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House of Lords

Tuesday, 9 July 2013.

2.30 pm

Prayers—read by the Lord Bishop of Chester.

Council Tax


2.36 pm

Asked By Lord Woolmer of Leeds

To ask Her Majesty’s Government what assessment they have made of the impact on council tax arrears of the reduction in council tax benefit and the localisation of support for those in need.

The Parliamentary Under-Secretary of State, Department for Communities and Local Government (Baroness Hanham): My Lords, the design of local schemes and the assessment of their impact is the responsibility of local authorities. It is for authorities to design local council tax support schemes that will minimise the possibility of anyone falling into arrears on their council tax. Localisation gives local authorities the freedom to choose how to manage the funding reduction and they are best placed to understand their local priorities and the needs of their vulnerable residents. This reform enables them to take these local factors into account when deciding on levels of support.

Lord Woolmer of Leeds: I thank the Minister for that reply. Does she recognise the additional costs being borne by local authorities in seeking to collect council taxes from some of the lowest income and poorest communities in their areas for the very first time? These costs include setting the support scheme, counselling and advising, seeking to collect and even, in extremis, taking people to court. Would the Minister be willing to review, with the local authorities, what those costs actually are in the coming months so that there is agreement on the costs being borne by them in seeking to introduce that policy in their communities?

Baroness Hanham: My Lords, local authorities were well aware of what the council tax support was going to be. They were also well aware that their schemes should take into account any additional costs which came about as a result of the council tax support scheme. As with everything else to do with local authorities, we will keep this under review but it would not qualify for any consideration under new burdens because council tax is always something that the council has had to deal with.

Lord Shipley: My Lords, does the Minister agree that one way of helping those on low incomes would be to increase the number of council tax bands at the top end, so that those who are wealthier pay more?

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Baroness Hanham: My Lords, my department and the Government have made it clear that they have no intention of rebanding council tax.

Baroness Hollis of Heigham: My Lords, because the Government have cut the funding for council tax benefit for local authorities by 10%, local authorities are having to charge people on benefit who have never paid council tax before. As a result, chief executives are estimating that up to 75% of those new payers will not pay. As it costs £10 to collect £2.50 a week, we are going to create a culture of non-compliance just like there was with the poll tax. Will the Minister please think again? It is a very foolish policy indeed.

Baroness Hanham: My Lords, the matter is implemented now and the noble Baroness will be as aware as I am that the councils were all offered a transitional grant at the outset if they set a council tax support scheme which was not more than 8.5% from zero. A number of local authorities have done that. Nearly 200 took advantage of that transitional grant and if others had they would not be in the position which I think the noble Baroness is trying to describe.

Lord Brooke of Alverthorpe: My Lords, is the noble Baroness saying that the Government do not know whether or not council tax arrears have gone up? If she does know, will she tell the House, and if they have gone up, will she say what steps the Government will take to ensure that councils can get them down?

Baroness Hanham: My Lords, council tax arrears for 2012-13 have gone down. The new support scheme that started in April 2013 has barely had an opportunity to get off the ground but clearly this is something that will be kept under review. However, as I said, if local authorities had done what we gave them the opportunity to do and taken the grant, they would not have to ask people to pay council tax that they could not perhaps afford.

Baroness Gardner of Parkes: What is the position if you are in arrears but have a spare room? What is being done by councils to encourage such people to let their spare room? Our council is setting up a way for anyone to discover where those rooms are. I keep meeting people who are being put out of where they are and are dying to rent a room but cannot find any of these council people with a spare room which I would have thought would suit both parties to agree that they can occupy.

Baroness Hanham: My Lords, if the noble Baroness is referring to the extra rooms associated with the welfare reforms, I am sure there will be opportunities for local people who are affected by those to see whether they can take on a lodger as long as their subletting arrangements are sufficient for the local council.

Lord Beecham: My Lords, in light of the fact that 50% of councils have not taken up the transitional grant, will the Government apply the unallocated

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fund that they originally created to extend the transitional period to perhaps two years for those authorities which have taken up the offer? In that way, they could mitigate the problems that have been referred to by other noble Lords today.

Baroness Hanham: My Lords, it was made clear from the outset that the transitional grant would be for one year and one year only. Therefore, I do not anticipate that the question asked by the noble Lord will be answered in a way that he would like.

Lord Campbell-Savours: Is the Minister aware of the culture of non-compliance referred to by my noble friend Lady Hollis?

Baroness Hanham: My Lords, people are required to pay their council tax and I am sure that local authorities will make certain that they collect any arrears that are owed to them as necessary.

Baroness Farrington of Ribbleton: My Lords, would the Minister care to comment on the complaint from local authorities that the reductions are disproportionately heavy in areas such as the north of England and that it was therefore much harder for them to qualify for the transitional grant? Why do the Government keep favouring the south?

Baroness Hanham: My Lords, that is not evident. Of course, local authorities in the north sometimes have more to deal with than those in the south but I do not think that there is any evidence that there is an overweighting. Local authorities, irrespective of where they are in the country, were perfectly able to adjust their schemes for council tax support to take account of the transitional relief had they wished to do so.

Defence: Trident Review


2.43 pm

Asked By Lord Lea of Crondall

To ask Her Majesty’s Government whether their review of Trident will include the issue of non-proliferation.

Lord Wallace of Saltaire: My Lords, the starting point for the review of alternatives to a like-for-like replacement of Trident was that the UK will continue to comply with its international obligations, in particular with the Nuclear Non-Proliferation Treaty.

Lord Lea of Crondall: My Lords, we know that the alternatives review will address the issue of options for replacing the Vanguard submarines. Will it also consider whether, relatively soon in a submarine’s lifetime, its missiles will need a new warhead? The Government plan to consider that question in the next Parliament, deferring the timetable for consideration in this Parliament given in the 2006 White Paper. Secondly, is it possible to develop a new warhead without testing it and

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therefore without rescinding our moratorium on testing and indeed contravening the provisions of the Comprehensive Nuclear Test-Ban Treaty? If it is not tested, how can we be assured that any new warhead would be effective?

Lord Wallace of Saltaire: My Lords, the British Government, under both the previous and the current Administrations, have been strong supporters of the Comprehensive Nuclear Test-Ban Treaty. We have developed sophisticated means of simulating the testing and checking of warheads. This is one area in which we are now co-operating with the French: on the sophisticated facilities available for examining current nuclear warheads and considering further developments in design.

Baroness Miller of Chilthorne Domer: My Lords, surely, whatever the outcome of the decision on Trident, it is important that this country continues to play its full role in diplomatic efforts towards non-proliferation and disarmament. Why did the UK ambassador not attend the UN open-ended working group intended to kick-start efforts in this area?

Lord Wallace of Saltaire: My Lords, the United Kingdom remains strongly committed to nuclear disarmament, and we are working in a range of different international contexts to achieve this. As noble Lords will know, the next Review Conference on the Nuclear Non-Proliferation Treaty will meet in 2015, and the preparatory committee met earlier this year.

Lord Browne of Ladyton: My Lords, the Minister will be aware of recent credible research which, using modern climate change models, found that even a regional war using nuclear weapons between emerging nuclear-armed states with relatively primitive weapons would quickly lead to significant global climate change, reduce temperatures, reduce growing seasons, have significant adverse agricultural effects and then quite devastating effects for all the world’s populations. Why, then, did the coalition Government not attend the Oslo conference on the humanitarian effects of nuclear weapons? Why did they boycott it? Do we have nothing to say to the rest of the world about these issues? Will we go to the follow-on conference in Mexico in 2014?

Lord Wallace of Saltaire: My Lords, I pay tribute to the noble Lord’s work within the context of the European Leadership Network and the Nuclear Threat Initiative, which is highly desirable, multilateral work involving the Russians and many others. It is exactly the sort of work that needs to be done and published to inform the debate on the future of nuclear weapons. Her Majesty’s Government decided, in the context of preparations for the Oslo conference, that we should be pursuing this, as far as possible, through the conference on nuclear disarmament; the priority was to unblock that conference. As for attendance at the follow-on conference in Mexico, British diplomats in Mexico met Mexican officials some weeks ago to discuss the question.

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Lord Hylton: My Lords, is there not a contradiction between, on the one hand, the statements of successive British Governments about the weapons of mass destruction of others and the risk, therefore, of killing non-combatant civilians and, on the other hand, their own possession of nuclear missiles?

Lord Wallace of Saltaire: My Lords, I have no doubt that when the Trident alternatives review is published, it will stimulate a good deal of, I hope, informed and rational debate about the future of our nuclear weapons programme and of nuclear weapons as a whole. That was part of the intention of commissioning this review.

Lord West of Spithead: My Lords, unsurprisingly, the alternatives review that the Minister refers to seems to show that are no real alternatives to replacing the Vanguard class submarines if we wish to maintain our best-value and most capable deterrent. The only thing that will be looked at further is continuous sea deterrent and, even in that, the worst probability is that we will have to order two Vanguard replacements. With that in mind, will the Minister not agree that we should order those two replacements now, to remove the uncertainty hanging over many hundreds—indeed, over 1,000—skilled workers and their families about their future, and to save £300 million?

Lord Wallace of Saltaire: My Lords, I am not sure that major defence decisions should be driven either by the need to employ a large number of people to build aircraft carriers in Scotland or by the need to maintain employment in Barrow-in-Furness. There are larger issues at stake.

Lord Palmer of Childs Hill: My Lords, will my noble friend confirm that the purpose of that review, which is yet to be fully announced, is to reduce the number of nuclear weapons at sea and on land and that that is part of the non-proliferation effort that we are all engaged in? That is the purpose of the review, and I look forward to its outcome.

Lord Wallace of Saltaire: My Lords, of the declared nuclear states, Britain already has the fewest nuclear weapons. Under current plans we will further reduce the number of nuclear weapons deployed in recent years. We are therefore very much already at a minimum nuclear deterrent. The purpose of the Trident alternatives review, like the EU balance of competences review, which will also be published shortly, is to provide for an informed public debate. That is highly desirable on both major topics.

Lord Foulkes of Cumnock: My Lords, while the Minister and I will be campaigning side by side to keep Scotland within the United Kingdom, there is an outside chance that we might lose in that referendum. Why, therefore, is the Ministry of Defence not undertaking contingency plans to work out what will happen to the independent deterrent in that event?

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Lord Wallace of Saltaire: My Lords, we shall be campaigning side by side. I hope that my son will have a vote in that election, since he may be about to move to Edinburgh. The question of whether Scots living outside Scotland should be allowed to vote is, as the noble Lord knows, a very active one. I would rather leave to another day hypothetical questions as to what would happen if Scotland were to become independent.

Sudan: War Crimes


2.51 pm

Asked by Lord Alton of Liverpool

To ask Her Majesty’s Government what assessment they have made of the report by Amnesty International, We had no time to bury him: War crimes in Sudan’s Blue Nile State.

Lord Wallace of Saltaire: My Lords, we are deeply concerned about the suffering caused by the conflict in Blue Nile state. Accounts presented in Amnesty’s report underline our serious concern about the impact on civilians of the military tactics used. Our priority is a cessation of hostilities and full access to the area for life-saving humanitarian assistance. We continue to press both the Government of Sudan and the Sudan People’s Liberation Movement-North—the SPLM-N—to enter into talks to achieve this.

Lord Alton of Liverpool: My Lords, is the Minister aware that, in addition to this shocking report, new satellite imagery compiled by Amnesty International shows the sheer extent of the purging of the Nuba people from these areas of South Kordofan and Blue Nile, as well as the scorched-earth policies being pursued by the Sudanese military—unabated, uncondemned and unobstructed by the West? Can the Minister tell us when this situation was last raised in the United Nations Security Council and whether we support the extension of the current arms embargo on Darfur to the rest of Sudan? Rather than locking out refugees from camps such as Yida, why are we still not collecting first-hand accounts from witnesses that detail the genocide and war crimes against humanity which are carried out on a day-by-day basis?

Lord Wallace of Saltaire: My Lords, the noble Lord asked about six questions, and I am not sure that I can answer all of them. The UN is extremely heavily engaged both in Sudan and in South Sudan, with three UN missions and a number of other UN operations. We and other Governments make entirely clear to the Government of Sudan our horror at what is taking place. However, as the noble Lord knows, access to the areas of conflict is extremely difficult for diplomats at present.

Lord Chidgey: My Lords, more than 18 months ago, Matthew LeRiche found that civilians in the Blue Nile State were living in constant fear because of indiscriminate terror campaigns aimed at rendering

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the population unable to provide even the basics of daily life. Those perpetuating these crimes with impunity had the backing of President al-Bashir and six other ICC indictees. Does my noble friend agree that unless the ICC arrest warrants are implemented, there is little or no deterrence for the present crimes? Will the Government therefore press this case with the international community with absolute vigour to see a result?

Lord Wallace of Saltaire: The question of what is the international community for these purposes is very delicate. Arresting an active head of state in his own capital is not the easiest thing to do without going to war. We are deeply concerned about the current situation, but I should stress that the fighting which broke out in South Kordofan and Blue Nile two years ago was in fact sparked by the SPLM-N and it is the Government of Sudan who have responded in a particularly brutal and indiscriminate fashion.

Baroness Kinnock of Holyhead: My Lords, in an appalling repetition of history, the Government of Sudan have spent the last two years deploying the same brutality that they used in Darfur to crush the rebellions that have been mentioned in South Kordofan and Blue Nile. Does the Minister agree that the lessons of Darfur have not been learnt and that the United Nations Security Council is again failing to respond to the suffering of the Sudanese people, who are being bombarded by their own Governments?

Lord Wallace of Saltaire: My Lords, we have to be careful not to assume that the United Nations can do too much. The UN has been actively engaged in this extremely complex series of wars. Let us be quite clear: there are not just two sides on this, as the noble Baroness herself well knows. There is conflict within South Sudan; there is conflict within Sudan itself; there is conflict between groups which are claimed to be supported from across the border. It is now 10 years since the Darfur conflict started. Things are a little better than they were. I speak with some direct experience, having a close friend who has worked both in Darfur and in Abyei in the past three years. Sadly, there are limits to what the international community can achieve, but I assure the noble Baroness that the British Government and others are working extremely hard and providing as much humanitarian assistance as they can in this dreadful situation.

