HL Deb 04 July 2003 vol 650 cc1163-71

12.15 p.m.

Baroness Andrews

rose to move, That the draft order laid before the House on 12th June be approved [22nd Report from the Joint Committee].

The noble Baroness said: My Lords, the order being debated this afternoon is designed to disapply the requirement for councils in England to produce a community care plan under Section 46 of the National Health Service and Community Care Act 1990. Community care plans covered community care services for all client groups. Their primary purpose has been to ensure that councils have a robust planning process to manage their community care responsibilities and that they work with health bodies and housing and other agencies. The plans have also proved a useful means of conveying important public messages about the direction of community care policy.

Since April 2002, however, local authorities have not been legally required to submit community care plans. This forms part of a wider initiative between central and local government to rationalise and streamline planning processes and to promote more joint working by health and social services.

Directions were passed disapplying the requirement to produce a community care plan for each of the years 2002–03 and 2003–04. The order before us is aimed at making this change permanent. It also consequentially removes Section 46 from the list of social services functions, in relation to England, which is found in Schedule 1 to the Local Authority Social Services Act 1970.

Those changes were driven, first, by a determination to simplify planning processes, and, secondly, to ensure that national priorities were more effectively delivered at local level. Let me briefly explain the background. In 2001 the Government commissioned a review of the plans they required councils with social services responsibilities to submit for scrutiny. It was widely accepted across local and central government that the then planning requirements constituted a heavy burden on local authorities. Social services alone were contributing to at least 40 plans each year, equating to more than 6,000 plans nationwide. Furthermore, the plans did not constitute a coherent whole from a local perspective. They took a variety of forms on a variety of timescales and were required by a variety of sources. A recurring theme was that the current process failed to make clear what the national priorities were, with each planning requirement concentrating on its own set of priorities. It was an unsatisfactory position that we attempted to address.

For example, one of the arguments for the original introduction of community care plans in the 1990s was that integrated community care packages were not developing on a sufficient scale and that the whole process needed much greater impetus. The introduction of community care plans helped to achieve that. I should add that councils had also been given the option of incorporating the essential elements of community care plans into their joint investment plans and health improvement plans, or they could remain as stand-alone plans. We were looking for change and best practice.

The 2001 study acknowledged that local authorities were drowning in planning bureaucracy, and suggested that a new framework was needed to assure Ministers that national policy priorities were being successfully translated into local action. The department accepted the report′s recommendations and, as in many other areas of government policy, where joint working has been strenuously developed in recent years, the past two years have seen the introduction of more integrated and streamlined planning processes within both local authorities and NHS bodies.

Most significantly, a new planning framework for health and social services, which came into effect this April, now means that the majority of current planning requirements will be replaced by a single, integrated three-year local delivery plan for health and social care. Just as the community care plans helped to inform the joint investment and health improvement plans, so they have informed the development of the local delivery plans. All aspects of the community care plan have been incorporated into the new planning framework, which is linked to health, as appropriate. I am sure that noble Lords will applaud the fact that the plan also has the advantage of having fewer national requirements and fewer targets.

The focus and coherence of community care plans have provided a strong basis for what we consider to be a more responsive and rigorous planning structure. The functions and the profile of community care will, we anticipate, be enhanced as the partnerships gear up towards a new generation of planning and service delivery. But we are also looking to better community care planning in terms of both the national service frameworks—for example, in the National Service Framework for Older People and the National Service Framework for Mental Health—and the local community strategies themselves, which bring together all aspects of community development.

I want to make a few additional points. First, when the department embarked on a consultation process in August 2001, it sought the views of all chief executives of health authorities, directors of social services and selected voluntary groups on removing the legal requirement to produce the community care plans. We were very pleased with the response. Ninety per cent of respondents were supportive of the proposal because they argued, as we had, that in many cases community care plans had failed to reflect user views, they were considered to be time-consuming, much of the work was replicated within other planning documents, partnership working had progressed and, indeed, other options had been found for meeting the needs of diverse groups.

However, they raised two important concerns, which I want to conclude by addressing. The first was that the needs of users and carers should be reflected positively in the existing planning processes, and, secondly, that the needs of vulnerable groups should not be "lost" in the plethora of planning reports. The issue of inadequate information and confusion was raised repeatedly as being a barrier to the involvement and participation of service users. Frequent references were made, in particular, to the needs of minority ethnic groups, people with sensory and physical impairment and people with learning disabilities.

In the light of the comments received, the Department of Health issued a response which stressed the need for clear sign-posting for service users to ensure that minority groups′ needs were addressed. It also stressed that health and local authority partners needed to identify and address any gaps in provision and that local authorities and health partners needed to own as well as develop their joint plans.

Since then, many actions and developments have taken place. Local authorities have indicated that they are providing "sign-posts" for service users, demonstrating the range of plans, and, where there are gaps in addressing specific service requirements, the local authority, together with its health partners, will now have to address how best to reflect those in what they do. Many local authorities are also preparing an annual publication, which will provide an additional sign-post to plans, together with a co-ordinated statement for smaller groups of service users where the needs were not accounted for in the main plans. I hope that all that will be seen as a positive response to the problems which we picked up.

