Health and Social Care Bill

My Lords, the amendments concern the issues of integration and advice, and in particular the use of arrangements under Section 75 of the National Health Service Act 2006 between the authorities and clinical commissioning groups. Section 75 arrangements would effectively be a means for CCGs and local authorities to work together in an integrated manner, often to commission health and social care services. The Bill contains a number of provisions to encourage and enable the NHS, local government and other sectors to improve patient outcomes through more effective co-ordinated working. It provides a basis for better collaboration, partnership working and integration across local government and the NHS at all levels. Health and well-being boards will have a strong role in promoting joined-up commissioning between health, public health and social care. Through their duty to promote integrated working between commissioners, they will also be in a good position to be able to promote more integrated provision for patients, social care service users and carers. They will also be able to encourage close working between commissioning of social care, public health and NHS services and aspects of the wider local authority agenda that also influence health and well-being, such as housing, education and the environment. Through statutory guidance on preparation of the joint health and well-being strategy and the Government’s mandate to the NHS Commissioning Board, we will be encouraging lead commissioning and integrated provision. Section 75 arrangements are an effective means of enabling local authorities and the NHS locally to align and pool budgets, as well as share other resources, such as staff, goods and services, for a wide variety of functions, to meet the health and well-being priorities of the local population. CCGs will sometimes, rightly, want to enter into these arrangements but there will be other times when they will not. The NHS Commissioning Board, under its existing duty to encourage CCGs to enter into Section 75 arrangements, could decide to include guidance on the matter in the commissioning guidance that it must publish for CCGs and to which CCGs must have regard. Our strong view is that commissioners, who are after all ultimately concerned with improving health and social care outcomes rather than focusing on working arrangements, must be allowed the ultimate discretion to decide which arrangements are the most appropriate under differing circumstances. That is why we do not intend to mandate integrated working or to specify the form in which integrated working should take place. Approaches to commissioning and delivering integrated care will be dependent on local circumstances and, as such, we do not wish to force organisations to follow a fixed model of integrated working. CCGs are already under integration duties in their own right, and as members of health and well-being boards they must co-operate with the health and well-being board in the exercise of its functions, which will include duties in relation to encouraging integrated working between commissioners of health or social care services. The Bill sets out a minimum membership for health and well-being boards but one that can be added to by either the local authority or the health and well-being board. We recognise that local authorities and the boards themselves will want to draw sensibly and flexibly from a range of expertise in addition to the minimum membership outlined in the Bill. It is important to be clear that the purpose of this policy is not primarily about setting up a committee but about stimulating effective joint working for and with local people and communities. The health and well-being board will be central to this joint working but it must not represent its limit. We know that a large number of local areas are already working with all the relevant stakeholders to explore and agree how they can work together in the future to make the biggest difference to local people so that everyone, whether that is district councils, clinicians, local providers or the voluntary sector, can contribute in the most appropriate way. That is something that is best left to these conversations rather than being prescribed in the Bill. Finally, the duty in new Section 14V to obtain appropriate advice is related to the definition of the comprehensive health service and is itself deliberately wide in scope. In response to Amendment 197BA, it could indeed include any health-related issues relating to maltreatment. There is no reason why CCGs would not seek professional advice in relation to maltreatment, but this is only one of many specialist areas. I hope that this reassures my noble friend and that she will feel able to withdraw her amendment.