Baroness Cox: My Lords, is the Minister aware that I visited South Kordofan and Blue Nile states earlier this year and witnessed at first hand the constant aerial bombardment of civilians, which deliberately targeted schools and clinics, forcing civilians to hide in caves with deadly snakes and in banks carved out from rivers, and preventing them harvesting crops, with many dying of starvation? Does the noble Lord agree that this aerial bombardment of civilians is being undertaken only by the Government of Khartoum and that, therefore, there is no moral equivalence between the policies of Sudan and South Sudan? What are Her Majesty’s Government doing to call the

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Government of Khartoum to account for this aerial bombardment, which has been carried out so far with complete impunity?

Lord Wallace of Saltaire: My Lords, we are not the only external actor influencing Sudan. We have to work with the Chinese, who are major actors in terms of external influence on Sudan, the Arab League countries and others. As the noble Baroness will know, there is a tripartite body consisting of the United Nations, the African Union and the Arab League which is attempting to mediate on what is happening in Blue Nile and South Kordofan. I do not in any sense underestimate the horrors of what is happening there.

I am very grateful to the noble Baroness for sending me some material on what she witnessed in her recent visit. It is the most appalling—I emphasise—series of interconnected conflicts from Darfur all the way across to Jonglei and Blue Nile. Part of the problem is that Governments in both South Sudan and Sudan are weak and do not control the whole of their territories.

Lord Triesman: My Lords, the Minister made the point that President al-Bashir would be hard to capture in his own capital. That is of course entirely true, but he must be one of the most widely travelled Presidents of almost any country in Africa. He is at meetings and conferences throughout Africa, throughout the Middle East and occasionally completely out of the hemisphere. What influence are we trying to bring to bear on those other countries that he routinely visits and which do not necessarily have an adverse view of bringing a war criminal to justice?

Lord Wallace of Saltaire: My Lords, the noble Lord will be well aware from his own experience as a Minister how complex these issues are. It is not just a question of Sudan and the ICC. There are delicate questions of Kenya and the ICC at the moment as well. Her Majesty’s Government do of course make representations to other Governments whose territories ICC-designated people visit. Unfortunately, Britain does not command as much influence as we might like in a number of countries in the third world.

Lord Hussain: My Lords, I have had the opportunity of visiting South Sudan and Sudan in the past year or so. Does the Minister agree that, according to the comprehensive peace agreement, the Government of Sudan were required to withdraw all their military forces from South Sudan, which they have done, and that the SPLA was required to withdraw its military people and armed forces from north Sudan but has so far failed to comply?

Lord Wallace of Saltaire: My Lords, the border drawn between Sudan and South Sudan has not been entirely settled. Questions remain about who belongs where, because a number of tribes are pastoral and move across the border. Many issues are not entirely clear or settled. That is very much a problem that we face after the prolonged civil war from which the two countries emerged.

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Bank of England: Monetary Policy Committee


3 pm

Asked By Lord Barnett

To ask Her Majesty’s Government what is the Chancellor of the Exchequer’s assessment of the latest statement by the Monetary Policy Committee of the Bank of England.

Lord Newby: My Lords, the Bank of England Act 1998 gives powers of operational responsibility for monetary policy to the independent Monetary Policy Committee of the Bank of England. The updated MPC remit set at Budget 2013 by the Chancellor requests the MPC to provide an assessment of the merits of using intermediate thresholds in monetary policy in its August 2013 inflation report, which will be published on 7 August.

Lord Barnett: My Lords, in the House last week, in answer to me, the Minister quoted the Prime Minister as saying at the G8 that the UK Government were “supporting … [an] active monetary policy”. How can he say that when it is not their responsibility? Is it because the new governor is virtually unsackable at the moment? Or is it that the Government are simply not interested at all in monetary policy? The new governor took his first meeting, to which the Minister referred. During the meeting, unusually for a governor, he gave some guidance and said that interest rates would be low for a long time, and could even go a little lower. In those circumstances, the pound dropped substantially. Some people are very happy with that. Is the Chancellor?

Lord Newby: My Lords, on the first point, the Government updated the remit of the Monetary Policy Committee at Budget 2013 to give it greater powers to clarify the trade-offs that are involved in setting monetary policy to meet a forward-looking inflation target. That is what the governor and the Monetary Policy Committee will do over the coming months. On exchange rate policy, as the noble Lord knows, the previous Government did not have a policy for an exchange rate, and this Government do not have one, either.

Lord Lamont of Lerwick: My Lords, perhaps the Minister will comment on one aspect of the asset purchase scheme—quantitative easing—about which there has been some argument. When the original document setting up the asset purchase scheme was signed, and it was made consistent with the Bank of England Act 1998, was it set down that increases in the scale of the asset purchase scheme required the agreement of the Government, and that while day-to-day monetary policy may be the responsibility of the Bank of England, an increase in the scale of quantitative easing would require endorsement by the Government? Is that correct?

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Lord Newby: My Lords, my understanding is that it is for the MPC to decide on the scale of quantitative easing. As my noble friend will know, there is a Treasury representative at all meetings of the MPC. That representative is allowed to speak but does not have a vote.

Lord Sharkey: My Lords, last week the New Economics Foundation suggested a new approach to quantitative easing. It suggested channelling investment directly into housing infrastructure and SME lending. Does the Minister agree with that suggestion?

Lord Newby: My Lords, the Government are looking at a number of ways of increasing investment in all those areas of infrastructure. We set out in the spending review our plans for doing that in 2015-16 and subsequently. Plans or programmes already in place, such as the finance for lending scheme, are already having a significant impact on new housing construction.

Lord Davies of Oldham: My Lords, would not a word of caution be apposite at this time? Is not the American experience—where it has been difficult for the Federal Reserve to press on the monetary brake without destabilising the markets, as we have seen—a lesson that we need to learn for the British economy, particularly if there is any pick-up at all and the possibility of rising inflation?

Lord Newby: My Lords, the American experience demonstrates how tricky it is for central banks to give forward-looking guidance without it having an effect on the market. However, as the MPC said at its meeting just last week, it viewed the implied rise in the expected future bank rate as not warranted by recent developments in the domestic economy. It is trying to be cautious and reduce any potential volatility.

Lord Vinson: My Lords, the world’s biggest gilt brokers, PIMCO, wrote about four weeks ago, as reported in the Financial Times, that the new Governor of the Bank of England would have only one shot in his locker, and that is to let the pound depreciate. Is it such a bad thing if, after 30 years, a trading nation begins to consider the rate at which it trades with the rest of the world? Is not our failure to look at the rate of our exchange in the past one of the reasons why we have such a high imbalance of trade?

Lord Newby: My Lords, the pound has fallen in value against other international currencies by about 20% in recent years and that has not automatically had a vast impact on the balance of payments. There are considerable signs of optimism about that. For example, exports in goods to the EU increased by almost 7% last month. However, I think that recent experience has shown that devaluation on its own does not cut the mustard—we also need to have a whole raft of supply-side measures in place. That is why things ranging from the additional resources to UKTI, at one end, to bringing more money into science and apprenticeships, at the other, are necessary if we are to have a significant improvement in the balance of payments.

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Local Audit and Accountability Bill [HL]

Order of Consideration Motion

3.07 pm

Moved By Baroness Hanham

That the amendments for the Report stage be marshalled and considered in the following order:

Clause 1, Schedule 1, Clause 2, Schedule 2, Clauses 3 to 7, Schedule 3, Clauses 8 and 9, Schedule 4, Clauses 10 to 17, Schedule 5, Clause 18, Schedule 6, Clauses 19 to 23, Schedule 7, Clauses 24 to 28, Schedule 8, Clauses 29 to 32, Schedule 9, Clause 33, Schedule 10, Clauses 34 and 35, Schedule 11, Clauses 36 to 42, Schedule 12, Clauses 43 and 44, Schedule 13, Clauses 45 to 47.

Motion agreed.

Offender Rehabilitation Bill [HL]

Offender Rehabilitation Bill [HL]

Third Reading

3.07 pm

Amendment 1

Moved by Lord McNally

1: After Clause 10, insert the following new Clause—

“Arrangements for supervision and rehabilitation: female offenders

In section 3 of the Offender Management Act 2007 (power to make arrangements for the provision of probation services), after subsection (6) insert—

“(6A) The Secretary of State must ensure that arrangements under subsection (2) or (5) for the supervision or rehabilitation of persons convicted of offences—

(a) state that the Secretary of State has, in making the arrangements, complied with the duty under section 149 of the Equality Act 2010 (public sector equality duty) as it relates to female offenders, and

(b) identify anything in the arrangements that is intended to meet the particular needs of female offenders.””

The Minister of State, Ministry of Justice (Lord McNally): My Lords, I am pleased to move Amendment 1 which seeks to recognise the needs of female offenders and put them firmly in the Bill. It requires the Secretary of State to ensure that arrangements for the supervision and rehabilitation of offenders state that, in making those arrangements, he has complied with the public sector duty under Section 149 of the Equality Act 2010 as it relates to female offenders. The arrangements must also identify any provision that is intended to meet the particular needs of female offenders. It applies both to the contract with private providers and services provided by the public sector probation service.

I pay tribute to those noble Lords who have argued for such statutory safeguards for female offenders. I am particularly grateful to the noble and learned Lord, Lord Woolf, for his earlier amendments and for his constructive discussions with me about this amendment. I am delighted that he has agreed to put his name to the amendment today. I likewise thank my noble friend Lord Marks and the noble Lord, Lord Beecham, for adding their names.

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The amendment inserts a new subsection in Section 3 of the Offender Management Act 2007, which relates to making arrangements for the provision of probation services. Under the first part of the amendment, arrangements for the provision of supervision or rehabilitation services must state that the Secretary of State has complied with the public sector equality duty at Section 149 of the Equality Act 2010. This means that the Secretary of State must consider evidence on the particular needs of female offenders where they differ from those of men, and consider whether any adjustments or special provision for female offenders is necessary to address these needs. Where a particular need is identified, this will be reflected in the contractual or other arrangements, which will include outputs specific to female offenders.

In order to win contracts, service providers will be required to demonstrate that they understand and will respond to the particular needs of female offenders where these differ from those of men. This will include, for example, taking account of women’s family and caring responsibilities. We will be looking for providers to come up with innovative ways to deliver gender-specific services that are responsive to local needs, and we will expect them to make links with partner agencies to provide a holistic service at a local level.

As I have mentioned to the House on previous occasions, service providers will be supported by guidance on working with female offenders and the sorts of provision that are known to be effective, which is being prepared in collaboration with members of the new advisory board on female offenders. Once bids have been through a robust evaluation process to ensure that potential providers are offering innovative and effective services to female offenders, the second part of the amendment requires contracts and other arrangements to identify anything in the arrangement that is intended to meet the particular needs of female offenders. Noble Lords will also be pleased to hear that, in the spirit of transparency, details of contracts and service level agreements will be published. This will mean that people can see what provision is being made to meet the needs of female offenders and hold us to account. Contract managers within the Ministry of Justice will also monitor service delivery to ensure that key outputs for female offenders are being delivered.

I hope that noble Lords will welcome and support Amendment 1, which I firmly believe will provide the recognition and safeguards for female offenders that the House has been seeking. I beg to move.

Lord Woolf: My Lords, I should remind the House, particularly in view of the generous way in which the Minister introduced the amendment, and his references to myself, that I am the chairman of the Prison Reform Trust, and received considerable help in putting forward the matter from that trust in that capacity.

This is a considerable step forward in the way in which we treat criminal offenders who are female. It has been well recognised that their needs are different, and it is certainly time that those who are responsible for meeting those needs should have responsibility clearly set out in statute. I am particularly grateful that the Minister and his advisers found ways in which

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that could be done in the shape of this Bill. The amendment is not as clear as I would have liked but it has to be recognised that what we are achieving is being done by using three pieces of legislation, which is not the ideal way to legislate, but it achieves a purpose. I am very conscious that we are told that we must not look a gift horse in the mouth when it is offered, but I have to confess that this gift horse, if that is an appropriate description, was examined most carefully.

I am particularly grateful for the way in which the Minister introduced this amendment. He stressed the importance of clarity and transparency with regard to various connected matters, so that it achieves the purpose he identified. During debates at the earlier stages of the Bill, the Minister indicated that there would be an annual statement of progress so we can all see that it is moving forward as we would hope. Does he not agree that this is one matter that can be dealt with that way?

It is possible that, when three pieces of legislation are involved—as in this case—the time will come when they are initially disconnected. If this does occur, I believe—and I am sure the Minister will confirm this—that the department will ensure that no prejudice is caused to female offenders as a result of any gap in time. I repeat my gratitude for this amendment and would strongly recommend it to the House.

3.15 pm

Lord Marks of Henley-on-Thames: My Lords, in supporting this amendment, I would associate these Benches with everything that the noble and learned Lord, Lord Woolf, has said in welcoming it and in thanking the Government and congratulating them on the way in which they have considered and recognised the particular needs of women in the system. In Committee, we moved certain amendments which would have required the recognition of those needs at various points in the system and we are content that this all-embracing amendment meets them.

I would also associate myself with what the Minister said in tribute to the noble and learned Lord, Lord Woolf, who has campaigned so hard for recognition of the needs of women in this area. As a spokesman on these matters for one of the coalition parties, it gives me particular pleasure to note that we have made a great deal of progress on two of the significant issues for which he has campaigned—restorative justice and women offenders.

I particularly welcome the commitment in this amendment to transparency because, as has been pointed out during the passage of this Bill, we are entering a new era for the probation services. The ability to monitor what is being done after this legislation is passed is of considerable importance.

