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Baroness Jay of Paddington moved Amendment No. 2:


Page 5, line 21, at end insert:
(" "(c) other persons with professional expertise in and experience of social care," ").

The noble Baroness said: My Lords, this amendment seeks to ensure that the new health authorities must secure advice from people with social services expertise and experience in the same way as they will be required to take advice from healthcare workers.

On Report, I moved an amendment to make the chairman of the relevant social services committee a full member of each health authority board. In reply, the noble Baroness, Lady Miller, said that that would not accord with the Government's wish that non-executive members of health authority boards should all be generalists (col. 755 of the Official Report of 24th April). The noble Baroness restated that the Government are opposed to representatives of any outside bodies serving on health authorities. Although we do not agree with that position, I acknowledge that the Government will not at this stage be moved from it.

However, throughout our debates on the Bill and at other opportunities in your Lordships' House, great emphasis has been placed on the need for co-operation and collaboration between local health and social services agencies. Ministers have often spoken of their ambition to move more and more health services out of hospitals and into the community, and to improve health education and promotion through the so-called "healthy alliances" between different types of agency. Those goals will be smoothly and properly achieved only by formally establishing strong working links between health and social services authorities.

I expect that in reply the Minister may repeat what the noble Baroness, Lady Miller, said on Report: that mechanisms such as joint consultative councils already exist and that, in general, it is best to rely on good practice and the local development of good personal relations. However, as we discussed on Report, joint consultative committees have a very limited power and agenda. The noble Baroness, Lady Miller, and I discussed our relative experiences of serving on such committees—hers was happier and more fulfilling than mine. Whatever the relative personal experiences, I am not sanguine about leaving very important matters, such as continuing and community care for the elderly, the mentally ill and the young disabled solely to the insubstantial hope of good practice in every health authority or to the rather frail mechanisms of organisations such as joint consultative committees.

4 May 1995 : Column 1491

The boundaries of health and social care are becoming increasingly blurred. The confusion about financial responsibility for different services is creating tensions and difficulties in many areas across the country, and in many areas local authorities often resent what they see as an additional burden on their tight budgets. If health and social service agencies are arguing about their relative responsibilities, the people who are suffering are their clients, their patients. I was talking this week to an executive director of a London health authority who was pleased by the development of good informal relations with social services colleagues in her borough, but she cautioned me at the same time that that was by no means universal. In her graphic phrase, "There's war out there".

We have a duty in framing the legislation to try to do everything that we can to ensure that the services that are often needed by the most vulnerable members of our society are delivered to a high standard throughout the country. If every health authority is required, as it would be by the amendment, by statute to take advice from social services, that would go some way towards establishing national standards of care.

The Government clearly think that it is essential that health authorities receive advice from people with experience and expertise in healthcare—from general practitioners, nurses and midwives among others. That is contained in the provisions of Schedule 1(3) as it now stands. Amendment No. 2 would strengthen the pool of professional advice available to health authorities by including those with the kind of social services experience and expertise that will be essential for the development of the National Health Service. I beg to move.

Baroness Cumberlege: My Lords, I welcome this opportunity to debate an important aspect of health authority responsibilities: that of working with statutory, voluntary and private social care organisations to secure effective and co-ordinated provision for a range of needs.

I have made clear in previous debates that the Government are committed to close working between the new health authorities and local authorities on many issues, but especially on community care. There are mechanisms already in place to help health authorities and local authorities to comply with their statutory duty of co-operation. In particular, there are the joint consultative committees. I appreciate, however, that the noble Baroness has highlighted that there are mixed views on this, but joint consultative committees will continue after the reorganisation and we expect that their work will be made considerably easier by the streamlining of local NHS authorities in this Bill.

The high priority that the Government give to co-operation on community care issues is reflected in a great deal of guidance issued in recent years. The guidance issued in February on


    "NHS responsibilities for meeting continuing care needs"

reinforces the need for effective local and health authority collaboration. Specific guidance on joint commissioning is being issued to local authorities and health authorities shortly. The guidance has sought to clarify the responsibilities of the different agencies and to ensure that they evolve effective means of working together.

4 May 1995 : Column 1492

This amendment deals with a particular aspect of that co-operation: securing professional advice. Your Lordships will be aware that we have been consulting on draft health service guidelines on the importance of health authorities involving professionals in their work and some ways in which they might do that. The draft guidelines carefully distinguished between involvement of staff working in the NHS (who would often be directly approached for advice) and involvement of staff working for other agencies, such as local authorities, where the normal protocol would be for the approach to be made more formally and as part of an inter-agency agreement.

