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Baroness Thornton: My Lords, the noble Baroness, Lady Gardner, has raised this issue in relation to dentists both in Committee and on Report. As I said in my response to those amendments, she knows that I am sympathetic to her view. As a result of the debate we had on Report, the noble Baroness has widened the scope of her original amendment to provide that the Secretary of State must make regulations giving powers to a health care regulator to establish a non-practising register with a reduced fee if the regulator requests it. It does not include any provision for social care regulators—the noble Baroness, Lady Howarth, is quite right on that.

This amendment is an enabling provision. As I have said previously, we already have such a power to amend the law in Section 60 of the Health Act 1999. As the noble Baroness and my noble friend have asked, I shall put it clearly on the record again that we already have the powers to do everything the noble Baroness is asking for. We do not need another power to do this. Adding this amendment to the Bill would be duplicating what already exists. The noble Baroness knows this but is mounting a justified and effective campaign.

As noble Lords know, Section 60 orders enable changes to be made to both primary and secondary legislation. Since 1999, these orders have become the usual means by which legislation relating to healthcare professions is made and amended. Indeed, your Lordships’ House has agreed 11 Section 60 orders since 1999. In other words, I do not understand the reservations that were expressed in the letter to the noble Baroness by the General Dental Council. Importantly, Section 60 orders provide safeguards, such as requiring consultation with the professions and the public and affirmative approval by Parliament, which the amendment does not contain. Given that we already have the power to change the way regulators deal with retired members of the professions, the debate we need to have now is not whether we need another enabling power but whether we need to use the existing powers to change the system.

I understand that non-practising and retired dentists may want to keep in touch with their profession, especially—as with the two noble dentists here today—when it has been a fundamental part of their identity. There is a strong argument that those who consider themselves no longer in practice but who teach, lecture, write health-related articles or are on boards of governors or boards of companies where professional advice is required should be registered with the regulator. That model has been adopted by the Royal Pharmaceutical Society of Great Britain.

All those issues are being considered at the moment by two of the working groups that have been set up to help implement the White Paper, Trust, Assurance and Safety. Those groups include external experts such as the regulators themselves, professional representative groups such as the BMA, and patient and consumer organisations such as Which?. We are looking at the issues raised by revalidation and the new process by which all health professionals will have regularly to show that their professional skills are up to date. The way the registers are kept by the regulators may have

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to change as a result. A large part of that will consist of looking at the implications of revalidation for people who may no longer treat patients but have an active professional role or are retired.

The noble Baroness, Lady Gardner, may also be assured to know that your Lordships’ House will be debating a Section 60 order to enable quick re-registration of appropriately qualified professionals in the event of a emergency—for example, of retired doctors. I will be taking that order through the House on Thursday. I am happy to use my best endeavours to help the noble Baroness take forward this cause, and I have been discussing it with officials. Given the breadth of her amendment, it is legitimate that we now raise the whole issue with all the regulators. I will be happy to do so with her support, which I know she will give me.

I hope that my response has indicated that we take the issue seriously and that the noble Baroness will be sufficiently encouraged to withdraw her amendment.

Baroness Gardner of Parkes: My Lords, I thank the Minister for that reply, which was very positive. These professions should look on that reply as being suitable encouragement to feel that we are not going to be overlooked. It may be too late for me in dentistry—I am not worried about that—but it is a much bigger issue than that, something that has become apparent in these debates. Revalidation is going to mean a dramatic change for all healthcare professionals. Whatever dividing lines there have been in the past, there will be much greater ones after revalidation comes in. There is a place for professionals to continue to be listed, and it may be desirable to have entirely separate lists for the validated ones and those who do not wish to continue practising. In fact, it is in the public interest to have them as entirely separate lists, which in the past has not been the case; doctors are still in their ordinary basic list. After revalidation, it will be better to have separate lists. The Minister has said that she will do her best to see that all the regulators looking into this and all the consultations about the White Paper will fully consider all these points.

