HL Deb 27 March 2003 vol 646 cc968-74

5 Clause 2, page 2, line 5, after "hospital" insert "after 1st April 2004"

The Commons disagreed to this amendment for the following reason:

5A Because it is necessary for the Bill to come into force before 1st April 2004.

Baroness Andrews

My Lords, I beg to move that the House do not insist on their Amendment No. 5 to which the Commons have disagreed for their reason numbered 5A. I shall speak also to Amendment No. 47.

Noble Lords have argued throughout our debates on the Bill that it should not be introduced until April 2004. I understand concerns that we should not set up an unworkable scheme without regard to the consequences. I believe I can address those concerns and am pleased to do so. We have thought long and hard and want to be both fair and equitable, meeting the concerns articulated by noble Lords.

Something upon which we in this Chamber are all agreed is that patients—they are mainly older patients—should be supported in leaving hospital when they are medically ready and that when current arrangements let them down, as occurs all too often, we have to act to put that right. Our problem with a further six months' delay beyond October this year is the very real risk that the benefits of the concentrated efforts already made by health and social partners will be lost. We know that much good work has already been done. Instead of local authorities and trusts across the country continuing to work together we are afraid that there could be additional delay.

I wish today to assure noble Lords that although the Government still intend to commence the provisions which implement the process—that is, the giving of the notices and the assessment—in October, they will not commence the provisions dealing with charging until 1st January 2004.

In addition, noble Lords will remember the commitment announced by the Secretary of State in November to transfer an extra £100 million to councils. budgets for each full year of the scheme's operation. I can confirm now that councils will proportionately receive £50 million for 2003–04. This will be paid as soon as practicable so that councils can invest these extra resources in expanding older people's services as fast as possible so that they can be well prepared for implementation in January. There will then be £100 million in 2004–05 and again in 2005–06.

We have delivered, therefore, a period of grace. It means that the NHS and local authorities will have a three-month period over the winter to prepare for full implementation during which the charging operates only in shadow form and no charges for delays will change hands. I believe that this will bring health and social care partners together and, crucially, allows for proper planning without the loss of momentum. Part 2 of the Bill will come into effect on Royal Assent.

I turn to the sunset clause, Amendment No. 47. We are still convinced that it is not an appropriate use of a so-called sunset clause. While delayed discharges are a serious matter for the patients and families, they can hardly be called a matter of national emergency. Neither is there any inherent reason for the Bill to come to an end in five years' time other than the Opposition seeking to limit its effect.

It is an important point. Are we really saying that noble Lords should be able to put a time limit on a Bill which the elected Government have brought forward? Constitutionally, I believe that that sets an extremely unfortunate precedent. In a previous debate, the argument was made elegantly by the noble Earl that it would be no bad thing if all Bills had a sunset clause. In certain cases, such as national emergency or where civil liberties are affected, that may be appropriate. But in the case of the majority of Bills there are already procedures for repeal or amendment. We have dealt with that. To require Parliament to revisit legislation without a very good reason for doing so places a fetter on Parliament's ability to legislate and to do so in this Bill would set an unfortunate precedent.

We recognise that policies and Acts have a natural lifespan. However, in this Bill our goal is to encourage a reduction in delays through joint working and our expectation is that that will be achieved in the way we have set out with the additional funding In the unlikely event that in some areas the Bill does not work as well as we believe that it will, we have reliable and well-established procedures and monitoring systems which will give us an early indication of what is going wrong.

On those grounds, I hope that noble Lords are able to accept our changes and to reject the amendment.

Moved, That the House do not insist on their Amendment No. 5 to which the Commons have disagreed for their reason numbered 5A—(Baroness Andrews.)

Earl Howe rose to move, as an amendment to the Motion that this House do not insist on its Amendment No. 5 to which the Commons have disagreed for their reason numbered 5A:

5B Leave out "not".

The noble Earl said: My Lords, perhaps I may address the two issues in reverse order by taking first the issue of the sunset clause. That may seem perverse but the noble Baroness may understand shortly why I do so.

I listened carefully to what she said. In essence, she has taken many of the same lines of argument against the amendment as were used by the noble Lord, Lord Hunt, during our debate last week. I do not accept the arguments which attempt to portray sunset clauses as somehow anti-constitutional and as fettering the will of Parliament. If Parliament decides that an Act must be subject to a mandatory review in both Houses after a certain period of its operation, then Parliament is entitled to make that decision, no matter what the subject of the legislation. I take some comfort from the fact that it was not only Conservatives and Liberal Democrats who joined me in pressing that opinion through the Lobbies last week: there was also a heal thy number of very distinguished Cross-Bench Peers. I was heartened by and grateful for the support of all noble Lords who voted for the amendment. Nevertheless, in deciding what to do with the amendment today, I feel that I must take account of the considerable number of concessions made by the Government during the Bill's entire passage. They are not insignificant concessions. I do not propose today, therefore, to press the sunset amendment. I believe that we have had a useful debate on the subject. Another place has considered the issue and rejected it and there the matter should lie.

