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Baroness Thomas of Walliswood: I am not entirely satisfied with that reply. Some of the voluntary sector people who have made representations to us will also not be satisfied.
It is particularly unfortunate that in his reply the Minister suggested that in some sense the voluntary sector would hold the National Health Service and the local authorities back in terms of their innovatory approach to joint working. In fact in many cases the voluntary sector is the most innovative in providing for new patterns of care. That was a particularly unfortunate statement.
Lord Hunt of Kings Heath: If the noble Baroness will allow me to intervene, I am sorry if I gave that impression. I did not mean to imply that the voluntary sector would hold back an innovative approach to working together, to developing health improvement programmes and providing joint services. Far from it. I believe that the NHS has learnt much from the voluntary sector about innovative approaches to health services. I spent a large part of my previous life in the health service encouraging strong development between the NHS and the voluntary sector.
I was trying to explain--perhaps badly--that in these new arrangements we are trying to establish a much more dynamic approach to working relationships between the NHS and its partners, statutory or voluntary. One does not want to see such dynamic relationships constrained by too many set, bureaucratic conditions. However, I assure the noble Baroness that it is our intention that the voluntary sector will play a very full part in the new arrangements.
10.45 p.m.
Baroness Thomas of Walliswood: I thank the Minister for that assurance. We shall have to read with great care what the Minister said in both his interventions and no doubt talk to the people who have pressed us on this matter. In the meantime, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendments No. 151 and 152 not moved.]
Clause 25 [Joint consultative committees]:
Baroness Sharp of Guildford moved Amendment No. 153:
Leave out Clause 25 and insert the following new Clause--
(" . It shall be the duty of joint consultative committees constituted under section 22(2) of the 1977 Act to advise the NHS bodies and local authorities on the proper performance of their duties under section 21 above.").
The noble Baroness said: Once again this amendment picks up the whole issue of consultation and voluntary sectors. We are concerned at the loss of the statutory right for the voluntary sector to be represented--which is the result of the abolition of the JCC as a statutory requirement--coupled with the lack of provision in the Bill for alternative joint arrangements which would maintain this representation. As I have said, it is the issue that we have been banging on about for some time now.
The right of representation has been crucial in enabling voluntary organisations at the local level to influence decision making and resource allocation, and to work in partnership with the health and local authorities to develop more services appropriate to people's needs. It has acted as a basis for involvement by a wide range of voluntary organisations, including small groups, at all levels of joint health and social care planning.
The loss of the right of representation is a retrograde step. That goes against stated government intentions for greater voluntary sector and service user involvement in health and community care. It will reduce the capacity of voluntary organisations to operate as an equal partner within the statutory sector in delivering improvements in health and social care. We have therefore tabled the amendment to ask the Minister to consider, once again, whether the JCCs really do need to be abolished or whether they should continue to be maintained as statutory organisations. I beg to move.
Baroness Gardner of Parkes: Perhaps the Minister can tell us about that. I was not aware, having served on JCCs, that voluntary organisations had a statutory right to be there. Perhaps I never understood the position correctly. Maybe the Minister can clarify the point.
We have heard a lot about voluntary organisations. Of course, we are all very much in favour of such organisations and all that they do. However, "the voluntary sector" is a vague term. It comprises very large numbers of organisations. Such organisations seem to come and go. Some are long-established and unchanging; others are growing up, brand new and meeting new requirements overnight. I do not quite understand how there can be a statutory position and whether it applies to one or to many.
Lord Hunt of Kings Heath: I start by saying to the noble Baroness, Lady Gardner, that voluntary organisations have a statutory right of three places on JCCs.
From what I have said in the last few debates, I hope it is clear to Members of the Committee that I and the Government recognise that the voluntary sector has a crucially important role to play in the new NHS. However, I do not believe that the retention of JCCs is necessarily the way to reflect and underpin that role.
In the new NHS, health improvement programmes have been established as the key planning mechanism determining investment in services to improve the public's health. They include the contribution of both the voluntary sector and local government. Maintaining a separate planning mechanism for the voluntary sector and local government within a JCC concept would only increase bureaucracy, duplicate the planning process and maintain the isolation of these areas from the day-to-day work of the NHS. I recognise that JCCs have performed an important and valuable role in the past and that all members have made an enormous contribution, but to retain them would run against the spirit of partnership working we have adopted in this Bill.
An important theme running through our discussions has been the rejection of simplistic structural solutions to allow local initiatives to flourish. The new flexibilities provided for in this provision will allow the NHS, local government and the voluntary sector to be involved in partnership working. When health improvement programmes are fully developed, they will be much more effective as a way of ensuring partnership because their scope will be much wider than that of JCCs.
For the first JCC that I attended, we had to hire a town hall to accommodate its 70 or so members. One remembers the bulk of paper! Although JCCs were a useful structure 20 years ago in getting health authorities and local government sitting together, almost for the first time, I believe that their time has come and is now past. On that basis, I hope that the noble Baroness will withdraw her amendment.
Baroness Sharp of Guildford: I thank the Minister for that reply. In the light of what he said, we accept that it is the intention of the Bill to replace the JCC framework with a wider and more flexible framework through the local health improvement plans. However, I repeat the point that I made earlier: where there is not a statutory obligation to consult, there is always the temptation not to do so. The old NHS was not good at involving other organisations in its planning. We look forward to seeing how the health improvement plans develop and we reserve the right to bring back at another stage the issue of the statutory right of the voluntary sector to some form of consultation. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Lord Clement-Jones moved Amendment No. 154:
After Clause 25, insert the following new clause--
. Upon a regional assembly being created for any region in England, such regional assembly shall for the purposes of the 1977 Act, the National Health Service and Community Care Act 1990, or under or by virtue of any prescribed provision of any other act, assume responsibility for--
(a) strategic planning,
(b) capital infrastructure, and
(c) specialised services commissioning,
in the health service in respect of such region.").
The noble Lord said: When my noble friend Lady Sharp starts referring to "banging on", I know that the hour is late. As we still have some important clauses ahead, I shall speak to my next two amendments quickly.
We know that the Government want, or are prepared, to create regional assemblies where there is demand for them. We have seen one outcome of that in terms of the Greater London assembly. In a sense, this is a probing amendment to see in which direction the Government are moving. No doubt, when the GLA Bill comes to this House we shall discuss the precise powers of that authority. Particularly in public health, the powers given seem extremely disappointing.
This amendment is an attempt to draw matters wider than public health. Regional assemblies should have a strong position with regard to the provision of health care in their regions in terms of strategic planning, capital infrastructure and specialised services commissioning, which subsumes the work of the regional office of the NHS. The amendment is designed to ascertain the Government's intentions in this respect. I beg to move.
Baroness Carnegy of Lour: I shall listen to the Minister's reply to this amendment with great interest because one understands that the regional assemblies are intended to be a counterbalance, among other things, to the Scots Parliament. The Government are requiring the Scottish Parliament to appoint 15 health boards to perform these the functions and not to do it themselves. We shall be coming to that issue in a later amendment, but it would be interesting to know whether the Government are consistent in their thinking.
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