Health and Social Care Bill

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Mr. Burstow: I am sure that the LGA and others will have listened carefully to the Minister. Perhaps we will return to the matter if others outside the House are not persuaded by what he has said. On the basis of the assurances that he has given to us today, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

10.45 am

Mr. Swayne: I beg to move amendment No. 310, in page 38, line 21, leave out from `made' to end and insert—

    `(a) after consultation with all statutory patient representative bodies in existence at the time the application is made; and

    (b) where a report on the consultation undertaken in accordance with subsection (a) above accompanies the application and the designated authority is satisfied that the consulted bodies concur with the application; and

    (c) where the application is made jointly by every prescribed body.'.

The Chairman: With this it will be convenient to take amendment No. 291, in page 38, line 21, at end insert—

    `which application shall include details of the outcome of the consultation process regarding the application with those organisations representing health and social services users and with those who are users of either health or social services in that area, and with representatives of the local community'.

Mr. Swayne: Amendment No. 310 is about consultation, which we consider to be of considerable importance. The amendment requires that the statutory patient representative body be consulted when an application for formation of a care trust is made. Where a report is produced consequent upon that consultation, it should partly determine whether the trust is formed. We have received many representations, principally from the Royal College of Nursing, Age Concern and Help the Aged. Those representations all concerned the need for consultation, which is why we attach such importance to the amendment.

The formation of a care trust is a major undertaking. It will involve the shifting of statutory responsibilities, which will imply a major shift of resources, staff and information systems. That is bound to have a significant start-up cost in financial and organisational terms. Inevitably, it will cause disruption. There must be clear evidence that the process will result in a significant improvement in the quality of service provided.

It is well known that it will be horses for courses as far as care trusts are concerned. Some local authorities will not want to enter into such arrangements, but others will, to the clear benefit of those whom they serve. The amendment seeks to ensure that the decision to do so should be based on evidence. All innovation should be based on evidence. I understand that that is the principle that underpins the National Institute for Clinical Excellence. It is also the principle that will underpin the social care institute for excellence.

What evidence will be required to prove that a proposed care trust will be more effective in providing social care than the local authority? We look to consultation as the main source of such evidence. That is why we consider it to be important. It is through consultation with those who will be served by the arrangement that we seek the justification for proceeding with it.

Mr. Burstow: The group of amendments includes amendment No. 291, which is in my name and that of my hon. Friend the Member for Isle of Wight. We, too, want to pick up on a matter on which we have received representations, relating to the nature of the process of consultation that will be undertaken in respect of the establishment of care trusts. A briefing note was helpfully circulated in advance to the Committee, for which I am grateful to the Minister and his departmental team, because it fleshes out the proposals that are set out in the explanatory notes. It refers to a prescribed period of meaningful consultation, and offers us the prospect of guidance on the details of the future arrangements. I hope that the Minister will be able to tell the Committee what issues he and his Department would expect to be covered in such a consultation. There are several matters that need to be aired locally, with respect to consultation.

Dr. Peter Brand (Isle of Wight): Does my hon. Friend agree that if consultation produced significant or even universal opposition to such mergers the Government should pay attention—unlike previous Governments who, for instance, established national health service trusts according to a pattern set down by the Secretary of State rather than by the communities concerned, and in complete disregard of consultations?

Mr. Burstow: Flaws of that kind have occurred in past consultation arrangements. However, the briefing notes make it clear that applications

    ``will need to provide evidence of . . . local support for the proposals''.

That will be an important consideration for the Minister concerned to take into account. I hope that the question of coterminosity of the organisations coming together to form care trusts will feature in consultation. From the patients' perspective, the boundaries between agencies are often a major obstacle to the provision the seamless service that the Minister described with reference to an earlier amendment

A good example exists in my area of the way in which lack of coterminosity could hinder the intended operation of the clause. A primary care trust covers about 20 per cent. of the population of my borough, while a primary care group covers the rest. The Nelson primary care trust might perhaps apply to become a care trust in conjunction with the London borough of Merton, the bulk of whose population it serves. What would happen to a resident of my local authority area who received GP services from within the PCT, and therefore the new care trust, but who was also receiving care packages provided by the local authority social services department of the London borough of Sutton, not the London borough of Merton? How will that state of affairs be unpacked? How could the service be provided in a seamless way?

I should have thought that that issue would need to be explored during local consultation processes. I hope that the Minister can shed light on the question today, to inform such processes in the future.

Another issue about which many people will want to be informed in the process of local consultation on care trusts is the Government's precise arrangements for those trusts. Will there be direct representation on trust boards for stakeholders such as older people? Will councillors be included? More details of the Government's thinking would be helpful.

During consultations representations are likely to be made about the expertise that social services departments have developed in holistic assessments. Those focus on the needs of the user of the service, or patient, alongside the needs of carers. I hope that the Minister can comment on that, not least because he and I spent some time last year in Standing Committee considering the Carers and Disabled Children Act 2000. Arrangements under that Act are designed to ensure equality of treatment between carers and users, through the assessment arrangements. How will that approach be affected by the establishment of care trusts?

I particularly want to hear from the Minister about coterminosity, which is lacking in many places and will no doubt frequently be a matter for consultation. I hope that one of the amendments will be included in the Bill.

Sir George Young (North-West Hampshire): I welcome the co-pilot to the controls after a long wait to get to part III of the Bill.

I want to argue for the consultation process to include certain key matters, some of which were touched on by the hon. Member for Sutton and Cheam and my hon. Friend the Member for New Forest, West. Clause 45 has enormous implications for local government. Social services is one of the most important local authority functions—the most important function after education—and the clause proposes the voluntary transfer of a key responsibility of local authority to a body that is, in effect and in law, a national health service body. When consultation is entered into at local level, I hope that people will ask whether taking such a radical step is the right way forward.

Many people believe in local government as an important element of a decentralised society and as a counterbalancing democratic body to central Government. If one takes away services from local government one begins to alter the balance of the constitution. I see that as a step away from a decentralised society towards a more centralised one and from a democratic society to a slightly less democratic one. One is potentially removing a chunk of important services from a body that is democratically accountable to local people to one that comes under the control of the Secretary of State.

Some 10 years ago, the Conservative Government looked into setting up an alternative primary care trust as an interface between social services and the health service. We decided not to go down that path, but to give responsibility to local government, partly because we did not want to set up two extra interfaces—one between the care trust and the rest of local government and one between the care trust and the rest of the NHS. When local people are consulted, I hope that a number of questions will be asked: first, about accountability. At the moment if something goes wrong in social services people know who to complain to—their local councillor. There is a clear chain of accountability. If social services are provided by a care trust it is less clear to me what the local councillor would be able to do about a complaint. He would simply say, ``I'm very sorry, but these arrangements no longer come under the county council or district council. They are now in a care trust with its own budget and it is run by a body—yes, we have one or two representatives on it but it is an NHS body.'' I hope therefore that issues of accountability will be raised in consultation.

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