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Baroness Byford: My Lords, before the noble Lord sits down, perhaps I may thank him for standing in for the noble Baroness, Lady Hayman. We quite understand why she is not here. I want to ask him two things. The question of insurance was raised. Some pig farmers do insure against swine fever. However, when the matter is considered again, perhaps he would raise the question of what happens in relation to reinsurance. I believe that some people are experiencing difficulty in obtaining reinsurance cover.

My other comment is that he reflected the sadness that was felt at the lack of competence when BSE broke out. If three outbreaks have occurred and they

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are still reflecting incompetence, surely we need to get to grips with what we do and how we do it. However, I thank the noble Lord for the way in which he responded.

Health and Social Care Bill

8.43 p.m.

House again in Committee.

Lord Rix moved Amendment No. 259:


    After Clause 53, insert the following new clause--


"PROHIBITION OF NEW CHARGES AS A RESULT OF THE CREATION OF CARE TRUSTS
No new charges shall be created for new or existing services as a result of the creation of Care Trusts.".

The noble Lord said: I am sure that the Minister will have been advised as to the technical as well as the policy problems with my new clause. What can be said in its defence--and that is no mean virtue--is that its purpose is crystal clear. Even I can understand it. It is intended to ensure that the setting up of a care trust does not open the way to charging for existing services which at present are free, and that it does not open the way to creating new services which will then be charged for.

I accept the assurance that introducing care trusts does not of itself remove the distinction between social services for which charges may be made and health services for which charges may not be made. However, we all know that an important aspect of the increase in charging has been the replacement of free services by chargeable services. The Bill, as it stands, does nothing to prevent the continuation of that process. So far as I can see, it would be open to the managers of the new hybrid to designate all new or amended services as social services for charging purposes. That would not be possible with my quite simple amendment.

I believe that we already have more than enough charging. People should not be taxed on essential activities which are forced upon them by disability or by disadvantage. They already, according to their means, pay taxes towards the cost of public services. Those services should be free at the point of receipt. My amendment would go far to slamming the door on this imaginative creation of new burdens for disabled people, even though it would stop short of removing existing charges.

I hope that the Government will see some attraction in removing from the innovation of care trusts--whether the voluntary arrangements or, as we have heard quite often this evening, the shot-gun wedding variety--the stigma of concern about new charges. With that threat out of the way, the new partnership arrangements can be considered on their merits. I beg to move.

Baroness Greengross: I support the amendment. I have grave concerns that people may not always know what is an NHS service and what is a social service. New methods of flexible working are very welcome.

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We all agree that they will make sense to most service users but they may mean that staff themselves will not always know whether a particular service that they provide comes under health legislation or social service legislation. Many staff members already find it difficult to make that distinction. Therefore, perhaps inadvertently people will be charged inappropriately. I support the noble Lord, Lord Rix, because I believe that his amendment seeks to avoid that happening.

Baroness Masham of Ilton: I refer to the point that I made previously in relation to the amendment to which the Minister spoke. I am sure that he will give more assurances now.

Lord Clement-Jones: I rise to support the amendment. I believe that it concerns a very important principle. As I recall, I believe that the noble Lord, Lord Rix, tabled a similar amendment when we debated the Care Standards Bill. We received a set of valuable assurances on that occasion. Each time that we deal with a new piece of legislation which takes powers or which changes the structure of the way in which we proceed, it is important that Ministers return to give us those assurances anew.

My motive in rising to speak on this occasion is horror at the recent consultation on fairer charging policies for home care. In relation to that type of issue, it is absolutely vital that, however welcome it may be, the creation of the new structures does not lead people--particularly vulnerable people or those who need a great deal of support--to being charged where they were not charged previously. I believe that that is absolutely crucial. As the Minister knows, we on these Benches would roll back the boundaries a great deal further than the Government are doing. However, let us at least keep those boundaries where they are at the moment.

Lord Hunt of Kings Heath: I fully accept that this is a useful opportunity for me to place on the record the Government's position. As I said earlier this evening, the creation of care trusts should not be seen, as perhaps has been feared, as a way of extending means-testing or cost-shifting between the NHS and local government.

It is clear that care trusts are likely to be established to commission or provide services, some of which are charged for and some of which are not. The policy on charging or not charging will remain. Where charges are made currently, there will continue to be charges; and where the services are free--most notably, NHS services--that will also remain the case. In addition, where local authorities have discretion to charge, the policy will continue to be the responsibility of the local authority. I believe that that answers the question that was raised earlier by the noble Baroness, Lady Barker. The care trust will carry out the charging policy as appropriate.

I stress that, because a care trust provides some services that are charged for, there is no intention to introduce charges for NHS services. NHS services will remain free at the point of delivery.

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I pick up the concerns that were raised by the noble Baroness, Lady Greengross, about the impact of charging on integrated provision--the noble Lord, Lord Rix, also mentioned that. That concern is nothing new. In relation to partnership arrangements, when staff and managers see the benefit of working together to provide better services, they find ways to minimise any difficulties involving charging. The assessment process is key in that regard. I respond to the noble Baroness by saying that I agree that, from the outset, potential users of services need to know clearly that some services may be charged for. They need clear information so that they can make decisions about the care that they want. Equally, staff need to be trained to ensure that they give clear messages and have good written information to leave with the user.

I am aware of the concern that setting up a care trust might enable people to consider cost-shunting. Once again, I make it absolutely clear that that is not the intention and that the assessment process is key to ensuring that there is clarity in determining which services are free and which are not. The frameworks for performance assessment and performance management exist to pick up any problems that might arise and to enable us to deal with the matter.

Baroness Masham of Ilton: I have one question for the Minister. I have had notification from the Incontinence Society, which is concerned in this context about catheters, incontinence sheets and so on. Will he give an assurance that such matters will come under nursing care?

Lord Hunt of Kings Heath: The assurance I can give is that the development of care trusts will have no impact on that issue. Essentially, care trusts combine local authority services with NHS services. The point is that if one has a charging policy in relation to some social services, that will be brought into the care trust and the charging policy will be determined by the local authority that is entering the voluntary arrangements. If an NHS service is involved, that will be provided mostly free at the point of delivery, apart from the few cases in which the service is not free. The care trust will have no impact on those wider policy issues.

Lord Rix: Would the Minister say whether a name shift could take place? A service might be provided but not charged for; the body might change the title of the service, as it were, and it might possibly slightly change the content of the service, which might be ruled to be a chargeable item. Is that a possibility?

Lord Hunt of Kings Heath: If there was a deliberate attempt to cost-shift by changing the relevant names, one would not wish to support that and the attempt should be picked up in the performance management process. The key in that regard, surely, is that in the initial agreement to become a care trust, health and local authorities will have worked out those issues so that there is a clear statement of policy. Nothing should be undertaken that compromises the fact that

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the service, if it is an NHS service, is provided free at the point of delivery. I should expect that to be sorted out by the partners to the agreement on the care trust.


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