|Health and Social Care Bill
Sir George Young: Would those bodies be additional to the primary care trusts or would there be additional responsibilities for the existing primary care trusts? Are we looking at two NHS bodies or one?
Mr. Hutton: We are looking at one body. We are not in favour of fragmentation. If the local partners want it, the primary care trust, under the arrangements in clause 45, can enter into a care trust with the local authority, and a care trust will be established. The primary care trust will be the building block and the foundation into which the local authority social servicesor whatever bodywill be incorporated. That is a sensible way of proceeding and it avoids the fragmentation that would arise if we took a different view.
Mr. Burstow: I am grateful for that helpful clarification of how the new entities will come into existence. Can the Minister develop further how the issue of coterminosity will be addressed? At present, PCTs can overlap with social services authority areas. A PCT could provide services through a care trust using a local authority that did not cover the same local authority area. In that case, how would the Minister envisage a person navigating his or her way through the care system if he or she lived in one local authority area but received social services from another as a result of the care trust arrangements?
Mr. Hutton: The hon. Gentleman will find an answer to his predicament in subsection (3) of clause 45.
These issues before us have been wide-ranging. Hon. and right hon. Members have raised several concerns about important issues.
Sir George Young: It would be helpful if the Minister could amplify the point further. That was the first time that I had heard a clear and explicit statement that a care trust is a primary care trust with additional functions added on. If that is the case, we should now address important governance arrangements. If this is to be a partnership of equals between the NHS and the local authority, and there is an established primary care trustan NHS bodywith a lot of people involved in it, how can there be equal representation of the local authority when a relatively small amount of money is being given to an existing body that already has many other responsibilities?
Mr. Hutton: Let me correct the right hon. Gentleman. If he has read clause 45 carefully, as I know that he has, he will know that we are not talking just about primary care trusts. There is also the possibility of NHS trusts becoming the foundation from which the new care trusts will be constructed. The details of the Government's arrangements are still subject to consultation between the LGA and other interested parties. I know that the right hon. Gentleman wants me to announce today the exact proportion of local government representation and NHS representation on the board of each trust. I am not in a position to do that, as he well knows. I repeat, for his benefit and that of the Committee, that we want those arrangements to represent a fair and sensible balance between the interests that local government naturally have in these issues and the provision of NHS services by the care trusts. That will be the subject of ongoing discussions. I am sure that we will come to a sensible conclusion and that those arrangements will be reflected in the regulations and guidance.
Lorna Fitzsimons: Does my hon. Friend accept that some of us are slightly surprised by some of the lines of argument that we have heard? In my constituency, for many years, people involved in local government and the provision of social services and social care have argued for just this type of arrangement? They do not see it as a hostile takeover but as a seamless continuum of the way that they have operated with professionals in the area for many years.
Mr. Hammond: The hon. Lady has coterminosity.
Mr. Hutton: I agree with my hon. F. I hear the hon. Member for Runnymede and Weybridge chuntering on about coterminosity. He is a very good chunterer. Issues such as coterminosity are boundary issues, and I accept that they are complex. That is inevitable given the nature of the organisations with which we are dealing. We have tried to deal specifically with the point raised by the hon. Member for Sutton and Cheam about what will happen if the NHS responsibilities of the primary care trust are narrower than those of the local authority. It is clear from subsection (3) that that will not impede the delivery of social care services to a wider population than is currently served by the primary care trusts. That is a sensible solution.
Mr. Hammond: I should like to explore further the line of argument that my right hon. Friend the Member for North-West Hampshire developed. Does the Minister foresee the possibility within these governance arrangements that local authority representatives might be involved at a different level, perhaps in a committee of the trust that will deal with the social services part of the function being discharged by the care trust, rather than at the main board level of the trust? After all, the trust will have much wider functions than the discharge of social care functions for which it will be responsible.
