Clause 46 - Care Trusts where directed partnership arrangements
Health and Social Care Bill
12:00 pm
Mr Philip Hammond (Runnymede and Weybridge, Conservative)
Before lunch, I drew a distinction between clause 45, which provides for an evolution of care trusts from the partnership arrangements first introduced in the Health Act 1999, and this clause, which provides for compulsion in that regard.
It is fair to say that the power to remove a function of a democratically elected body, take control of a slice of that body's budget, including locally generated council tax funding, and allocate it elsewhere, possibly directing it in support of a centrally funded and controlled service—the national health service—is a serious step. Despite the Minister's rhetoric of co-operation and partnership, which we heard today and during previous discussion of arrangements for co-operation between NHS and local authority bodies, it is, in effect, the exercise of brute power—the Secretary of State using his power under the Bill to re-allocate tasks from one body to another, as well as the budget that supports them.
An interesting exchange took place this morning about the Government's dilemma and their thinking on these matters. The Minister, of course, wants the arrangements to be entered into voluntarily. Indeed, he told us that they should be voluntary whenever possible. He also said that the one-size-fits-all approach did not find favour with him, and that flexibility is necessary, along with a recognition that different solutions will recommend themselves in different situations.
The undertone of the Minister's comments was that, if the Government regard something as a good idea, there is a moral obligation to roll it out. Clearly, a tension exists between the assertion that voluntarism is to be the main principle, and the assertion that there is an obligation to push forward measures that the Government think are a good idea.
If I may hark back to a couple of years ago, when a Committee debated primary care groups and primary care trusts, and a great deal of time and energy was expended on discussing the degree of pressure that would be applied to primary care groups to take on primary care trust status. Nobody questions that primary care trust status may be a good idea for some primary care groups. I concluded from those discussions that the Government's view was that there should be a genuine mixed economy of primary care groups and primary care trusts, and that some arrangements would suit some areas, while other arrangements would suit other areas. The assurances given by Ministers satisfied us that that was a sensible approach—that there would not be a push for a one-size-fits-all model. It was a nice soundbite.
However, two years later, inexorable pressure is being put on primary care groups to move towards the primary care trust model. The Government have clearly stated their preference for that model. When I heard the Minister saying that care trusts would be a model, but not the only model, I wondered whether, in two years' time, we will find that the Government are putting so much pressure behind their preference for care trusts that they will become, in practice, the model to be followed. We are worried that the Secretary of State will have powers under the clause to oblige movement to a primary care trust or directed partnership arrangement.
The pernicious thing about this measure is that the Minister is absolutely right: the Secretary of State will not have to use the powers under clause 46, except perhaps in extreme cases-of course he will not, because the mere existence of those powers means that he is unlikely to have to use them. When an unarmed man walks up to a man holding a machine gun, the chances are that the unarmed man will do what the man with the machine gun wants him to do without him being obliged to use it.