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Earl Howe moved Amendment No. 133:
The noble Earl said: Clause 19 is a short and delightfully simple-sounding clause which states that:
Looking at the clause purely as a matter of law, the first question is very simple: what does the duty amount to? Who is to decide whether the duty has been breached or fulfilled? What mechanisms are to be put in place to ensure that the duty is met? How is the duty to be enforced? What are the penalties for non-compliance? Indeed, are the terms of Clause 19 sufficient to enable a court to reach a judgment on the issue, if it came to that?
That is why we need some flesh on the bones and that is the reason for my amendment. If the duty of partnership is to amount to anything tangible or to mean anything to the public, there must be an opportunity for bodies which are working in partnership to meet to discuss how they can work together more effectively. It is necessary also for those meetings to be reported so
Lord Hunt of Kings Heath: The noble Earl expresses some scepticism about the duty of partnership laid down in the clause. I regard this is an extremely important component of the Bill.
I believe that the very specific requirement imposed by Clause 21 on health authorities, primary care trusts and NHS trusts--the bodies to whom that duty applies--to participate with their local authority in developing health improvement programmes and in working together to implement them is a clear indication of the strength and breadth of the duty of partnership, because that requirement makes clear that the Bill is about partnership and co-operation for a purpose--namely, improving the health of local communities and improving the health services they use.
We already have in Clause 21 a framework for bringing together all the local players with an interest in an inclusive process. That includes also local authorities and community health councils, along with the wider community and a wide range of local organisations. I am sure that we shall discuss that in depth when we deal with the amendments to Clause 21.
Perhaps at this stage I may concentrate on what seem to be difficulties with the amendment now before us. First, I have some concerns about its scope. Clause 19 is deliberately drafted to embrace co-operation between bodies right across the NHS. In the main, of course, the need will be for local co-operation in the planning and delivery of local services. The health improvement programme process reflects that. But there will be many instances where much wider co-operation is at issue, some of them on important themes on which we have already touched in this Committee--in the commissioning and provision of specialised services, for example; on matters of education and training; or on research. Each NHS body will need to co-operate through a network of different relationships for these purposes and we intend the scope of Clause 19 to reflect that.
I do not believe it would be appropriate to subject each such example of co-operation to the sort of arrangement proposed in the amendment. The key ongoing relationships will be covered by the health improvement programme process. To subject other wide-ranging forms of co-operation to the processes in the amendment would, I fear, prove bureaucratic and burdensome. Indeed, at worst it could prove a disincentive to the very partnership working we are all seeking to achieve.
Secondly, I am uneasy at the concept of a series of meetings and reports "to discuss partnership arrangements." I would much rather see all concerned getting on with the business of working together to achieve some results for their local communities. We want partnership for a purpose and I believe that is what the partnership clauses of this Bill, taken as a whole, offer us.
I believe that we are right to set a broad duty of co-operation in Clause 19. I should be reluctant to see it circumscribed by procedural requirements. We must certainly ensure that partnership working becomes a reality but I believe that the health improvement programme process at Clause 21 provides a better means of achieving this.
The noble Earl raised some questions about how such co-operation was to be enforced. From my experience of working in the National Health Service we should not under-estimate the capacity of the NHS to respond to the underlying philosophy enunciated in the clause in relation to the NHS bodies we wish to see co-operating. If there were specific situations where it was seen that some NHS bodies were not co-operating and that that was undermining the effectiveness of the health service, exceptionally the Secretary of State's powers of direction could be used over NHS players. But I hope that that will be unnecessary. The clause is an important philosophic statement about the way in which we expect the NHS to conduct itself in the future. I have every confidence that the NHS will accept and embrace that philosophy.
Baroness O'Cathain: Does the Minister really believe that people volunteer to be co-operative the whole time when they have so many jobs to do? This type of arrangement whereby people would need to put into their diaries the relevant names of those with whom meetings had to be arranged once a quarter would target attention to co-operating. They would not allow something to go to the bottom of the in-tray; they would just get on with it.
It may be that these bodies could be told to meet just four times a year in public. If they needed to meet more frequently they could do so because the amendment suggests "at least" four times a year. If people know that they have to meet those with whom they should be co-operating on the basis of once a quarter, that will focus their attention on co-operation. The Minister says it is a philosophic statement. It is also philosophic to say that they should have a target to co-operate.