Lord Beecham: My Lords, I join the Minister and the noble Lord, Lord Marks, in congratulating the noble and learned Lord, Lord Woolf, and thanking him for bringing this matter to the fore in the debates on the Bill. I am happy to break the habits of a brief parliamentary lifetime and congratulate the Minister on his constructive response. I hope he finds this habit catching, in which case I promise to reciprocate.

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Like other noble Lords, I have received a briefing from the Prison Reform Trust. While welcoming the amendment, there are a couple of matters on which they seek some assurance—and I would echo their request. First, that the Government should require the contractors to specify—within the contract specifications —what particular services would be provided for women, and that the tender criteria, in turn, as part of the contract, would give sufficient weighting to that element. I imagine that should not present any difficulties but it would be good if the Minister could confirm it. Equally, the commissioning bodies will be given guidance along those lines.

Perhaps I may raise a point related to women prisoners that is not specifically covered by this amendment but which has been referred to in the course of our debates—that is, resettlement prisons. It is a welcome concept and certainly should help to reduce reoffending by ensuring that women serve their prison sentences, or at least the latter part of the sentence, closer to where they are likely to return on release. I raised a question in earlier debates about the specific position of women in this respect because, as I understand it, there are only 13 women’s prisons in the country and they are not necessarily geographically distributed in such a way as to facilitate the Government’s intentions. I am not asking the Minister to confirm specifically today, but it would be good to know that that is being considered and that it is an objective which it is hoped the Government will seek to achieve. It would largely complete the work raised by the concerns now embodied in the amendment, which these Benches certainly fully support.

Lord Ramsbotham: My Lords, I support the amendment and I am extremely glad to see that it has been introduced by the Government. For many years people have been hoping that there would be an improvement, and therefore it is to be warmly welcomed. The amendment refers to arrangements for supervision. I would like to raise one point in connection with that because the supervision, of course, involves the probation service.

As noble Lords will know, each of the 35 trusts has a volunteer probation board which is the employer of all the probation staff working in a trust. Apparently, there is an expectation that board members do not criticise the wishes of the Government because although they are volunteers, they are not civil servants. They have been reminded by the head of Transforming Rehabilitation that they should have regard to the constraints imposed on civil servants. I have had representations from board members about the vote which was passed in this House on Report about the requirement for the Secretary of State to allow us to discuss changes to be made to the probation service. Apparently, the board says that planning is going ahead on the timetable which I outlined on Report regardless of the vote in this House. Probation staff around the country are, as he described it, lost for words because it was expected that at the very least the Government would respect the vote of this House and reconsider their proposals, or at least appear to do so. As it seems that that is not happening, and this amendment is all about the supervision of women offenders,

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I should be grateful if the Minister could tell the House exactly what is happening following the vote on Report.

The Minister of State, Ministry of Justice (Lord McNally): My Lords, perhaps I may deal with that matter first. The Bill is now in this House. It will then go to the other place, which will also have views about an amendment which the noble Lord was told at the time was defective and which remains defective. I do not think I can go any further than that. We will see what the other House thinks about the amendment and in due course it will come back to this House to be dealt with.

I thank the noble Lord, Lord Beecham, for his kind remarks. He will find that that gives him a warm glow and so I recommend that he continues to make a habit of it. As my noble friend Lord Marks has said, the noble and learned Lord, Lord Woolf, has a good strike record on these Bills and I very much enjoy working with him and benefiting from his wisdom. On the question of the report on progress in dealing with women in the criminal justice system, we will be reporting to Parliament and we will be able to see the progress not only of these measures, but of others that we are taking.

With regard to the prison estate, the noble Lord, Lord Beecham, has drawn attention to an issue that we are currently looking at. We have a number of thoughts on this matter and a study is being undertaken of the prison estate. We will come forward with specific ideas about how released prisoners and the specific issue of women offenders will be dealt with.

On contracts, the contract specifications will set out the services that contracts are obliged to provide. The contract will contain specific outputs designed to meet the needs of female offenders. In order to comply with this new duty, the contract will state that the Secretary of State has,

“complied with the duty under section 149 of the Equality Act”,

and will also draw attention to the specific outputs. As my noble friend Lord Marks pointed out, we will publish these contracts and they will be brought forward with all possible transparency. I hope that this will give confidence and that the House will adopt the amendment.

Amendment 1 agreed.

Amendment 2

Moved by Lord Beecham

2: After Clause 17, insert the following new Clause—

“Provision for veterans’ treatment courts

(1) Within one year of the passing of this Act, the Secretary of State shall report to both Houses of Parliament on the case for establishing veterans’ treatment courts for dealing with ex-service personnel convicted of offences for which non-custodial sentences could be imposed by the trial court (“relevant ex-service personnel”).

(2) The report under subsection (1) shall cover but not be limited to the following—

(a) the statutory basis of veterans’ treatment courts;

(b) the composition and functions of veterans’ treatment courts;

9 July 2013 : Column 164

(c) whether veterans’ treatment courts would be of most effect in diverting, where possible, ex-service personnel from the criminal courts or in overseeing the rehabilitation of ex-service personnel offenders sentenced by the criminal courts;

(d) an estimate of the impact of veterans’ treatment courts on the rehabilitation of, and in reducing re-offending by, relevant ex-service personnel;

(e) an analysis of relevant international comparators; and

(f) an account of consultation which shall be undertaken with all relevant parties including magistrates.

(3) Within six months of the laying of the report under subsection (1), the Secretary of State may by statutory instrument make provision for one or more pilot schemes for veterans’ treatment courts, to extend for two years.

(4) A pilot scheme under subsection (3) shall, within six months of its conclusion, be independently evaluated, and a report of that evaluation laid before Parliament.

(5) Within six months of the laying of the report under subsection (4), the Secretary of State may by statutory instrument make provision for a permanent scheme for veterans’ treatment courts.

(6) A statutory instrument made under subsection (3) or (5) shall be laid before, and be subject to approval by resolution of, both Houses of Parliament.”

Lord Beecham: My Lords, this is the fourth iteration of the concept I floated at Second Reading and which we have debated in Committee and on Report. I can claim no credit for the idea. It was conceived in the United States in 2008 where it has been applied with remarkable success in terms of the reduction in reoffending by ex-service men and women and in promoting their welfare, with courts now established in every state. It is now seen as embedded in the justice system and is an integral part of what we in this country call the military covenant, under which we recognise the special responsibility we have as a society for those who have served their country, often in difficult and dangerous circumstances.

The veterans’ treatment courts do not adjudicate on guilt or innocence. Nor do they deal with those who are convicted of, or plead guilty to, crimes for which only a custodial sentence would be appropriate. Their purpose is to promote the rehabilitation and prevent the reoffending of men and women who often find it hard to readjust to civilian life, which is so different from the collective existence—perhaps better described as the regimented existence—that, of necessity, military service often involves. Some will have suffered, and may continue to suffer, combat stress or post-traumatic stress disorders and a number will fall foul of the law, with crimes of a violent or sexual nature being particularly common.

The courts in America are presided over by the relevant judge. A veteran mentor is assigned to each offender, who has to attend monthly court sessions and is helped in a variety of ways to adjust to life in the wider community, receiving practical, psychological and, where necessary, clinical support. Failure to co-operate with the treatment court leads to a return to the sentencing court and the risk of a prison sentence.

It must be said that there is no certainty about the numbers that might be involved in this country were we to adopt the system, even for those serving prison sentences. The MoD estimates that some 3.5% of

9 July 2013 : Column 165

prisoners at any one time are ex-service personnel. However, other estimates rise as high as double figures. A survey by Mr Colin Back of the Regular Forces Employment Association, who has worked extensively with this group and who attended a recent helpful meeting with the Prisons Minister, Mr Damian Green, has produced an estimate of those claiming and proven to have served in the Armed Forces to be an average of 6% of the inmates in a wide range of establishments, with a lowest figure of 3% and a highest figure of 11%. It is likely, however, that these figures are understated because some of those in prison do not wish to disclose their status to other prisoners or to those who, like Mr Back, are inquiring as to their position, because of concerns about how other prisoners will react or fear of loss of pensions and the like.

Be that as it may, it is clear that the number of ex-service men and women who come before the courts will substantially exceed the number who end up in prison. Even 3.5% of those who receive non-custodial sentences such as probation or community sentences will amount to several times the lowest estimate of those in custody, which is around 2,500. I do not find the number quoted by the Minister on Report for this group of non-custodial offenders of some 5,800 to be particularly credible, except perhaps as an annual figure. Therefore, over time the offending group will be quite substantial and the cumulative total must be considerably higher. We must remember that the figures are but a snapshot at any one time so the total who will have been in the system over time, whether in prison or—particularly relevant here—on non-custodial sentences, will be correspondingly greater. Moreover, at current reoffending rates, the figure would be further inflated. Obviously, addressing the general reoffending rate is the whole point of this Bill. Finally, those who have served in Bosnia, Iraq and Afghanistan are due to return and 20,000 will leave the forces, so the potential for an upward spike in numbers is all too apparent.

3.30 pm

Therefore, it is clearly in the interests of those who leave the services and who face—or cause—difficulties in the civil society to which they return, to help them avoid reoffending, which after all is the purpose of this Bill, whose objectives of course we all share. The US experience is overwhelmingly successful in that respect, with the original veterans’ court in Buffalo, New York, recording a 100% success rate. Making every allowance for the differences between our two countries, their legal systems and their support mechanisms for veterans, the evidence surely speaks for itself. I pay tribute to the work of the British Legion and other bodies that offer support to ex-service men and women, but we need to develop a system which, while working with such organisations, has a more formal character and is designed specifically to deal with this problem.

In previous debates I mentioned work done in the north-east, the largest contributor of recruits to the Armed Forces, around the health needs of the ex-service community, particularly mental health needs. A number of initiatives have taken place in local authorities in the region, working with the NHS and NOMS, for example. The Northumbria Probation Trust—which,

9 July 2013 : Column 166

of course, will be abolished if the Government press on with their proposed changes to the service, contrary to the amendment to the Bill carried by this House, to which the noble Lord, Lord Ramsbotham, referred a moment or two ago—has a veterans’ champion in each of its six delivery units. Local councils have developed a greater awareness of veterans’ needs and have been recalibrating relevant services accordingly. It is the ideal area in which a pilot scheme, as envisaged by proposed new subsections (3) and (4) of the amendment, might be established and evaluated. Of course, there might be other contenders. Mr Oliver Colvile, the Conservative Member for Plymouth Sutton and Devonport, who attended the recent meeting with Mr Green, would be an advocate for such a pilot in his area, which has a substantial Royal Navy presence.

The amendment does not seek an unequivocal commitment to the establishment of veterans’ treatment courts. On Report, the Minister was kind enough to characterise me as a latter-day Lenin. On this issue, I see myself as more of a Fabian, of the kind with whom the Minister, in a previous incarnation, would have felt comfortable. The amendment calls for a report dealing with, but not limited to, a range of issues and providing for the option of pilots and, if successful, the creation of a permanent scheme. The Minister has expressed some sympathy with the proposal but a virginal reluctance to commit. Mr Green was also sympathetic and mentioned the possibility of including it, should legislation be necessary, in what he rather alarmingly referred to as another possible justice Bill in this Session.

I cannot see why the Government should be so diffident about the proposal, which does not tie their hands, would not involve building courts—let alone vastly expensive Titan-type prisons—and would cost significantly less to pilot than the Chancellor has pledged to commemorate those veterans who fell 200 years ago at Waterloo. Accepting the amendment would both symbolise our continuing commitment to those who serve and help the Government achieve the objectives of this Bill by reducing reoffending, thereby protecting the public and saving public money. I beg to move.

Lord Ramsbotham: My Lords, I support this amendment, to which I have added my name. We have spoken about this issue many times before. Several advantages come with this amendment in the context of the Armed Forces covenant, for which the Government are very much to be commended, not least because it requires an annual report to both Houses of Parliament by the Secretary of State.

What has been most encouraging since the announcement of the covenant is the number of local covenants that have been commissioned around the country. There is a huge support network for a particular focus on the multifarious needs of the Armed Forces. Mention has already been made by the noble Lord, Lord Beecham, of the large voluntary sector which supports the military and their families. Those organisations are very capable of carrying out many of the functions that are needed. In addition to that, a growing support network is being developed for those suffering from mental health problems—the Minister

9 July 2013 : Column 167

has mentioned post-traumatic stress disorder and other kinds of fatigue—not least a number of official recovery centres based around the country which are linked into the military command structure. This is a diversion scheme, very much on the lines of the scheme developed by the noble Lord, Lord Bradley, which the Government have supported. It is poised to go, supporting an element of the community to which the Government have said that they wish to pay particular attention.

I was present at the very encouraging meeting with the Minister, Damian Green, and was glad that he took all these points on board. Therefore, I hope that the Minister will be able to respond positively to the amendment and give the House an indication of the sort of timing that we might expect in terms of a government response.

Lord Lloyd of Berwick: Before the noble Lord sits down, perhaps I may ask him one question for my elucidation. I am interested in the use of the word “treatment” in connection with the word “courts”. Is it the intention that these courts should be available only to those who are shown to be suffering from either post-traumatic stress disorder or, let us say, Gulf War syndrome, or are they to be open to all, whether or not they need “treatment” in that sense?

Lord Ramsbotham: I think that I should defer to the noble Lord, Lord Beecham, who is responsible for the wording of the amendment.

Lord Lloyd of Berwick: I am very sorry. I had hoped to ask the question of the noble Lord, Lord Beecham, before he sat down, but it was by then too late. Somebody, I hope, will give me the answer.

Lord West of Spithead: My Lords, I support the amendment, to which I have added my name. The amendment is the least that we can do for the men and women who have put their lives on the line for our nation’s security.

Viscount Slim: My Lords, the Minister will be aware through conversations and debate in the Chamber that I strongly support this amendment. I know that he has been working on a plan along the lines that we asked for. Here it is. It is a good one; it should be trialled. Like the noble Lord, I hope that the Minister will see the sense in it and give his blessing to it. If not, I hope that the House will take the necessary steps.

