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Baroness Noakes: My Lords, I start by thanking the Minister for introducing the order and for explaining it in her customary clear and comprehensive way. At first blush, the order looks completely straightforward but I have a few questions for the Minister.
First, perhaps I may deal with the timing of the order. Consultation took place between August and November 2001. Since then, there has been no action on the order other than the ad hoc removal of the obligation to produce annual community care plans. Can the Minister say what was the cause of the delay between November 2001 and July 2003?
Secondly, and related to the subject of timing, the consultation was completed 20 months ago. The Minister outlined some of the findings of that consultation. Are the Government clear that nothing has changed in the meantime? What procedures have the Government followed to ensure that the decision to abolish the annual community care plans remains valid?
Thirdly, the abolition of annual community care plans is, of course, welcome if it relieves local authorities from a burden without loss of value to the community. When considering the burden on local authorities in this area, I looked for the subject of community care plans on the department's website and discovered the following non-exhaustive list of plans and planning mechanisms that local authorities engage in with regard to the areas covered by the plans. It includes: local strategic partnerships; local health partnership and modernisation boards; health improvement and modernisation plans; joint investment plans; national service framework local action plans; better care higher standards; local community strategies; carers' strategies; and best value plans.
As I said, I am told by the Department of Health's website that that is a non-exhaustive list. "Frightening or what?" for local authorities, I say to that. I am tempted to say that the Department of Health has on its hands a far bigger task in relation to simplification than this modest measure before us today. The noble Baroness talked about reducing the number of plans submitted to the centre. But, if the Department of Health website is to be believed, significant burdens are still left on local authorities.
Perhaps I may ask the Minister two questions relating to this area. First, how can the Government be sure that, in moving away from annual community care plans to a plethora of planning mechanisms, usually on longer planning timescales, sight will not be lost of short-term developments? Three years can be a very long time on the ground in dealing with needs.
Secondly, how can the Government be sure that the needs of all groupsespecially minority groupsare taken care of? That was a particular strength of the way that community care plans were developed and it was one of the strong messages received in the feedback from the consultation exercise carried out by the department.
The Minister talked about sign-posting and how some local authorities carry that out. I fully accept that. But can she say how the department ensures that local authorities make it clear how all groupsin particular, minority groupscan make their views heard and have them fed into the process? It is not enough simply to issue guidance about sign-posting; we must be sure that it is happening in practice in the way that it did happen to engage groups under community care plans. We do not oppose the order but we believe that these are serious questions that require answers.
In this House, we do not have a habit of giving our speeches titles. But, if I had the opportunity to do that, I would like to steal the title from an event that I attended a couple of weeks ago. It was entitled "More
The order is welcome because it reflects the increase in joint planning and joint consultation which has been taking place over the past two years. The noble Baroness, Lady Noakes, questioned whether the department's actions had, in fact, reflected reality. They have, and I say that as someone who is, from time to time, involved in helping users and stakeholders to become involved in this issue. There has been an explosion in consultation meetings and consultation mechanisms. That is a huge problem. If local authorities are drowning in the consultation requirements placed upon them, just think what it is like for small community organisations. The truth is that they cannot manage to keep up.
One concern is not addressed by the order, but it is a real one all the same. The requirement for consultation carries with it no resources. Small organisations are being required to take part in consultations but they do not have the time, money or staff to do so. I happen to work for a large and well-established voluntary organisation, one which is strong at local level. One of the people I worked with now works in the North West. She calculates that she works one week in four on consultation for statutory authorities. She is not paid for that, nor is her organisation. Frankly, small community organisations are not going to be able to undertake it.
One of the lessons that has been learnt from the process of community care planning is that the most beautiful of plans means nothing if that is the only involvement that stakeholders have in it. During the years social services have become good at producing plans which have some meaning. But the NHS, which is increasingly involved in joint implementation plans in health and patient care, has a long way to go in its ability to make the processes work, never mind the outcomes.
A couple of months ago, I was told about a consultation meeting for older people which took place somewhere in London. The consultation meeting was set up for nine o'clock on a Monday morning in a hospital site not on a public transport route and without transport laid on. The health authority was surprised when no users turned up. The authorities are beginning to improve, but only slightly.