Lord Hunt of Kings Heath: My experience of NHS bodies, if we take, for example, the area of a district health authority and the organisations within that authority--NHS trusts, primary care groups and so forth--is that they will meet many more than four times a year.
My point is that the duty of co-operation is an important statement about the values within which we expect the NHS to operate. That is unlikely to be added to or solidified by a requirement to meet four times a year. We shall come to this matter later, but as regards joint consultative committees and the requirement to meet with local government, in the past 20 or 30 years we have moved beyond that. Relationships are so important now to provide integrated services that whether or not there are four statutory meetings a year
Earl Howe: Of course, I understand that it is important, in the context of the Bill, that the various arms of the health service should work together. I did not mean to sound like a sceptic on the concept of partnership or, indeed, to question the worth of making statements of intent. My only concern was that the words that we convert into law should have real meaning; that any duty in law should be capable of being enforced and adhered to, and that there should be proper mechanisms in place to help the parties to do that.
With the best will in the world, there will be conflicts of interests at play, even with this duty in place. My noble friends alluded to those. Health authorities, primary care trusts, NHS trusts and so forth will sometimes have to sublimate their own interests in order to assist or support one another if this duty is to be fulfilled. What happens if they have different priorities? All these questions arise.
I thank the Minister for his reply. However, I shall have to reflect a little further on what he has said. In the meantime, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendment No. 134 not moved.]
Baroness Pitkeathley moved Amendment No. 135:
Page 15, line 33, at end insert--
("(2) To this end any bodies mentioned in subsection (1) which have co-operated with each other in exercising prescribed functions shall--
(a) meet at least 4 times per year in public to discuss partnership arrangements;
(b) invite a representative from all affected community health councils and local authorities;
(c) make an annual report on such meetings to the Secretary of State, which he shall publish.
(3) In subsection (2) "prescribed" means prescribed by regulations made by the Secretary of State.").
"It is the duty of Health Authorities, Special Health Authorities, Primary Care Trusts and NHS trusts to co-operate with each other in exercising their functions".
So short is the clause that I feel I must ask the Minister a few questions.
After Clause 20, insert the following new clause--
(" .--(1) Section 47 of the National Health Service and Community Care Act 1990 (assessment of needs for community care services) is amended as follows.
(2) In subsection (3), for the words "notify that Health Authority or local housing authority and invite them to assist, to such extent as is reasonable in the circumstances, in the making of the assessment;" there shall be inserted "in the case of a Health Authority require, and in the case of a local housing authority invite, the authority concerned to assist, to such extent as is reasonable in the circumstances, in the making of an assessment;".").
The noble Baroness said: This amendment would require the health authority to assist a local authority when it is carrying out an assessment of a person's need for community care services. The health authority would be required to assess the person's health needs in relation to community care. The amendment also mentions that housing authorities would be invited to assess those needs.
The background is as follows. As noble Lords will know, the National Health Service and Community Care Act 1990 came into force in April 1993. The Act places the responsibility for arranging community care services on local social services authorities. A local authority must carry out a community care assessment where it appears to that authority that a person may be in need of community care services which the local authority may provide or arrange.
Where the local authority believes that the person has health needs, it is required to invite the local health authority to assist in that assessment. However, there is no corresponding requirement on the health authority to respond to a local authority's request for assistance.
Accordingly, the amendment would place a duty on the health authority to participate in the assessment of a person's health needs when asked to do so by the local authority. The amendment makes it clear that the health authority's duty is to assist the local authority,
I should point out that the amendment has the support of the Association of Directors of Social Services, the Local Government Association, and of charities such as the Carers National Association and Scope. I beg to move.
"to such extent as is reasonable in the circumstances".
In my view, that would very much accord with the duty of co-operation set out in Clause 20. I am sure that it is very much in keeping with the commitment to partnership between health authorities and local authorities which is expressed in the Bill and which, as we know, is active between many of the professionals involved.
9.45 p.m.
Lord Skelmersdale: I spoke slightly on this matter at Second Reading. It seems to me to be absolutely vital that if Clause 22, which we have not yet reached, is to stand part of the Bill, the local authorities, social services, health authorities and the whole health machine must talk together before anything can happen. Therefore, I support the noble Baroness in her amendment.
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