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Baroness Sharp of Guildford: I thank the Minister for his reply. As the noble Earl, Lord Howe, said, it is extremely important that these local health improvement plans are locally embedded and locally owned. That is why the whole process of consultation is so important. As the Minister stressed, that has not been the habit of the NHS, and old habits die hard. There are occasions when it is useful to embody new procedures in statutory instruments rather than in directions. This might have been an occasion when it would have been useful to do so in order to push people out of old habits. However, given the Minister's assurances that he will monitor progress and that, if this provision does not seem to be sufficient in engendering a new spirit of consultation in local NHS participants, he will issue the necessary directions, I shall withdraw the amendment for the present time.

Amendment, by leave, withdrawn.

[Amendments Nos. 139 to 144 not moved.]

10.15 p.m.

Lord Clement-Jones moved Amendment No. 145:

Page 16, line 37, at end insert ("which shall include needs assessment, statement of resource (including human resource) requirements and identification of priorities for action,").

The noble Lord said: On the previous Committee day we had a most interesting discussion on Amendment No. 64 relating to medical workforce planning and the shortage of consultants. Amendment No. 145 is similar in intent. I believe that we on these Benches have made it clear that we very much welcome the health improvement plan process. Indeed, I am very influenced by the document produced by the department which considered why Health of the Nation had not been as effective as it might have been. I have a suspicion that, if we get these health improvement plans right, they will make Our Healthier Nation successful where The Health of the Nation was not. Health improvement plans may be the instrument by which to do that.

That said, there is nothing on the face of the Bill as to how matters are to be dealt with in relation to the content of the strategy stated in Clause 21. We believe that that is a gap. The circular itself to an extent goes into the detail but we believe that it is important to state at least some of the contents of the plans. For that reason we have repeated some of the wording of the circular. The noble Lord, Lord Hunt of Kings Heath, has spotted the way that we have put together the amendments; namely, we have looked at the circulars to see what is

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in them. We believe that that is a reasonably informed way to do it. I admit that we gagged slightly at the phrase "resource mapping", since we were not sure how many members of the Committee would accept the insertion of such a phrase on the face of the Bill. We thought that "human resource planning" might be slightly less jargonised.

This is a matter of some concern. As in the case of medical workforce planning, hospital doctors wished us to table this amendment, particularly the aspect of human resource planning. They wanted us to make the point very strongly that the whole question of the number of jobs and the people required to fill them--the human resource requirement of hospitals--was a matter of intense and important debate at local level. It was an opportunity for staff, particularly junior staff, to get involved in discussion particularly about levels of staffing required in hospitals. This may be a bridge too far in terms of wanting to insert this in primary legislation but it is nevertheless a very important point. Junior staff in particular should be allowed to enter the debate and discuss the human resources required at their level. I beg to move.

Lord Hunt of Kings Heath: I am sorry that the noble Lord does not like the term "resource mapping". I regarded it as a rather good phrase. I readily recognise the important point he makes that the human resource dimension should be fully taken into account in relation to the future plans and priorities of the health service at local level. All of us with experience of the NHS are aware of the problems that can arise when this is not done. The intention expressed in this amendment is one that the Government absolutely share. As the noble Lord implies, this matter is reflected already in guidance that we have issued in the health improvement programme process. The issue before the Committee is not whether those plans should take proper account of needs assessment and available resources including, critically, appropriately trained clinicians and other staff. Clearly, they should. They should certainly focus on local and national priorities and the way that they can best be addressed. The difference between us is not about our aims but about whether this kind of essentially procedural detail belongs on the face of the Bill.

The Bill includes a direction-making power that combines the ability to specify certain core requirements, should that seem appropriate, with flexibility to modify and update these in the light of experience. I believe that this offers the best means to ensure that the points put forward by the noble Lord are given due weight. It has already been stated that the HR requirements of the health improvement process will be published within the health improvement programme. We have also made clear that when we talk of the need to take account of the views of staff we mean all staff--not just clinicians and professionals but all staff in the health service. I hope that on that basis the noble Lord is prepared to withdraw his amendment.

Lord Clement-Jones: I thank the Minister for that very helpful reply, which is not unexpected. Clearly, this is an issue that needs to be aired because it is a matter

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of considerable importance particularly to those staff within NHS trusts. I fully accept that the intention is that they will be involved in that process. We look forward to seeing how that works in practice. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 146 and 147 not moved.]

Clause 21 agreed to.

Clause 22 agreed to.

Clause 23 [Payments by local authorities to NHS bodies]:

[Amendment No. 148 not moved.]

Clause 23 agreed to.

Clause 24 [Arrangements between NHS bodies and local authorities]:

Lord Clement-Jones moved Amendment No. 149:

Page 20, line 17, at end insert--
("( ) Nothing contained in this section shall permit charges to be made for health care by any local authority.")

The noble Lord said: This is potentially an important amendment. It goes to the core of joint working arrangements on food, budgets, and so on, It seeks clarification on the interface between social care and healthcare. Clause 24 allows the NHS and local authorities flexibility to work together in new ways by pooling budgets and delegating functions and resources. Health and local authorities will be able to agree which is best placed to provide particular functions.

However, it is incumbent on the Government to answer a number of questions about the way in which those arrangements will operate. Do they recognise the barrier that charges present to joint working at present; and the fact that those problems will increase with an unamended Bill? Precisely when do they expect to publish guidance on charging? Currently it is not available.

Charges cannot be made for NHS services, but local authorities are under a duty to charge for residential services and have the power to charge for non-residential services. We are concerned that it is not clear how the charging for services will work. Most local authorities now charge for non-residential services. But the current charging policies are complex and confusing. We are concerned that many carers may be paying for services received by the person for whom they care despite the fact that carers should not be charged for such services.

We welcome the statement in the government paper, Partnership in Action, about guidance being issued. However, there is little consistency nationally on charging. Little consideration is being given to the impact of charging on the joint working arrangements.

The Select Committee on health--we have referred to it on previous occasions during Committee stages--commented about the confusion as to which agency, health or social services, is responsible for which service. It said that this confusion is epitomised by the farcical question of whether a person in the community needing a bath should receive a "health" bath or a "social" bath. The first comes free; the second, in theory

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at least, has to be paid for on a means-tested basis. I do not wish to carry things to their logical conclusion--that clearly takes things to an absurdity--but it is a typical example of what could grow into a considerable problem with the joint working arrangements. We are concerned that the requirement to charge for social care proposed by the Bill could lead to more services being treated as social care and therefore subject to a charge, thus seriously undermining the principle that healthcare should be provided free of charge. The amendment ensures that the situation is clarified.

Perhaps I may refer to other services such as physiotherapy. The chartered institute is worried that, where local authorities are the lead provider of some community health services, the services will be prevented through means testing and that there will be charging for them. We on these Benches wish to see on the face of the Bill confirmation of the Government's intentions. I beg to move.

10.30 p.m.

Baroness Thomas of Walliswood: I wish to speak in support of the amendment on behalf of the noble Lord, Lord Rix, who cannot be here today. One of his principal concerns about the Bill is to ensure that partnerships between health and social services are well managed financially and operationally. MENCAP's recent report, Fully Charged, reveals that there is a growing trend towards charging people with learning disabilities for important community care services, such as day care attendance.

We need to ensure that services which are currently provided free by the NHS remain free once these new partnerships are forged. That was the point made by my noble friend. Lowering the boundaries over what counts as health services and social services should be to the advantage of service users, not to broaden the scope for charging.

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