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Baroness Thomas of Walliswood: I rise briefly to echo the words of the noble Lord, Lord Skelmersdale. I look forward very much to hearing the Minister's response to this interesting amendment.

Lord Warner: I too speak in support of the amendment. In doing so, I declare an interest as a member of the Association of Directors of Social Services. From my experience as a director of social services, I regard this as a worthwhile amendment which would deal with some of the occasionally difficult cases where health authorities do not always co-operate.

Lord Hunt of Kings Heath: The effect of the amendment would be to require health authorities to assist in community care assessments undertaken by local authorities. I believe that the amendment is unnecessary.

Local authorities are under a duty to give a community care assessment to anyone who, in the authority's view, may be in need of community care services. We have made clear in guidance that these assessments should always involve medical professionals when appropriate, but this will not always be necessary.

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Community care assessments should enable the local authority to make appropriate decisions about service provision, but the exact form of each assessment is something best left to them. In some circumstances, a fully comprehensive assessment will clearly be essential, involving people from a number of professional backgrounds in working with a person with multiple needs to identify the best way forward. But in other cases, a quick and simple assessment may be all that is needed so that necessary help can be provided with minimum delay. Requiring NHS input in every assessment might make it more difficult to target timely help where it is most needed.

I believe that my noble friend and I have the same underlying aim: to get the right services to the right people at the right time. Although I do not believe this amendment offers the best way forward, we do have other action in hand. We set out in our better services for vulnerable people initiative the requirement on health and social services to develop a joint framework for multi-disciplinary assessment of older people in acute and community healthcare settings. Improved multi-disciplinary assessment--where this is appropriate--leads to better co-ordination of care between agencies and better outcomes for service users. I believe this developmental approach to multi- disciplinary assessment is the right way of achieving flexibility and better outcomes for service users by tailoring assessment to their needs.

We shall, of course, continue to monitor the development and implementation of these multi- disciplinary assessment frameworks to ensure there is good progress on the aims I have described. I hope that my noble friend will accept that this is a serious endeavour to address the concerns behind her amendment and will not feel the need to press it.

Lord Skelmersdale: Before the noble Baroness goes any further, the Minister mentioned multi-disciplinary assessments. He is, of course, absolutely right, but unless one organisation--the health authority, for example, or the local authority--can push the case of an individual--it will almost invariably be an individual whose needs are being assessed--there will not be a multi-disciplinary assessment. How does the Minister intend to carry this forward? To paraphrase, he said, "We will wait to see how the system develops." I am tempted to use the oft-quoted expression in this House, "How long, dear Lords, how long?"

Lord Hunt of Kings Heath: We should not underestimate the likely impact of the better services for vulnerable people initiative because it is intended to deal with the problem of people slipping through the net who are not best served by the current assessment procedures. In the very nature of achieving better co-ordination care between agencies and better outcome for service users, the whole intention is to deal better with the needs of the individual.

Clearly, noble Lords have raised issues on the basis that it is deemed that the NHS is failing to respond to local authorities in the assessment procedures. It is certainly my hope that NHS failures to provide the

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support the local authority requires are limited. However, there is an overall duty of co-operation and powers of direction under Section 17 of the National Health Service Act 1977 which allow the Secretary of State to direct health authorities and trusts to provide services. So there is a chain of accountability which enables the health service to respond to problems in this area.

Baroness Pitkeathley: I thank the Minister for his thoughtful reply. It is no part of my approach to doubt his commitment and that of other noble Lords to a multi- disciplinary approach to assessment. The amendment was put forward to address the few problem cases we can identify. I shall carefully study what has been said and trust that his hopes are justified about the limited number of cases to which this would apply. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn

Clause 21 [Plans for improving health etc.]:

Baroness Sharp of Guildford moved Amendment No. 136:

Page 16, line 6, after ("Authority") insert ("and Special Health Authority").

The noble Baroness said: This is a minor probing amendment. We believe that special health authorities as well as the health authorities should have a duty to prepare a health improvement plan. I believe that it is the intention of the Government eventually to phase out special health authorities, but for the moment they exist and it is important that they do not opt out of the health improvement framework in the Bill. I beg to move.

