|Health and Social Care Bill
Mr. Burstow: The right hon. and hon. Members who have contributed to the debate have already posed several of the questions that have arisen. If the Government have not yet come to any final conclusions, such questioning helps to tease things out a little further.
Several questions arise from my own experience of the configuration of primary trusts, primary care groups and local social services departments. How will the issue of overlapping boundaries between the agencies be dealt with? Who commissions the social care services in areas where a care trust covers part of the population for one social services department and the majority of the population for another? Does the authority in which the person resides commission that service or does the authority that is providing the service commission it? Or does that function fall to the care trust, as a way of bridging the gap?
Who provides the care? If a care trust is based upon a local authority, but also operates in another local authority area, is the care package that it provides, which includes elements of social care, delivered by the local authority that has joined into the care trust or by the local authority that just happens to have the care trust operating on its patch but is not part of it? Who provides the care? In my constituency would it be the home care workers working for the London borough of Sutton, or would it be provided by those working for the London borough of Merton, which is part of the care trust?
Who pays for the service? Does the London borough of Sutton pay for the service and passports the money through to the London borough of Merton to pay into the care trust, or is the money mysteriously magicked away through the wonders of SSAs and rolled up into the grants that go to the care trusts?
Who sets the charging policy? If my constituent is provided services by a care trust which includes social care that is provided by the London borough of Merton, are the eligibility criteria and charging policies that apply those of the London borough of Merton or those of the London borough of Sutton?
Who monitors the service at a national level? Will it be the social services inspectorate or the Commission for Health Improvement or a joint arrangement? How will that work?
What are the issues around probity? The methods of guaranteeing probity between a managed service such as the NHS and local authorities are different. Where does the district auditor fit into scrutinising the accounts of the NHS bodies that are spending local authority-derived funds?
Finally, the hon. Member for New Forest, West described the arrangements for scrutiny by local authorities. Which local overview scrutiny committee would scrutinise the serviceswould it be that of the London borough of Sutton or that of the London borough of Merton? Where do my constituents go if they wish to raise concerns? I am sure that we will be told that their first point of call will be a patients forum, but if they have wider issues to raise, will they go to the London borough of Merton or will they have to come back to their Member of Parliament because he is the only person who could possibly help them navigate the systems that are being set up?
During our consideration of the proposed amendments to the clause various questions were asked and the Minister graciously answered quite a few of them. However, one or two still have not been addressed. I have asked twice so far today whether the Government's arrangements will specifically include older people. It would be useful to know whether, in principle, the Minister accepts the case for such inclusion.
The legislation governing social services has evolved through case law. There is a great wealth of case law now determines a good deal of practice in social services departments. The NHS, however, tends to be driven by guidance. It would be useful if the Minister could tell us where and how the line will be drawn. How will case law that has already developedand no doubt will develop in futureaffecting the operation and delivery of social services impinge upon the operation of NHS bodies within the framework to be put in place by the legislation?
My final question is again one that I asked earlier, but to which I have had no answer. It relates to the need to ensure that carers and service users are included in the arrangements for assessment and are entitled to separate assessments. As the Minister knows, that is established through the Carers and Disabled Children Act 2000. How will it apply within a care trust? Will it apply, as now, within the context of that statute, or will there be new arrangements? Many carers who supported that private Member's Bill would like to have clarity on that at the earliest opportunity.
Mr. Hutton: We have had a full debate on clause 45. I have been described as a blancmange by the hon. Member for New Forest, West, and that is certainly a first.
Mr. Swayne: I was referring to the Bill.
Mr. Hutton: With respect, I believe that he was describing me as a blancmange. That is certainly how it struck me and I am not altogether sure whether it is a flattering observation. I shall need to consult my learned friends on that and no doubt return to the matter later.
Generally, however, I am grateful for the clause's reception, which has at times been positive. I am also anxious to dispel some of the lingering doubts that Opposition Members have expressed. The leading doubter is the right hon. Member for North-West Hampshire, who knows about the subject from when he was a Minister, and obviously remains a sceptic about care trusts.
