Standing Committee E
Tuesday 6 February 2001
[Mr. John Maxton in the Chair]
Care Trusts where voluntarypartnership arrangements
Mr. Paul Burstow (Sutton and Cheam): I beg to move amendment No. 295, in page 38, line 12, leave out
`is, or is to be, a party'
`and a local authority are, or are to be, parties.'.
The clause and part III of the Bill establish a useful innovationa tool for developing integrated care servicesand we want to explore how it will be used. Although we welcome the policy intention, a number of organisations have expressed concern about how it will be translated into practice. The Local Government Association has made representations to all hon. Members about its underlying unease, and the amendment attempts to address that unease. Nevertheless, we support the proposition that there should be more joint working and that the flexibilities in the Health Act 1999 should be built upon. A structure of the sort envisaged in the clause is one way to achieve that integration.
The Bill makes it clear that the mechanism to establish the new care trusts voluntarily does not allow for equal partnership between the two agencies. The amendment seeks merely to put local authorities on an equal footing with the NHS bodies with which they will working to put the new independent care trust arrangements in place. It should be a marriage of equals, leading to an entity that is genuinely the product of the two organisations.
I suspect that I will stray too far, Mr. Maxton, if I start to raise other questions about the clause during this debate. I hope that we shall have the opportunity on clause stand part to probe some of the issues not dealt with in amendments. Suffice it to say that I hope that the Government will respond positively to this amendment and to several others. That will help allay the concerns of local authorities and enable them to enter into such arrangements with full commitment, which will allow better services to be provided jointly between health and social services.
Mr. Desmond Swayne (New Forest, West): I share the concern and hence understand the motive behind the amendment. Indeed, it sets the theme for many of our amendments to this and the next three clauses. The Bill makes no provision for local authorities to take any responsibility for health services, or even to share the responsibility equally with health trusts. In essence, we are talking about the removal of statutory responsibilities from democratically elected local authorities and local government management by what is fundamentally an NHS body. That begs all the questions that were raised in previous sittings about the centralised nature of the NHS, about micro-management and about the lack of accountability and scrutiny. That is all reinforced in the clause, which changes an accountable local authority function to one that is less accountable.
On Second Reading, the Secretary of State said:
``Incidentally, I do not believe that the best way forward for local government and social services is to have a national health service takeover.''[Official Report, 10 January 2001; Vol. 360, c. 1089.]
We share that view. We believe that the accountability of local authorities is an important principle that should be preserved within care trusts. It should not be diluted in the provision of services to local people.
The Leonard Cheshire organisation states:
``Trusts will effectively be NHS bodies. This signals real dangers. Firstly and most importantly, that the whole culture underpinning the commissioning process for primary/community care services will be medicalised. This poses a direct and significant threat to the understanding and use of the social model of disability by providing agencies.''
I take that last stanza, so far as I understand it, to mean that local authority provision has had the objective of supporting people in their own homes where possible. The emphasis of the NHS may be different, with its concerns for treating ill health.
We share the concerns behind the amendment and are favourable to it.
The Minister of State, Department of Health (Mr. John Hutton): I welcome what the hon. Member for Sutton and Cheam (Mr. Burstow) said in moving the amendment. He expressed his support, and that of the hon. Member for Isle of Wight (Dr. Brand), for the principle behind care trusts. I suppose that one should accept small mercies when they are offered, and it is always nice when the Liberal Democrats support a Government policy. I shall try to deal with some of the problems raised by the hon. Members for Sutton and Cheam and for New Forest, West (Mr. Swayne).
The hon. Member for Sutton and Cheam will recognise that the amendment is modest and minor. He will not be surprised when I tell him that what it tries to do is fully covered by the Bill already. It is clear from clause 45 that care trusts are voluntary arrangements, in the sense that they are entered into by local authorities and the national health service. His suggestion that we need to make the role of the local authority explicit in applying to the Secretary of State for an order establishing a care trust is met already by the clause. The amendment is unnecessary.
