Health and Social Care Bill

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Dr. Peter Brand (Isle of Wight): In an ideal world, the Secretary of State would set out strategies that local authorities would have the will, ability and resources to deliver. The real world is not like that. Luckily, it is rare for things to go completely amiss or disastrously wrong, but the Secretary of State is rightly held accountable when they do. However, it is unreasonable to hold him accountable if he does not have the powers to intervene. That is the dilemma for politicians in opposition: we do not want to give the Secretary of State powers, but we want to hold him accountable for everything that goes wrong. I have some sympathy with the Government's point of view.

If the Secretary of State is to exercise powers of coercion, that process should be seen to be open, transparent and accountable. I am worried that no process is provided in the Bill for appeals or further consideration when a decision has been made.

Government amendment No. 318 to clause 45 inserted the words

    Where a body is designated as a Care Trust under this section—

and set out ways in which the trust could be dissolved. Does the Minister envisage having two types of care trust? The legislation suggests an interest not in performance, make-up or responsibilities, but in how care trusts were set up in the first place. Would a care trust set up under this clause have the same right to ask the Secretary of State to reconsider its future under that amendment? We might more easily accept the powers that the Secretary of State is taking—which I hope will be exceptional—to force an amalgamation of functions through a care trust, if we knew that the protective devices that the Government felt were necessary under clause 45 were also available under this clause.

Mr. Hutton: The debate has reached the point from which we started, when we discussed the principle of whether the Secretary of State should be given the power to establish a care trust compulsorily, against the wishes of local partners, as a result of a failing service.

Hon. Members need to address the fundamental question of what measures should be available to the Secretary of State to deal with evidence of a failing public health service. We should all consider that issue, not only in our constituencies but in the context of the Bill. The clause is designed to give the Secretary of State new powers to deal with clear evidence of a failure to deliver public services of an appropriate quality, which our constituents have a right to expect.

I accept that Opposition Members have reservations and concerns about the fundamental philosophy behind the clause. As I understand their argument, they do not believe that it is right in principle that services that are locally democratically accountable should ever be the subject of such an approach by the Secretary of State. However, we argue that giving the Secretary of State that power puts public interest at the top of the list of priorities. I do not query their position, but it is a difficult one for the official Opposition to occupy, because I do not see any proposal for an effective resolution of these problems in their argument.

Mr. Hammond: Our point is that the imposition of a partnership arrangement against the wishes of the partners is internally illogical, as the words ``imposed partnership arrangement'' suggest. We are saying that it is not practical. Other mechanisms may be necessary to deal with failure, but requiring people to co-operate and work harmoniously together cannot be the solution.

Mr. Hutton: I accept the hon. Gentleman's argument, but that is only half the clause. The other half relates to the establishment of a care trust. We have provided directed powers in relation to the partnership arrangements and have included provisions relating to the care trust. I do not agree with the hon. Gentleman: that is how the clause will work in practice, as I shall explain in a moment.

The hon. Gentleman mentioned our proceedings on the Health Act 1999. It was never my intention, and I hope that he was not suggesting that it was, deliberately to mislead the Committee. As I understand the debate—I stand to be corrected—we were discussing whether the Health Bill required or allowed the Secretary of State to mandate or require partnership arrangements to be entered into. It does not. That is why we decided to introduce the new powers, as I shall explain later.

Underlying today's debate is an important argument relating to the legitimate Government response and how to put the interests of patients and the public first in dealing with a failing public service. The hon. Gentleman has a different view on such matters. We have presented our proposals in clause 46, and we believe that the powers are necessary and sensible. I believe, and I hope that my hon. Friends agree, that they put the interests of the public first and foremost, and will allow us to make progress in improving public services.

Mr. Hammond: I must clear up one point. Of course I accept that the undertaking that the Minister gave in Committee related to the Health Act 1999. He is now taking a power for the Secretary of State to direct pooled arrangements, which he told us the Secretary of State would not do under the Health Act 1999. The Secretary of State will now be able to do so under this Bill. I accept that technically what the Minister said in 1999 was correct and does not contradict the Bill, but the spirit of it is certainly contradictory, and he should have the good grace to recognise that, and explain to the Committee what has happened between then and now that has caused him to make a 180-deg U-turn in his view about what is necessary or expedient.