I turn, therefore, to the issue of the sunrise clause. I thank the noble Baroness for her extremely constructive and helpful speech. The amendment we are debating is, as she will know, one to which we attach very great importance. We do so not through a desire to make life difficult but because of the intense anxiety that exists in local government, the voluntary sector and the NHS itself about the speed with which the legislation was to be introduced. I shall not rehearse the arguments at length; that has been done enough already. But in essence they boil down to two concerns: the need for local authorities to put in place the necessary human resources to enable them to deliver what is required of them on the ground, especially home care services; and the need to deal with issues emerging from the ombudsman's report and the Coughlan judgment to ensure that there are properly understood and consistent procedures in place throughout the health service to deal with decision-making about NHS-funded continuing care.

Twelve months, I believe, was the minimum period necessary to allow for those matters to be expedited in order for the Bill to stand a chance of achieving its aims even on a restricted definition. This very day I received a letter from the Local Government Association which urges this House to continue supporting the inclusion of my amendment within the Bill. I do not believe that the noble Baroness should be under any illusion about the strength of feeling "out there" about this matter. However, this is the second occasion on which the House has had to decide this issue. Another place has rejected the amendment that was carried here last month.

There is, I think, a natural limit to the parliamentary process in that sense. Today the Government have made a considerable effort to be conciliatory. That has to be recognised; I do recognise it. In an ideal world, I would have wished for a deferral of the financial penalties until April 2004. However, from debates in this House and from my private discussions with the Minister, I do not believe that that is an end result which the Government would ever concede. If I have understood the Minister correctly today, she has very considerably expanded the concession made in Committee by the noble Lord, Lord Hunt. She said that the Bill will come into operation on 1st October 2003 but that the operation of the financial incentives and penalties will not commence until 1st January 2004. At the same time, funding of £50 million will be made available to local authorities as if the scheme had been fully operational for a full six months of the next financial year. If that is a correct understanding of the Government's offer, it represents a considerable step in our direction, and it would not be a productive use of parliamentary time to call a further Division on the issue.

Will the Minister tell us how the sum of £50 million is to be distributed among local authorities? Will she also allow me to press her on the amount of money itself? She will know that there is real worry in local government about the shortage of resources in social services. Will she undertake to leave the door open on the possibility of increasing the amount of money available during the coming financial year? The LGA has estimated that, if £50 million is distributed from October or perhaps even sooner, as much as £35 million will be swallowed up in fines between January and April 2004. That would leave little for investment into building up capacity, which everyone agrees is the single most important task for local authorities in the coming months.

The compromise offered by the Government, although not everything that we could have wished for, is a significant step forward. I thank the Minister for that. I do not propose to ask the House to express a collective view on the issue a second time. I beg to move.

Moved, as an amendment to the Motion that the House do not insist on their Amendment No. 5 to which the Commons have disagreed for their reason numbered 5A, leave out "not"—.(Earl Howe.)

Baroness Barker

I add my support to the noble Earl, Lord Howe. I realise that the Government have moved a very long way and that the blunt instrument that the Bill was a few weeks ago has been considerably sharpened.

I wish to question the Minister on timing. The issues of money and time are closely interrelated. We argued consistently about time being a precious commodity for local authorities. We have not focused much in our debates on the fact that, as well as new services being put in place, much effort will have to be spent on reshaping and redefining existing services, such as day care. We have not discussed those services much. They are not always provided directly by the local authority, and it will take some time to ensure that they become part of the whole process of rehabilitation of older people.

When will the £50 million be announced? It would be a much more effective investment if it were implemented very soon, way ahead of the Bill coming into force. There is a real possibility that when the fine system starts in January, in the areas where the system does not work for some reason and when the single assessment process is introduced in 2004, local authorities may begin the financial year with a deficit that they could not have worked out. January to March is a short time for them to reorientate their budget. Playing with budgets at the back end of the year is not always easy.

I agree with the noble Earl, Lord Howe, that it would have been preferable to introduce the system in April 2004, but that is not going to happen. However, there will be time for local authorities and the NHS to do some tight planning and redefinition of services. I stress that the NHS is integral to the process. I hope that the department teams responsible for the change will work closely with local authorities and the NHS during those six months to give them a steer to help them implement these measures successfully.

