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Baroness Barker: My Lords, I hope that the noble Baroness will forgive me at this late stage. I agree with her that the change agent team is a fascinating part of the Department of Health website—I spent much time studying it. I do not believe that any noble Lord on this side of the House is in any way trying to undermine what the department is trying to do about the dissemination of good practice. I go back to an example that the Minister gave when we were in Committee; that is, Kingston. What has been missing from the discussion throughout is an attempt to find out why some things work in some areas and why other things do not work in others.

In Committee the Minister quoted three examples: Barnsley, Bristol and Kingston. I have found out a little about why the situation in Kingston works. First, it is a small authority so its percentage decreases are large. Secondly, like Barnsley and Bristol, it happens

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to be an area in which much of the property is significantly cheaper than in the surrounding areas, so there are many care homes in comparison with other areas. Thirdly, not only have they conducted much joint planning, but they have also invested in hospital discharge schemes, some of them with the voluntary sector and some with organisations with which I work and others.

Missing from the department's analysis as put forward to us is the contextual information about why some things work and others do not. The only argument the department has come up with time and time again is the lack of a power to force recalcitrant social services departments to do what the NHS wants. That is the flaw in the argument. In no way does that underestimate what is being done with the change agent team in relation to good practice.

9.15 p.m.

Baroness Andrews: My Lords, one reason why the Bill is being introduced is to address variable performance across the country. Some authorities are much better than others at reducing their discharge rate and at promoting better learning. I am interested in what the noble Baroness says, but I would expect the implementation team to be able to analyse the information coming from good authorities, and to ensure that that understanding and the variable context are factors by which we can identify the common good principles from which people can learn.

To conclude, the change agents are working together with the Department of Health and we believe that the time for pilots has certainly come and gone. Now we must support best practice in the field and the work of the implementation team. I hope that the noble Lord will feel able to withdraw his amendment.

Baroness Noakes: My Lords, before the Minister sits down perhaps I can clarify what the change agents will do. I understand that they will disseminate best practice, which we all agree is good. The idea of pilot schemes is to learn the behavioural impact of a new scheme; in this case putting money flows in. Can the Minister say what, if anything, the change agents will do to ensure that people learn about the effects of the Bill? That is the essence of pilot-scheme learning.

Baroness Andrews: My Lords, the change agents and others working with them are finding out where the blockage is or where the passage is accelerating and where we need to focus our attention to prevent delays. That is their key contribution.

Lord Clement-Jones: My Lords, with the greatest respect to the Minister, I am afraid that the arguments put forward by her are no more plausible the second time around than they were the first time. I believe that we have managed to tease out more flaws in the argument than were obvious before. It is precisely because the responsibilities are unchanged, that spreading best practice, the change agent team and so on are of enormous value. Of course that is within the existing framework.

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I am in favour of best practice, but the noble Baroness makes the point that the behavioural issues involved, where one has a penalty on local government, make the whole pattern entirely different. The Minister is saying that we need to universalise the penalty which then risks upsetting all the best practice that the change agents are trying to put into effect. That strategy appears to be extraordinarily high risk. I do not know of any organisation that would try to put in a completely unproven set of penalties in the face of some great progress, great best practice and extremely useful partnership working that has been taking place over the years. That seems to be organisational anomie, to use an anthropological term. It is absolutely extraordinary that the department thinks that is the best way to proceed.

The responsibilities in law may not have changed, but, whatever the Minister says, these penalties will alter the way that all the agencies involved will behave. I do not believe that the Minister is able to gainsay that, precisely because there has been no pilot scheme to establish whether or not that is the case. But one would suppose that the behaviour of the agencies involved ipso facto will change.

This is not to decry the skills and so on of the members of the change agent team, nor indeed the quality of the website, but we are working in uncharted waters. Piloting would send the right signals. It would show that the department really is prepared to listen and that it understands that these charges will have a profound effect on behaviour. Indeed, why else would the Government be introducing the Bill if it was not for the fact that they intended the Bill to have an effect on behaviour? Our case is that they are not piloting that change of behaviour to see whether it is beneficial or adverse to the patient.

The hour is getting late. I will not pursue the argument further. But I can guarantee that we will bring back further related issues at a later stage. Meanwhile, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 6 [Dispute resolution]:

Lord Hunt of Kings Heath moved Amendment No. 50:

Page 5, line 41, leave out subsections (1) and (2) and insert—

"(1) Regulations may make provision for panels appointed by Strategic Health Authorities in England and by Local Health Boards in Wales to assist in the resolution of disputes between two or more public authorities about matters arising under or in relation to this Part.
(2) The persons forming a panel for the purpose of a particular dispute must be appointed by a Strategic Health Authority or Local Health Board from lists of persons required by the regulations to be kept by the Authority or Board.
(2A) The regulations must contain such provision as the appropriate Minister considers appropriate for ensuring that each social services authority situated (or any part of whose area is situated) in the area of a Strategic Health Authority or a Local Health Board is consulted about the persons whose names appear on any list kept by the Authority or Board for the purposes of subsection (2).

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(2B) The regulations may make provision about the panels, including in particular—
(a) provision for determining who is to appoint a panel in the case of a dispute between public authorities which are not all situated in the area of a single Strategic Health Authority or Local Health Board;
(b) provision specifying the descriptions of disputes which may be referred to a panel;
(c) provision about the recommendations (including recommendations relating to the payment of any amount by one party to another) which may be made by a panel in relation to any dispute referred to it."

The noble Lord said: My Lords, we had a debate about the panels. Some noble Lords said that the provision was perceived perhaps to be unfair, giving the wrong impression to local government because it was a requirement placed upon strategic health authorities to establish those panels. We went down that route because there is no strategic equivalent in local government. If, for instance, one placed the duty on a local authority one would end up with a situation where each strategic health authority would need to set up a panel jointly with five or six local authorities.

We have discussed with local government and others what the local agencies which may bring disputes to this panel want from the system. The feedback is that they want a panel in which they have confidence. They do not want to be involved in further bureaucracy around jointly setting up panels, but they want to know that a panel will be selected from a group of men and women whose judgment they trust and who have no axe to grind in the particular case.

In Committee, I listened very carefully to the comments made. As a result I have tabled Amendment No. 50 and the consequential Amendment No. 55. Essentially, we believe that confidence in the panel will best be achieved by requiring the panel to be set up in consultation with local authorities within the strategic health authority area. We intend to make it clear in guidance that this will include allowing all parties to propose names for the list of members so that they can have confidence in that list.

The draft regulations that we published on 5th February for consultation show that we intend the panel to consist of one NHS representative, one local authority representative and an independent chair, and that for any particular dispute neither of the panel members should be drawn from the body in dispute. That is a very satisfactory outcome. It will, I believe, be perceived to be fair. By requiring consultation to take place with the relevant local authorities it will, I am sure, assure those local authorities that the panels to be established are those in which they can have full confidence. I beg to move.

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