I speak as a dentist, but also to a certain extent as one of the many healthcare professionals. We should be satisfied with what the Minister has said, because she has been very positive about this matter. Her response should be acknowledged by everyone as being very helpful and something that we can bring forward when those consultations and determinations are made. For that reason I thank her for all that she has done. Indeed, the whole House has been very patient as I have gone through this issue time after time. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Baroness Thornton moved Amendment No. 5:

(a) after subsection (4) insert—“(4A) An instrument of appointment—

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(a) must be contained in regulations if it provides for the appointment of a Primary Care Trust or other person as a determining authority in relation to the remuneration to be paid to persons who provide services under section 126, and(b) if paragraph (a) does not apply, may be contained in regulations.”, and(b) in subsection (5), omit paragraph (b) and the word “and” immediately preceding it.(a) after subsection (4) insert—“(4A) An instrument of appointment—(a) must be contained in regulations if it provides for the appointment of a Local Health Board or other person as a determining authority in relation to the remuneration to be paid to persons who provide services under section 80, and(b) if paragraph (a) does not apply, may be contained in regulations.”, and(b) in subsection (5), omit paragraph (b) and the word “and” immediately preceding it.”

The noble Baroness said: My Lords, I shall speak also to government Amendments Nos. 7 to 9, 13 and 14. I will be brief because your Lordships are very familiar with the issue: the funding of community pharmaceutical services.

Section 164 of the National Health Service Act 2006 allows the Secretary of State to authorise any primary care trust or other person to exercise the functions of a determining authority when setting or varying remuneration for those providing NHS pharmaceutical services. There is corresponding provision in the National Health Service (Wales) Act 2006. As it stands, the authorisation may be, but is not required to be, set out in regulations. Noble Lords tabled a number of amendments that sought to remove this discretion in respect of payment for the essential services that all pharmaceutical services provide.

I fully appreciate the intention to ensure that we continue to support the vital role of community pharmacies. As noble Lords know, the Government have repeatedly given a commitment, both in public consultation and during the passage of the Bill, that the Secretary of State will continue to set the fees and allowances for the national elements of the community pharmacy contractual framework. However, the noble Earl, Lord Howe, and the noble Baronesses, Lady Barker and Lady Finlay, put forward persuasive arguments as to why we should look at this again and we undertook to consider whether an amendment might be appropriate. I am therefore pleased to be able to put forward Amendment No. 5. The amendment will ensure that where the Secretary of State appoints someone to be the determining authority in respect of essential services, this must be done by regulations. That will apply to services provided under both Section 126 of the National Health Service Act 2006 and Section 80 of the National Health Service (Wales) Act 2006. Government Amendments Nos. 7 to 9, 13 and 14 are consequential to this change. I hope these amendments will provide noble Lords with the reassurance that they sought. I beg to move.



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Earl Howe: My Lords, it would be wrong to let this amendment pass without expressing my thanks to the Minister for bringing it forward. It will provide pharmacists and the Royal Pharmaceutical Society, which has been assiduous in promoting this issue, with the added confidence and reassurance that they were seeking. I am most grateful.

On Question, amendment agreed to.

4.30 pm

Baroness Campbell of Surbiton moved Amendment No. 6:

(a) has arranged or is providing such services, or(b) is making payments to such a person in lieu of care services under section 57 of the Health and Social Care Act 2001 (c. 15) or section 17A of the Children Act 1989 (c. 41); and(a) give notice to the new authority if it becomes aware that a person to whom it provides care services or direct payments intends to become ordinarily resident in the new authority’s area; and(b) co-operate with the new authority in making appropriate arrangements for such a person.(a) services of an equivalent type and quantity to those provided by the original authority; or(b) direct payments enabling an equivalent type and quantity of support to that provided by the original authority,(a) be made with the involvement and consent of the person concerned;(b) include effective arrangements to meet any new or different needs of the person concerned; and(c) be made in accordance with regulations made under this section.(a) prescribe the period or periods during which the original authority retains funding responsibility for a person’s care needs;(b) prescribe the period or periods during which the original and new authorities must resolve any disagreements concerning their respective funding responsibilities;(c) prescribe the period or periods by which the new authority must assume funding responsibility for an individual’s care needs;(d) provide for reimbursement by the new authority of expenditure made by the original authority whilst the authorities were resolving a disagreement as to their respective funding responsibilities; and(e) provide for the payment of interest on any sums reimbursed.

