partnership. NHS staff may take over the new tasks and there may be some ensuing confusion. It is a serious issue, but it is an issue which might be raised wherever joint working takes place. As I have said, joint working has been welcomed, and is one of the things which we all agree provides an opportunity to create new approaches to the way in which we provide services. It also creates an opportunity to use new language, to develop new roles for people across services, and will deliver better services. That is what these regulations exemplify.

Regulation 5 simply means that if a local council decides to transfer some of its staff to the NHS to work in integrated teams in relation to care trusts or NHS-led partnerships, it can now also choose to transfer those functions and the staff who work on charging for those services alongside them. There is an element of continuity here, because those staff who have been transferred will carry on with the work that they have always done—but now within the integrated team.

The kinds of tasks that are involved—assessing an individual's ability to pay, collecting charging and monitoring how charging is working—will be the things that are important to the client. It has not been possible until now to do this. It means under the current legislation that council staff are still required to make decisions about people for whom all other services are being handled by the new partnership teams. I will give noble Lords a practical example of the impact of that.

I believe that this brings a better service and I want to reassure the noble Baroness that under the new arrangements the charging administration is likely to involve the very same council staff, such as finance assessment teams who have transferred into the NHS under partnership arrangements. At this stage, it is unlikely that new people will be involved. Therefore, we are not assuming that there will be any change or confusion for clients.

However, these are evolving projects; these are evolving and developing institutions. Over time, they may come to involve new people; either new recruits for the NHS team or existing NHS staff such as care managers. That involves retraining. In fact, they might involve the finance staff. It would be up to the partnership to decide who is best placed to deliver that.

Let me stress the evolving nature of the role. We believe that it will allow time for adjustment, particularly for proper training. I want to pick up and reinforce everything all noble Lords said about the importance of appropriate training. We see it as extremely important, but the case which the noble Baroness cited was a good example of bad practice. I am sure it is not the kind of practice to which we would want to expose any patient in any situation.

In a new framework, with new languages and opportunities, it is important to recognise that staff have a changing and expanding role. They will be trained in different ways for different purposes. We are bringing together health and social care for the first time. We have lessons to learn, but training sits at the heart of that, particularly in response to the complexity of information, as the noble Earl, Lord Howe, pointed out.

I can assure noble Lords that there will not be a sudden shift from care responsibilities to financial responsibilities; nor will there be a sudden shift to new staff. That is where confusion could occur. As regards the training that is provided, I put it to your Lordships that few people could be better suited to providing advice on benefits or charges than those people who will have the day-to-day contact with clients, wherever they are. A person involved in arranging someone's care, properly trained, will be in a good position to put the whole picture together and give the right information.

Therefore, rather than undermining or changing the relationship between the NHS and clients, we see this as a way of supporting and growing close and confident relationships for the future.

I turn to the issue of confidentiality. As the noble Baroness said, we have addressed this many times in this House in recent months. When Age Concern, for example, responded to consultation, obviously it wanted to ensure that there would be clear arrangements about which staff should be able to collect financial information. We share that concern. But, in the first instance, all organisations operating in partnership are required to adhere to strict protocols on information sharing and confidentiality and that includes the Data Protection Act and the Caldecote principles. We will reiterate that in the guidance that we will prepare.

In the second instance, I would argue that in practice the fewer people who are involved in managing the process of information and the support that is given, the more likely it is that confidentiality will be protected. I completely take the point made by the noble Earl, Lord Howe, that if one knows the person involved, it is more likely that one will obtain more personal, sensitive and effective support. Therefore, all information about the person's care and financial arrangements under the new arrangements may be kept within one organisation and team instead of continually trafficking between the NHS and the local authority.

Under these regulations, care managers, who know the service users well, will be able to undertake those sensitive financial assessments while they are arranging their care package. It means fewer people being involved and fewer visits being made. But, again, it is imperative that those working in the field and the service users are clear about the changes involved and what they must do to communicate their impact.

That is why we have put the requirement for information to be provided into regulations rather than into guidance. Regulations 6 and 7 cover that point. It means that partnerships must explain to service users which services they are being offered, which elements of a care package are the responsibility of the NHS, which are the responsibility of the local authority and what the charges are for. Those regulations will be backed up by guidance. I want to emphasise that we will be consulting with all interested parties on that guidance. The regulations and the guidance will therefore deal with the other major concerns which were raised in conversation and which were referred to by noble Lords today.

However, the amendments have the potential to cause confusion for service users; that somehow NHS services free at the point of use and local authorities will be conflated and that NHS services might incur a charge.

Let me be absolutely clear about this: the legislation in no way alters or compromises the overriding principle that NHS services are free at the point of use. There are no loopholes that will enable charging to creep into NHS services. The amendment is focused on the local authority functions that have already been delegated. The only services that can be charged for are the social care services that carry charges at the moment such as home care or residential charges. The partnership could not decide to move outside the framework already set by the council. Those changes do not represent in any sense a take-over of local government powers by the NHS.

Two other points have been raised. Locally accountable councils remain firmly responsible in law for charging policy, determining which services incur a charge, what they should be and the eligibility criteria for a service. Nothing changes that overriding principle or shifts that responsibility. I hope that answers the point raised by the noble Earl, Lord Howe. I can also reassure noble Lords that these amendments do not enable the delegation of the legal enforcement of payment. I hope I can reassure the noble Baroness, Lady Barker, on that point. That must remain with the council.

