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Baroness Noakes: Can the Minister tell me where in the Bill it ensures that local authorities and the NHS should work well together?

9.15 p.m.

Baroness Andrews: The principle of joint working runs through the Bill. It is implicit in Clause 2, which provides for an assessment. I know the noble Baroness does not like that word, but we can come back to it on Report.

Amendment No. 42 was spoken to by the noble Lord, Lord Bradshaw, and the noble Baroness, Lady Barker. The noble Lord drew attention to the situation in relation to care homes, particularly in the South East. He challenged the Government to explain what they were doing. We discussed the issue of care homes earlier in the debate. We obviously dispute some of the figures, extrapolations, which have been used.

I should explain two matters to the noble Lord. First, as my noble friend Lord Hunt of Kings Heath said, we are not simply talking about care homes. There has been a loss of beds but we are looking to much more flexible and appropriate forms of provision. Intermediate care now represents the half-way house between hospital, home and residential care. Many people will find the six weeks that they can spend in intermediate care—the old convalescence—very appropriate on discharge. We are serious about this provision and we have put more money into it, as we have with extra provision for housing as well.

We are looking for alternative forms of provision where care homes are not the only objective, the only solution. Even now, for many people, care homes are not an appropriate solution. I know from personal experience that there can be resistance to care homes and yet there can be no alternative. We see the problem as an opportunity as much as a challenge to investigate what we can do by way of modernising the options that we have for elderly people who can no longer be independent in their own homes.

Obviously we want to see a greater degree of independence and there are some extremely successful supportive care packages. For example, local authorities such as Croydon and Kingston upon Thames are carrying out extremely innovative and encouraging work in this field, although I take the point made by the noble Lord. If he agrees, I shall be happy to write to him about some of these alternative good practice examples, especially those in the South East. Much of what is proposed in the amendment is unnecessary. It is already achieved by existing legislation.

The noble Baroness raised the question of the Care Standards Act. The amendment proposes that the assessment carried out under Section 3 must include sufficient information in the care plan to allow the provider of the services to satisfy certain standards set out in the national minimum standards for domiciliary care.

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We believe that both these requirements are unnecessary. The Care Standards Act 2000 introduced minimum standards. The Act governs compliance with the standards. So local authorities already have to meet those standards and it is not necessary to include them in the Bill. The amendment refers to Standard 3 in the National Minimum Standards. Standard 3.2 makes it clear that in the case of individuals who are referred to a home by social services, a summary of the health and social services assessment and a copy of the care plan produced from the assessment will be suitable. We hope that that will be sufficient to provide the assurances sought by the noble Baroness.

I turn finally to the group of amendments referred to by the noble Baroness as necessary to trigger the comprehensive assessment: Amendments Nos. 23, 36, 45, 70, 115 and 116. We are aware of the importance that is attached to the standard assessment process. It is the key to delivering seamless, person-centred care to older people. It has no statutory basis in the sense that the noble Baroness is attempting to create, but the guidance on SAP was issued as formal guidance to the NHS and as section guidance to local councils—meaning that it has to be acted upon. For those reasons, we believe that the intention behind the amendments, while admirable, is not necessarily borne out in having the SAP written on the face of the Bill in the way the noble Baroness seeks.

A great deal of provision is in place for encouraging and enabling joint partnership working. I hope that the noble Baroness will accept that. Given the time, perhaps I may write to her about the individual elements of her amendment which relate to different parts of the provision that is already in existence. She will then be able to see in more detail how her concerns are met in different ways. If the noble Baroness is agreeable to that, it would save about 10 minutes at this stage of the evening, as the detail is considerable.

Perhaps I may refer to Amendments Nos. 115 and 116. I take the point as to why the noble Baroness has linked the proposal to the intermediate care period. The problem is that the amendments introduce definitions that are not necessary. Amendment No. 115 introduces a definition of "assessment". We have already defined the assessment carried out under this Bill as either a Section 47 assessment or as a carer's assessment; and in Clause 3(5) "the carer" is defined as a person who is entitled to ask for an assessment.

With the proviso that I shall write to the noble Baroness and respond in more detail to the individual elements of her proposals, I hope that she will accept the need to withdraw the amendment.

