Health and Social Care Bill

My Lords, I congratulate my noble friend on bringing forward the amendment, to which there seem to be two limbs. The first involves finance and looks forward—indeed, arguably it paves the way—to the Dilnot report or some version of it being the basis for the complex issue of catering for the needs, present and future, of a significant proportion of the population. The second limb is directed more towards the services that will be required, which we would all agree need to be better co-ordinated than they have been. In that respect, I have a certain sense of déjà vu. At the time of the 1973 reorganisation, I was chairman of my city council's social services committee when various services that were directed to run adult social care were transferred to the health service—chiropody, bath attendant services and the like. At that time, the area health authority, as it then was, found itself in difficulties and unable to fund the continuation of the service, so my authority contributed significantly financially to preserve the very services that we had handed over. That illustrated clearly the need for a much better relationship between the two sides that, a generation later, has still to be achieved. My noble friend's amendment would certainly direct us further along the road to integration. The noble Lord, Lord Skelmersdale, refers to the impossibility of progress being achieved without a single body organising it. I do not think that that is right. In fairness to the Bill and the Government, the creation of the health and well-being boards, with the obligation to produce a joint strategic needs assessment and to collaborate in implementing the measures required to deal with those needs, provides a more coherent framework for that necessary degree of collaboration. Nor is the noble Baroness, Lady Murphy, correct in saying that my noble friend's amendment constitutes a new Bill. It constitutes at least a partial completion of the Bill, filling a lacuna in adult and social care, which is part of the Title of the Bill but thereafter becomes virtually invisible. In effect, his amendment paves the way for further reforms. If I have any reservation about my noble friend's amendment, it is one that perhaps applies to the Bill as a whole. We have talked repeatedly about adult social care as we have gone through the Bill, but there is very little about the social care of children in it. Perhaps that is something to which we ought to have devoted a little more time. There have been occasional references, and there are some amendments, but we will have to return to the subject if not during what little time remains for this Bill then in the not too distant future. Having said that, my noble friend's amendment advances the argument and lays out a structure that could be most useful in ensuring a degree of collaboration, which is necessary to maximise the return on the social and financial investment in the care of a significant proportion of our population. I certainly commend it to the House.