We have drastically reduced the number of plans required to be submitted to the department from 30 to two. We are convinced that, by replacing the community care plans with the local delivery plans, we shall strengthen the focus. We shall be addressing and identifying proper priorities for care, with all client groups involved, and the coherence which is needed will be enhanced. I should say that only the local delivery plans now have to be submitted to central government.

Therefore, the order addresses different kinds of realities. In particular, it addresses the fact that Section 46 of the National Health Service and Community Care Act 1990 still requires councils to produce community care plans, which is why we seek the disapplication. The proposed change was consulted on in autumn 2001 and was subsequently approved with the full involvement of Ministers. The proposal for the order has lain in the House of Commons and the House of Lords for the required 60 days without comment from either House. Therefore, I hope that suggests that we shall have the support of all parties. I commend the order to the House.

Moved, That the draft order laid before the House on 12th June be approved [22nd Report from the Joint Committee].—(Baroness Andrews.)

Baroness Noakes

My Lords, I start by thanking the Minister for introducing the order and for explaining it in her customary clear and comprehensive way. At first blush, the order looks completely straightforward but I have a few questions for the Minister.

First, perhaps I may deal with the timing of the order. Consultation took place between August and November 2001. Since then, there has been no action on the order other than the ad hoc removal of the obligation to produce annual community care plans. Can the Minister say what was the cause of the delay between November 2001 and July 2003?

Secondly, and related to the subject of timing, the consultation was completed 20 months ago. The Minister outlined some of the findings of that consultation. Are the Government clear that nothing has changed in the meantime? What procedures have the Government followed to ensure that the decision to abolish the annual community care plans remains valid?

Thirdly, the abolition of annual community care plans is, of course, welcome if it relieves local authorities from a burden without loss of value to the community. When considering the burden on local authorities in this area, I looked for the subject of community care plans on the department′s website and discovered the following non-exhaustive list of plans and planning mechanisms that local authorities engage in with regard to the areas covered by the plans. It includes: local strategic partnerships; local health partnership and modernisation boards; health improvement and modernisation plans; joint investment plans; national service framework local action plans; better care higher standards; local community strategies; carers′ strategies; and best value plans.

As I said, I am told by the Department of Health′s website that that is a non-exhaustive list. "Frightening or what?" for local authorities, I say to that. I am tempted to say that the Department of Health has on its hands a far bigger task in relation to simplification than this modest measure before us today. The noble Baroness talked about reducing the number of plans submitted to the centre. But, if the Department of Health website is to be believed, significant burdens are still left on local authorities.

Perhaps I may ask the Minister two questions relating to this area. First, how can the Government be sure that, in moving away from annual community care plans to a plethora of planning mechanisms, usually on longer planning timescales, sight will not be lost of short-term developments? Three years can be a very long time on the ground in dealing with needs.

Secondly, how can the Government be sure that the needs of all groups—especially minority groups—are taken care of? That was a particular strength of the way that community care plans were developed and it was one of the strong messages received in the feedback from the consultation exercise carried out by the department.

The Minister talked about sign-posting and how some local authorities carry that out. I fully accept that. But can she say how the department ensures that local authorities make it clear how all groups—in particular, minority groups—can make their views heard and have them fed into the process? It is not enough simply to issue guidance about sign-posting; we must be sure that it is happening in practice in the way that it did happen to engage groups under community care plans. We do not oppose the order but we believe that these are serious questions that require answers.

12.30 p.m.

Baroness Barker

My Lords, I, too, thank the Minister for the way that she introduced this very welcome disapplication order. She did so in her customary thorough manner.

In this House, we do not have a habit of giving our speeches titles. But, if I had the opportunity to do that, I would like to steal the title from an event that I attended a couple of weeks ago. It was entitled "More than Sandwiches and Samosas". It reflected the experience of older people being involved in consultation on all these plans. I want to talk very much from the user point of view.

The order is welcome because it reflects the increase in joint planning and joint consultation which has been taking place over the past two years. The noble Baroness, Lady Noakes, questioned whether the department′s actions had, in fact, reflected reality. They have, and I say that as someone who is, from time to time, involved in helping users and stakeholders to become involved in this issue. There has been an explosion in consultation meetings and consultation mechanisms. That is a huge problem. If local authorities are drowning in the consultation requirements placed upon them, just think what it is like for small community organisations. The truth is that they cannot manage to keep up.

One concern is not addressed by the order, but it is a real one all the same. The requirement for consultation carries with it no resources. Small organisations are being required to take part in consultations but they do not have the time, money or staff to do so. I happen to work for a large and well-established voluntary organisation, one which is strong at local level. One of the people I worked with now works in the North West. She calculates that she works one week in four on consultation for statutory authorities. She is not paid for that, nor is her organisation. Frankly, small community organisations are not going to be able to undertake it.

One of the lessons that has been learnt from the process of community care planning is that the most beautiful of plans means nothing if that is the only involvement that stakeholders have in it. During the years social services have become good at producing plans which have some meaning. But the NHS, which is increasingly involved in joint implementation plans in health and patient care, has a long way to go in its ability to make the processes work, never mind the outcomes.