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(a) section 2 of the Chronically Sick and Disabled Persons Act 1970 (c. 44);(b) section 4 of the Disabled Persons (Services, Consultation and Representation Act) 1986 (c. 33);(c) section 17 of the Children Act 1989 (c. 41);(d) section 47 of the National Health Service and Community Care Act 1990 (c. 19).”

The noble Baroness said: My Lords, I apologise for not being here to move this amendment on Report. Unfortunately I was in St Thomas’ Hospital with pneumonia—just across the river, so near and yet so far. I thank the House for its generosity in allowing me to move this amendment on Third Reading.

The amendment proposes a practical solution to the intolerable injustice of being, as I am, almost a prisoner of one’s local authority, unable to enjoy the same social and economic mobility and freedom of movement as our non-disabled counterparts. Once in receipt of a care package, we are to all intents and purposes required to remain in one place or risk losing the support we rely on to live if we move to another local authority. Those who do move often face agonising stress, hardship and uncertainty. It can take months and even years for the new local authority to decide what type and level of care package, if any, it will provide. Continuity of care is thrown to the wind.

I shall explain how the amendment would resolve the situation and what it would mean in practice when someone in receipt of a care package moved to a new local authority. Their original authority must notify the receiving council and work with it to effect a seamless transition of an equivalent level of support. Crucially, the original authority would retain funding responsibility for a short time until the receiving authority took over the responsibility. The receiving authority would thus be paid to maintain an equivalent level of support for a period specified in regulations. In this way, a disabled or older person would have the statutory guarantee of continuity of support, enabling him or her to maximise opportunities for employment or a better family life.

Noble Lords may think that continuity of care is already a statutory obligation under community care law. However, Luke Clements, one of the country’s leading social care lawyers, argues that it is nearly always frustrated by bureaucratic delay and maladministration on the part of the receiving authority. He argues that the Government must urgently implement specific and corrective legislation, as provided by this amendment, to make continuity of social care support a reality.

The view of the Equality and Human Rights Commission—on which I serve as a commissioner as chair of the disability committee; I therefore declare an interest—is very clear. In its opinion, the current situation could be open to challenge under the Disability Discrimination Act and the disability equality duty. Discontinuity of support negatively impacts on equality of opportunity for older and disabled people; for example, to move to take up employment or educational opportunities, as would their able-bodied counterparts.

As noble Lords will be aware, the Local Government Association has expressed concern that the amendment will put undue pressure on budgets and services. I can

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reassure the House that that will not be the case. No new demand for services will be created by the amendment. Against the costs to a receiving authority of taking over funding responsibility for someone must be offset a considerable range of savings, such as other service users leaving the authority, and ending unnecessary and costly bureaucratic reassessments.

The LGA also questioned whether the amendment could tie the hands of a receiving local authority and be impractical by requiring it to provide exactly the same services to the new arrival. It has been reassured by the fact that the amendment refers to support services,

It does not require the same care package. The receiving authority will have great flexibility in how underlying needs are met.

