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Session 2000-01
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Standing Committee Debates
Health and Social Care Bill

Health and Social Care Bill

Standing Committee E

Tuesday 6 February 2001


[Part I]

[Mr. John Maxton in the Chair]

Health and Social Care Bill

Clause 46

Care Trusts where directed partnership arrangements

Question proposed [this day], That the clause stand part of the Bill.

4.30 pm

Question again proposed.

Mr. Philip Hammond (Runnymede and Weybridge): Before lunch, I drew a distinction between clause 45, which provides for an evolution of care trusts from the partnership arrangements first introduced in the Health Act 1999, and this clause, which provides for compulsion in that regard.

It is fair to say that the power to remove a function of a democratically elected body, take control of a slice of that body's budget, including locally generated council tax funding, and allocate it elsewhere, possibly directing it in support of a centrally funded and controlled service—the national health service—is a serious step. Despite the Minister's rhetoric of co-operation and partnership, which we heard today and during previous discussion of arrangements for co-operation between NHS and local authority bodies, it is, in effect, the exercise of brute power—the Secretary of State using his power under the Bill to re-allocate tasks from one body to another, as well as the budget that supports them.

An interesting exchange took place this morning about the Government's dilemma and their thinking on these matters. The Minister, of course, wants the arrangements to be entered into voluntarily. Indeed, he told us that they should be voluntary whenever possible. He also said that the one-size-fits-all approach did not find favour with him, and that flexibility is necessary, along with a recognition that different solutions will recommend themselves in different situations.

The undertone of the Minister's comments was that, if the Government regard something as a good idea, there is a moral obligation to roll it out. Clearly, a tension exists between the assertion that voluntarism is to be the main principle, and the assertion that there is an obligation to push forward measures that the Government think are a good idea.

If I may hark back to a couple of years ago, when a Committee debated primary care groups and primary care trusts, and a great deal of time and energy was expended on discussing the degree of pressure that would be applied to primary care groups to take on primary care trust status. Nobody questions that primary care trust status may be a good idea for some primary care groups. I concluded from those discussions that the Government's view was that there should be a genuine mixed economy of primary care groups and primary care trusts, and that some arrangements would suit some areas, while other arrangements would suit other areas. The assurances given by Ministers satisfied us that that was a sensible approach—that there would not be a push for a one-size-fits-all model. It was a nice soundbite.

However, two years later, inexorable pressure is being put on primary care groups to move towards the primary care trust model. The Government have clearly stated their preference for that model. When I heard the Minister saying that care trusts would be a model, but not the only model, I wondered whether, in two years' time, we will find that the Government are putting so much pressure behind their preference for care trusts that they will become, in practice, the model to be followed. We are worried that the Secretary of State will have powers under the clause to oblige movement to a primary care trust or directed partnership arrangement.

The pernicious thing about this measure is that the Minister is absolutely right: the Secretary of State will not have to use the powers under clause 46, except perhaps in extreme cases-of course he will not, because the mere existence of those powers means that he is unlikely to have to use them. When an unarmed man walks up to a man holding a machine gun, the chances are that the unarmed man will do what the man with the machine gun wants him to do without him being obliged to use it.

Mr. Hilton Dawson (Lancaster and Wyre): Is not the logic of what the hon. Gentleman is saying that he and anyone else who votes against this clause are prepared to tolerate inadequate services?

Mr. Hammond: No, that is not the logic. I said this morning that the Secretary of State has adequate powers-which he has used on several occasions-to deal with failing social services providers. He already has those powers, so that in an emergency, when the public are at risk, he can step in and give those authorities ultimatums. Eventually he can take over their powers as social services authorities if they are performing inadequately. The Minister is looking aghast. My understanding is that the Secretary of State has the power to take over the powers of a failing social services authority, and unless my memory is failing me, when the Minister of State, Home Office, the right hon. Member for Brent, South (Mr. Boateng) and I had the pleasure of discussing the situation that arose in Ealing some two and a half or three years ago, he made it clear that he would indeed be ready to use those powers.

Mr. Dawson: I hope that the hon. Gentleman is right, because I would support that power, but if that power is available-and presumably the hon. Gentleman supports it-why does he object to the power under this clause?

Mr. Hammond: As I said this morning, for the Secretary of State to have the power to step in when something is going badly wrong-when an authority is clearly failing-is one thing. For the Secretary of State to take powers to impose what is supposed to be an enduring partnership arrangement is palpably crazy: you cannot impose a requirement on people to work together and co-operate; that is clearly a problem.