Mr. Hutton: I will certainly do that if the hon. Gentleman will allow me to finish my remarks. As I explained on earlier amendments to clause 46, the power will not be used lightly, or, I hope, frequently. However, it gives us a positive opportunity to act when other methods are inappropriate. I regard it as a power of last resort, as I said this morning. I envisage the power being used when it seems that no effort, support or outside help can change a culture of failure and decline, and when delegating a function to another body would release those problems and give staff and management a new lease of life.

I do not accept Opposition Members' implicit suggestion that the clause is an attack on social services. It is not. There are some outstandingly good social services throughout the country, as evidenced in our constituencies and on our travels around the country, but I do not believe that any of us would claim that that is universally true.

Difficult though it is, it is absolutely right for the Government to examine all such issues and consider what powers they believe to be appropriate in the public interest to advance the cause of high-quality public services. That is what underlines the provision made in clause 46. I understand the differences that exist between the two sides of the Committee, but as a matter of principle and record it is important to state clearly why we are taking the new powers.

The issue of what constitutes failure arises, and the clause refers to inadequate services. A body of evidence drawn, for example, from inspections will show us where we need to direct our attention. An inspection will be the precursor of consideration of the use of the powers. In tackling the problem, care trusts are one option, but they are not the only solution. They are not the default mechanism, but one of the options for directed partnership arrangements. The power is just one of a range of powers that can be used in specific circumstances. Just like the existing powers to intervene in social services, the new powers in the national health service relate to specific circumstances. We must be able to act appropriately to protect vulnerable people. That in a nutshell is what the clause will allow us to do, and that is why I hope that my hon. Friends will agree to its remaining part of the Bill.

Question put, That the clause, as amended, stand part of the Bill:—

The Committee divided: Ayes 11, Noes 4.

Division No. 6]

Bradshaw, Mr. Ben
Brand, Dr. Peter
Burstow, Mr. Paul
Dawson, Mr. Hilton
Denham, Mr. John
Foster, Mr. Michael Jabez
Hutton, Mr. John
Jamieson, Mr. David
Naysmith, Dr. Doug
Prosser, Mr. Gwyn
Stewart, Mr. Ian

Burns, Mr. Simon
Hammond, Mr. Philip
Swayne, Mr. Desmond
Young, Sir George

Question accordingly agreed to.

Clause 46, as amended, ordered to stand part of the Bill.

Clause 47

Further provisions about directions in connection with care trusts

Question proposed, That the clause stand part of the Bill.

Sir George Young (North-West Hampshire): Before we move on to part IV, I should like to press the Minister on the financial arrangements that follow the scenario that we have just discussed under clause 46. Clause 47 relates to the amount that must be transferred from local government to the care trust following the establishment of the care trust. Some important issues are involved on which the Minister must focus.

By definition, we are discussing a local authority that has failed and did not want to enter into a voluntary arrangement but for which none the less, for the reasons that the Minister described, a care trust has been established. The issue arises of how the care trust will be funded. The Minister will look to the local authority to transfer the social services budget for the provision of the services that the local authority would previously have provided.

I do not believe that it will be straightforward. At present, most local authorities spend more than their standard spending assessments. The local authority in my constituency spends more on social services than it is supposed to under the rate support grant formula. It would be perfectly reasonable for the local authority to say to the Government, ``You think we ought to spend £x million on social services, which is the amount in the RSG; that is the amount to which you should help yourselves in order to run social services.'' However, the Minister might say, ``You are spending more than the SSA. I think it entirely reasonable that a larger sum than the SSA provision should go to the care trust.'' If the Minister had his way, that would affect the local authority, as money that might otherwise be designated for education or transport, for example, might go to the trust.

We now come to what will happen in the event of a disagreement. Paragraph (c) provides that in the event of a disagreement an arbitrator will be involved. The explanatory notes touch on that. In the event of a failure to agree locally on the level of funding an arbitrator can be brought in to determine the appropriate level, which can be checked against a national formula to compare decisions made locally. I wonder whether the Minister might say a little more about that. It is a novel arrangement—I have not come across it before—whereby an outside person will adjudicate as to how much money is transferred from a local authority to a central Government Department. That will require the wisdom of Solomon. If, as is suggested in the clause, he refers to a national formula, I imagine that that is the SSA. If that is the amount that ought to be transferred, the result may be that slightly less money is put in than was being spent previously.

On clause 47 stand part, it would help the Committee and local authorities to know exactly how much money the Secretary of State was going to take out of their pockets in order to go ahead with the arrangements under clause 46.

5 pm

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Prepared 6 February 2001