Lord Hunt of Kings Heath: I accept the points made by the noble Baroness, but there is a problem in seeing how the duty in Clause 21 could properly be laid on the special health authorities, which would include NICE, the Central Blood Laboratories Authority and the Special Hospitals Authority. It is difficult to see how they could strictly fulfil the requirements of Clause 21.

We will ensure that all special health authorities work in partnership with others in the NHS and local government to ensure that NHS services are delivered effectively to improve the health of the population. That is why special health authorities are explicitly included in the duties of co-operation in Clauses 19 and 20. Clause 21 is different because it is based upon the duty of each health authority to secure health services for, and advance the health of, a defined local population. All the more detailed requirements of Clause 21 flow from that starting point. It is difficult to see how that could realistically be extended to put this duty on special health authorities, which are established generally with a much more closely defined function, usually exercised on a national basis.

If the intention is to ensure that all special health authorities seek to exercise their functions with the aim of improving health and healthcare, I do not think that there is any disagreement between us in principle. I hope

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that the noble Baroness will agree that extending Clause 21 in the way suggested is not the best means to achieve this aim.

Baroness Sharp of Guildford: I thank the Minister for his most helpful reply. I think we now understand better the reasons for leaving out these authorities. In the light of that, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Baroness Sharp of Guildford moved Amendment No. 137:

Page 16, line 6, leave out from ("Authority") to ("to") in line 7.

The noble Baroness said: Amendments Nos. 137 and 139 would have the effect of making it the responsibility of each health authority to prepare its health improvement plans on a rolling basis, publishing them on a regular annual basis. The reason is to ensure that health authorities recognise that it is their responsibility to produce the plan and thereby have a sense of ownership rather than regarding it as just another of those tasks which must be completed for the department. Annual publication would keep the authority up to the mark. Amendment No. 138 makes it clear that such a plan would provide a framework for wider consultation within the community. I beg to move.

Lord Hunt of Kings Heath: The effect of these amendments would be to put on the face of the Bill a mandatory requirement that a health improvement programme be prepared annually. As a general rule, we would wish to avoid specifying matters of administrative procedure on the face of the Bill. In the case of health improvement programmes, I would be particularly uneasy because one of our aims is to break out of the strait-jacket of the annual planning and contracting round. We certainly intend--as the noble Baroness suggested--that the programme should be rolled forward, and published, each year. Our existing guidance makes clear this expectation. I am happy to give a firm assurance now that this is what we intend for the future.

However, our intention is that the health improvement programmes should cover a three-year period. As they are rolled forward each year, we intend that a number of issues will be reviewed in depth rather than the whole plan being updated in every detail. We believe that this will enable better planning for strategic change. Critically, it will allow more time for the in-depth involvement of users and carers, community groups, clinicians and other staff--all those whom noble Lords are keen to see more fully engaged and who, as my noble friend Lord Harris, the noble Lord, Lord Rix, and others, have pointed out, have found the traditional arrangements for formal and tightly timetabled consultation on comprehensive plans so frustrating.

We want to develop the new arrangements differently. For example, we expect the health improvement programmes for the period beginning April 2000 to cover implementation of the first two national service frameworks on coronary heart disease and mental health. If we take the example of mental

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health, I can tell the Committee that during 1999 we envisage that health authorities will plan to bring together NHS trusts and the clinicians concerned, primary care groups, social services and other local authority representatives--such as housing--and other local players, together with users, carers and the voluntary groups to whose important contribution the noble Lord, Lord Rowallan, drew our attention earlier in the proceedings. The intention is that, together, they will take the time to look in depth at what needs to be done and plan the way ahead. When the programme comes to be rolled forward again, the same sort of in-depth review would be applied to other topics.

It is on that basis that I would be reluctant to see us put anything on the face of the Bill that bound us tightly into an annual round at the expense at this sort of in-depth planning on a longer cycle. I hope that I have reassured the noble Baroness of our clear intention to see regular publication of what is contained in this work and that, on that basis, she will be prepared to withdraw the amendment.

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