Lord Hylton: My Lords, my noble friend Lord Ramsbotham referred to existing support systems for ex-servicemen. I imagine that he has in mind the British Legion, Help for Heroes and other voluntary organisations, together with local authorities. However, the sad fact remains that a significant number of ex-servicemen find themselves homeless and sleeping rough, many of them in London. Could this factor also be borne in mind in whatever preventive work is done?

9 July 2013 : Column 168

Lord Ahmad of Wimbledon: My Lords, I thank all noble Lords who have participated in this debate. The noble Lord, Lord Beecham, has once again returned to the very important issue of providing support for ex-service personnel impacted in this way who find themselves involved with the criminal justice system.

However, we should not lose sight of the fact that the vast majority of men and women who serve in our Armed Forces go on to lead successful, law-abiding lives. Ex-service personnel are an important asset to the economy of this country and any employer should welcome the skills that they bring to any job. I also pay tribute to all the brave men and women who serve in our Armed Forces and continue to do so with great distinction and honour. We pray for them, particularly those who find themselves on the front line as we speak today.

The noble Lord, Lord Beecham, has already mentioned the meeting he had with my right honourable friend Damian Green, the Minister who sits appropriately in both the Home Office and the Ministry of Justice and who is ideally placed to consider the issue of ex-service personnel who find themselves in the criminal justice system. That meeting was attended by not only the noble Lord, Lord Beecham—as he has acknowledged—the noble Lord, Lord Ramsbotham, David Anderson, the MP for Blaydon, and my honourable friend Oliver Colville, the MP for Plymouth Sutton and Devonport, were also present. Therefore, it is fair to say that there is support for looking at this important issue both here and in the other place, throughout the country and across the political spectrum.

Also at that meeting were a number of representatives of veterans’ groups, such as Tony Wright of Forward Assist. I know that my right honourable friend Damian Green particularly welcomed their input and the information that they supplied about the experiences of ex-service personnel. One of the key things that emerged from that meeting is that the focus is not necessarily on ex-service personnel who are in prison. It is of course important that we continue to develop services for those who are in custody, such as the veterans in custody support officers, and expand the specific guidance that is produced in collaboration with interested government departments and the important voluntary sector.

As I said in Committee, it will be important to have tailored supervision for ex-service personnel on release, including, for example, mentoring from those with service backgrounds—a subject that we have talked about previously. So while we continue to work with ex-service personnel in custody, we also need to focus on those who receive non-custodial sentences or those who can be diverted from the criminal courts altogether. We believe that there are a number of ways to address offending by veterans at that level. For example, we could look at the programmes that are available as part of conditional cautions, which are administered by the police.

The noble Lord, Lord Beecham, also mentioned the US experiences. That is something that the Government are also looking at. For those receiving community orders or suspended sentence orders, there are powers available to the courts to review sentences,

9 July 2013 : Column 169

essentially to monitor progress of that particular order. We suspect that these approaches might benefit some ex-service personnel. However, we need to know more about the problem of offending at this level in order to decide what the best solution is.

One of the most striking things raised by veterans’ groups is the lack of detailed information about the scope and nature of offending by ex-service personnel. That point was well made by the noble Lord, Lord Beecham. Even in prisons there are significant differences in the estimates, ranging from 3% of the population to 11%. For those involved in less serious offending, the information is even less clear. That is why we want to work with the veterans’ groups to try to establish a better understanding of the nature and extent of offending. If we have that information, we believe we can focus better on a response.

The Government are already taking forward work to look at the data that are available. I am also happy to make a commitment that the Government will produce an assessment of the issues identified, as raised in this amendment, including a veterans’ court and other mechanisms to provide support. We will share that assessment with noble Lords. I am also confident that we will be looking to complete this particular assessment and share the findings with noble Lords within the coming year.

Likewise, I reassure noble Lords that we will continue to consult relevant groups. We want to discuss the issue with other key government departments, such as the Ministry of Defence, as well as the Department of Health and the Department for Work and Pensions. We will also need to talk to the judiciary about its experience of dealing with ex-service personnel.

3.45 pm

Crucially, we also want to work with the voluntary sector. I join in the comments of other noble Lords in paying tribute to organisations such as Help for Heroes and the Royal British Legion. We believe that working with such voluntary organisations in formulating what needs to be done will help us to understand better the problems of ex-service personnel and to identify offenders with service records as early as possible.

I give the commitment that the Government will continue the cross-party discussions that my right honourable friend Damian Green in the other place has started. As we look at the data and look at working with the voluntary groups, I also give the commitment to engage fully with noble Lords, who have great expertise, to ensure that we develop the best solution to this most important of issues.

I reiterate that the Government share the commitment of the noble Lord to look at new ways of addressing the needs of veterans who go on to offend. However, I believe that we need to reflect on this issue, look at the data and formulate the correct response, which may well mean considering veterans’ courts, as my right honourable friend Damian Green has said. However, we also need to ensure that we consult effectively. In the light of the reassurances that I have given and with the commitment to return within the next year, I hope that the noble Lord will be minded to withdraw his amendment.

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Lord Beecham: My Lords, I am grateful to the noble Lords who have participated in this short but important debate. The noble and learned Lord, Lord Lloyd, asked about the term “treatment”. It is not designed to refer to clinical treatment. It is a phrase used in the American system, and treatment can take a variety of forms, including advice and support of all kinds. As I said, it does not necessarily have a medical or clinical connotation.

The noble Lord, Lord Hylton, referred to homelessness as a particular problem, and that of course is true. Indeed, it is the function of the mentor and others in American veterans’ courts to assist precisely with that kind of problem. To a certain extent and as the noble Lord, Lord Ramsbotham, pointed out, it is something that is now increasingly carried on across a number of local authorities, especially those in my home region of the north-east.

Nothing in what the Minister said is excluded from the range of the amendment. The amendment is not at all incompatible with what he said. It sets out a process and one would hope to end up with the option of a system clearly rooted in the experience abroad. It would also have to be tested here, as we are suggesting.

I welcome the warmer response given by the Minister today compared with that given previously. I understand that parts of the Government are addicted to something called the “nudge theory”, in which people can be encouraged by a nudging process to change their ways. I think that it would be appropriate to seek to nudge the Government in the right direction by having a clear expression of opinion on the amendment. Accordingly, I wish to test the opinion of the House. I hope that we can give a clear message that we want the Government to build on their growing warmth and accept the principles set out in the amendment. One hopes that they will move in due course, on the basis of piloting, to making a systemic change in the way that we deal with offenders.

3.49 pm

Division on Amendment 2

Contents 186; Not-Contents 205.

Amendment 2 disagreed.

Division No.  1


Aberdare, L.

Adonis, L.

Allenby of Megiddo, V.

Alton of Liverpool, L.

Anderson of Swansea, L.

Andrews, B.

Armstrong of Hill Top, B.

Bach, L.

Bakewell, B.

Bassam of Brighton, L. [Teller]

Beecham, L.

Best, L.

Bichard, L.

Bilimoria, L.

Bilston, L.

Boothroyd, B.

Bradley, L.

Brennan, L.

Brooke of Alverthorpe, L.

Brookeborough, V.

Brookman, L.

Browne of Ladyton, L.

Cameron of Dillington, L.

Campbell-Savours, L.

Chester, Bp.

Christopher, L.

Clancarty, E.

Clark of Windermere, L.

Clarke of Hampstead, L.

Clinton-Davis, L.

Cobbold, L.

Colville of Culross, V.

Condon, L.

Corston, B.

Cox, B.

9 July 2013 : Column 171

Craig of Radley, L.

Cunningham of Felling, L.

Dannatt, L.

Davies of Coity, L.

Davies of Oldham, L.

Davies of Stamford, L.

Dean of Thornton-le-Fylde, B.

Desai, L.

Donaghy, B.

Donoughue, L.

Drake, B.

Dubs, L.

Eames, L.

Elder, L.

Elystan-Morgan, L.

Erroll, E.

Evans of Parkside, L.

Falkland, V.

Farrington of Ribbleton, B.

Faulkner of Worcester, L.

Fellowes, L.

Finlay of Llandaff, B.

Foulkes of Cumnock, L.

Gale, B.

Gibson of Market Rasen, B.

Golding, B.

Gordon of Strathblane, L.

Gould of Potternewton, B.

Graham of Edmonton, L.

Grantchester, L.

Grenfell, L.

Grey-Thompson, B.

Hanworth, V.

Harries of Pentregarth, L.

Harrison, L.

Hart of Chilton, L.

Haskel, L.

Haworth, L.

Hayman, B.

Hayter of Kentish Town, B.

Healy of Primrose Hill, B.

Henig, B.

Hilton of Eggardon, B.

Hollick, L.

Hollins, B.

Hollis of Heigham, B.

Howarth of Breckland, B.

Howe of Idlicote, B.

Howells of St Davids, B.

Howie of Troon, L.

Hoyle, L.

Hughes of Stretford, B.

Hughes of Woodside, L.

Hunt of Kings Heath, L.

Hutton of Furness, L.

Irvine of Lairg, L.

Janner of Braunstone, L.

Jay of Paddington, B.

Jones of Whitchurch, B.

Jones, L.

Judd, L.

King of Bow, B.

Kinnock of Holyhead, B.

Kinnock, L.

Kirkhill, L.

Knight of Weymouth, L.

Lea of Crondall, L.

Liddell of Coatdyke, B.

Liddle, L.

Lipsey, L.

Lister of Burtersett, B.

Listowel, E.

Low of Dalston, L.

McAvoy, L.

McDonagh, B.

McFall of Alcluith, L.

McIntosh of Hudnall, B.

MacKenzie of Culkein, L.

Mackenzie of Framwellgate, L.

Mallalieu, B.

Mar, C.

Martin of Springburn, L.

Mawson, L.

Maxton, L.

May of Oxford, L.

Meacher, B.

Monks, L.

Morgan of Drefelin, B.

Morgan, L.

Morris of Aberavon, L.

Morris of Handsworth, L.

Morris of Yardley, B.

Norwich, Bp.

O'Loan, B.

O'Neill of Bengarve, B.

O'Neill of Clackmannan, L.

Palmer, L.

Pannick, L.

Patel of Blackburn, L.

Patel of Bradford, L.

Patel, L.

Pendry, L.

Phillips of Worth Matravers, L.

Prescott, L.

Quirk, L.

Radice, L.

Ramsay of Cartvale, B.

Ramsbotham, L.

Rendell of Babergh, B.

Richard, L.

Rix, L.

Rogan, L.

Rosser, L.

Rowlands, L.

Royall of Blaisdon, B.

Saltoun of Abernethy, Ly.

Sawyer, L.

Scotland of Asthal, B.

Sherlock, B.

Simon, V.

Slim, V.

Smith of Basildon, B.

Smith of Gilmorehill, B.

Soley, L.

Stevenson of Balmacara, L.

Stoddart of Swindon, L.

Stone of Blackheath, L.

Symons of Vernham Dean, B.

Taylor of Blackburn, L.

Taylor of Bolton, B.

Thornton, B.

Tomlinson, L.

Touhig, L.

Trees, L.

Triesman, L.

Truscott, L.

Tunnicliffe, L. [Teller]

Turnberg, L.

Turner of Camden, B.

Uddin, B.

Warnock, B.

West of Spithead, L.

Wheeler, B.

Whitaker, B.

Whitty, L.

Wigley, L.

Wilkins, B.

Wills, L.

Winston, L.

Woolmer of Leeds, L.

Worthington, B.

9 July 2013 : Column 172


Addington, L.

Ahmad of Wimbledon, L.

Alderdice, L.

Anelay of St Johns, B. [Teller]

Armstrong of Ilminster, L.

Astor of Hever, L.

Attlee, E.

Avebury, L.

Baker of Dorking, L.

Barker, B.

Bates, L.

Benjamin, B.

Berridge, B.

Blackwell, L.

Bonham-Carter of Yarnbury, B.

Bowness, L.

Brabazon of Tara, L.

Bradshaw, L.

Bridgeman, V.

Brinton, B.

Brittan of Spennithorne, L.

Brooke of Sutton Mandeville, L.

Brougham and Vaux, L.

Browne of Belmont, L.

Browning, B.

Caithness, E.

Cathcart, E.

Chalker of Wallasey, B.

Chidgey, L.

Clement-Jones, L.

Coe, L.

Colwyn, L.

Cope of Berkeley, L.

Cormack, L.

Cotter, L.

Courtown, E.

Craigavon, V.

Crickhowell, L.

De Mauley, L.

Dear, L.

Deben, L.

Deighton, L.

Dholakia, L.

Dixon-Smith, L.

Doocey, B.

Dundee, E.

Dykes, L.

Eccles of Moulton, B.

Eden of Winton, L.

Edmiston, L.

Emerton, B.

Empey, L.

Falkner of Margravine, B.

Faulks, L.

Fearn, L.

Fellowes of West Stafford, L.

Fookes, B.

Fowler, L.

Framlingham, L.

Freeman, L.

Freud, L.

Garden of Frognal, B.

Gardiner of Kimble, L.

Gardner of Parkes, B.

Geddes, L.

German, L.

Glasgow, E.

Glendonbrook, L.

Glentoran, L.

Gold, L.

Goodlad, L.

Grade of Yarmouth, L.

Greaves, L.

Green of Hurstpierpoint, L.

Greengross, B.

Hanham, B.

Harris of Richmond, B.

Higgins, L.

Hill of Oareford, L.

Hodgson of Astley Abbotts, L.

Hooper, B.

Howe of Aberavon, L.

Howe, E.

Howell of Guildford, L.

Hunt of Wirral, L.

Hussain, L.

Hussein-Ece, B.

Inglewood, L.

James of Blackheath, L.

Jenkin of Kennington, B.

Jenkin of Roding, L.

Jolly, B.

Kerr of Kinlochard, L.

Kilclooney, L.

King of Bridgwater, L.

Kirkwood of Kirkhope, L.