The order will assist in one other aspect. People say they are burnt out by consultation. We have a race of super pensioners who have a great time. They are professional pensioners who go to consultation meeting after consultation meeting. But even they are having enough of the sandwiches and samosas. In Age Concern recently, we had an application from a bunch of pensioners who have become firm friends. They have been to so many consultation meetings that they have got to know each other. They applied to us for some money and they were most specific in their requirements. They wanted money to have outings and
Baroness Barker: No, they would not do very well in here! The Minister is right. There are other mechanisms. Better governance for older people is an interesting one to look at. The better governance for older people programme has left a good legacy of involvement of older people, but sustaining it at local level now that the national funding has disappeared is proving to be difficult and much of the good work done under that programme is being dissipated.
The noble Baroness was right to talk about the importance of local development plans. They are important locally, as are health improvement plans. But they will only be as good as the data they produce. During the past 10 years or so of community care plans, a great deal of effort has gone into the process of writing the plans but I have yet to find anyone who has been able on a sustained basis across an area to say what has resulted from them.
One of my colleagues at Age Concern used to have the delightful job of going through every community care plan in London trying to find out what it said about older people. That was a job in itself. Now that she has retired, I am not sure that we have any better information about service planning. Therefore, in welcoming the rationalisation, I ask the Minister whether, when we are down to one or two planning mechanisms, they will have the resources to be real and where the data they generate can be found. It is hard enough finding the processes on the Department of Health's website. Finding the results is even more difficult.
Baroness Andrews: My Lords, I am grateful for the welcome which the noble Baronesses, Lady Noakes and Lady Barker, have offered the order. I shall deal with a few of their questions in turn. Yes, it has taken us a little time to come forward with the order, but we introduced the disapplication directions which gave the clearest possible steer to people that we did not want them to duplicate effort. In the interim, the planning process has not changed.
However, it has been a period of considerable development. For the first time we have tried to be serious about the delivery of joint working on the ground in health and social care. It is a major challenge following the Health and Social Care Act 2001. We have put a great deal of effort into ensuring that what can work on the ground is what happens.
We are certainly not complacent, but during the past three years we have not had a hiatus in development or delivery. We have introduced local delivery plans which are better and integrated and address some of the issues that were ignored. I am not surprised that when the noble Baroness, Lady Barker, looked at the website she found so many examples. I am sure the
There is an issue about the annual community care plans and their time-scale, but the local delivery plans are living documents. They are not set in stone for three years and they can be amended. Corrective action can be taken if delivery goes off course, or if there are new and urgent priorities or opportunities. Although I understand why the noble Baroness raised the question, we can have confidence that there will be flexibility.
On the seriousness about consultation, I shall address the issues which came from different parts of the House. I am delighted that we have had an incredibly proactive impact on the people concerned, whether they are the elderly, parents without work, or whatever. The idea of consultation overload is a little daunting and I hope that we do not inhibit people from coming forward. I believe that the challenge is to find ways of involving and identifying the people whose voices are never heard.
We have some opportunities in initiatives such as Neighbourhood Renewal for involving people. We are undertaking similar work in drug action development. My noble friend Lady Massey recently spoke about drug action teams talking to small groups of mothers in very deprived areas where there are big drug problems. They talk to small groups in order to get them involved as the voices of their community. There is no doubt that we have not been very successful and there are better ways of doing it. I take the warning she offered. It is the greatest disappointment to involve people at the early stage of a process and never to be able to show them how their words, influence and expertise made no difference to the outcome.
Section 11 of the Health and Social Care Act 2001 places a specific duty on local authorities to ensure that the service users and carers are involved in the planning process. The technical guidance that is issued on local delivery plans, which I would be happy to pass on to the noble Baronesses, Lady Barker and Lady Noakes, operates to a standard template. There is a lot of detail about what we expect to see. The guidance must summarise how key partner organisations have been engaged in the process, how supportive they are of service proposals and, indeed, how they will be affected. We are getting serious about the audit trail of involvement and outcome. I would be very happy to circulate the guidance. It is extremely important that we involve such organisations throughout the process. I take the point about resources for voluntary organisations. One encouraging aspect is the contact that has been set up between government and the voluntary sector, which may make a difference in some centres.