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Earl Howe: I welcome the Minister's assurance that this power will not be used lightly and that it is to be regarded as a power of last resort. I am interested in his interpretation of the word "adequately". He felt that the word "inadequate" meant something serious and I am glad he feels that it does carries that meaning. However, I am not sure that in everyone's eyes "inadequate" suggests a considerable degree of seriousness. Nevertheless, the noble Lord's point was reassuring, at least in part.

My difficulty here is that I do not believe that we have moved much further forward in our understanding of how these powers might be used in practice. I realise that it is difficult for the Minister simply to conjure up hypothetical examples, but it

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would have been helpful if the Committee had been offered a more graphic understanding of what this will involve.

Lord Hunt of Kings Heath: I am grateful to the noble Earl for giving way. It is always difficult to cite the "what ifs?". Where I would envisage this power being utilised is where there is clear evidence that a service is inadequate--I confirm that I believe that that word suggests a serious matter--and that, despite intervention and help, things are not getting any better; namely, that the nature of the difficulties make it clear that one of the problems in the service provision stems from the fact that the agencies, at the local level, are simply not working well together. In those circumstances, based on the kind of reporting mechanisms we have established, the clear failure of local leadership to be able to provide remedies would indicate the kind of conditions where one might wish to direct a care trust approach.

Earl Howe: I am grateful to the noble Lord for his helpful intervention. There are formidable problems involved in the whole idea of bringing people together who may be reluctant partners. Indeed, I shall raise this again when, with the permission of the Committee, we have a general debate on clause stand part. Nevertheless, doubtless the Department of Health and the Secretary of State will approach such an operation with their eyes open and so one hopes for the best. In the meantime, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 251 to 255 not moved.]

Lord Hunt of Kings Heath moved Amendment No. 256:


    Page 56, line 13, at end insert "within that"

The noble Lord said: This is a technical amendment which clarifies that a care trust can provide social services across a local authority area or to any part of the area covered by a local authority. I beg to move.

On Question, amendment agreed to.

[Amendments Nos. 257 and 258 not moved.]

On Question, Whether Clause 53, as amended, shall stand part of the Bill?

Baroness Barker: It is evident from our debates on the amendments to this clause that there are a great many misgivings about the circumstances in which a directed care trust may be formed. I shall refer back to some of the questions put by the noble Baroness, Lady Cumberlege, on Clause 20. Exactly what are the conditions under which the Secretary of State would make an intervention? I believe that it is important for those who will try to make a success of care trusts to have a clear understanding of that right from the beginning.

Despite the reassurances given by the Minister today, a great deal of the detail of exactly how care trusts are going to work is still missing and it is extremely difficult to form a complete picture. How

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will the relationship between health and social services work? The Minister was not pleased when I put a number of detailed questions to him, but I shall ask him one more, because it illustrates some of the potential problems that may arise in both non-directed and directed care trusts.

Under the delegated powers, care trusts will exercise social services functions. One obvious example of the functions which they may take over is that of setting discretionary charges for home care services. I assume that a care trust would collect those charges. Will the calculation of care charges of this kind come under the remit of the care trust or would it remain with the local authority? What accountancy procedures will be put in place? Who will monitor these matters so as to ensure that NHS services are not simply redefined as social care services in order to attract charges? Those issues will come up under this direction.

I believe that insufficient thought has gone into exactly what the Secretary of State will need to deal with under these new powers. I made a point in our earlier deliberations which I believe is equally relevant here: the extent to which social services and health can work together is still of concern because it is not clear. Furthermore, the extent to which they can work together as the result of a direction coming down from above is in even greater doubt.

At this stage, it might be appropriate to paraphrase Woody Allen. He said that the lion and the lamb can lie down together, but the lamb would be well advised to stay awake. I believe that, unless and until we are given a great deal more detail on these proposals, in particular as regards how the directed care trusts are to work, we shall continue to see, not paranoia, but a genuine fear on the part of local authorities about what could be a good working relationship.

Earl Howe: There is perhaps only one point to make about Clause 53 and the noble Baroness, Lady Barker, has made it very well; namely, the idea of partnership imposed by fiat is inherently contradictory and implausible. This is the point in the Bill where the Government have to confront two irreconcilable instincts: the laudable instinct of wanting to see bridges being built and, to my mind, the far less laudable instinct of wanting to dragoon people all over the place.

My right honourable friend Sir George Young observed in another place that it is difficult to see how a care trust can be, at one and the same time, a reward for good behaviour and a punishment for bad behaviour. However, that is the logic of the Government's position. In Clause 53 they are seeking to deal with a situation in which either a health authority or a local authority, or both, does not wish voluntarily to enter into an arrangement. Furthermore, one or perhaps both parties have been failing to perform their functions adequately. That, to put it mildly, is not an auspicious beginning to a marriage.

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But there is more to the issue than that. We are dealing with a power to interfere in a major way with local democracy. Clause 53 essentially provides the power to remove a function of a democratically elected body, take control of part of that body's budget, including money generated from local council tax receipts, and allocate the money elsewhere against the express wishes of the body concerned. If ever there was an example of the Government's tendency towards centralism, I put it to the Minister that this is it.

We hear a great deal from Ministers about encouraging voluntary arrangements in terms of local flexibility, devolved decision-making and so on. But, on the other hand, we hear that there are some matters that are just too important in the Government's eyes to be left to chance, and that these may need to be forced on people. Those are diametrically opposed positions, yet Ministers act as if there were no contradiction at all.

There is perhaps another contradiction lurking here. If a PCT or NHS trust is failing in some way, it is quite a leap of faith to suppose that, by becoming a care trust against its wishes, it will all of a sudden cease to fail. It is interesting to recall that during the passage of the Health Act, which introduced the concept of co-operation between health bodies and local authorities and the pooling of budgets, Ministers assured Parliament that there was no question of such co-operative arrangements being forced on either the NHS or local government by ministerial powers of direction. Yet less than two years later exactly such a power is being proposed.

Setting aside the fact that my confidence in ministerial assurances has experienced something of a jolt as a result of this, it would be helpful to know why in such a short time the Government have undergone such a change of heart. The simple truth is that shotgun marriages rarely prosper. Where there is also a blatant undermining of local democracy we need to be very cautious indeed about such a proposition. Frankly, the case for it has not been made.

7.30 p.m.

Baroness Noakes: I support what my noble friend Lord Howe said about the clause being in direct opposition to the provision in Clause 52 dealing with voluntary care trusts. The Minister spoke of an enthusiastic partnership between health and local government as an essential prerequisite. If it is an essential prerequisite for Clause 52, it seems to me that it is equally a prerequisite for Clause 53.

The NHS has had a great deal of experience of working in different kinds of partnership over a number of years. The Minister gave examples, as did my noble friend Lady Cumberlege. The private sector, too, has considerable experience of working in joint venture and partnership mode. The experience in the private sector is that the majority of partnerships and joint ventures fail. They do so for a number of reasons: lack of a shared vision; lack of leadership at the top; lack of a common philosophy; and, importantly, lack of trust. I do not know whether any studies have been

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done into failures in partnerships in the NHS--and there have been failures--but I should be very surprised if the results were any different.

When we come to Clause 53, we find that the Secretary of State or the relevant authority has the ability to take functions and put them into another body without looking at whether commitment, shared philosophy, joint leadership and trust are in place. If these powers are allowed to stand, we are legislating for failure. All our experience in similar situations tells us that such organisations will fail. For that reason, I do not believe that we should support the clause.


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