Knight of Collingtree, B.

Laming, L.

Lamont of Lerwick, L.

Lawson of Blaby, L.

Lee of Trafford, L.

Lexden, L.

Lindsay, E.

Lingfield, L.

Linklater of Butterstone, B.

Lloyd of Berwick, L.

Loomba, L.

Luce, L.

Luke, L.

Lyell, L.

McColl of Dulwich, L.

Macfarlane of Bearsden, L.

MacGregor of Pulham Market, L.

Mackay of Clashfern, L.

McNally, L.

Maddock, B.

Mancroft, L.

Mar and Kellie, E.

Marks of Henley-on-Thames, L.

Marlesford, L.

Mawhinney, L.

Mayhew of Twysden, L.

Methuen, L.

Miller of Chilthorne Domer, B.

Miller of Hendon, B.

Montagu of Beaulieu, L.

Montrose, D.

Morris of Bolton, B.

Morrow, L.

Neville-Jones, B.

Newby, L. [Teller]

Noakes, B.

Northbrook, L.

Northover, B.

Norton of Louth, L.

Palmer of Childs Hill, L.

Parminter, B.

Patten, L.

Perry of Southwark, B.

Phillips of Sudbury, L.

Plumb, L.

Popat, L.

Rawlings, B.

Razzall, L.

Redesdale, L.

Renfrew of Kaimsthorn, L.

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Rennard, L.

Renton of Mount Harry, L.

Ridley, V.

Risby, L.

Roberts of Llandudno, L.

Rodgers of Quarry Bank, L.

Roper, L.

Rowe-Beddoe, L.

St John of Bletso, L.

Sassoon, L.

Scott of Needham Market, B.

Seccombe, B.

Selborne, E.

Selkirk of Douglas, L.

Selsdon, L.

Sharkey, L.

Sharp of Guildford, B.

Sharples, B.

Shaw of Northstead, L.

Sheikh, L.

Shipley, L.

Shrewsbury, E.

Shutt of Greetland, L.

Skelmersdale, L.

Smith of Clifton, L.

Spicer, L.

Stedman-Scott, B.

Stewartby, L.

Stirrup, L.

Stoneham of Droxford, L.

Storey, L.

Stowell of Beeston, B.

Strathclyde, L.

Sutherland of Houndwood, L.

Swinfen, L.

Taylor of Holbeach, L.

Taylor of Warwick, L.

Thomas of Winchester, B.

Trimble, L.

Tugendhat, L.

Tyler of Enfield, B.

Tyler, L.

Ullswater, V.

Verma, B.

Vinson, L.

Waddington, L.

Wakeham, L.

Wallace of Saltaire, L.

Wallace of Tankerness, L.

Walmsley, B.

Warsi, B.

Wei, L.

Wheatcroft, B.

Wilcox, B.

Williamson of Horton, L.

Willoughby de Broke, L.

Wilson of Tillyorn, L.

Woolf, L.

Younger of Leckie, V.

4.01 pm

A privilege amendment was made.

Bill passed and sent to the Commons.

Care Bill [HL]

Care Bill [HL]1st Report from the Delegated Powers Committee

Committee (5th Day)

Relevant document: 1st Report from the Delegated Powers Committee.

4.01 pm

Clause 2: Preventing needs for care and support

Amendment 80

Moved by Lord Best

80: Clause 2, page 3, line 2, at end insert—

“( ) the importance of identifying housing options required to exercise that duty”

Lord Best: My Lords, we come now to a group of amendments, five of which are in my name and the names of my noble friends Lady Wilkins and Lady Tyler. These five amendments have the same underlying purpose—namely to give greater prominence to the crucial role that housing can play in preventing and reducing the need for health and social care services. The amendments have been prepared by the Care and Support Alliance, which is composed of more than 70 organisations that support and represent older and disabled people. I am particularly grateful to the National Housing Federation, which has helped bring these amendments together and given excellent briefings to interested Members of your Lordships’ House.

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The Bill has been welcomed by those organisations, and they note with approval that the definition of “well-being” in Clause 1 covers “suitability of living accommodation”. Also, in relation to the duty on local authorities to meet needs for care and support, Clause 8 includes reference to such assistance being provided “at home”. However, these passing references to the place where many elderly and disabled people spend almost all their time do not do justice to the significance of housing to enabling people to live independently.

The Bill takes highly significant steps to integrating health and social care services, but downplaying the housing element—the third leg of the stool—will undermine the legislation’s good intentions. The Age UK report, Stop Falling: Start Saving Lives and Money, notes that falls cost the NHS around £4.6 million every day and that around half of the people over the age of 80 suffer a fall each year. It makes clear that it is accidents in the home, or on the icy step outside, that so often lead to hospitalisation. Cold and damp premises are equally likely to be the cause of a deterioration in health. Once in hospital, if the home to which the patient should return is totally unsatisfactory, their discharge will be delayed and/or there will be a swift readmission to hospital when the home fails them. Informal family carers cannot cope with someone’s care needs if they are battling with the inadequacies of a home that has unmanageable stairs or cannot accommodate a wheelchair.

The case has been made for the financial benefits of getting the housing service right. The National Housing Federation’s new report, Providing an Alternative Pathway, for example, shows that housing for someone with dementia in a self-contained flat in an extra-care scheme provided by a housing association can cut the cost of their care by up to 50%, allowing them to live more independently with care and support on-site, rather than in a costly residential care home. Currently, the UK is spending £9.43 billion on housing those with dementia in care homes, so housing alternatives can have a huge impact on health budgets.

Often the ideal housing solution for so many of us as we grow older is a move to a more manageable home with very low heating bills, no stairs or steps, but with high standards, space, light and ventilation. As a wonderful bonus, when an older person downsizes, a much needed family home, probably with a garden, comes on to the market for the next generation. I declare my interest as chair of Hanover Housing Association, which endeavours to build accommodation of this kind, which is in turn likely to be the best place for care and support services to be delivered. The housing provider can supply the back-up, not only through emergency call systems—now much enhanced by new technology—but in personal terms in acting as helper and ally in securing care services. Age-friendly housing developments for older people also protect against loneliness and isolation for the resident through ensuring a sociable, companionable environment.

However, the great majority of people will stay put in their family home. A joined-up care and housing service can make this possible. Sometimes very minor adaptations are all that are needed to extend people’s independence and autonomy. Handrails that are discreetly

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and strategically placed can prevent falls in the home. Long-armed “D” taps for people with arthritic hands can reduce the occupier’s need for costly help. Introduction to a “handy person” service can get these things fixed. Arrangements to pay for a defunct central heating boiler to be revived can end the misery of choosing between being freezing cold and spending a fortune on an electric bar heater which may well be unsafe. This investment in the home can keep people well.

Home improvement agencies, often called “care and repair” services, can organise access to disabled facilities grants for items like stair lifts or the installation of walk-in showers, making life so much easier for family carers as well as for the person themselves. It is good to note, in the spending review, the transfer of resources from the Department of Health to fund a planned 20% increase in the budgets of disabled facilities grants.

All these measures that prevent the need for more costly care services achieve very rapid payback as well as transforming people’s lives. If a patient cannot be discharged from hospital for a couple of weeks because their home cannot take them back, the NHS will incur costs of well over £5,000—money that could have been so much better spent fixing the home and preventing a series of unnecessary and unwanted hospital stays. Avoiding a move into residential care for a couple of years will save tens of thousands of pounds.

Each of these amendments covers a different clause in the Bill and inserts a housing dimension to the very welcome measures already therein. First, Amendment 80 addresses Clause 2, which focuses on preventing or delaying a person’s need for care. It seeks recognition that housing is a crucial part of a preventive care service.

Secondly, Amendment 81 is particularly significant. It adds housing to Clause 3, covering promotion of integration of care and support with health services. It is interesting to note, in this context, that in Scotland this holistic view of integration is now taken. The relevant Scottish guidance says:

“It will be important that, in bringing … health and social care closer together, partners ensure that housing services (including those provided by housing associations and the third sector, as well as by local authorities) are fully included in the integrated approach to service planning and provision, and that health and social care planning and local housing strategies are mutually supportive”.

So says the Scottish guidance. Sadly, our Health and Social Care Act 2012 does not explicitly reference housing, and a framework for engagement was neglected in that Act’s guidance. This has led to a very patchy involvement with housing by the new health and well-being boards. Some are examplars of engagement with housing providers in a three-way partnership, while others seem blind to the significance of this element in the equation.

Thirdly, Amendment 86 covers Clause 4 and relates to information and advice. Again, this is a very important amendment. The Joint Committee that looked at the Bill strongly recommended that local authorities provide information and advice on the housing options available in their area. However, although the Government have incorporated the need for independent financial advice, the recommendation from the committee to include housing has not been taken up. This amendment, by

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including housing options in the Bill, should ensure that local authorities provide the requisite information on specialist and adapted housing in their area, on ways for people to get their home adapted, and on the ways in which people can cover the costs of home improvements.

Fourthly, Amendment 87 seeks to improve Clause 5, which is concerned with the diversity and quality of local services. It extends the definition of care and support services to ensure that local authorities include specialist housing, accessible housing and housing-related support in their mix of services.

Finally, Amendment 88 addresses Clause 9, which relates to the assessment of an adult’s needs for care and support. It is intended to make sure that local authorities pick up on whether adaptations to a home are needed or whether a move to more specialist housing would be best. Assessing the housing requirements of the individual is a vital part of the process of seeing what is best for that person and how their lives can be improved. The amendment seeks to make sure that this ingredient in the process is covered as a matter of course.

I hope that the Minister will feel able to take on board the kind of changes to the Bill which these amendments advocate. The report last year from the All-Party Parliamentary Group on Housing and Care for Older People, Living Well at Home, spelt out the case for the three-way integration of health, social care and housing. The White Paper published prior to the Bill promoted the theme of including housing more centrally in the future of social care. The House of Lords Select Committee report, Ready for Ageing?, highlights the housing requirements of older people. The pre-legislative scrutiny committee, so ably chaired by Paul Burstow MP, took this forward with strong recommendations for a higher profile in this Bill for the housing dimension. The 70 organisations in the Care and Support Alliance, which have a real understanding of the needs of older and disabled people, believe passionately that these changes would greatly improve the Bill. I beg to move.

Baroness Wilkins: My Lords, I strongly support the amendments which have been so expertly described by the noble Lord, Lord Best, and to which I have added my name, as well as Amendment 87ZC in the name of my noble friend Lord Hunt of Kings Heath.

This is an important group of amendments. In combination, they will help to ensure that housing is at the forefront of decision-makers’ minds when providing for an individual’s care and support needs. The person will be supported in a way which makes them the least dependent on health and social services only if housing solutions are properly taken into account. However, that element is all too often ignored, and dependency is ensured.

I well remember a dispirited social worker who described the effects of a two-year delay in providing an arthritic lady with lever taps. In the mean time, she had to have considerable support to wash and cook and objected strongly when that support was taken away because she was now able to turn on the taps. However, it helped to convince the council to clear their backlog of occupational therapy cases.

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It is so often the case that the housing element ensures that a person can maintain their greatest independence and be enabled to live their life to the fullest extent they can. Housing solutions have to focus on the individual—ensuring that the person is at the centre of the services and not the system. There are numerous examples of how, when housing, health and social service professionals work well together, people are able to regain a control over their lives which can all too easily be lost when social or health care are seen as the only options.

4.15 pm

The National Housing Federation’s recent report Providing an Alternative Pathway gives many telling examples. One is of a man called Bruce which will resonate with anyone who has had experience of a spinal injury unit. He was left tetraplegic after a motorcycle accident which also killed his son. In an instant, his home had been made inaccessible to him and all he could do was move into residential care. He quickly went downhill and after three months attempted suicide. Fortunately for him, the residential care was part of Papworth Trust, which was able to move him, as his health improved, to a semi-independent living scheme, still offering him lots of support. In the mean time, a two-bedroom flat was specially adapted to his needs and he now lives there independently, with a weekly care package, and is back in employment. In the National Housing Federation's estimate just this case represents an annual saving of more than £50,000 a year in social care costs.

Mencap's excellent report, Housing for People with a LearningDisability, was the focus of a recent meeting of the All-Party Parliamentary Group on Learning Disability. One mother described what happens when housing does not form part of the three-legged stool of the noble Lord, Lord Best. Her son, Sam, has severe learning disabilities and no speech. Following school, he spent three years away from home learning independent-living skills at college, with social services promising that they were planning appropriate provision for him when he returned home. He returned home to find nothing—no provision. Residential care was deemed inappropriate; the only supported housing was for people with more moderate needs and Sam needed 24-hour support. The housing department was not even aware of its responsibilities to youngsters with learning disabilities as a group with supported-housing needs. It was only by chance that Sam's mother heard of an empty, run-down house in the borough—empty because it had been left in a legacy to be used for people with learning disabilities and the council could not find tenants to fill it. It was about to be sold. The rest of her story was all too familiar, with hurdles and obstacles placed in her way, but her son and three other youngsters with severe learning disabilities moved in on 10 March last year. They are now flourishing in the community with their health and well-being markedly improved.

These solutions require teamwork and for people to work across disciplines in an integrated way. Why does it not happen? Is it that co-ordinated effort can all too easily be forgotten if it is not a legal duty and people are working under pressure? So it requires a clear duty on all the participants involved.

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I hope that the Minister will reconsider the recommendations made by the Joint Committee and that he will come back with his own amendments on Report or accept these to be included in the Bill. I urge noble Lords to support them.

Lord Rix: My Lords, having heard the words about Mencap spoken by the noble Baroness, Lady Wilkins, I, as president, must of course support this amendment. I say “must”, but I am surprised that these amendments have to be tabled at all. I would have thought that any Bill dealing with care must deal absolutely explicitly with housing. After all, noble Lords will remember when the long-stay, sub-normality hospitals were closed in the late 1970s, the 1980s and the early 1990s, the very thing that was required was housing. Mencap did provide the housing in those days, as best it could, with the Mencap Homes Foundation. It has progressed now to Golden Lane Housing, which allows people with a learning disability actually to own their own housing with the appropriate support. These provisions are necessary, and I am amazed that these amendments were necessary in the first place.

