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Lord Hunt of Kings Heath: I acknowledge that there are issues in this area which we must examine in relation to the responsibilities respectively of health and social services. We will be considering the detail of the framework on charging, promised in the social services White paper, in the light of the recommendation of the Royal Commission report published and discussed in the House today. Until we have studied the recommendations in detail, I cannot say when we will publish the framework.
I believe that the amendment is unnecessary. We have made clear on numerous occasions that we have no intention of changing the fundamental principle that NHS services are provided free to patients. NHS bodies have no powers to charge for NHS services, except where permitted under the 1977 Act. The Bill does not alter that. There is no power for local authorities to charge for NHS services. The Bill does not alter that. Where a local authority provides or commissions NHS services on behalf of an NHS body, those services will remain free to the service users.
I understand the reason why noble Lords seek the amendment. The use of the new operational flexibilities provided for in Clause 24 will allow health bodies and local authorities to work more closely in commissioning and providing healthcare and local authority services. Under some arrangements, health and social care will be provided by the same body. Under the integrated provider flexibility, a social services authority might develop a service providing some healthcare on behalf of an NHS body--for example, physiotherapy or speech and language therapy--together with domiciliary care. As at present the healthcare provided will be free and the social care could be charged for.
We clearly recognise concerns that the distinction between health and social care may not at all times be sufficiently clear. The simple fact remains that NHS care is free and local authorities have a power and sometimes a duty to charge for the social services they provide. That distinction will remain. I am sure your Lordships will be reassured to know that we fully intend to make that clear in the regulations provided for under Clause 24.
We stated in our discussion document, Partnership in Action, that we would require authorities seeking agreement from the Secretary of State for their use of the new powers to set out clearly how their charging regimes for social services would be applied. Guidance on applications for use of the flexibilities will state clearly the position on charging for healthcare and that NHS services remain free at the point of use. We will require that applicants set out in their proposals how their local charging policies will be applied in the light of that. The bodies concerned will need to set out clearly what is NHS care and what is social care. We will use the application process to monitor how the bodies will ensure that healthcare remains free to users.
I hope that in the light of that explanation the noble Lord will agree to withdraw his amendment.
Lord Clement-Jones: I thank the Minister for that comprehensive reply. I understand what he says about guidance and monitoring, but at the beginning of his answer he seemed to imply that it would be unlawful for a local authority to charge for healthcare services. Is that correct?
Lord Hunt of Kings Heath: Yes.
Lord Clement-Jones: I am taken aback by the brevity of that answer! On that basis, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Baroness Thomas of Walliswood moved Amendment No. 150:
The noble Baroness said: In moving this amendment, I shall speak also to Amendment No. 151.
The context for these amendments is the loss of the JCCs, which is dealt with in Clause 25. Many voluntary organisations have conveyed to us that those joint
The wording of Clause 21(5) is stronger in terms of consultation than is subsection (6) of this clause. Subsection (6) provides that the Secretary of State may issue guidance. I believe that we must have "must issue" even though I believe that the word "directions" is less preferable than "guidance". Therefore, I shall not insist on every word of this amendment.
The rest of Amendment No. 151 provides what the guidance must consist of and who the consultees shall be; namely, the local community health council, organisations representing the interests of people for whom the health authority is responsible--that is, people in the locality--and organisations which represent the interests of carers of those people. Broadly speaking, that is the equivalent of those people who currently have a right to nominate people to sit on the JCCs.
I hope that the Minister will recognise that at present, where they are working well, the input of the voluntary organisations and the community health councils is extremely valuable in making sure that work is well-targeted. I hope that the Minister will be able to strengthen the wording of Clause 24 accordingly. I beg to move.
Lord Hunt of Kings Heath: The new approaches to joint working provided in Clause 24 put in place a framework which will allow local innovation. It is very important that we do not stifle innovation by placing on authorities requirements which may not be necessary in every case. I understand that the reason behind the amendment is to ensure that appropriate local consultation takes place when NHS bodies and local authorities wish to use the new flexibilities. But setting out in detail on the face of the Bill who should be consulted on every occasion is against the spirit of local flexibility and partnership which underpins those provisions.
The approach we have taken is to leave the detail of the provisions to regulation while setting on the face of the Bill what those regulations might cover. Subsection (3)(b) of the clause allows the Secretary of State to prescribe through regulations the conditions to be satisfied by authorities, including in relation to consultation. I consider that power to be more than adequate to ensure that authorities consult appropriately.
The Committee will appreciate that we wish to use the regulatory powers sparingly. We do not wish to stand in the way of progress by placing unnecessary burdens on authorities. The Bill allows us to require authorities to consult particular organisations if it is necessary to do so. It also allows us to issue guidance to authorities to help them to ensure that they consult appropriately. I do not believe that we need a further
I turn now to the specific issue of community health councils. Of course we want CHCs to be consulted on proposals where appropriate. Health authorities already have a duty to consult CHCs when considering substantial developments or variations in services. And we want patients and carers to be consulted. But those groups will be properly involved in the development of the health improvement programme under which the new provisions will be used. It is important that the right people are consulted at the right time. But it is not necessary to set out on the face of the Bill all the details. The powers in the clause to make regulations and issue guidance are the right way of ensuring that the appropriate people and organisations are consulted. On that basis, I hope that the noble Baroness will feel able to withdraw the amendment.
Lord Rowallan: I make no apologies for once more standing up on behalf of the voluntary sector. Can the Minister give me an assurance that the money that goes into the pool will be available for all service providers, which must include the voluntary sector, and not just those that are affiliated to either the health or local authorities? Obviously that is an important issue.
Lord Hunt of Kings Heath: I assume the noble Lord is pointing to a situation where the health and local authority agree to pool funds. It would then be up to the managers of those joint funds to decide how that resource should best be spent. Whether we are talking about health improvement programmes or about the use of funds in this way, I expect voluntary organisations to play a full part in that process.
Lord Rowallan: Forgive me for coming back again. Surely if there is nothing written in the Bill and if those governing the pooled resources take the view that they do not want anybody else involved in that pool of money, that will leave the voluntary sector completely outside. Should not something be written into the Bill to ensure that that cannot happen?
Lord Hunt of Kings Heath: I hoped that I had made clear that in the whole process of partnership, health improvement programmes, developing joint initiatives and the pooling of funds, we expect the voluntary sector to play a full part in the deliberations that will take place. Indeed, I do not see how the kind of proposals being made here can be effective when it comes to developing services without the full involvement of the voluntary sector.
In relation to the issue of the money that has been pooled, it will be possible for that money to be allocated to the voluntary sector.
Page 20, line 18, leave out ("may issue guidance") and insert ("shall issue directions").
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