Labour Members subscribe to conspiracy theories on a routine basis. It seems as though that virus has infected the right hon. Gentleman where care trusts are concerned. Let me say in all candour that there is no hidden agenda about financial issues or charging responsibilities in relation to social care services. Care trusts are not a short cut. There are no quick fixes to the policy that we are pursuing, which is the closer integration of health and social care.
As usual, the hon. Member for Isle of Wight displayed common sense when he talked about the different cultures of the organisations, which we know exist. I strongly believe that sensible solutions are at hand to facilitate the success of care trust organisations. We have scrupulously tried to ensure that the proposals in the Bill put those in the NHS plan into effect. The right hon. Member for North-West Hampshire tried to imply that the proposals in the Bill were somehow different from those in the NHS plan, but that is not the case. We set out the strategy in the NHS plan, and the Bill provides the technical means whereby the care trusts can come into existence.
I assure the right hon. Gentleman, and the hon. Members for Sutton and Cheam and for Isle of Wight, that care trusts are not a vehicle for extending charges. We have heard the mantra that establishing a care trust is some cloak-and-dagger operation to allow the NHS to charge for its services, but Opposition Members should get real. As a Government, we have made it repeatedly clear that we will not extend charges for NHS services. That may be the agenda of the Conservative party; it may even be the agenda of the Liberal Democrats, but it is not our agenda. That argument is bogus and false.
Dr. Brand: My concern was not that the Minister might extend charges; I would not be so uncharitable. I warned that the existence of charges as at present in social services militates against the joint working relationships that we are so keen to see. That was clearly one of the findings of the Select Committee on Health.
Mr. Hutton: I do not accept that, as I have made clear. The last occasion on which I did so was in the House last night. The issue of charging has been raised, but it has been a feature of social care delivery in this country since 1948. I accept that we have not achieved all that we have wanted in terms of closer working between the NHS and social care services since 1948, but to attribute that largely to the issue of charging for social care services is to misread the situation.
We must address organisational issues, and the care trusts will help us to do that. We could hide in our bunkers, as I suspect that the Liberal Democrats are doing, and say that charging makes it impossible for health and social care services to work effectively together. That is essentially what the hon. Member for Isle of Wight just said, as he said that it impeded effective working. However, that is a false analysis and is not borne out in reality.
Mr. Hammond: Perhaps rather predictably, I am rising in response to the Minister's provocation, and I suspect that it may not be for the last time today. As he knows full well, the policy of the official Opposition is that we have ruled out any extension of NHS charges.
Mr. Hutton: Well, there we are. We all feel reassured about that. I hope that the hon. Gentleman will not mind the fact that I am glad to say that the matter remains academic, given that, rather obviously, he will not be in a position to have any bearing on the future of the national health service. Those who saw how the Conservative party managed the affairs of the national health service are entitled to take everything that the hon. Gentleman and his right hon. and hon. Friends say with a heavy dose of salt.
Mr. Hammond: On a point of order, Mr. Maxton. I hope the Minister is not suggesting that in making that statement I sought to mislead the Committee or that it was not a true statement made in good faith.
The Chairman: That is not a point of order.
Mr. Hutton: I am genuinely sorry to have upset the hon. Gentleman.
Mr. Hammond: There will be more of that.
Mr. Hutton: Yes, perhaps there will, because many Labour Members have longer memories than the hon. Gentleman and remember the contribution that he and his party made to the history of the national health service. I do not think that any Labour Member would be other than horrified at the prospect of he and his right hon. and hon. Friends having jurisdiction over the national health service in future. Indeed, I think that that would apply to anybody in the country as we know exactly what the Tories think about the national health service. It is clear from their actions and their words that they do not believe in it. However, that is a wider topic.
|©Parliamentary copyright 2001||Prepared 6 February 2001|