Baroness Jolly: My Lords, I support this suite of amendments—this flight of amendments—on housing. As noble Lords have eloquently said, housing is the third side of the care triangle. Those of us who sat on the scrutiny committee were absolutely clear on that. We thought that it had been extended to our report, but clearly it has not been reflected totally in the Bill. There was mention of it in Clause 1, the well- being clause, in Clause 6 on co-operation, and also in Clause 8 on how to meet needs. The noble Lord, Lord Best, has filled in the gaps, with Clause 2 on prevention, Clause 3 on integration, Clause 4 on the provision of information and advice, Clause 5 on market shaping and Clause 9 on the assessment of needs. In each of these elements of the Bill, housing is imperative. The anxiety that many of us share is that if housing is not in these clauses, it will not be dealt with when an individual is assessed, or when there are issues around integration.

In the Select Committee, the most compelling witnesses were from the housing sector. They understood the impact that appropriate housing, and any adaptations to houses, would have on the lives of the people living there—on the health and well-being of the individual. The amendments in this group put housing where it should be. It is core to assessment and core to integration of care. It is a preventive measure, and it is also core to the provision of information. There is no point in having a conversation as a result of your assessment and as part of the information process if you are not aware of what your housing needs are, because without housing, the conversation makes no sense.

Local authorities need clear direction from the Government. The noble Lord, Lord Best, articulated this clearly when he introduced his amendments. Some health and well-being boards have got it and some have not. Those that have not should have it spelled out, so the amendments in this group are absolutely appropriate. I hope that my noble friend, when he sums up, will reassure the House in this regard.

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Baroness Emerton: My Lords, I support the amendments of the noble Lord, Lord Best. I also support what my noble friend Lord Rix said about closing the large institutions and providing the necessary housing. The reason the necessary housing could be found, either through charities or local authorities, was that it was clearly spelled out in government policy. I therefore strongly support the need for this provision to be in the Bill. Without that background, I would have found the job of closing two large institutions extremely difficult, because there was resistance from local authorities and local communities to providing suitable accommodation. However, as it was government policy, we were able to persuade and influence the local authorities to do it. Therefore, I support the amendments in this group.

Lord Campbell-Savours: My Lords, I will speak primarily to Amendment 88, in the wider context of Clause 9, and put an idea to the Minister that dawned on me during conversations with local authorities that are faced with problems in this area. Clause 9 deals with the assessment of an adult’s needs for care and support. It states:

“Where it appears to a local authority that an adult may have needs for care and support, the authority must,”

carry out an assessment. The clause goes on to list what the assessment must include. Amendment 88 would add,

“housing options to contribute to the achievement of those outcomes”.

What struck me as an outsider looking into these matters is that, irrespective of the changes to which the noble Lord, Lord Rix, referred, problems still arise where elderly people—perhaps in their 80s, 90s or whatever—have to transfer out of their homes, which they may well own, or from hospital into some kind of care environment, perhaps a nursing home. I wonder whether it would be possible for that process to be made more seamless in circumstances where a local authority took on the responsibility of marketing—I shall come on to what I mean by “marketing”—the home for sale, clearing the home and making all the arrangements for the transfer of that resident, be it from their home or from hospital, into a care environment.

It may be that a local authority could offer a package. At the moment, that package, in part, is offered by some of the charities. I have spoken to charities, such as Age Concern, which carry out various components in this process of transfer but I wonder whether money could be raised by local authorities through taking a proportion of the commission on the sale of properties by estate agents. In other words, a local authority would advertise within its area and estate agents could tender for the right to handle the properties for which the local authority took responsibility in this process of seamlessly transferring people from their homes to a caring environment.

As estate agents would not necessarily know whether they would get that business if it was organised in the wider market, if they knew they were going to get all the business provided by the local authority—in other words, that they would be the estate agent responsible for carrying out the process of transfer in a particular district—they might be prepared to share their commissions

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with the local authority because they had access to business which they might not otherwise have had. It would provide a revenue stream.

As we introduce amendment after amendment to the Bill, I keep thinking, “Where is the money coming from?”. It has to come from somewhere. It is all right Parliament passing legislation placing all these new responsibilities on authorities but, at the end of the day, the local authority has to find a way of raising the revenue. If local authorities could somehow attach themselves to the revenue from the sale of houses, it might well provide an income stream—and what better way to do so than to provide a package for the seamless transfer of the elderly into a more caring environment? I put it simply as a proposition that the Minister might wish to consider over time.

Lord Martin of Springburn: My Lords, everyone supports these amendments. I do not wish to detain the House but I would like to add my voice to that support.

When I became a councillor in 1973, it was my duty to concern myself with the housing problems of constituents who lived in my ward. After seven years, when I became a Member of Parliament, I thought the housing problems would go to the councillor who took my place. That was not the case. Right up to my last week of being a Member of Parliament, I was still receiving housing complaints and problems. I recall in another life, when I was a member of the Labour Party, some of my friends saying, “Education, education, education”—that was the motto—but I said there should be something else: “Housing, housing, housing”.

If people do not live in decent homes, they will not be able to do anything. If dampness is coming down the walls, the brightest child will never be able to study properly and get the best out of his or her education. So I say to the Minister that sometimes it is the simple things that matter in housing, not the expensive things that the noble Lord, Lord Campbell-Savours, has referred to.

I have mentioned dampness. There used to be a great deal of dampness in some of the houses in my area of Glasgow. A scheme was introduced—all credit to the Government, as it was not just the local authority —to bring in central heating. What a difference it made to the health of the young and old who lived in those houses. They could get up in the morning to a warm house and go to bed in the evening in a warm house. It meant that bronchitis, emphysema and all the other problems were greatly reduced.

4.30 pm

I do not wish to bring in a highly sensitive matter, but I have to say to the noble Earl, that it rolls off the tongue of some government Ministers, including the Prime Minister, to say, “There is a simple solution to housing underoccupation. We can get people out and give them another house, so we will have vacant properties for others”. What if the elderly person is occupying—or perhaps underoccupying—a four-apartment dwelling, and her daughter stays round the corner? If the person is moved, the daughter will not be able to give the support that is needed. The Government may say that

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it does not apply to pensioners, but what happens if the person is in their 50s and is not too well, or suffers from an illness, such as asbestosis, which we debated in this House? If the person is moved away from family support, the support has to come from elsewhere.

I do not know whether I should, but maybe I will declare an interest. I am a member of the Glasgow North Housing Association, although with no pecuniary interest. Community-based housing associations have done marvellous things throughout the United Kingdom, and I have witnessed it in Glasgow. I talk about the small things again, such as a warden being available in sheltered housing. A person may have suffered a stroke or have some other illness. The very fact that that warden can chap the door and find out that the elderly person or stroke victim is all right makes a marvellous difference to the families of those with relatives in sheltered housing. It gives a great sense of security to families who sometimes live many miles away.

I remember one of the first cases that I ever had as a councillor. I was only 27 at the time and did not fully understand depression and the other problems that anxiety can bring. I remember a young woman saying to me, “I’m getting tablets from my doctor because of the anti-social behaviour in the tenement I’m living in”. I went about the business of trying to get her moved, and the local authority was able to do it. Her husband said, “I now know that I can go to work without getting a phone call to say that my wife is in a terrible situation. I know that my wife can now go to pick up the children from school as she liked to do before that deep depression”. In other words, the change of house and the relaxation that came from not having anti-social people around her made all the difference. Housing is so important to each and every one of us.

Baroness Howarth of Breckland: I want to bring us back briefly to the amendments that we were discussing. Broadly, housing obviously has a tremendous impact on people’s lives, but we are talking about inserting the word “housing” in a number of clauses that will enable co-ordination between health, social care and housing.

Many local authorities and well-being boards, as the noble Baroness, Lady Jolly, mentioned, already have it—that is, if you achieve this co-ordination, you will make savings and produce better outcomes for the individuals being helped. Having it on the face of the Bill will ensure that the leadership of all these authorities has to pay attention to it, and I think that is important. At the moment we have a postcode lottery. If you are fortunate enough to live in an authority that has got it together, your adaptations will arrive; you will have all your other housing issues sorted out, along with your care package, and, if you are an old person in hospital, you will be out in a very short time. If you are a person with a disability, as that disability increases, or if you have a sudden disability, your adaptations will appear because there will be that co-ordination.

In many local authorities, however, the housing department can opt out and not play its part, which causes huge delays—I speak as someone who works in a number of charities and with people with disabilities. I want to support the amendment’s inclusion in the

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Bill so that the leaderships of authorities have to take it to heart and so that we do not have a postcode lottery and this is all part of strategic planning for the authority.

Baroness Wheeler: My Lords, the Joint Committee on the Bill acknowledged that it had been widely welcomed, but asserted that this did not mean that it could not be improved—there are gaps and risks and unintended consequences. The failure of the Bill adequately to underline the importance of housing not just to well-being but to integrated care, to prevention and to being included in the provision of advice and information on quality of care and assessment is what these amendments seek to address. The interplay between housing and well-being—the standard of someone’s living circumstances and their health condition, the appropriateness of their house or flat and the likelihood of their being able to remain in it and care for themselves—is long established. However, as noble Lords have shown, it is overlooked in key clauses of the Bill.

Our Amendment 87ZC takes forward the vision of specialist houses fully integrated into the health and social care system which was so comprehensively set out by stakeholders from across the housing sector in their evidence to the Select Committee. The quality of that evidence was commented on by the noble Baroness, Lady Jolly. There are numerous examples of inspiring best practice where housing is an integral part of care and support and service delivery. The Bill needs to provide the momentum for good practice to become embedded across all local authorities and health providers.

The evidence to the Select Committee from organisations across the housing sector cites inspiring examples of where housing, health and social care provision and support join up to provide integrated person-centred care. However, alongside this, there is huge frustration that progress across the country has been so slow and patchy. This is especially so when what stakeholders refer to as low-level interventions, which really make a difference, are often the services earliest to be cut back and dispensed with. The Anchor Trust, for example, described the determination to keep its service-level manager on site at one of its sheltered housing schemes because it made all the difference. The noble Lord, Lord Martin, made this point, too. Anchor said that, in its view, once the manager left, the next steps for elderly and frail people were usually into residential care. This was one of the many examples given of the consequences of not having housing-related support regarded as a key social determinant of health. I look forward to the Minister’s explanation as to why the Government have not ensured that this is fully reflected in the Bill.

Earlier, we heard the case from the noble Lord, Lord Best, and my noble friend Lady Wilkins for Amendment 81, supported forcefully by the noble Lord, Lord Rix, on the importance of including the promotion of housing provision in the duties of local authorities under Clause 3 to provide integrated services, and of ensuring that there are similar duties placed on the health service. Our amendment to Clause 6 complements this by reinforcing integrated joined-up working with registered housing providers, including

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housing associations and registered social landlords, and recognising these as key, relevant partners under the Bill.

The need to recognise housing as a preventive service cannot be overestimated or overemphasised. Schemes such as Midland Heart’s reablement service for the elderly or frail combine social care and housing association support to enable people to be discharged from hospital back to their homes quickly and help independence to be regained. They delay or prevent the need for more intensive care, reduce the likelihood of repeated hospital stays and can prevent avoidable accidents. Commissioners need to be encouraged to consider specialist housing, home-from-hospital services, housekeeping-related support and adaptations when designing preventive services. Housing is a crucial preventive service and Amendment 80 is important for ensuring that this is recognised in the Bill.

Amendment 88 is also important for ensuring that needs assessments include an assessment of housing options, as is Amendment 86, which underlines the importance of ensuring that local authorities provide information and advice for adults and carers on available housing options and the choice of providers available in the authority’s area. While in Amendment 87 we fully recognise the need for more specialist housing to be built to meet the needs of care and support, we would be cautious at the present time of putting this extra burden on local government when it does not have the resources or the means to deliver. It is the responsibility of national government to provide the £10 billion extra investment in infrastructure that the International Monetary Fund has called for to get the economy moving and make shovel-ready projects such as housing happen.

I am grateful to the National Housing Federation for its excellent briefing, and I refer to an example of integrated care and support it gives that was provided by one of its members, the housing association Look Ahead, for a psychiatric patient. It shows what can be achieved. Following a six-month stay in hospital, it had initially been intended that he should move to a residential care placement, but instead he was referred to Look Ahead’s rehabilitation service. The support that he received helped him with basic life skills, diet management and managing his condition. After 18 months, he had successfully moved to his own flat, had been able to reduce his psychiatric medication and had started a nursing diploma. This service, taking him from hospital to independence in his own flat in 18 months, was provided by successful joint working between the housing association, the local authority and the NHS trust, with an estimated saving of nearly £250,000 across the three services.

We heard, too, at our latest stakeholder group meeting yesterday about a successful jointly procured and delivered reablement centre in Liverpool that is funded by the local authority and the clinical commissioning group in respect of hospital discharge. The scheme provides two to three weeks of intensive occupational therapy and other key services, which doubled from 40% to 80% the percentage of patients who did not require a continuing care package after this initial support. However, we understand that in

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some parts of the country CCGs are expressing reluctance to enter into joint funding schemes with local authorities in case the health funding element is leaked into other council services, given their budget situations—literally, I suppose, into filling potholes or such like. Can the Minister tell us what steps are being taken to reassure CCGs about this potential barrier to providing integrated services?

As part of its oral evidence, Jake Eliot from the NHF said:

“Too often, the integration that occurs happens because service users, carers, providers and commissioners are working skilfully in spite of the system rather than because of it”.

This is something that the Bill can change effectively. I hope that the Minister takes these words to heart and accepts the amendment. It would ensure that the Bill recognises the importance of housing. It is important not just for well-being but for prevention, for the provision of advice and information in the assessment process and for ensuring that the overall quality of care is fully recognised.

