Clause 46 - Care Trusts where directedpartnership arrangements

Part of Health and Social Care Bill – in a Public Bill Committee at 12:15 pm on 6 February 2001.

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Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health) 12:15, 6 February 2001

It may be helpful to the Committee if we start our discussion about the amendment with a few observations about the structure and nature of the clause. As the right hon. Member for North-West Hampshire will be aware, subsections (1), (2) and (3) of clause 46 are about directed partnership arrangements and subsection (4) is about the step that the Secretary of State might want to take to establish a compulsory care trust. The problem that we are trying to address, which is the failure to deliver an adequate level of service, can be addressed in one of two ways: either by a directed partnership arrangement under the Health Act 1999 or, if the Secretary of State so wishes, by the establishment of a compulsory care trust.

The right hon. Gentleman will have had an opportunity to read the Government's briefing note in which we try to put some flesh on the bones of our thinking on the clause. We make very clear the circumstances in which we would expect to take steps to establish a compulsory care trust. We use the expression that it would be established ``as a last resort''. I hope that that is an important clarification for the right hon. Gentleman.

The hon. Member for Runnymede and Weybridge talked about the arbitrary nature of the powers in clause 46 and expressed his concern that they could be used arbitrarily by the Secretary of State. That is not the case. We have debated similar issues on many occasions and he will be aware that the Secretary of State is not allowed to act arbitrarily. There is a framework of public law and general principles of law that makes the method by which the Secretary of State is expected to reach such decisions and conclusions quite clear. There is no suggestion, either in the Bill or in what Ministers or the Government have said in the NHS plan, that those general principles—the need to act fairly on the basis of evidence, and so on—will in any way be supplanted by what is proposed in clause 46.

It is very important, for my hon. Friends at least, that the Committee should understand that this is not—to use the expression of the hon. Member for Sutton and Cheam—using a sledgehammer to crack a nut. I ask hon. and right hon. Members to ask themselves why would we want to do that? We clearly would not. We want to develop the policy about care trusts in a sensible and reasonable fashion.

The right hon. Member for North-West Hampshire asked me to change my vocabulary and I am trying to do so. Let me reassure him, too, that this is not a smoke and mirrors operation whereby we shall effectively be able to use clause 46 to establish care trusts compulsorily across the country. If the hon. Member for Runnymede and Weybridge had looked at the Bill carefully he would know the answer to that question. He might want for his own reasons to be seen to be opposing clause 46; but I can reassure him that the clause has nothing whatever to do with any suggestion that the Government's policy is to use the provision universally to require the establishment of care trusts. That could not be done because, notwithstanding the Opposition's amendments, a clear set of preconditions needs to be established before the Secretary of State can use those powers; and those preconditions would have to be complied with to the letter before he could act.

The purpose of clause 46 is to ensure that the Secretary of State can intervene if service users are being failed, and if the integration of NHS and social service functions would improve the outcome for them. The Secretary of State needs to be able to act, and the words ``any of'' are important in allowing us to target that intervention to the benefit of the user.

The aim of social services is to provide a package of care to support older people and enable them to live independently within the community. If one element of that package—perhaps the home help service—fails to deliver the appropriate high-quality service, and if social services fail to monitor and review that provision, those people could be at risk and their ability to live at home compromised. If it becomes clear that it is not a one-off problem but a consistent failure of function, it would be the Government's duty to intervene. It would be sensible to use the intervention power in relation to that failing service. We need to be able to target the direction power, and we can add other functions if necessary.

The amendment would not limit the breadth of the new power. For local authorities, clause 46(3) limits intervention to a failure in social services. However, the words ``any of'' serve a crucial purpose. They make it clear that the Secretary of State can intervene when there is a failure of any health or social services function. Removing those words would cast doubt on that power, and might limit the intervention to cases of failure in all of a local authority's social services functions, or all of a primary care trust's health functions.

We are not using a sledgehammer to crack a nut. We shall be specific. We need to ensure that the package that is delegated is capable of being improved, and that it is not put at a disadvantage by being isolated from related services. That point is covered in subsection (2), which we seek to clarify with an amendment that I hope will have the support of the right hon. Member for North-West Hampshire.

Finally, I turn to the functions of the NHS and social services as set out in the partnership arrangements under the Health Act 1999. Amendment No. 259 attempts to build a detailed package around the need to intervene when services are failing. The right hon. Gentleman probably knows that we already have appropriate mechanisms to identify failure. They include performance management, monitoring, inspections and reviews. Those mechanisms will provide evidence to show when it is appropriate to use those powers. The usual process of enabling a body to improve its services through special measures will be allowed; but the direct use of the power may be required.

Clearly, if patient or client safety is an immediate problem, action may need to be taken more swiftly. It is not necessary to construct a new set of arrangements and begin the proliferation of new processes of review. The powers are intended to build on what already exists and not to replace other models of intervention. They are designed to give us the additional and valuable option to direct the use of the partnership arrangements. We shall therefore act if there is evidence of failure, using existing mechanisms to allow us to come to a decision, and we shall act in a reasonable manner. When intervening, we shall consider the best options to improve services for the benefit of all our constituents.