The Minister of State, Department of Health (Mr. John Hutton): I have to check this, but as far as I am aware, the Secretary of State has no powers to take over the direct running of the social services department of a local authority. Social services have to be delivered under section 7 of the Local Authority Social Services Act 1970 under general guidance from the Secretary of State, and of course there are best value powers, but they do not involve or encompass the Secretary of State directly running a social services department.

Mr. Hammond: I stand to be corrected, and obviously I do not have available to me the instantaneous resources available to the Minister to check my recollection, but my understanding is—I may be wrong on the detail—that the Secretary of State already has powers to step in and deal with a problem. I made that assertion this morning and the Minister did not question it then; no doubt he will have chapter and verse to hand in a moment to correct me if I am wrong on that point, but that is my understanding. I suspect that it is not essential to my point, so perhaps I can move on and if I have got that wrong I should be interested to hear the detail from the Minister, and I will then have to go and refresh my memory of the exchanges that I had with the right hon. Member for Brent, South.

I have raised this issue because we are dealing with the question of compulsion—of requiring a local authority to surrender its functions. I am referring to assertions and assurances that have previously been given about the Government's intention to compel things to happen. In that context, I listened carefully to what the Minister said this morning. At one point, he said that I had ungraciously questioned the assurances that he has given to the Committee. I did that for a reason, which is that the hon. Gentleman and I already had such an exchange when discussing the Health Act 1999 in Committee.

Clause 46 gives the Minister the power to

    ``direct those bodies to enter into such delegation arrangements or pooled fund arrangements in relation to the exercise of the appropriate function''.

Pooled fund arrangements are defined as

    ``arrangements falling within section 31(2)(a) of the Health Act 1999''.

When debating in Committee what eventually became that section of the Health Act 1999, I tabled an amendment that would have inserted

    ``provided that nothing in this subsection shall be construed as requiring any such bodies to enter into such arrangements.''

By that, I meant arrangements for the co-operation and pooling of funds between local authorities and health bodies. Our consistent position has been that those arrangements may be beneficial when they are voluntary, but are unlikely to be helpful when they are imposed. When speaking to that amendment—it must have been nearly 1 o'clock because I was extremely brief—I said:

    ``The amendment takes us back to a theme that we have already explored—the permissive nature of the arrangements. In our minds, there seemed to be a doubt about the wording of the clause. By adding the additional words, the amendment is designed simply to make it absolutely clear that nothing in subsection (1) should be construed as requiring such bodies to enter into such arrangements for any reason. If the Under-Secretary''—

now the Minister of State who is with us today—

    ``can give us an assurance that that is the Government's intention that the arrangements will be entirely voluntary and that the Secretary of State will not issue any directions that would require pooled budgets, I shall have no problem in withdrawing the amendment.''

The Minister responded by saying:

    ``I can give the hon. Gentleman that assurance.''—[Official Report, Standing Committee A, 18 May 1999; c. 801.]

He gave me a clear and categorical assurance that the Secretary of State would not issue directions requiring pooled budgets.

Here we are less than two years later with a Bill that will give the Secretary of State the power to

    ``direct those bodies to enter into such delegation arrangements or pooled fund arrangements''.

I am not seeking to be ungracious, but since that discussion in 1999 when the Minister gave me that assurance, which induced me to withdraw the amendment, perhaps he has had a change of heart. Alternatively, perhaps the Government intended all along that there should be such powers of direction to require a pooling of budgets between health bodies and local authorities. However, the Minister did not say that to me in Committee in 1999.

Will the hon. Gentleman say whether it was always the Government's intention to create such directed partnership arrangements or whether such a policy came into their mind since he made the statement in 1999? If so, what has happened since then to make the Secretary of State believe that coercion may be necessary and is a desirable weapon? To say that the Government may believe that coercion is better than voluntarism may be a slight exaggeration.

Without wanting to put too fine a point on the matter, what has happened has started to colour my judgment a little about some of the Minister's assurances to Conservative Members this morning. Given the nature of such proceedings, we often table amendments to probe the Government on certain matters and receive assurances that, although certain measures are not in the Bill, the ubiquitous regulation-making powers that the Government are giving to themselves will be used in a certain way or, indeed, will not be so used. However, now I find, on checking back, a clear example of legislation that is less than two years old—in fact, it came into force last April, so it is less than one year old—in which the assurance given by the Minister in Committee is clearly no longer valid. In this Bill, the intention appears to be diametrically opposite to that asserted at that time by the Minister in Committee.

4.45 pm


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Prepared 6 February 2001