RADAR, Scope, the British Institute of Human Rights, Age Concern, Carers UK, Mencap, the National Centre for Independent Living and Help the Aged are among the many other organisations which support the amendment and have been working towards it for years. Like me, they are not prepared to be told once again that a Green Paper consultation on this issue is needed. We have raised the issue during previous social care Green Paper consultations for more than a decade. Each time new social care legislation is introduced, we are told that it is not the right Bill. I believe that this is the right Bill, unless the Minister can give firm assurances that the provisions of this amendment will be very closely reflected in the Green Paper on adult social care and in subsequent legislation. This amendment will enhance the quality of care for older and disabled people at the same time as effectively creating a climate of fairness for all. Let us today pull down one of the most glaring remnant of the old Poor Law that puts disabled people at the mercy of their parish. We owe it to all British citizens to seize this opportunity. I beg to move.

Baroness Wilkins: My Lords, I strongly support this amendment, to which I have put my name, and which has been so persuasively presented by the noble Baroness, Lady Campbell of Surbiton. What an indictment of a local authority—and of its association, the LGA—to argue that it is justified in refusing to accept another authority’s judgment of a disabled person’s assessed needs. Disabled and older people do not move on a whim. It takes an enormous amount of organisation and effort. As we have heard, some people have no option but to move and throw themselves on the mercy of another authority. Is that authority then likely to decide in the end that the person has vastly different needs? What justification is there for the months of misery, cost and wastage that can currently take place while needs are being reassessed?

As a Labour Peer I am proud of my Government’s commitment to independent living and the goal of equal lives for disabled people. So many policies have been put in place to improve our social and economic well-being. We have rightly invested thousands of pounds in schemes to help disabled people out of poverty, off benefit and into employment. Yet what greater disincentive can there be to prevent someone seeking employment which is just over the boundary of their authority than forcing them to take this gamble with their care needs?



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The Minister is expected to say that this problem of portability will be dealt with in the forthcoming Green Paper on adult social care. I welcome that Green Paper, but it will be many years before that policy becomes everyday practice. In the mean time, let us give disabled and older people with support needs the freedom that they desperately need: the freedom to move to be closer to their family and friends; the freedom to get the education they need; and the freedom to apply for the job of their choosing wherever that may be. I urge noble Lords to support this amendment.

Earl Howe: My Lords, the Minister will know how vitally important this issue is for disabled people; it is an issue of literally life-changing importance. For our society to allow disabled people to feel trapped in a local authority area, and to find themselves unable to take up employment opportunities elsewhere or to be near family, is simply unacceptable. It is equally unacceptable to subject disabled people who move to another area to the insecurity, worry and bureaucracy that almost inevitably ensues.

I know that the Minister is sympathetic to the arguments that the noble Baroness, Lady Campbell, has so ably put forward. However, I am aware that she is unlikely to be able to accept the amendment as it stands. What we need from her is a commitment that this problem will be sorted. I am not sure that a rather loose promise to place a set of proposals in a Green Paper is quite enough to allay the fears and worries of the disabled community. We need an undertaking that the Government will take this issue away and deal with it appropriately. If there is to be a proposal in a Green Paper, that part of the Green Paper should have very distinct white edges to it. I hope the Minister will be able to give us the reassurance that we seek.

Baroness Finlay of Llandaff: My Lords, this amendment goes to the heart of the rights of those needing a care package to live independently. The question before us is one of principle. If people cannot move to be economically active or to be nearer relatives and other support, they are locked into dependency on the state, deteriorating health through demoralisation and thus increased social and health costs. The provision makes economic sense as well as being fundamental to equality of the right to work and the right to family life.

I fear the Minister will say that the issue will be addressed in a Green Paper and that that will solve the problem. It will not. We need to know exactly when the matter will be sorted out, which needs to be in the lifetime of this Parliament. The provision must address people of all ages, including children, and must be delivered through the legislation set out in the amendment. You cannot ask those with a disability and their families to settle for anything less or to wait any longer.

Baroness Tonge: My Lords, I am somewhat horrified that this amendment has been brought before the House at such a late stage. It should have been discussed weeks ago because this matter is of such tremendous importance to the individuals concerned. It is a huge issue. All of us have only one life and if we are disabled we need enormous support to try to make it as normal as possible.


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