Mr. Hutton: The right hon. Member for North-West Hampshire raised that point earlier, and I can say that we envisage that there will be an executive committee structure for the care trust and the supervisory board. We have made that clear on previous occasions. The exact composition of the executive committee will have to be discussed with the various interests that are speaking to us about such matters and we have made no final decisions.
Let me repeat for the benefit of the Committee that there are difficulties. The right hon. Gentleman was right to say that concerns have been expressed by local government, and we are trying to respond to those concerns sensibly. It is all well and good to look at the problems, but there are solutions, too. If our objective is to find a closer way to integrate health and social care services, which is the right thing to do, I believe that those solutions are not beyond us.
There is a sensible way forward. Like my hon. Friend the Member for Rochdale (Lorna Fitzsimons), I detect a willingness on the part of local government to look carefully at the benefits that a care trust model will offer. For our part, we will make sure that the care trust option remains attractive, and we will look carefully at the governance arrangements. As we have done already today, we want to make sure that nothing in the Bill can act as a deterrent to local authorities and the NHS taking important steps forward.
The hon. Member for Sutton and Cheam asked a number of times about the resourcing aspects, which I tried to deal with earlier. We shall have to consider carefully how to incentivise and encourage the development of care trusts. The hon. Gentleman will be aware that, as part of the NHS plan, we announced details of a new social services performance fund in an effort to improve enhancements and services for older people. That is a top priority for the Government: we want better health and social care services for older people, and we rehearsed some of the arguments for that last night. We will look seriously at how we can use the performance funds to make services better for older people. However, that has to be done in a way that is consistent with primary legislation and does not impose obligations or requirements on local authorities that are not encompassed by the legislation that the House approves.
Mr. Burstow: The Minister's last comments were helpful and will no doubt give rise to further questions and examination in due course. I am still puzzled about the issue of reconfiguring services around care trusts. That may not present insuperable problems, but it will undoubtedly cause some problems that will need to be surmounted. For example, let us say that a local authority such as the London borough of Sutton has a primary care group covering the bulk of its populationabout 80 per cent. of it. If another primary care trust covering the population of another local authority covers 20 per cent. of Sutton's population, Sutton will have to enter into a voluntary arrangement with that local authoritythe London borough of Merton, perhapsto provide a care trust. Merton will presumably be providing social care services for at least 20 per cent. of the population of Sutton. If that is so, how will those local authorities be funded?
Under the SSA methodology, which is a demographically driven number formula, money will be sent to the local authority to provide for the needs of its community. Yet part of that community will have its meets met by another local authority and that, too, will be formula-funded under the SSA. How will that be unpicked? Will the money that goes to provide social care go with the individual to the care trust? In other words, will arrangements be needed to facilitate such a transfer of resources? I hope that the Minister will say a little more about those matters, because a lot of detail remains to be exposed.
Mr. Swayne: I certainly want to hear the answers to those questions. I hope that we will hear them during the stand part debate, because a number of other questions have not yet been answered. In seeking to include in the Bill our requirements for local authority representation, we intended only to probe. The Minister says, with some justice, that those matters are dealt with in subsections (7) and (8). Yes, they are, but we want to know how.
The result of our probing was not what we expected. In one respect, it was a pointless exercise, because the probe hit a blancmange[Laughter.] Hon. Members may laugh, but that is the correct analogy. The Minister said that flexibility was needed; he certainly has it. He has absolute flexibility because he has not told us anything. Instead, we have to rely entirely on his assurance of a proper and fair balance of representation. We wanted to the Minister to tell us where that balance was to be found, but he was not prepared to tell us. In that respect, we have not been able to probe effectively. However, under the intense and perceptive scrutiny of my right hon. Friend the Member for North-West Hampshire, we have been told something of the nature of trusts, particularly of primary care trusts.
We shall certainly wish to think about that and look at the record before returning to the subject, but I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Question proposed, That the clause, as amended, stand part of the Bill.
|©Parliamentary copyright 2001||Prepared 6 February 2001|