Question proposed, That the clause stand part of the Bill.

Dr. Francis: On Second Reading, the Minister announced his intention to introduce directions under section 28 of the Health Act 1999, which he hoped would deal with some of the issues raised by clauses 2 and 5 of my Bill. I am grateful to him for that, as I have been able to consider whether to accept his proposal to leave out those clauses, which are vital for carers. I have received warm support for clause 2 from the Association of Directors of Social Services.

We all know how important the planning of information and the involvement of health bodies is to carers, and we are all familiar with the statistics about how caring has an impact on carers' health. Given that carers save the state a staggering £57 billion a year, we cannot afford, economically, for that relationship to break down. I am reassured that the directions will achieve some of the principles that my Bill set out to achieve.

I understand that the Minister is concerned that clause 5 duplicates existing legislation, and I think that the directions provide an important compromise. Although they do not achieve everything that I set out to achieve with clause 5, they do come close. I welcome the fact that they are clearly worded, and I know that certain organisations in England will also welcome such clearly worded secondary legislation. The Welsh Assembly will also consider the Bill in relation to the directions, but that, of course, is a matter for it.

Dr. Ladyman: The carers' strategy identified the fact that information plays a key role in supporting carers. Information should be available as early as possible—we will discuss the importance of that when we debate later clauses—and I appreciate that my hon. Friend's intention when he originally drafted the Bill was that clause 2 should provide the planning structure to ensure that information is delivered.

The concept that local authorities and NHS bodies should work together to provide carers with information about their rights and benefits is well established, but the NHS has been much slower to recognise the role of carers. An obligation on local authorities to work with the NHS to provide such

information would support the intention laid out in the carers strategy and would certainly reflect best practice. Nevertheless, I still have some concerns about the clause. Its wording suggests that the intended outcome is to prepare a strategy in co-operation with NHS bodies. I have two concerns about that.

First, the existence of a strategy does not mean that carers would have access to the relevant information, and it is important that any obligation imposed by the clause should have the effect of getting information to carers. To begin with, the clause appears to be about an information strategy and the responsibilities of social services authorities with respect to carers, but it ends up imposing duties on all local authorities to develop an information strategy about promoting carers' health and well-being.

Secondly, and perhaps of greater concern, community strategies are not the appropriate vehicle to ensure that authorities consider the issues that the Bill addresses. As I said on Second Reading, central Government should not and must not be over-prescriptive or dictate to councils what the form and content of their community plans must be. Councils must be able to make strategic decisions about what best suits their populations and to respond to individual needs.

Finally, the duty is to act in co-operation with NHS bodies, but it is unclear whether that also imposes an obligation on NHS bodies to co-operate. If so, it would be necessary to specify both which NHS bodies were intended and what the NHS had to do with education, training and leisure opportunities. Local authorities already have duties to participate in the preparation of local delivery plans. The key is to ensure that the NHS starts to consider the needs of carers in its planning. To that end, the Department has been looking to the most appropriate way of ensuring the participation of health bodies. In our opinion, using the existing powers in NHS legislation is the most appropriate method.

To that end, we have developed a consultation draft of directions, with regard to the inclusion of carers' issues within the primary care trust planning process, under section 28 of the Health Act 1999. Although the proposed directions on which we shall go to consultation are not part of today's debate, I have taken the liberty of putting copies of them on the Table. Members of the Committee may look at them if they so wish.

The aim of the directions is to establish a planning mechanism at PCT level to ensure that local bodies recognise that they have a role in supporting carers in the broadest context, with consideration of delivery of information and support to carers.

PCTs will have to take into account the health needs of carers and consult the director of social services and other bodies about delivery of support for carers when preparing or reviewing any plans. That fact is key to raising the profile of carers. The requirement will mean that the health service will consider carers in its overall planning process, but

without dictating in detail the terms and the mechanism. The provision will also promote an open dialogue between the health service and colleagues in councils. Moreover, it will place only negligible financial demands on the NHS, since the obligation will be to consider carers within the normal process of planning.

The intention is to make those directions available to stakeholders for consultation, both in hard copy and on the Department's dedicated carers website. That will be announced in the chief executive's bulletin and through the carers networks. We would welcome comments on the draft directions from the Committee and through the consultation process.

The National Assembly Minister for Health and Social Services will consider the need for directions in Wales, and a decision will be reached in the light of existing planning guidelines on local health, social care and well-being strategies, after discussion with organisations representing carers in Wales. Clearly, however, that is a matter for the National Assembly and Wales, not for me.