We fear that the amendment might have the effect of clouding the respective role of health care and social care authorities. The Bill currently makes clear that health authorities must make arrangements to take advice from health care professionals. I think that there would be a danger of undermining the role of, for example, social services departments, if health authorities were also required to take advice from social care professionals. The correct route for that advice, in so far as it affected health care, would be through inter-agency working. We must maintain parity of roles to avoid placing obligations on health authorities, which might result in their second guessing the social care agencies. I therefore invite the noble Baroness to withdraw the amendment.

Baroness Jay of Paddington: My Lords, I am grateful to the Minister for that reply. The only phrase which surprised me slightly was the one about clouding the boundaries between social and health care, because it seems to me that in the development of health and social services, particularly in the fields of continuing and community care, we are seeing the clouding of those boundaries with what I had thought were intended to be positive results.

I am aware, as I said when moving the amendment, that there have been considerable difficulties about financial responsibilities between local authorities and health authorities. To describe the merging, as it were, of social and health care as clouding the boundaries in a pejorative sense is surprising. There will obviously be some further development of inter-agency working. The purpose of the amendment is to give that structure a formal mechanism and to ensure that all health authorities, both good and bad, would be forced to take the appropriate advice to help them through their new responsibilities for community care on both sides of the fence.

However, it is something upon which, in a sense, we shall never agree, because it concerns the formality of mechanisms and the understandings that we on this side of the House would like to see in regard to representation on health authorities of people with additional responsibilities which affect health care. As I say, this reflects a fundamental difference, but at this stage of the Bill I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

4 May 1995 : Column 1493

Baroness Jay of Paddington moved Amendment No. 3:


Page 5, line 24, at end insert:
("(1A) Every Regional Chairman shall make arrangements for securing that they receive from universities with undergraduate medical and dental schools advice appropriate for enabling the Health Authorities in their region effectively to exercise the functions conferred or imposed on them under or by virtue of this or any other Act." ").

The noble Baroness said: My Lords, this amendment too is concerned with professional advice. In earlier debates, we on these Benches, the noble Lord, Lord Walton of Detchant, and others, expressed concerns about the possibility that links between academic medicine and the health service will be seriously weakened by the new arrangements proposed in the Bill. Potentially, the weakest link in the chain is at the regional level, and yet that is the crucially important level at which the academic world of medicine should be concerned with the health service.

That is where, until now, postgraduate medical deans have been full members of the RHAs, and where the complicated, but nonetheless essential, joint funding arrangements between the university medical schools and the NHS have been managed. The Department of Health now funds directly a large number of academic posts across the country. In some medical schools, I understand as many as 40 per cent. of clinical academic posts are funded through the health service. That is obviously of great mutual benefit to all the institutions involved and it is of great benefit to the patients and users of the health service. The link contributes greatly to this country's tradition of excellence in academic medicine and NHS care.

The universities have been given undertakings that that form of funding (support for those clinical posts) will continue, but precisely how the systems will be managed is still in doubt. There are no clear provisions in the Bill to create statutory mechanisms to organise joint funding nor to create joint working arrangements to ensure that the views and ideas of the medical and dental schools are available automatically to the NHS.

As so often in the Bill, the Government seem to be relying upon the development of good practice to solve everything. In Committee, I drew attention to correspondence earlier this year between the Secretary of State for Health and the chairman of the CVCP. The Secretary of State said that the regions had been reminded to take account of the views of university's inappropriate circumstances, but Dr. Edwards, chairman of the CVCP, writing in March replied that that was not good enough and,


    "given the very great uncertainties ahead, it is our view that a formal mechanism which is clear and unambiguous needs to be in place from the start".

The Minister has told your Lordships that since then informal discussions have taken place to try to resolve that issue, but, so far as we know, nothing has yet been agreed about regional arrangements—certainly nothing appears on the face of the Bill. On Report, the noble Lord, Lord Walton, said:


    "Surely it is not beyond the wit of man to devise a mechanism whereby universities can play a major statutory, advisory role at regional level".—[Official Report, 24/4/95; col. 749.]

4 May 1995 : Column 1494

I can only echo those words. Amendment No. 3 is designed to assist the wit of man to achieve precisely that purpose.

We know that the Government will not accept outside representation on the management boards of the new regional offices, but, as the Minister said on Report, regional chairmen will have a special responsibility even in that area. Amendment No. 3 seeks merely to bind those regional chairmen to securing advice from the universities in the same way that the local health authorities will be statutorily bound to involve local health professionals under Schedule I. In that way, the regional chairmen will have a formal stimulus to establish the kind of mechanisms the Minister commended on Report, to include the vital contribution of university representatives. I beg to move.

4.15 p.m.

Lord Addington: My Lords, I support the amendment which has to it the name of my noble friend Lady Robson. To suggest that the new health authorities receive advice from the academic medical establishment is not unreasonable or radical. As the noble Baroness said, to rely on good practice taking place in the future is chancy, because it may not take place. By having on the face of the Bill, "you shall consult" overcomes that problem, and will result in that necessary contact. I support the amendment strongly.


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