The Parliamentary Under-Secretary of State, Department of Health (Earl Howe): My Lords, in tabling these amendments, the noble Lord, Lord Best, brings to the attention of the Committee the important role that housing plays in both care and support, and as a determinant of well-being. I have listened with care to the powerful contributions in support of them. Having done so, I begin with an observation that I hope is incontrovertible, which is that simply having a roof over your head will have a profound impact on your well-being. Having access to suitable housing for those with care and support needs plays a vital role in promoting not only their well-being, but their independence. The noble Lord, Lord Best, brought this point home very well. Properly taking into account the suitability of someone’s living accommodation could, for example, help to prevent a frail older person from falling and thus suffering the pain and trauma of broken bones and an unnecessary stay in hospital, the need for a greater level of care and support following discharge, and the costs of this to the public purse. It is vital that the system actively works to promote independence rather than waiting for people to reach a crisis point.

To reflect the importance of housing as a determinant of well-being, we have explicitly included the “suitability of living accommodation” in Clause 1(2), which sets out a list of things to which well-being relates and that the local authority is required to promote in performing its care and support functions. Furthermore,

“accommodation in a care home or in premises of some other type”,

is set out in the high-level list of examples of how to meet needs in Clause 8. Together, this means that the Bill ensures that housing is an integral part of care and support, where it is not general housing as excluded by Clause 23.

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In doing this, we are clear that local authorities are required to do several things. They must identify housing options that could prevent, delay or reduce needs for care and support under Clause 2(2)(a). They must

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shape the market for suitable and specialised housing under Clause 5. They must consider the suitability of living accommodation in a needs assessment under Clauses 9 or 10, by virtue of it being included in the list of matters in Clause 1(2) that must be considered as part of the assessment process. They must also give information and advice on suitable and specialised housing options, as well as housing adaptations under Clause 4, and integrate this with other housing information that they or another authority provide in their area.

In addition to the information and advice that local authorities are required to give under this Bill, they have duties under other legislation to give information and advice about housing in their local area. We would expect local authorities to align these information services in line with their duties towards integration in this Bill.

Before I move on to that matter, I will address the very interesting idea put forward by the noble Lord, Lord Campbell-Savours, that local authorities should share in any revenue from the homes of those moved into care. I shall certainly think about that. Some local authorities fund organisations to smooth the difficult process of moving house for older people whose homes have become unsuitable. In going further, while the noble Lord’s suggestion appears to have some merit, the preliminary advice that I have had suggests that there may be legal difficulties in local authorities gaining financially from such a service. However, I shall investigate that point further.

Joining up housing with care and support offers the potential to make measurable improvements in patient experiences and outcomes. Clause 3 requires local authorities to promote integration between care and support, health and health-related provision. This reflects the integration duty placed on clinical commissioning groups under Section 14Z1 of the National Health Service Act 2006, as amended. “Health-related provision” includes any service that may have an effect on the health of individuals that is not provided as part of the health service or local authority social services. This clearly and intentionally includes housing, thus creating a clear duty on both local authorities and the NHS to promote integration between care and support, health and housing.

To be able to meet needs in a joined-up and integrated way, multiple agencies must co-operate to ensure that care and support is properly co-ordinated. Clause 6 requires local authorities to ensure the internal co-operation of relevant officers, including housing officers, in delivering services relevant to care and support. As recommended by the Law Commission, the Bill places a reciprocal duty to co-operate on the relevant partners listed, all of which are public bodies with relevant care and support and carer’s functions at a local level. It also imposes a clear duty on local authorities to co-operate, as appropriate, with anyone involved in functions or activities relevant to adult’s care and support or carer’s support. This could include all relevant housing providers with which local authorities work.

The noble Baroness, Lady Emerton, asked what happens if there is resistance from local authorities to provide appropriate housing support. Clause 7 creates a duty to co-operate in response to specific cases.

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Through this, a local authority in its care and support functions could request the co-operation of the local housing authority in the case of housing an adult with needs for care and support. The housing authority would be required to co-operate with this request unless doing so would be incompatible with its duties or have an adverse effect on its functions.

The noble Baroness, Lady Howarth, pointed out that the degree of co-operation with local housing services varies by area. Of course, we recognise that there is local variation, but when areas respond co-operatively, fully involving housing as part of the solution, there can be manifest benefits to health and social care; for example, in the north-west of England, an initiative at Whiston Hospital arranges for adaptations to be made to an older person’s home, ensuring a safe and timely discharge after a fall or injury. With that in mind, my department is undertaking work with NHS England and stakeholders to form a compact that will identify and break down barriers to the integration of health, care and support, and housing. This is also linking housing to outcomes in the health, social care and public health systems.

The noble Lord, Lord Best, rightly emphasised how vital it is for housing providers to co-operate with commissioners and relevant partners in their local area. I agree, but we need to consider how best to achieve this in a meaningful and practical way. It is not our intention to impose new regulations on private, voluntary and third sector providers. Rather, we would expect local authorities to ensure that those who provide services on their behalf are required to co-operate through contractual arrangements.

The Government have shown their commitment to supporting joined-up and co-ordinated working by making £3.8 billion available for joint spending between the NHS and local authorities in 2015-16, which I mention particularly in response to points made by the noble Baroness, Lady Wheeler. She is right that there is anxiety about funds leaking out into wider local authority budgets. We believe that the arrangement we have proposed, whereby local services will have to demonstrate that the money they are going to receive will directly benefit the patient or service user in terms of their health or social care needs, will ensure that there is no leakage in that sense. By including within that joined-up fund the disabled facilities grant, which helps to fund adaptations that can support people to live independently in their own homes for longer, there will be a real incentive to drive integration between care and support, housing and health.

I hope I have reassured the Committee not only that the Government recognise the importance of housing but that the Bill makes it clear that access to suitable housing—including, where necessary, the provision of accommodation—is an integral part of care and support; and that, further, it creates a legal basis for integration and co-operation between care and support and housing more generally. I hope that the noble Lord, Lord Best, is comforted by all that and that he is content for the moment to withdraw his amendment.

Lord Best: My Lords, I am deeply grateful to all those who have participated in this debate, particularly the noble Baroness, Lady Wilkins, for coming in so

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supportively and giving us those really practical examples. It is astonishing that, in the case she mentioned, £50,000 a year was being saved, giving a much better life to Bruce, the tetraplegic she talked about. Big money is being saved in improving people’s lives, absolutely underlining the essence of what we are trying to do here. I am grateful to the noble Lord, Lord Rix, for bringing in the Mencap dimension so fully and reminding us of those old mental institutions, which the noble Baroness, Lady Emerton, was so instrumental in closing, and how housing was seen as the link that really mattered.

I am grateful to the noble Baroness, Lady Jolly, for pointing out how important the Joint Committee thought this to be. I know that members of that committee have not been happy that housing has not appeared in the Bill in the way that they had hoped when they produced their report.

The noble Lord, Lord Campbell-Savours, recognised that we have to find the money from somewhere. Sharing estate agents’ fees is a clever idea. The more likely one, I guess, is the transfer of resources from the NHS, because it is there that the savings are found and the two tie together so well.

The noble Lord, Lord Martin, emphasised the role of housing. He touched on central heating making such a difference to people’s homes, preventing bronchitis and emphysema and so on. When I visited the Care & Repair scheme in Leeds recently, staff told me that one of the most frequent causes of people having to go into hospital and of their homes being found totally inadequate was the fact that a central heating system that was 15 or 20 years old had fallen apart, and they did not have the wherewithal or the knowledge to replace it with a new boiler because that would involve a few thousand pounds. That one adaptation to the home alone would have made a huge difference to their health and well-being.

I am grateful to the noble Baroness, Lady Howarth, for emphasising that putting things in the Bill attracts the attention of the leadership of local authorities to their priority and importance. I am grateful also to the noble Baroness, Lady Wheeler, who emphasised what the Joint Committee on the Bill had said and how, since the previous legislation had gone through, we had seen very patchy take-up, with health and well-being boards and the rest, in recognising across the piece that housing is so important.

The Minister hoped that I would be comforted by the very full exposition that he gave of how there is the implication in so many places in the Bill that housing should be taken on board. I am sure that it is the intent of government that housing should be there; it is just a shame that it is so well hidden from so many of us. Although using the spending review’s £3.8 billion as a ring-fenced sum will require people to be more joined-up, including in relation to disabled facilities grants, and although the legal basis is no doubt in the Bill, it would be helpful if that was more overt and the Bill could make it a little clearer. We may want to return to this matter when we have heard about the compact that the Department of Health is working on, which would be very important if it emphasised housing in a fundamental way. For the moment, I beg leave to withdraw the amendment.

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Amendment 80 withdrawn.

Amendments 80A to 80C not moved.

Clause 2 agreed.

Clause 3 : Promoting integration of care and support with health services etc.

Amendment 81 not moved.

Amendment 81B

Moved by Baroness Wheeler

81B: Clause 3, page 3, line 41, at end insert—

“( ) In exercising its duties under this section, a local authority must have regard to the relevant joint strategic needs assessments and joint health and wellbeing strategies required under sections 116 and 116A of the Local Government and Public Involvement in Health Act 2007.”

Baroness Wheeler: My Lords, the amendment is supported by my noble friends Lord Hunt and Lord Beecham. I shall speak also to our Amendments 81C and 87ZZA, as well as to other amendments in the group.

As my noble friend Lady Pitkeathley showed last week, we on these Benches will never tire of banging the drum for the importance of integration of health and social care—and housing—from the point of view of patients, service users and their carers. Our amendments would include in Clauses 3 and 6 specific reference to the body that stands the best chance locally of making this happen: the health and well-being board. These clauses deal with integration and the duty of local authorities to co-operate with relevant partners. We also stress in respect of these clauses, and Clause 2 under our amendment in an earlier grouping, the importance of the Bill emphasising a joint responsibility for co-operation and collaboration between local authorities and relevant partners, such as NHS bodies in their area.

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We support the view of both ADASS and the Local Government Association that the Bill should include a specific duty on NHS bodies, equivalent to the duty on local authorities, to integrate services, enshrining this shared involvement in legislation.

Joint strategic needs assessments and joint health and well-being strategies should provide a strategic overview of how the health and well-being of local communities can be improved and how health inequalities can be reduced. The noble Baroness, Lady Jolly, suggested earlier that some health and well-being boards have got it and others have not. Amendment 87ZZA would ensure that they all got it, giving health and well-being boards powers in keeping with the duties that the Health and Social Care Act places on them. Amendment 87ZZA also adds health and well-being boards to the list of bodies between which the local authority has to ensure co-operation.

During the passage of the Health and Social Care Bill we argued strongly for health and well-being boards to be the bodies that play the lead strategic role in integrating services. Their role is pivotal to achieving

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integration. If they had been given the role of signing off CCGs’ plans, as we and other noble Lords argued, they would have both the power and authority to be the drivers of integrated care and joint budgets across health and social care and public health in their areas.

Joint budgets and ensuring that legislation and regulations support and enable their use across services, including housing, leisure and transport, are the key tool for making integration happen. That is why our independent commission on whole-person care will look at ways of bringing health and social care budgets together. As the shadow Secretary of State for Health announced to the Local Government Association last week, we are working closely with six councils that have agreed to be whole-person care innovation councils. These are Plymouth, Derbyshire, North East Lincolnshire, Lancashire, Islington and Gateshead—a good range of county, unitary and metropolitan councils from different parts of the country. These innovation councils will help to develop and test out the commission’s proposals. We will certainly want to explore how health and well-being boards are developing and how they can be given teeth to do the job that we want them to do.

As my noble friend Lord Hunt stressed in our recent response to the CSR, we welcome the announcement that an additional £2 billion a year from the NHS budget will be joined up with local government health and social care services to help to deliver care. Pooled budgeting was a Labour idea in 2009 and the integration of health and social care is the narrative of our whole-care commission. However, how does it sit with the CSR’s cut of 10% to local authority budgets? Will the £2 billion transfer be ring-fenced? What are the Government doing to tackle the crisis in health and social care that is happening now?

I also support, as part of this group, the intention behind Amendment 87ZB in the name of the noble Lord, Lord Rix, in support of his later proposals on safeguarding adults at risk of abuse and neglect. Clause 6(6) specifies the relevant partners of local authorities, including county and district councils, each NHS body, the police, prison and probation authorities and others specified in regulations. Amendment 87ZB would ensure explicit reference in the Bill to the providers of services being the relevant partner—that is, those which have been commissioned by the authority to provide care and support or other services as part of the individual’s care plan. Subjecting such providers to the same duty to co-operate as other bodies and services specified in this clause will improve accountability and bolster safeguarding and have a major impact in cases where someone has experienced, or is at risk of experiencing, abuse or neglect. We know all too well that, in a number of prominent cases, providers have blocked or impeded safeguarding proceedings by failing to co-operate on request. The refusal of Winterbourne View providers to share information for the serious case review is a stark and serious example of failure to be held accountable for appalling levels of abuse and neglect of vulnerable adults.

Finally under this group, I support the amendments to Clause 6 and Schedule 3 in the name of the noble Baroness, Lady Greengross, which list the purposes for which local authorities undertake their duties.

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These include promoting well-being, improving the quality of care and support, safeguarding and, importantly, identifying lessons to be learnt where there is abuse or neglect and applying these lessons in the future.

The noble Baroness’s amendment is right to specify under these clauses the importance of ensuring the early and co-ordinated assessment of an adult with care and support needs following discharge from hospital or other acute settings. Of course, there are many examples of both good and bad practice in this regard, and we heard about them during the earlier debate on housing. With good practice, you will often find a very comprehensive discharge policy in place and the decision being followed or adhered to.