Mrs. Browning: Will the Minister provide some clarification? We are all grateful that he has circulated the draft paper today. There are some cases where social services are not the lead authority in day-to-day contact with the person whose needs are being met by the carer. I am thinking in particular of people with mental health problems, such as people on the autistic disorder spectrum, who may be in direct contact with a community psychiatric nurse instead of a social worker. Such cases would come under the health umbrella rather than the social services umbrella.

The Minister's recommendations on improving the way in which the health service looks at carers' needs are not quite the mirror image of what the Bill requires social services to do for carers—that is, what a PCT would also have to adopt, under conditions of equality between the two services, which one would presumably expect. Can he reassure me on that point? Multi-agency conferences are not always held to deal with the needs of the person being cared for and the carer. If it was a health-related responsibility along the lines that I have suggested, would the recommendations and guidelines to PCTs mirror the social security requirements that we have talked about so far?

Mr. Goodman: Further to my hon. Friend's comments, what the Minister said in relation to the directions straddles clauses 2 and 5—he referred to both clauses. He explained why the Government were unhappy with the idea of local authorities and health bodies being obliged under clause 2 to promote carers' health and well-being in their community strategies. I have a couple of brief questions in relation to clause 5.

Clause 5 identifies national health service bodies and local authorities. The new directions are narrow. They seem to apply solely to PCTs, and not to other health bodies—the point made by my hon. Friend the Member for Tiverton and Honiton (Mrs. Browning). They seem not to apply directly to local authorities, although I expect the Minister will say that they are

covered in the directions and that he wants to place a duty on PCTs. Clause 5 also contains the words

''to promote and safeguard the health and welfare of carers in England and Wales.''

It presumes that health and welfare are not identical. The directions refer only to health, so he might want to explain why he did not include welfare.

Mr. Andrew Turner (Isle of Wight) (Con): May I extend slightly the questions asked by my hon. Friend the Member for Wycombe, and ask whether the paragraph to which he referred should include ambulance trusts? My local NHS trust is one of only two that are integrated with an ambulance trust. Carers have an important role for patients travelling by ambulance. We recently commissioned a jumbulance, an ambulance that can carry three patients and an equivalent number of carers, to transport patients to the mainland. I wonder whether that is adequately covered by the new provisions.

Mr. Burstow: On clause 2, will the Minister elaborate the thinking behind the substitution of the directions? The direction deals with PCTs; as a commissioner, I can understand how that picks up ambulance trusts and other organisations. However, I am puzzled that the original intention was to ensure that local authorities should promote the economic and other well-being of their communities, because that general duty is already provided for in statute. I do not understand why it is felt inappropriate for the legislation to provide a clearer duty on local authorities, in partnership with other agencies, first and foremost to identify carers in order to provide them with information. Will the Minister explain why it is inappropriate to seek to place such a duty on local authorities, yet, in the new devolved NHS, it will still be appropriate to place such a duty on PCTs?

Dr. Ladyman: I shall answer those questions as best I can. I stress that the directions that we have tabled—they are not formally the subject of this debate—are a draft version on which we intend to consult. Hon. Members have suggested some good changes to the wording of those directions. I shall ensure that the official record of today's proceedings becomes part of the consultation process on the directions. I am sure that hon. Members will have other views on how to improve them in the fullness of time.

It is important to stress that the directions are made under section 28 of the Health Act 1999, so they can state only what that allows—it defines the boundaries that the directions can encompass. With that proviso, I assure the hon. Member for Tiverton and Honiton that the concerns that she raised will be considered.

Hon. Members are being slightly unfair in asking why the directions, and the Government's approach, do not go far enough, and also in suggesting measures that were not in the Bill. They really cannot criticise me because the draft directions do not do something that the Bill itself never intended. They may be good ideas, to which we shall return, but they are not within the scope of the Bill.

Were we to agree to clause 2, it would add £7 million to local authorities' costs in producing strategies that would not help carers. I suspect that

carers would want that £7 million to be spent on something more constructive than people writing plans to fulfil unnecessary objectives. Clause 2 should not stand part of the Bill. The Government directions will go a long way to ensuring that PCTs live up to the obligations to carers that we want to impose on them. The new clauses that we have tabled, and the directions, will achieve all the objectives that my hon. Friend the Member for Aberavon intended for clause 2 when he first introduced his private Member's Bill.

I hope that the Committee will reject clause 2.

Dr. Francis: In the light of the Minister's reassurances and observations, I am happy to withdraw my support for clause 2 and I urge the Committee to do the same.

Question put and negatived.

Clause 2 disagreed to.