Health and Social Care Bill

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Mr. Burstow: The Minister repeatedly said at the start of his response to the debate that the Bill made it clear that the arrangements were voluntary. However, the briefing document describes the provisions as another stage in the evolution of the arrangements for joint working. Evolution implies that the current situation and that established by the arrangements will change.

Will the Minister give us more information as to how he envisages the proposal on care trusts will proceed? I am not asking how many care trusts there will be, and I am sure that he will not want to set targets. Is the proposal a central part of what the Government want to happen, or is it merely something that can happen?

Mr. Hutton: With great respect to the hon. Gentleman, I am not sure that I can answer the question in that way. We have told local government and the NHS that they have two options and can decide which they want to develop. They may want to go down the clause 45 route of voluntary care trusts, or they may decide to develop closer arrangements under section 31 of the Health Act 1999.

I made it clear earlier that we believed that the care trust option had a great deal to commend it. It has many attractions, as it will provide for the first time a coherent organisational structure in which the closer partnership arrangements can be delivered. In that sense, it represents evolution from the Health Act flexibilities, as it takes them a step further.

I am an evolutionist. I think that we all are, or we would not have ended up where we are. I do not think that the hon. Gentleman, I or anyone else in the Committee has a precise blueprint for the position of the NHS in 10 or 15 years.

Mr. Burstow: I am grateful to the Minister for clarifying his position on the creation of care trusts, but will he make one final comment? Does he rule out the possibility, as an incentive to the establishment of care trusts, of using specific grants with the condition that they are available only to local authorities that enter into care trusts?

Mr. Hutton: It is clear that any conditions attached to the use of special grants have to be consistent with primary legislation. What the hon. Gentleman suggests could not happen. We cannot use special grant resources outwith the framework of law agreed by the House and the Committee.

We started the debate on the issue of consultation, and have now come full circle. I tried to make it clear that, as with existing NHS organisations, we will set out the national application and approval process for care trusts in guidance. Subsections (7) and (8) will clearly regulate the process whereby an application to establish a care trust will be made at local level to the Secretary of State under clause 45. We intend that the regulations will clearly set out the procedure for the consultation exercise. Therefore, there will be a proper consultation process for the establishment of care trusts, as is essential. Similar rules apply to every other NHS body, and there is no reason to disapply them to care trusts.

I end with a homily about the concept of care trusts, about which many hon. Members have raised concerns. The right hon. Member for North-West Hampshire appeared to see care trusts as a takeover of local authorities by the NHS, but that is not so. This is not a change for change's sake, either. It is not an organisational game of musical chairs to involve local authorities in the NHS. We are not making fundamental changes in the pattern of delivering services simply for the sake of it. We have considered the issues carefully. The NHS plan sets out a strong argument for developing the Health Act flexibilities and taking them a stage further. That is what we meant by the reference to evolution.

11.15 am

If we sort out the problems, establish the case for care trusts at a local level, establish the credibility of the organisation, evidenced by strong local support, deal with the issues of governance, which I am sure we shall, and resolve the issues of charging--the right hon. Gentleman made rather too much of that in his objections to the principles of care trusts--we can take things to another level and bring health and social services much closer together. That is what our constituents want. They are sometimes baffled and confused by the arbitrary lines that we have created through decisions taken by this House in previous Parliaments, which have left us with organisational divisions between health and social care services. We should never lose sight of the fact that we put those lines in place, so we can take them out. It is as simple as that.

Mr. Swayne: Despite what the Minister has said, my right hon. Friend the Member for North-West Hampshire did the Committee a service by reminding us of the history of these matters and drawing our attention to the problems. Notwithstanding those problems, as I sought to make clear on the first group of amendments, we want to give care trusts a fair wind. However, we want there to be proper evaluation before they are established, which is why we attach such great importance to the question of consultation.