A couple of months ago, I was told about a consultation meeting for older people which took place somewhere in London. The consultation meeting was set up for nine o′clock on a Monday morning in a hospital site not on a public transport route and without transport laid on. The health authority was surprised when no users turned up. The authorities are beginning to improve, but only slightly.

The order will assist in one other aspect. People say they are burnt out by consultation. We have a race of super pensioners who have a great time. They are professional pensioners who go to consultation meeting after consultation meeting. But even they are having enough of the sandwiches and samosas. In Age Concern recently, we had an application from a bunch of pensioners who have become firm friends. They have been to so many consultation meetings that they have got to know each other. They applied to us for some money and they were most specific in their requirements. They wanted money to have outings and treats because they did not want to have to go to an event and sit and listen to yet another boring speech before they got the sandwiches.

A noble Lord

They would not do very well in here!

Baroness Barker

No, they would not do very well in here! The Minister is right. There are other mechanisms. Better governance for older people is an interesting one to look at. The better governance for older people programme has left a good legacy of involvement of older people, but sustaining it at local level now that the national funding has disappeared is proving to be difficult and much of the good work done under that programme is being dissipated.

The noble Baroness was right to talk about the importance of local development plans. They are important locally, as are health improvement plans. But they will only be as good as the data they produce. During the past 10 years or so of community care plans, a great deal of effort has gone into the process of writing the plans but I have yet to find anyone who has been able on a sustained basis across an area to say what has resulted from them.

One of my colleagues at Age Concern used to have the delightful job of going through every community care plan in London trying to find out what it said about older people. That was a job in itself. Now that she has retired, I am not sure that we have any better information about service planning. Therefore, in welcoming the rationalisation, I ask the Minister whether, when we are down to one or two planning mechanisms, they will have the resources to be real and where the data they generate can be found. It is hard enough finding the processes on the Department of Health′s website. Finding the results is even more difficult.

Baroness Andrews

My Lords, I am grateful for the welcome which the noble Baronesses, Lady Noakes and Lady Barker, have offered the order. I shall deal with a few of their questions in turn. Yes, it has taken us a little time to come forward with the order, but we introduced the disapplication directions which gave the clearest possible steer to people that we did not want them to duplicate effort. In the interim, the planning process has not changed.

However, it has been a period of considerable development. For the first time we have tried to be serious about the delivery of joint working on the ground in health and social care. It is a major challenge following the Health and Social Care Act 2001. We have put a great deal of effort into ensuring that what can work on the ground is what happens.

We are certainly not complacent, but during the past three years we have not had a hiatus in development or delivery. We have introduced local delivery plans which are better and integrated and address some of the issues that were ignored. I am not surprised that when the noble Baroness, Lady Barker, looked at the website she found so many examples. I am sure the search was not exhaustive, but it is a measure of how much has been devolved to local policy. So much integration and local strategy is being put in place. That is where we find the requirement to consult and to be serious and intent upon it.

There is an issue about the annual community care plans and their time-scale, but the local delivery plans are living documents. They are not set in stone for three years and they can be amended. Corrective action can be taken if delivery goes off course, or if there are new and urgent priorities or opportunities. Although I understand why the noble Baroness raised the question, we can have confidence that there will be flexibility.

On the seriousness about consultation, I shall address the issues which came from different parts of the House. I am delighted that we have had an incredibly proactive impact on the people concerned, whether they are the elderly, parents without work, or whatever. The idea of consultation overload is a little daunting and I hope that we do not inhibit people from coming forward. I believe that the challenge is to find ways of involving and identifying the people whose voices are never heard.

We have some opportunities in initiatives such as Neighbourhood Renewal for involving people. We are undertaking similar work in drug action development. My noble friend Lady Massey recently spoke about drug action teams talking to small groups of mothers in very deprived areas where there are big drug problems. They talk to small groups in order to get them involved as the voices of their community. There is no doubt that we have not been very successful and there are better ways of doing it. I take the warning she offered. It is the greatest disappointment to involve people at the early stage of a process and never to be able to show them how their words, influence and expertise made no difference to the outcome.

Section 11 of the Health and Social Care Act 2001 places a specific duty on local authorities to ensure that the service users and carers are involved in the planning process. The technical guidance that is issued on local delivery plans, which I would be happy to pass on to the noble Baronesses, Lady Barker and Lady Noakes, operates to a standard template. There is a lot of detail about what we expect to see. The guidance must summarise how key partner organisations have been engaged in the process, how supportive they are of service proposals and, indeed, how they will be affected. We are getting serious about the audit trail of involvement and outcome. I would be very happy to circulate the guidance. It is extremely important that we involve such organisations throughout the process. I take the point about resources for voluntary organisations. One encouraging aspect is the contact that has been set up between government and the voluntary sector, which may make a difference in some centres.

I hope I have been able to reassure noble Lords that we have addressed some of the issues which spring from the changes that we ask the House to support. I should be happy to reply further in writing to noble Lords. In the meantime I commend the order to the House.

On Question, Motion agreed to.