Health and Social Care Bill

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Mr. Swayne: I beg to move amendment No. 312, in page 39, line 21, at end insert—

    `( ) providing for the appointment of representatives of local authorities to Care Trusts.'.

The Chairman: With this it will be convenient to take the following amendments: No. 313, in page 39, line 24, at end insert—

    `( ) for securing the effective delivery of services relating to the functions of the trust and in particular the health-related functions of the local authority through proper integration of the functions of the prescribed bodies.'.

No. 261, in page 39, line 28, at end insert—

    `(e) requiring that the governance arrangements, including representation of local authorities on the Care Trust, and the structure and arrangements proposed for delivering services relating to all the functions of the trust and in particular the prescribed health related functions of the local authority will ensure the proper integration of the functions of the prescribed bodies.'.

Mr. Swayne: The intention behind amendments Nos. 312 and 313, which provide for further categories of regulations to be made, is fundamentally to strengthen the purpose for which care trusts are to be set up. A strong case can be made for local authority co-operation with the NHS in new arrangements to bring about improved services. However, the new bodies must reflect the strengths of the local government organisations.

The Minister has attempted to reassure us, but he is aware of concern that what is proposed will be not so much a merger as a hostile takeover by the NHS. Reassurance is therefore needed, and we want it to be expressed in the Bill by provisions such as our amendments. Trusts must reflect the views of locally accountable representatives, together with the experience gained by professionals in many years of providing social services in a local authority setting. Local authority representation should be strengthened by the Bill, and it should be made clear that those authorities' strengths will continue profoundly to influence the functioning of trusts.

Mr. Burstow: This group of amendments deals with some important issues relating to the Government's arrangements for care trusts. In the earlier debate on care trusts, I asked the Minister whether the Government intended to ensure, either through the Bill or through regulations, that patient groups, especially those for the elderly, were represented on the boards of care trusts. In addition, I hoped that the Minister would say more about the differences between care trust boards and primary care trust boards. If, as we have been assured, the intention is for the health service and local government to have equal standing on the new bodies, that must be reflected in the executive and non-executive governance arrangements of the new trusts.

Unison makes useful points about the current configuration of the governance of PCTs. When we had debates on the establishment of PCTs in 1998-99, the Government made a welcome commitment to having a lay majority on such boards. Will the Minister establish whether there will be equality between health service and local government interests on the boards? Will there be clear arrangements to provide for the involvement of the voluntary sector and other non-governmental organisations on the boards? If so, will the arrangements for appointment be the same as those envisaged for patients forums and other such bodies.

In the earlier exchanges, I asked the Minister about arrangements for incentivising localities to consider care trusts, and he said that it would not be possible for specific grants to have conditions that were outwith the legislative framework of the Bill. However, the briefing note that was circulated to Committee members states that the Government are considering encouraging the formation of care trusts through ``pump-priming.'' Presumably that means pump-priming with cash. That sounds like a clear mechanism to incentivise. Will the Minister say what he has in mind in terms of pump-priming? During the last Parliament, when arrangements were made for schools to consider opting out from their local authorities, pump-priming was used to incentivise that shift.

Mr. Hammond: As the hon. Gentleman is drawing a comparison, perhaps he will remind the Committee whether Labour Members took a favourable view of that at the time?

Mr. Burstow: I am sure that the Minister will explain what the Labour party felt about the measure at the time. I merely draw a parallel between the two mechanisms, hoping that the Minister will clarify the difference between the mechanism that was used to promote opting out by schools and the mechanism that is intended to promote the transfer or the merger of health and social care through care trusts. I look forward to his response.

Sir George Young: I would like to put to the Minister some points on governance that arise from amendment No. 312. Some helpful notes on governance were circulated yesterday. Paragraph 19 of those notes states:

    ``The Government is considering how all board members should be nominated and appointed, taking account of the role of the new independent appointments commission.''

I assume that the new independent appointments commission could not veto a local authority's nomination for representatives to a care trust, but that its role would apply only to other representatives. If the partnership is to be one of equals, as the Minister implied, the local authority ought to be able to nominate whom it wants.

11.30 am

Will the Minister clarify something fundamental to our debate on the composition of the new care trusts? Paragraph 7.9 of the NHS plan does not make it clear whether the trusts will be new bodies or primary care trusts with social services bolted on. It talks in terms of establishing

    ``new single multi-purpose legal bodies to commission and be responsible for all local health and social care'',

but goes on to state:

    ``This will require changes to the governance arrangements for primary care trusts to ensure representation of health and social care partners.''

It is not clear whether we shall simply tack social services on to primary care trusts or set up a new body to do part, but not all, of what the PCTs do and a little bit of what local government does.

I would like the Minister to comment on governance arrangements. Does he envisage a board on which councillors and the Secretary of State's nominees would sit, with an executive body underneath that? Will he talk about the balance on each, and how the system might work in practice? How often will the board—the top tier—meet? Will any of its members also be on the executive board? We need a slightly clearer vision than we have at present as to the governance of the new trusts.

Mr. Hutton: The amendments seek to provide for the appointment of local authority representatives to the boards of care trusts, and to ensure appropriate integration of local authority delegated functions in care trusts. Opposition Members should brace themselves, as they probably will not like what I am about to say. Those matters are already covered in subsections (7) and (8). I fully understand the concerns, but our regulation-making powers will deal with matters as they need to when voluntary care trusts are established under the clause.

The matters will be dealt with in secondary legislation. There will be guidance as to the composition of care trust governance arrangements, which will need to be flexible to reflect the different functions of each care trust. I hope that Opposition Members will support the idea of flexibility in the arrangements. It would be a mistake to adopt a one-size fits-all straitjacket about governance arrangements for the new care trusts.

I say to the right hon. Gentleman and the hon. Member for New Forest, West that there must be fair and balanced representations on the boards of the care trusts, to take into account and reflect the local authority's input into the services that the care trust will deliver.

Mr. Hammond: The Minister makes the important point that the one-size-fits-all approach tends not to work. A moment or two earlier, he told my right hon. Friend the Member for North-West Hampshire that the matters would not be dealt with in a transparent way that we could scrutinise, but under the secondary legislation to be made under subsections (7) and (8). Does the Minister therefore envisage that regulations might prescribe different regimes for different care trusts? Is he saying that there would be separate orders to establish different regimes for individual care trusts, or will a set of regulations apply across the board?

Mr. Hutton: There will clearly have to be an order to bring a care trust into existence, and it will have to specify the governance arrangements for that specific care trust. Such issues are still being discussed, as the hon. Gentleman will know. We have all had briefings from the LGA and others on them. We are actively trying to find a sensible set of solutions to the issues of the governance arrangements, about which I know that there is some sensitivity. We are asking local authorities to take an important step forward in delivering integrated care services through the establishment of the care trusts. Naturally, we do not want any of the arrangements that we will eventually propose to act as a deterrent.

The right hon. Member for North-West Hampshire and the hon. Member for New Forest, West were concerned that some aspects of the Bill would discourage the establishment of voluntary care trusts under clause 45. I hope that he will take it as read that the Government do not wish the Bill, or any part of it, to act as a deterrent to the establishment of care trusts, and we will try to find a fair and balanced way to ensure effective local authority representation on the boards of the care trusts.

The right hon. Gentleman asked whether the care trusts would be new bodies, and, of course, they would. They will be designated as care trusts and will have the wider role and function designated by that status, including social services functions.

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