The hon. Member for New Forest, West raised two concerns. They went slightly beyond the amendment, but I want to say something about them now. We are aware of many organisations' concerns about the model of care trusts that we propose in the Bill. However, I hope that none of us disagrees about the principle behind the care trust concept. We all know about the problem that we are trying to tackle. In our surgeries, we have all no doubt met constituents who felt that they had to navigate themselves around the care system, from pillar to post, between the NHS, social care and other agencies. For many, that is not a happy experience. In the past three and a half years, we have consistently tried to develop a much closer proximity between health and social care agencies. It is right in principle and practice that the two key and equal partners in the care system should more closely co-operate.
The hon. Gentleman is wrong to say that local authorities will lose responsibility for social services functions under clause 45. They will delegate functions but will retain overall responsibility for them, even in the context of a care trust. There is no question about where the overall social services responsibilities lie.
Mr. Burstow: Will the Minister shed further light on the Government's intentions about where responsibility will lie when a care trust has been established? As the Minister knows, local authorities have discretionary powers in respect of charging policies for home care services and for other services that in future may be delivered by care trusts. Where will the responsibility lie for determining the charging policy and the eligibility criteria on which it is based?
Mr. Hutton: I am genuinely surprised that the hon. Gentleman asked that question because we have answered it on several occasions. We have made it clear that the responsibility for determining charges for social services will rest with the local authority. There is no question of charging for NHS services that are delivered by a care trust. They will remain free at the point of use, and that will remain the case as long as the Government are in office.
The hon. Member for New Forest, West raised another concern, which has been doing the rounds. He quoted the Leonard Cheshire organisation, for which I have a great deal of admiration and respect. It does an outstanding job for many disabled people. However, there is a misunderstanding here about the nature of care trusts. They will not somehow medicalise social care. It is clear from what we have said and how we envisage care trusts being established that there will be a distinctive role for social care services delivered under the umbrella of a care trust. We are not proposing some ideological shift in values and culture in relation to the delivery of social care services. We just want them delivered in a more coherent way, positioned more closely alongside the NHS, as equal partners in the care system. It is important that Committee members understand that we are not proposing that the establishment of care trusts will lead to the end of social services and the current concept of social care. That would be ridiculous.
Mr. Burstow: I apologise to the Minister for interrupting his flow. He is making an important point, which addresses a concern that is shared by many outside the House about how care trusts will work in practice and his assurances are most helpful. Has he considered the recent research evidence on the experience of integrationalbeit on a different structurein Northern Ireland, which revealed concerns that placing social care in the context of a health body has lead to a domination of the medical model over the social model? The LGA cited that evidence. Has the Minister had a chance to consider it? If he has, does he accept it, and if so, what guidance will be made available to ensure that the pitfalls of the system in Northern Ireland are avoided in the United Kingdom?
Mr. Hutton: I have to be honest with the Committee and say that I have not seen that research, but I will dig it out. It is probably on somebody's shelf at the Department of Health and perhaps later today I will look at the executive summary.
Many admire the system of health and social care delivery in Northern Ireland, not least the Select Committee on Health, which looked favourably on the system. Perhaps the hon. Member for Isle of Wight, who is a leading member of that Committee, will advise us to the contrary. The Select Committee on Health did not think that bringing health and social services closer together would necessarily lead to the hon. Gentleman's proposition, that there would inevitably be a drift toward the medicalisationwhatever that isof social care services. That is absolutely not what we have in mind.
There is a distinctive and clear role for social care services. That role will continue under the umbrella of a care trust if, under clause 45, that is what local partners decide is the most appropriate vehicle under.
I will deal fully with some of the other wider concerns about care trusts later in our proceedings. I understand the spirit behind amendment No.295, but the concerns raised by the hon. Member for Sutton and Cheam are unfounded in relation to clause 45, which fully recognises that the arrangements will be voluntary. Local partners will apply to the Secretary of State for designation as a care trust. The amendment is legally unnecessary and would not help the drafting of the clause.