I now deal with a specific point which goes to the heart of some of the issues. When Age Concern responded to consultation it raised the prospect of a service user receiving a bill for care on NHS headed paper. It expressed fears that it had the potential to cause confusion and upset. We do not want that. Our response is that the key to avoiding service user confusion is a very clear information policy which sets out which services are being offered, which organisation is legally responsible for which services and which charges apply to the local authority services within the package. We agree that branding issues are very important. That is what people see and make a judgment on that basis. We will specifically mention this in guidance as something which partners should consider carefully.

The guidance will reflect and reiterate many of the issues that we have talked about today. It will emphasise the importance of appropriate training for all staff involved in charging administration. Councils will be required to ensure that any NHS-based team taking on charging administration and a delegated authority includes people with appropriate financial expertise. It will emphasise that partnerships must explain clearly to service users exactly what service is being received, where the responsibility falls and so forth, and what charges, if any, they may expect to receive for the social care element of their package, as already set out in Regulations 6 and 7.

The guidance will also require councils to ensure that they can monitor the effectiveness of charging policy across the whole of the local authority. I reiterate that we shall be consulting with interested parties on all these matters and what the guidance will contain. We shall be listening carefully to what people tell us.

I now take up a few of the specific questions raised by the noble Baroness. Liable relatives will not be included because that function is not delegable. I reassure the noble Baroness about that. The question of receivership will not be delegable. That is outside the scope of the provisions. Where there is an element of discretion about individual cases, it can be applied under the amendment, but only within the parameters set by the councils themselves. How to handle some of the issues that involve elements of discretion will be a matter for negotiation between the council and the NHS.

The noble Baroness, Lady Barker, asked me whether the regulations applied to supporting people on home care. The short answer is no. It is rather a technical judgment so I shall write to the noble Baroness to give her the background to the issue.

Perhaps I may say very briefly why we have introduced these regulations and what has inspired them. I shall be frank with the House. They are necessary because they correct a legislative error that has led to some inconsistency. It is already legally possible for councils to delegate charging functions to the NHS where these relate to home care services and non-residential services. That was an unintended consequence of the Care Standards Act 2000, which redesignated charging for home care services as a social service function and therefore made it delegable under Section 31. Our changes close that loophole and ensure that charging for home care services is treated now in the same way as any other service delegated under the principal Act. So home care and residential services will be brought into line now. But there is the positive change that I have been arguing tonight. It means that if you delegate the service, you can delegate the charging that relates to it. Local authorities who responded to our public consultation on the amendment supported that change. One care trust, Northumberland, was very proactive in initiating the change. Northumberland argued that it needed the amendment as it would give it increased flexibility with regard to how it arranged its services with NHS partners and in considering how they could best be provided. That case study says much that is rather hard to explain in a more abstract way. Northumberland explained that without the amendment it would face some serious practical difficulties.

Early last year there were some changes to social security benefits which meant that a group of older care home residents suddenly needed to submit claims for the first time. One of the council's care managers had previously worked as a financial assessment officer. Therefore, she both knew the residents and understood the financial issues. She was able to deal with the financial forms as part of her care management review of resident care plans. But if a similar issue had arisen once the care management team had transferred to the NHS, under the current legislation the only option would have been to send an administrative officer from the council as members of the care team would have been barred from being sent. However sympathetic that person might have been, he or she would not have known the residents and would have been less able to calm anxieties or to address other questions.

The regulations seek to make the most of joint working and to provide better services. Essentially they seek to organise services around the client. They are benign measures. I believe that they are the best of measures. They offer choice. It is a voluntary scheme. The regulations do not prescribe the way things should be done. They offer absolutely no compromise to the principle of the NHS being free to users. They introduce no new charges. They strengthen integration. The changes have been driven by practitioners.

If the amended regulations had been opposed—I am pleased that the noble Baroness has stated that she will not oppose them—it would not have meant the end of partnership working but it would have prevented Northumberland and other partners like them from operating in the future as they would want.

I refer to two other aspects of the regulations. I remind noble Lords that if they oppose the regulations they will prevent the Isles of Scilly from operating partnership arrangements. I am sure that we would not want to do that. We would also hold up the consultation on care trusts which is hardly controversial consultation.

I must confess that we have discovered a typing error in the regulations. Our solicitor's advice is that it does not in any way affect the way in which the regulations will operate in law. However, we have noted the error and we shall correct it at the earliest opportunity. In Regulation 5(2)(k) reference is made to Section 23(2) of the National Assistance Act 1948. That reference should be to Section 23(3).

I hope that having heard the explanation of what the regulations are intended to achieve, they are acceptable to your Lordships. I hope that your Lordships consider that they are a positive step to increasing local flexibility in joint working. I am grateful to noble Lords who have spoken.

Baroness Greengross

My Lords, I am most grateful to the noble Baroness, Lady Barker, and to the noble Earl, Lord Howe, for their contributions. I am especially grateful for the Minister's detailed, comprehensive and frank response. She dealt with most and possibly all my concerns and clarified the situation a great deal. If any of my concerns are still outstanding, I hope that I may write to the Minister. However, as I said at the outset, I do not intend to test the opinion of the House. I beg leave to withdraw the Motion.

Motion, by leave, withdrawn.

Baroness Crawley

My Lords, I beg to move that the House do adjourn during pleasure until 8.35 p.m.

Moved accordingly, and, on Question, Motion agreed to.

[The Sitting was suspended from 8.24 until 8.35 p.m.]