The Minister chided my right hon. Friend for drawing attention the problems that have to be faced, including the issue of charging. However, he himself said that there has to be a way round those problems. He is right. Part of the solution lies in the process of consultation that we have raised in the amendments. The Minister made clear the importance that he attaches to consultation, and he explained how the regulations will be drawn up in that respect. Therefore, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Mr. Hutton: I beg to move amendment No. 318, in page 38, line 32, leave out subsection (4) and insert—

`(4) Where a body is designated as a Care Trust under this section—

(a) its designation may be revoked by the relevant authority at any time—

(i) of the authority's own motion, and

(ii) after such consultation as the authority considers appropriate;

(b) if an application for the revocation of its designation is made to the relevant authority by one or more of the parties to the LA delegation arrangements, its designation shall be revoked by the relevant authority at the earliest time at which the authority considers it practicable to do so, having regard, in particular, to any steps that need to be taken in relation to those arrangements in connection with the revocation.'.

The Chairman: With this it will be convenient to take the following amendments: No. 311, in line 36, leave out

`of the authority's own motion'

and insert

`at the instigation of the authority'.

No. 258, in line 37, at end insert—

`(4A) If following receipt of an application to revoke a designation made by a local authority which is party to the LA delegation arrangements, the relevant authority—

(a) refuses the application, and the local authority has within two years of the date of its application renewed the application; or

(b) otherwise fails to revoke the designation,

the relevant authority shall on the expiry of two years from the date of the original application revoke the designation.'.

Mr. Hutton: In tabling the amendment, we have tried to respond to the perfectly reasonable concerns that have been expressed by local government interests about the nature and duration of voluntary care trusts under clause 45. It was never our intention that entering into a voluntary arrangement would be a once and for ever act of agreement between local authorities and the NHS. It was always intended that, in the absence of such agreement, the arrangements surrounding a care trust could be brought to an end sensibly and carefully so as not to compromise the integrity or ability of local health and social care services to deliver first class services for local people. The purpose of the amendment is to clarify the situation and to make our intentions crystal clear.

If any party wishes to end an arrangement, that will happen at the earliest time practicable. That will allow some local flexibility to ensure that local arrangements are appropriately sorted out before the care trust arrangements are terminated. It is not intended to encourage local partners to switch in and out of arrangements, depending on how the mood takes them. Care trusts are not a quick fix, but require a level of commitment from all the parties.

Given the other amendments that have been tabled in the group, I hope that right hon. and hon. Members who have expressed concerns about that aspect of the Bill will feel that we have tried to meet them more than half way. In doing so, we have emphasised the fact that the arrangements are voluntary. If there is no longer a voluntary agreement between the parties for a care trust to exist, we need to take that into account, and we have done so.

Right hon. and hon. Members may also want to know why the amendment retains the power of the Secretary of State, by his own motion, to dissolve a voluntary arrangement. I am told that the hon. Member for New Forest, West may want to raise the matter. Essentially, the power simply allows us to adopt a consistent approach with respect to care trusts and other NHS bodies. I hope that all right hon. and hon. Members would accept that the Secretary of State needs a reserve power to ensure that health care services are provided effectively and appropriately. In the amendment, we are not proposing anything other than what is applicable to every other NHS body.

Mr. Swayne: The Minister raises the intriguing question of who told him what the hon. Member for New Forest, West may want to raise. I am not aware of having had any conversations about the matter.

Amendment No. 311 is rendered redundant by the Government's amendment, although the latter retains the curious form of words about ``the authority's''—meaning the Secretary of State's—``own motion''. However, we shall not dwell on that. My right hon. Friend the Member for North-West Hampshire should take as a compliment the similarity between the wording of his amendment No. 258 and that of paragraph (b) of the Government's new subsection (4), in amendment No. 318. The Minister explained his intention to meet us half way.

On the assumption that we want to encourage local authorities to enter into care trust arrangements, the key point to be made about the amendments is that authorities are likely to be singularly reluctant to do so without an escape route. It is crucial to the success of the enterprise that the availability of an escape route should be explicit in the Bill.

Amendment agreed to.

 

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Prepared 6 February 2001