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Baroness Thomas of Walliswood: My Lords, I should like to thank the Minister for a very full and well directed answer. Anyone reading Hansard tomorrow (which after all is a record of intent) will be in no doubt as to what the Government have in mind for the consultation process. I was particularly interested in the ideas and dissemination of best practice. Experience in many other fields shows that that is one of the best ways of getting a change of habit or culture. With that I am very happy to withdraw the amendment.
Amendment, by leave, withdrawn.
Baroness Hayman moved Amendment No. 52:
On Question, amendment agreed to.
Clause 24 [Arrangements between NHS bodies and local authorities.]
Earl Howe moved Amendment No. 53:
The noble Earl said: My Lords, one of the creative features of this Bill, for which I give the Government full marks, is Clause 24, the provisions of which will allow the NHS and local authorities to work much more closely together than hitherto in areas where there is a commonality of interest. Joint working is, of course, nothing new either to the NHS or to local authorities, but the current legal barriers are such as to preclude the kinds of practical day-to-day arrangements that are conducive to maximum efficiency in the use of resources.
Clause 24 contains some important new powers which will allow the NHS to delegate functions to local authority departments and vice versa. They will allow for the provision of health and local authority services by a single managed provider, and they will allow for the pooling of money. Perhaps the obvious area where these arrangements will make a difference is that of delayed discharges from hospital, the causes of which, as noble Lords will be aware, are far from straightforward but can very often be traced to a lack of co-ordination between hospitals and social services. Greater flexibility in this sense is bound to pay dividends.
The amendment I have tabled is therefore for clarification. As Clause 24 is worded it would appear possible for the Secretary of State to allow for pooled budgetary arrangements between a health authority and a local authority if he feels that such a pooling of funds would assist in the delivery of health-related services. My first question to the Minister is exactly what that means. The functions of a local authority that are health related include practically all of its functions. Spending money on treating damp in the walls of a school classroom could be seen as health related. The same
If NHS money is allowed to support the wider public health agenda, I should have real concerns about seeing a reduction in the money devoted to patient care. Can the Minister reassure me that the phrase, "health-related functions", in subsection (8) are those areas of local authority activity such as social services which are intimately bound up with patient services as delivered by the NHS?
My second concern relates to accountability. We are told that once money goes into a pool it ceases to possess a health or local authority identity. If that is so, how will it be possible to maintain proper accountability for the way in which health or local authority funds are used, and who will be the person accountable? My hope is that, despite health money losing its identity in the pool, the chief executive of the health authority will still be answerable for its use. It would not be satisfactory if the loss of the money's health identity were allowed to dilute or confuse the normal accountability mechanisms that ensure financial propriety. I beg to move.
Lord Rea: My Lords, when first reading the amendment I thought how restrictive it was. Having praised the purposes of Clause 24, the noble Earl has now included wording that restricts the provision to social services. I understand now that his purpose was simply to allow my noble friend the Minister to expand on how the clause will work, and I welcome that.
I take the noble Earl's point that every department run by a local authority could have a health-related aspect. However, there are particular areas in certain departments which could well be thought of as helping in the delivery of personal health services. I am thinking particularly of housing and education as front runners. But, as the noble Earl says, there are many other functions. I shall be extremely interested to hear how my noble friend will describe how the extent of the spread of NHS funds through local authorities will be managed.
Lord Laming: My Lords, many of the new unitary authorities have introduced structures which, although their social services functions are clear, are not all conducted in departments that are called social services departments. Many of the new unitary authorities have introduced structures where children's services are linked with education, and where adult services are linked with other functions such as housing, environmental health and the like.
Lord Hunt of Kings Heath: My Lords, that was a helpful intervention.
I welcome the opportunity to debate this issue and to clarify some of the points that the noble Earl has raised. I also accept the positive comments he made about the need to oil the wheels of collaboration between health and local government. When one thinks of NHS/local
We have an ambitious agenda for the future of the health service. Underpinning that agenda is the need to tackle the root causes of ill health and to improve services from the point of view of users and carers by breaking down the barriers that exist between organisations. That must go wider than purely health and social services barriers. In order to achieve that, we wish to have the greatest degree of flexibility in the use of resources. We want local partners to be able to develop "joined-up" solutions to "joined-up" problems.
The Government are committed to breaking down barriers. I point to the work of the Social Exclusion Unit, the Better Government initiative and the proposals in Partnership in Action as evidence of our commitment. This amendment would tie our hands. We want to allow partnerships to develop between NHS bodies and local authorities as a whole. Failure to do so would mean the isolation of social services within local government. It would mean that the needs of some of our most vulnerable citizens would not be met in the most effective way. We want to allow education and housing to work in partnership with the NHS to meet the needs of vulnerable people.
If this amendment were to be accepted, local partners would not be able to put in place improved support for children with special educational needs as regards the provision of speech and language therapy in schools, or better co-ordination and sharing of responsibility for the provision of specialist aids and equipment which do not fit neatly into the responsibility of one agency, and pool budgets, for example, to cover home alterations such as for wheelchair accessibility or which would facilitate the discharge of people from hospital. Those are all areas where local partners have suggested that they would like to use the new flexibilities.
In the discussion document Partnership in Action, we have consulted on these flexibilities and asked specifically for views as to how they might be used between the NHS and corporate local government beyond social services. Of 171 organisations which responded to that consultation process, not one questioned the need to extend the flexibilities. Indeed, the majority were adamant that wider local government must have the opportunity to be involved. Health action zones, for example, have been keen to use the extended flexibilities and we believe that they will probably act as a test bed for some of the more innovative ideas.
In addition, the Department for Education and Employment conducted its own consultation exercise on the document, seeking views from local education authorities and others in the education field about whether and, if so, how education might be involved. Again, it found no one signalling that the wider use of
At this stage, it is not possible to second-guess how the flexibilities might be used in all cases. It is for authorities locally to come up with ideas within the framework that is set. However, we must be sure that we do not deny them the opportunity.
These and other ideas need to be worked out in detail. They would need to comply with the regulations laid down by the Secretary of State. The point of that is that the regulations would enable us to ensure that the necessary consideration has been given to how the flexibilities will operate and to the outcomes that they are intended to achieve.
We recognise that, in the early days, health and social services will lead the way in using the new flexibilities. Clearly, social services is the area where the majority of partnership working with the NHS has been developing and where the pressure for the flexibilities has originated. We want to learn the lessons from this experience. That will be invaluable in generating ideas and building up the wider partnership.
If we were to limit the scope of the provisions that are now before us by accepting the amendment, we should still be able to dismantle the barriers that exist between the NHS and social services, but in a sense it would leave remaining barriers between the other areas of local government. That would be unfortunate.
The noble Earl asked about accountability arrangements. I refer him to the discussion document, Partnership in Action. Paragraph 4.27 of the document makes it clear that the service and financial management accountability in audit--for instance, in the pooled budget--means that ultimate accountability for that budget links back to the existing accountability arrangements for each partner authority. That is extended to the chief executive of the NHS executive, the Secretary of State for Health and Parliament, on the one hand, and, on the other, to the local authority members and ultimately to the local electorate.
Before I sit down, perhaps I may correct a figure that I gave. We had 700 written responses to Partnership in Action; 171 of those responded on that point.
Page 17, line 21, leave out ("13") and insert ("13(4)").
Page 19, line 1, after ("the") insert ("social services departments of").
5.15 p.m.
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