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Lord Clement-Jones: Perhaps I may ask the Minister a quick question. Personally, I was heartened by the points that he made in relation to the lead that will be taken by different agencies and the fact that care trusts are not the only route. However, in that case, why follow the compulsion route in Clause 53?

Lord Hunt of Kings Heath: Compulsion does not apply only to care trusts; it applies to the whole partnership arrangement. The compulsion, as the noble Lord rather graphically describes it, in Clause 53 is for the--I am sure, rare--occurrences where it is apparent that partnership is simply not taking place and where, as a result, poor quality services are being provided. In certain circumstances, the Secretary of State will wish to have the opportunity to direct partnership act arrangements. However, they do not have to be trusts.

Lord Clement-Jones: I thank the Minister for that reply, which was helpful. However, the other question which arises is: will not care trusts inevitably be the model on which the delivery of services ultimately is based? In a sense, the use of the mechanism will become a pattern. I understand that the Minister says that, by definition, because of the way in which the department conceives of the scheme, they are NHS-founded bodies because they are based on primary care trusts.

However, would it not be better to conceive of something that effectively was the essence of partnership? One could give that label to partnership and that, therefore, could give rise to a care trust through a joint initiative. Thus, there would be joint governance. It seems that the department is missing a trick by defining care trusts as, in a sense, the sole NHS creature and by then bringing on board local government services. That does not seem to be in the spirit of partnership, which otherwise it could have been.

6.15 p.m.

Lord Hunt of Kings Heath: I believe that two points arise here. First, by making it clear that there are different options and that care trusts are not the only option to be used, I believe that we are showing that we are not seeking to force a particular path on to local government. Secondly--I do not know whether I can tempt my noble friend to join in on this point--it is clear that a number of local authorities are attracted by the care trust mechanism. However, at the end of the day, it is a voluntary mechanism and the arrangements will need to be worked out locally. If local authorities do not consider that it is appropriate, they do not have to go down that route.

Baroness Barker: I did not find the Minister's argument terribly convincing. I still do not see why these have to be primarily NHS bodies and why their

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governance must be within the NHS. The Minister said that care trusts are not the only option. In approximately five years' time, I shall look again at that statement in the light of what takes place. I shall be very surprised if other arrangements are still in existence.

The Minister makes a good point in relation to local authorities being attracted by the proposal. I believe that they are attracted by the potential for getting their hands near resources which currently are limited to the NHS. I am not so sure that they are attracted by the Government's arrangements. I understand that the Government--

Lord Smith of Leigh : Resources are always attractive to local authorities. However, essentially local authorities are attracted by achieving the best for the service users. We all want to see the delivery of proper, joined-up services, and that is what will attract local authorities.

Baroness Barker: I accept the noble Lord's point. However, I remain unconvinced about governance arrangements where there is a clear potential for the NHS to be a pre-eminent partner. Therefore, with some reluctance, I beg leave to withdraw my amendment, but I thank the Minister for his answer.

Amendment, by leave, withdrawn.

[Amendment No. 232 not moved.]

Baroness Barker moved Amendment No. 233:


    Page 53, line 25, after "authority" insert ", after consultation with other expert health and social services bodies,".

The noble Baroness said: I spoke earlier about the degree of anticipation in relation to care trusts. I believe that the number of amendments in this grouping, and the questions that lie behind them, reflects much of the anxiety about the proposals from the Government in relation to care trusts.

The emphasis of this group of amendments concerns consultation--that is, consultation not only with local authorities but also with users and those who are likely to be service users. At present, the extent to which proposals to initiate care trusts will be subject to widespread consultation is not clear. I hesitate to say this but, given the background to this matter, where some NHS bodies do not have a great track history on consultation, particularly with voluntary groups, I believe that it is necessary to be specific about the method of consultation and about those who have the right to be involved.

I take the Minister back to the creation and reorganisation of certain NHS trusts in the past. Some did not demonstrate a great deal of involvement with those who ultimately would be users. That is the gist of the amendments. I invite Members of the Committee to go further than I have done in probing the

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Minister's intention about the degree of consultation and involvement of all parts of the community that will take place. I beg to move.

Lord Hunt of Kings Heath: I take it that this group of amendments has been ungrouped.

Earl Howe: I do apologise. I shall speak to those amendments in the group that appear in my name; that is, Amendments Nos. 237, 241 and 249. They are designed to achieve much the same result as those to which the noble Baroness has just spoken. I agree with her; it is disappointing that there is so little provision for consultation in the Bill and particularly disappointing that such provisions have been omitted from the clause.

One hardly needs to spell out the reasons why consultation before setting up care trusts is so important. The main and most obvious reason is that care trusts, whenever and wherever they are proposed, represent uncharted territory for participants. Parties will be in no doubt that by coming together they face formidable adjustments not simply in terms of the shift in statutory responsibilities but also logistically in terms of staff, money and information systems. There will also be adjustments in the union of two very different cultures. Those involved have to be confident that such adjustments are manageable. Everyone needs to be certain that there are clear-cut advantages in moving to care trust status.

The provisions have significant implications for local government in particular. Although Ministers speak in terms of a delegation of responsibilities, many believe that the transfer of a key set of local government functions involves a dilution of accountability to local people. Local people must feel empowered both through the ballot box and day to day as service users.

There is uncertainty surrounding the Government's arrangements for care trusts, which we shall debate later. It is not clear to me how a change in the control of a local authority will translate into a change in direction at care trust level, should such a change be sought. We debated the fragmentation of the role of CHCs when we discussed earlier amendments. I hope that the new arrangements for patient empowerment recognise the need to have clear pathways for service users who wish to make a complaint. That requires a mechanism with a public profile that does not shunt such service users from pillar to post as they try to find the responsible department.

Perhaps I should also speak briefly to those amendments of mine that relate to Clause 53 and which are in this group of amendments. As the noble Baroness said, Clause 53 will enable the Secretary of State to force a care trust into existence against the wishes of either of the parties to it. That concept immediately raises questions about the workability of such a care trust. It is hard to envisage on the one hand a partnership, which has connotations of good will and voluntary co-operation, and, on the other, an

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arrangement that is forced on the parties from the outside. There is something inherently contradictory about that.

One point on which we may all agree is that whatever is or is not done by the Secretary of State in this context, the aim must always be the good of the patient. Care trusts are all about delivering effective and efficient services. I go so far with the Government as to say that if it is necessary to ruffle a few feathers in the process of moving to a better delivery of service, so be it. However, if the aim is the good of the patient, it follows that patients should have the opportunity to sign up to the arrangements that Clause 53 will put in place. That is why it is essential, as Amendments Nos. 254, 257 and 258 make clear, that whichever patients' organisations are in existence when these provisions come into force, those organisations should be consulted on the proposed use of the Secretary of State's powers of direction. The Secretary of State may judge that there has been a failure to deliver adequate services locally and, on that basis, decide to force a local authority to surrender its functions to him. That would be an extremely serious matter on which patients' representative bodies should have a right to comment.


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