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Lord Hunt of Kings Heath: My Lords, I always welcome the opportunity to debate Welsh constitutional issues with your Lordships. Those of us who have been happily debating the Health (Wales) Bill, which is going through your Lordships' House with as eager support as this Bill, will be aware of debates concerning the relationship between the National Assembly for Wales and the regulations that must be made in this House and another place.

The noble Lord, Lord Thomas, mentioned the commission being led by my noble friend Lord Richard on constitutional issues, which I believe is due to report later this year. I have no doubt that it will prove to be extremely interesting and we shall look forward to it with keen anticipation. I should say to the noble Lord, Lord Thomas, that at present the position is that Wales has no power to provide free personal care. In a sense, rather than taking power away from the Assembly, Clause 12 is giving a new power, but ensuring that it is consistent with the power being given in England.

Limitations have been placed on Clause 12 because it has never been intended to make personal care free. We had what I regard as a Second Reading debate in Committee on this issue. We had the Royal Commission. We considered the recommendations. We considered the recommendations of the minority report. We decided that we did not believe that the additional resource that would be required to finance free personal care would be justified. We considered that it would be much more effective to spend the money on intermediate care.

Therefore, the emphasis is on providing support for people to enable them to go back into their own homes or into community care, rather than effectively providing financial incentives for what, in many cases, would be residential care. I believe that there is a real issue about resources and priorities. It is easy to say that we believe that free personal care is good. But when it comes to the question of how resources should be spent, I believe that it is much more sensible and

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cost-effective to spend that resource—which, as far as England is concerned, is approximately £1 billion a year—on ensuring that as many people as possible are able to live full lives in the community. Hence, the restriction in Clause 12.

Of course, I understand the discussions that have taken place in the National Assembly for Wales on this matter. I read the comments of Members of the Assembly and the comments of Jane Hutt, the Minister responsible. In an earlier debate, she promised to approach the UK Government to fund and implement free personal care. She reported that the UK Government are presently maintaining their position that the priority for spending on long-term care should, as I have said, be on investment in improving the range and quality of services for older people.

If the Welsh Assembly wishes to introduce a policy specific to Wales, then as in other matters where primary legislation is required, the proposals should be discussed with the Wales Office, which in turn could table a Bill so that they could be treated in the same way as any other proposed legislation. That would be a matter for the Welsh Assembly. But I do not see that Clause 12 restricts the powers of the Welsh Assembly, rather that the provisions add to those powers, making them consistent with what is proposed should take place in England.

9.45 p.m.

Lord Thomas of Gresford: My Lords, in response to the noble Lord, when he says that he is making the provisions consistent with those in England, in fact he is putting a fence around the powers of the Welsh Assembly. When he says, "We have decided this or that" and, "Our priorities are this or that", he speaks as the Minister with responsibility for healthcare in England, not the person with responsibility for healthcare in Wales.

It may well be that when the National Assembly for Wales considers its priorities and how to spend across the board the limited cake allowed it by the Barnett formula, it may be that the Assembly will come to the same conclusion as the noble Lord. Members of the Assembly might then say, "We have decided this or that and these are our priorities". But essentially it is for the National Assembly for Wales to decide those priorities in the light of the resources available to it and having regard to the policies which were put forward to the people of Wales when the Assembly was elected.

The Minister has conceded that the Minister for Health in Wales has knocked on the Chancellor's door and asked for specific provision for free personal care and has been turned away. That is typical of the way in which the Chancellor deals with Welsh problems. When a Labour and Liberal Democrat partnership government comes to the door of the Chancellor, he turns them away. That is not satisfactory.

All we seek with the amendment is for Wales to be given its rightful chance to decide how to spend the money made available to it by the Chancellor. At this time of night it may not be appropriate to seek the

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opinion of the House, but I hope that the Minister will go back to the National Assembly for Wales to discuss the matter with his colleagues—colleagues from the same party whom his administration, through its decision making here, is letting down. I hope that when we reach Third Reading, he will be able to put a more positive view of the policy of this Government, as well as a better view of the constitutional position of Wales under devolution. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 14 [Consequential amendments]:

Baroness Barker moved Amendment No. 63:

    Page 9, line 25, at end insert—

"( ) In section 7 of the Health and Social Care Act 2001 (c. 15) (function of overview and scrutiny committees), after subsection (2) there is inserted—
"(2A) The overview and scrutiny committee shall agree and adopt with local NHS bodies in their area, joint local protocols as regards the discharge of hospital patients, to include—
(a) action plans to prevent and reduce delayed discharges,
(b) administrative and practical arrangements for the implementation of the Community Care (Delayed Discharges etc.) Act 2003, defining the roles and responsibilities of all parties,
(c) local targets for reducing delayed discharges,
(d) joint administrative arrangements for the local implementation of the duties in sections 2 to 5 of the Community Care (Delayed Discharges etc.) Act,
(e) named persons responsible for co-ordinating all stages of the patient journey up to and beyond discharge, and ensuring that all necessary arrangements are put in place at the right time,
(f) joint agreement on how payments made under section 4 of the Community Care (Delayed Discharges etc.) Act are used to encourage an inter-disciplinary approach to services for older people, and to ensure that all stakeholders are involved in deciding how the payments are spent.
(2) An action plan under this section is a document drawn up by the relevant bodies specifying the action intended to reduce delayed discharges, and to change procedures and arrangements which may cause or contribute to the failure to comply with duties under section 3 of the Community Care (Delayed Discharges etc.) Act.""

The noble Baroness said: My Lords, I thank my noble friend for withdrawing the amendment. It would have been wholly wrong to have held a discussion on this matter without the noble Lord, Lord Lipsey, present to make his contribution.

I return here to an issue that we discussed in Committee; that of local protocols. I do not wish to speak at length because many of the issues covered by the amendment are those which we have debated at all stages of the Bill. They are recurring themes covering the need for joint planning on the part of the NHS and local authorities; the need for joint understanding of how the administration of the schemes is going to work; and for there to be joint agreement on the practicalities and the respective roles of the two different organisations.

I take to heart two points made by the Minister during our debates in Committee: first, the absolute aversion to one statutory authority being in a position

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to tell another public authority what to do; secondly, the point made quite forcefully about not having an extra layer of bureaucracy.

The Minister will notice that the amendment is framed in a different way to the one considered in Committee. We have addressed the point by seeking to make this the responsibility of the overview and scrutiny committees of local authorities, which they are required to have under the Local Government Act 2000 and which already have a statutory role in monitoring local health trusts by virtue of the Health and Social Care Act 2001.

If it was evident that the Bill will work in practice in the way described by the Minister and be equally as hard on the NHS as it will be on local authorities, there would be no need for the amendment. But, in practice, it is difficult—sometimes impossible—for people from local authorities to argue their case with the NHS. The amendment seeks to place a positive incentive on both sides to come up with joint agreements about how money generated through the scheme will be used to encourage whole system approaches and how locally devised dispute management processes would work for the benefit of older people.

Finally, it seeks to cement joint working relationships. It does not take a huge hammer to them, as the Bill does through the mechanism of fines. It is not about trying to delay deferral and dodge the provisions of the Bill; it is about trying to make it work in a positive fashion within the existing local framework. It is in that spirit that I commend the amendment. I beg to move.

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