Baroness Barker: The noble Lord, Lord Clement-Jones, used the phrase "silver lining" in relation to the noble Baroness's previous response. I think that "light cloud" would be my description—with the odd ray of sunshine.

I thank the noble Baroness for her characteristically comprehensive reply. I thank her for taking the amendments in the spirit in which they were tabled. I

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appreciate that. I take heart from her remarks about the need for there to be a named person and from the fact that the regulations will amplify that.

I took the noble Baroness's answers to my amendments relating to "ordinary residence" in less good heart. I understand the point that is being made by the parliamentary draftsperson about determining people who have no obvious address. I have read the consultation paper on the determination of ordinary residence. I do not think that the Minister dealt with the issue of authorities being party to the decision about whether a person is within their area. I can quite understand that the NHS can decide which hospital or PCT area someone is in, but that is not the point. The point is about liable authorities. For once, unfortunately, the Minister did not answer my question.

I take the Minister's point about withdrawing in writing. I listened to what the noble Baroness, Lady Noakes, said about bureaucracy. As ever, it is a balance. Given that many of the people we are talking about will be mentally frail, there is a lot to be said for having things in writing, although anybody who has had to read doctors' writing might want to go further and say that it has to be in electronic form. I duck from the gaze of the noble Lord, Lord Turnberg, at this point.

On Amendment No. 28 and the days on which notices can be issued, it is one thing to talk about an expectation that services will be provided seven days a week. However, to think that there will be co-ordination and management of services seven days a week is not the same thing. The necessity to have that, as the Bill provides, adds another layer of cost. One of the things that came out of the Climbie report was the over-reliance on duty and agency staff. It happens with children; so, too, does it happen with older people.

I listened with great care to what the Minister said about partial assessments. People will have to carry out full assessments under Section 47 and will not be allowed to get away with not doing them. Again, I really wish I had her confidence. She is confident that partial assessments will be non-existent, but I do not share her view. Nevertheless, I will go away and look at what she has said.

I think that the Government are turning a blind eye to care home availability. If we look back, one of the reasons for delayed discharge, time and time again, is the lack of care home availability, as my noble friend Lord Bradshaw said. As he said about Oxfordshire, it is not a question of not being willing to pay—there are not the places to be bought. The National Audit Office has shown that in parts of the South East, care home capacity is reaching over 100 per cent. The places are simply not there to be bought. I will go and look at the examples of Croydon and Kingston, which the Ministers are clearly taken with. They are places I know fairly well from my work.

I return to a point I made on Second Reading. The Ministers can quote to us the Government's performance on delayed discharge, but they cannot tell us what they have sacrificed in order to achieve that and what they are

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not funding within their PCT areas. When we are talking about care home places, particularly for those who need dementia care, three days is not long enough to make an assessment. I think that Ministers are overestimating the availability of care home places for people with complex needs. To think they can be bought at three days' notice is not fully to understand the genuine difficulties that people have. Colleagues who were chairs of social services way before this legislation was on the horizon talked about how, in their authorities, they had to operate a policy of two out, one in. That is how tight things are on the ground, and I think that three days is excessively optimistic.

I got a partial assessment of my efforts on the trigger for the single assessment process. Perhaps it is best that the noble Baroness did not subject us to the fuller version. I know that the amendment is based on existing guidance. I would have thought that would commend it to the Minister. That is the point. It represents good practice. It is not a question of whether the definitions are right or whether it is right to repeat it. The key question is whether it is going to happen. I do not have a great deal of faith that it will happen in many places. Great efforts have been made in some areas to give people a single and comprehensive assessment process. I know that it will not formally be introduced until 2004, but some people are making great strides towards it because they see it as good practice. If I believed that it was common practice and full assessments were in place, we would not have bothered to repeat the legislation, but I do not.

I listened to the noble Baroness with great care. Whatever we may think about the motivations behind the Bill and the extent to which it has to be explicit, if the Bill is not explicit on the big issues, including consent and assessment, the Minister's claims for its overall thrust do not stand up. If nothing else comes out of this, even if people do not get services—and I suspect that they may not—if they cannot walk away from the process with a full assessment, the Bill is worth very little in practice. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

9.30 p.m.

[Amendment No. 18 not moved.]

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