From the point of view of long-term health needs, if you talk to patients and their carers, as I do regularly as a trustee of our local carer support voluntary organisation, they will often cite the hospital discharge process as the next most traumatic experience after the patient initially becomes ill. Often, people with long-term health conditions and their carers are completely new to the social care system, and discharge takes place into an unknown world of agency and voluntary sector providers of services and equipment, and primary and community care involvement. The good practice examples, where patients and carers are involved in and understand the homecare plan, meet the people who are going to help to deliver it and have a full picture of how GP and other community services will support them, stand out. However, with the current staffing and budget pressures on both hospitals and local authorities, the discharge processes all too often become a “fingers crossed that everything comes into place” process.

It is very important that the assessment and care plan are in place before discharge from hospital. Discharge from hospital and other care settings is a period of extreme concern for large numbers of patients and carers. Ensuring that there is an early and co-ordinated assessment of the adult’s and carer’s needs in the community and that a care plan is in place before the discharge is fundamental to the subsequent delivery of good-quality care and support, and I hope that the Minister will recognise the importance of the amendment.

In conclusion, we come back to the importance of underlining integration at every opportunity, and I look forward to the debate.

Baroness Greengross: My Lords, I rise to speak to my Amendments 87ZA and 104A. I thank the noble Baroness, Lady Wheeler, for what she said and I heartily agree with her.

We read far too often about frail older people blocking beds in hospital wards and, apparently unintentionally, making the health service very difficult to function properly. However, they are there due to inadequate planning. These two amendments are intended to try to ensure that the discharge process is started when somebody goes into hospital—that is, right at the beginning of their stay in hospital.

We all have experience of very poor practice. My personal experience is of a 94 year-old who was admitted to a London hospital as an emergency and therefore arrived in pyjamas and with bare feet. He was returned

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home in pyjamas and with bare feet in the late evening in winter. He had to cross a grassy patch, go into his block of flats and up a flight of stairs in that condition in order to reach his home. There was no planned process to look after him. That sort of thing is totally unacceptable. The aim of this Bill is to stop that sort of practice and to make sure that it does not happen in the future. I think that all your Lordships feel the same about this: we have to get it right. As I said, I feel that the discharge plan should be initiated when someone is admitted to hospital and it should be used as the template for the discharge, when it occurs.

I declare an interest as chairing the All-Party Parliamentary Group on Dementia. We know from one of the inquiries that we have carried out that most frail older people who go into hospital have comorbidity—that is, they have more than one condition. If they have gone into hospital for a fractured femur to be fixed or for some other physical condition to be dealt with, they will stay in hospital for much longer if they also have, for example, dementia. They stay in hospital longer partly for the same reason: that no plan has emerged to look after them when they come out. It is very bad for them to be in hospital and it is bad for all the other patients as well, for obvious reasons. We need to ensure that the local authority and relevant partners know about the special conditions of a patient to get the planning right. We need to ensure that special care and support needs are taken into account long before they leave hospital. That is the reason for those two amendments, which I very much hope that the noble Earl will accept as part of good practice.

Lord Rix: My Lords, I wish to speak to Amendment 87ZB, so wholeheartedly supported by the noble Baroness, Lady Wheeler. It would add providers of relevant services to the list of relevant partners of the local authority. The amendment lays the foundation for a number of amendments which I have tabled in the safeguarding section of the Bill, which will be taken later. There has been widespread concern that the mechanisms and procedures in place to safeguard adults at risk of abuse or neglect are totally inadequate.

Time after time, we have witnessed how processes have failed or safeguarding has not been taken seriously, which has led to serious consequences for people with a learning disability. For example, there is the death of Francesca Hardwick and her mother Fiona Pilkington, the murder of Steven Hoskin, and more recently, the abuse scandal at Winterbourne View. There have been a number of prominent cases where the provider has failed to co-operate in providing information on adults at risk or where cases have occurred such as that reported in the aftermath of Winterbourne, where the provider declined to share information for the serious case review and there was no requirement on it to do so.

The amendment is therefore intended to add providers as relevant partners, so that they are in the frame for further amendments to the safeguarding part of the Bill in Clauses 41 to 46. When we talk about providers, I am referring to those who are providing a service which has been commissioned from a person's care

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plan, such as care and support or education services. Although I appreciate that regulations will set out other relevant partners, we feel that providers should be named explicitly in the Bill. This will emphasise the importance of the provider of services being subject to the duty to co-operate and will bolster the safeguarding process accordingly. I look forward to hearing the Minister’s thoughts on the matter.

Lord Sutherland of Houndwood: My Lords, I give particular support to the amendment proposed by the noble Baroness, Lady Greengross, for two reasons. First, we all know from a passing acquaintance with hospitals either in our own or relatives’ cases that they are large and complex organisations. Unless a proper assessment is made early on after someone’s entry to hospital needing care, the entry will not be recorded. If it is not recorded, you can be sure that those responsible for the discharge of the individual will not have been present when the assessment was made.

The complexity of the system is such that that is how it is—would that it were better and, doubtless, it can be better, but the reality is that unless a proper assessment is made and recorded, those discharging someone from hospital will not be able to specify adequate provision. In education, we all talk about added value. That concept has a place in hospitals. What will be the added value that will allow a proper discharge and will, in that process of discharge, ensure that the patient in question will not return early to hospital? That is the second reason for supporting the amendment of the noble Baroness, Lady Greengross. The research that I have seen indicates that where inadequate care is provided—that includes care plans not made at the point of discharge—the individual is many times more likely to find themselves back in hospital within the month. It so happens that I have seen research related to intensive care units, where you might expect that to be even more prevalent, but it applies across the board. To be sure that the care is right is to be sure that the care plan is right. My argument in supporting these amendments is that that has to include an assessment at the beginning. It helps, too, when a patient is moved to another more specialised hospital. That happens quite often as the investigations take place, so there is a great need for this.

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Baroness Barker: My Lords, I wish to speak to Amendment 82A, which is in my name in this group, and to support the amendments in the name of the noble Baroness, Lady Greengross. For well over a decade, we have had evidence that the recovery rates for people being discharged from hospital during the week, through to people being discharged on Friday, vary enormously. There has been evidence in abundance for the past decade that the failure to integrate care plans for people leaving hospital with community services leads to their readmission into hospital as an emergency—and in some cases, to their death. All the factors that contribute to that should not be news to anyone who has ever read about delayed discharge.

At the heart of our failure to really look after older people who go in and out of hospital is not just the failure to carry out assessments at the proper time but

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the failure to share that information with all the relevant people along a care pathway. It has been interesting, particularly over the past year, to begin seeing something of a change taking place both in health and social care. One of the driving factors behind that are the shared outcomes frameworks to which health, adult social care and mental health now have to work. The fact that we have the five overarching domains and that each of them is working to performance indicators below them is beginning to have a real influence, not just on high-level strategic planning but on front-line work.

We have always known that there have been excellent examples of integrated care. Where care works well, it works fantastically well and where it does not, it is just a disaster. The trouble is that we can never really pinpoint and identify where that will happen, other than that the systems that work well are always those which have the patients at their heart, involved in the planning process as well as being recipients of care.

My Amendment 82A is prompted, as I think noble Lords will know from last week, by the Christian Scientists—the people who, as part of their belief system, wish it to be known that their care should not involve medical treatment because that is incompatible with their beliefs. Beyond that small group of people, whose beliefs I do not share, it is important to register in all this that when we are building systems that assess the needs of older people there has to be within them a point at which older people can dissent, particularly if quite forceful medical decisions are being made about their care. Sometimes we get incredibly enthusiastic in our support of doctors and manage to let that take things over completely.

The noble Baroness, Lady Greengross, has highlighted the key points that we need to focus on because, at the end of the day, integration depends entirely on all the different care providers in the pathway working to common information. If we cannot start now to develop those systems, we will not achieve what has proved for so long to be that elusive solution to integrated care.

Baroness Wall of New Barnet: My Lords, I also support all these amendments, particularly in relation to the previous discussion of getting older people out of beds that they are blocking, as I think the noble Baroness, Lady Greengross, put it. That is perhaps an inappropriate word but, in reality, those are the facts. The care plan that everybody has talked about is important, and hugely effective when it works. I have to admit that in my own hospital—I declare my interest as chair of Barnet and Chase Farm Hospitals Trust—it does not always work. Very often, the breakdown with the local authority can come from the start of the agreement on a care plan—what will happen to the individual, how many X-rays they will have, where they will go at the end and so on.

One of the good things in the new system—there are several—is the CCGs. The relationship between clinical commissioning groups and local authorities is proving, in the very short time that it has been working in my area, effective. The more pressure on commissioners in terms of getting hospitals running better, the more interest they have in making sure that local authorities

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are doing their bit as well. That partnership, in my view and my experience of the past months, has been working much better, which, for us, is a very good thing.

Baroness Gale: My Lords, I will speak to Amendments 92ZZEA and 92ZZEB. Clause 22 is titled:

“Exception for provision of health services”.

Subsection (1) is crucial, as it sets out the legal test for when NHS continuing care or registered nursing care should be provided and when the means-tested social care system may lawfully provide for nursing care.

Recently, I have been listening to people give evidence to the APPG on Parkinson’s, which I chair and which has been conducting an inquiry into NHS continuing care. Listening to the witnesses, it has become very clear that there are often lots of problems with the health service and social care services arguing over funding. People are having difficulty accessing continuing care under the NHS and have to get over lots of barriers. It is quite heartbreaking to hear the problems that people are having.

The wording of Clause 22 still carries a potential risk for those who self-fund their care. There are various provisions in the clause that allow local authorities to arrange for health services that should be provided by the NHS. Once councils start delivering healthcare, when they traditionally used to deliver means-tested and chargeable social care, there is a risk that someone—somewhere in the system—will mistakenly conclude that the council can charge for those services. There is a need to ensure that self-funders are not exposed if they are found to be eligible for NHS continuing care, or registered nursing care, and the package of delivery is with the local authority. These matters were raised by the Joint Committee scrutinising this Bill but have not yet been addressed.

In legal terms, local authorities are prohibited from providing anything authorised or required to be provided under the NHS Acts. This means that social services cannot provide care home accommodation if a power or a duty to provide the accommodation exists under any of the NHS Acts. Clause 22 has narrowed this down to just “required”, for example by omitting the “power” or authorisation provision. That leaves local authorities able to provide accommodation that the NHS has a power to provide. I believe that disputes and confusion have occurred between councils and the NHS over continuing care, and this seems to be a recipe for more. The Bill should be amended to prohibit local authorities providing a service or facility that is authorised or required to be provided under the NHS Act 2006.

My amendment would mean that local authorities would be prohibited from providing health services that are authorised or required to be provided under NHS Acts. My aim is to make it clear who can deliver what, so as to avoid self-funders being at risk, however small that risk might be, of having to pay for care that they should be getting free.

Clause 22(4)(a) also states that a local authority may, despite the prohibitions, arrange for care home accommodation with nursing care if it has consent to do so from the clinical commissioning group. This may also put self-funders at risk of being charged for services that should be free.

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These amendments would introduce an explicit clause that sets out that, where a local authority provides services on behalf of a clinical commissioning group, the authority may not recover the cost from the individual whose needs are being met. I trust I have set out clearly why these amendments are needed and I hope that the Minister will agree with me.

Earl Howe: My Lords, it is vital that care and support, health and other services are joined up, as this offers the potential to make measurable improvements in individuals’ outcomes and experiences of care and support. Clause 3 places a duty on local authorities to carry out their care and support functions with the aim of integrating services with those provided by the NHS or other health-related services such as housing. Amendment 81C, tabled by the noble Baroness, Lady Wheeler, raises the issue of co-operation duties on the NHS; I have no issue with that sentiment. Clause 3 is intended to reflect the similar integration duties placed on NHS England by Section 13N, and on clinical commissioning groups by Section 14Z1 of the National Health Service Act 2006, in the context of this Bill.

Clause 6 imposes a general duty to co-operate between the local authority and other relevant authorities that have functions relevant to care and support. Clause 7 supplements this by creating a specific duty to co-operate in individual cases.

Clause 22 sets out the limits on what a local authority may provide by way of healthcare and so, in effect, sets the boundary between the responsibilities of local authorities for the provision of care and support, and those of the health service for the provision of healthcare. Our intention is to replicate the effect of the current prohibitions on what a local authority may provide by way of healthcare, which are imposed under Sections 21 and 29 of the National Assistance Act 1948 and Section 49 of the Health and Social Care Act 2001. This is a matter eloquently raised by the noble Baroness, Lady Gale, in tabling Amendments 92ZZEA and 92ZZEB.

The word “authorised” in Section 21 of the 1948 Act has resulted in much confusion and case law. The intention behind Clause 22 is therefore to simplify the language and to make the boundary clearer without moving it. Make no mistake: where nursing care is being funded by the health service, it will continue to be unlawful for a local authority to recover the cost of this from the individual. It is the relevant clinical commissioning group that would be responsible for this cost.

On Amendment 82A, I wholeheartedly agree with my noble friend Lady Barker that no one should be given medical treatment or be medically assessed against their wishes where they have capacity to make such a decision. I hope that my noble friend will be reassured that the existing legal position and clinical practice is clear on that point.

Amendments 87ZZA and 81B were, again, spoken to by the noble Baroness, Lady Wheeler. The prominence of health and wellbeing boards will be strengthened through their role in signing off the joint plans that are required as part of the £3.8 billion pooled fund between local authorities and the NHS to support joined-up and integrated working. The need for local commissioners

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to engage with their health and wellbeing boards is made clear through their composition, which includes the director of adult social services, the director of children’s services, the director of public health and a representative of each relevant clinical commissioning group. The duty to co-operate already applies to these health and wellbeing board members.

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Section 116B of the Local Government and Public Involvement in Health Act 2007 requires local authorities and clinical commissioning groups to have regard to the relevant joint strategic needs assessment and joint health and well-being strategy in exercising any of their functions. This includes their duties to co-operate and promote integration.

On Amendment 87ZB, I agree with the noble Lord, Lord Rix, that it is important that providers co-operate with commissioners and relevant partners in their local area. However, public law cannot create an enforceable legal duty on private, independent or voluntary providers to require this. We expect local authorities to ensure the co-operation of providers through the contractual arrangements they make with them.