Baroness Howarth of Breckland

I associate myself with the comments of the noble Earl, Lord Howe, and the noble Baroness, Lady Barker. I do not want to repeat the arguments put so clearly by both of them, but I wish to add one comment. I declare an interest as a member of the boards of the John Grooms charity for disabled people, which means that I understand the issue of providers, and of the National Care Standards Commission, which means that I understand the issue of regulation. I wish to comment on how the process will affect providers, and the way in which they consider the issues across the board.

I have nothing to say about the sunset clause. I welcome the additional time, but it is a great pity that it had to be brought about by pressure from the opposition Front Benches, with additional pressure from the Cross Benches. I could not be present due to other commitments, but I associate myself entirely with the comments made by other Cross Benchers.

Will the Minister discuss with her department the complications that the measure will cause on the ground for those who are providing and regulating such decision-making? In her introduction, she said that extending for a further three months might delay the impetus of partnership between health authorities and local government. I challenge that comment because local government and health authorities are struggling and working hard together to provide services. The difficulty is one of change management, as the noble Baroness, Lady Barker, pointed out. That takes time. There are also issues of resources. One has to have resources in the right place at the right time.

Only today, I heard that fees for registration and inspection in the sector will be increased by 20 per cent. Although that has been planned for the future, it gives rise to an issue of timing in change management; it is an additional issue that make providers feel that they are not valued. It also causes stress. It will not help if people are wavering over whether to close their establishments. It will become extraordinarily difficult for inspectors to make decisions when they go into homes.

I give that example as an illustration of how complex the issues are on the ground when people are trying to deliver services. In my experience, having worked many years in local government and the voluntary sector, most people want to provide the best service for the individual old lady who is facing them in the old people's home on that day. Only this morning, I heard on the radio about a home that was going to close because the local authority was unable or unwilling to provide fees for the residents.

I welcome the changes. But will the Minister discuss these matters further with her department? There is certainly not time enough to have in place what we need to have in place, but the move is valued by many Members of the Committee.

Baroness Finlay of Llandaff

I do not want to repeat all the arguments that have been made, as they have been most eloquent. I take a slightly different line with regard to these amendments, and the enormous changes that have been made to the Bill since it was first introduced to us.

I congratulate the Minister, but I also send congratulations to the noble Lord, Lord Hunt of Kings Heath, who is not in the Chamber today. He worked ceaselessly and tirelessly on the Bill, and the compromises that he could afford and that he negotiated have been carried on so well by the noble Baroness, Lady Andrews, who has taken over his role.

I also congratulate both Opposition Front-Benchers, who have helped to ensure that the Bill is workable. I believe that, as originally drafted, the Bill was completely unworkable. I have been involved in shadowing health authorities, a process which can work very well. Although I appreciate the widespread reservations which will remain until the Bill has been proven to work, I acknowledge those noble Lords for a job well done.

4.30 p.m.

Baroness Andrews

My Lords, I thank all noble Lords for their generous response. I do so particularly on behalf of my noble friend Lord Hunt, who put tremendous effort into the Bill. He is very happy that we have been able to achieve a workable outcome. Noble Lords in the Chamber have taken the Bill apart and to heart in different ways and I am grateful to them.

I shall try to answer some of the questions, the first of which was on money. I say to the noble Earl that the final decision on allocation will be made shortly. The matter has been considered, but it has not been decided because of the question of a starting date. We will let noble Lords know as soon as possible As for when the £50 million grant will be available, that will have to be debated in Parliament under Section 88B of the Local Government Finance Act 1988, but we will pay it to councils as soon as practicable after that.

I hope that that goes some way towards meeting the issues raised by the noble Baronesses. Lady Finlay, Lady Howarth and Lady Barker. We need to create capacity, allow time and provide resources as soon as possible so that people can see exactly what they have to do. The extra funding will help them to be better prepared. The access grant provides for additional funding for home care, intermediate care and community care, and the first tranche will come into effect in April 2003. So resources will be available almost immediately. All I can say is that we shall be monitoring what is happening to the £50 million. I can say no more on that as it is a matter for the Secretary of State.

The noble Baroness, Lady Howarth, referred to the changes. We are conscious that we are expecting a lot from social services and that many other events are occurring in their world which require careful management. However, we embarked on this legislation in the knowledge that people were being inappropriately placed in hospital and left to become worse rather than better. The spirit behind the Bill has been to provide a better future for those people. We are aware of the dedication and hard work of social services. We have every expectation that they will be able to meet the challenge. But we do not underestimate the challenge and we are aware of the other difficulties. I hope that our changes will signal that we are aware of what they need to do and that we support them.

Earl Howe

My Lords, I thank the noble Baroness for her reply. I beg leave to withdraw the amendment.

Amendment No. 5B, as an amendment to the Motion, by leave withdrawn.

On Question, Motion agreed to.