My Lords, it is vital that care and support, health and other services are joined up, as this offers the potential to make measurable improvements in individuals’ outcomes and experiences of care and support. Clause 3 places a duty on local authorities to carry out their care and support functions with the aim of integrating services with those provided by the NHS or other health-related services such as housing. Amendment 81C, tabled by the noble Baroness, Lady Wheeler, raises the issue of co-operation duties on the NHS; I have no issue with that sentiment. Clause 3 is intended to reflect the similar integration duties placed on NHS England by Section 13N, and on clinical commissioning groups by Section 14Z1 of the National Health Service Act 2006, in the context of this Bill.
Clause 6 imposes a general duty to co-operate between the local authority and other relevant authorities that have functions relevant to care and support. Clause 7 supplements this by creating a specific duty to co-operate in individual cases.
Clause 22 sets out the limits on what a local authority may provide by way of healthcare and so, in effect, sets the boundary between the responsibilities of local authorities for the provision of care and support, and those of the health service for the provision of healthcare. Our intention is to replicate the effect of the current prohibitions on what a local authority may provide by way of healthcare, which are imposed under Sections 21 and 29 of the National Assistance Act 1948 and Section 49 of the Health and Social Care Act 2001. This is a matter eloquently raised by the noble Baroness, Lady Gale, in tabling Amendments 92ZZEA and 92ZZEB.
The word “authorised” in Section 21 of the 1948 Act has resulted in much confusion and case law. The intention behind Clause 22 is therefore to simplify the language and to make the boundary clearer without moving it. Make no mistake: where nursing care is being funded by the health service, it will continue to be unlawful for a local authority to recover the cost of this from the individual. It is the relevant clinical commissioning group that would be responsible for this cost.
On Amendment 82A, I wholeheartedly agree with my noble friend Lady Barker that no one should be given medical treatment or be medically assessed against their wishes where they have capacity to make such a decision. I hope that my noble friend will be reassured that the existing legal position and clinical practice is clear on that point.
Amendments 87ZZA and 81B were, again, spoken to by the noble Baroness, Lady Wheeler. The prominence of health and wellbeing boards will be strengthened through their role in signing off the joint plans that are required as part of the £3.8 billion pooled fund between local authorities and the NHS to support joined-up and integrated working. The need for local commissioners
to engage with their health and wellbeing boards is made clear through their composition, which includes the director of adult social services, the director of children’s services, the director of public health and a representative of each relevant clinical commissioning group. The duty to co-operate already applies to these health and wellbeing board members.
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Section 116B of the Local Government and Public Involvement in Health Act 2007 requires local authorities and clinical commissioning groups to have regard to the relevant joint strategic needs assessment and joint health and well-being strategy in exercising any of their functions. This includes their duties to co-operate and promote integration.
On Amendment 87ZB, I agree with the noble Lord, Lord Rix, that it is important that providers co-operate with commissioners and relevant partners in their local area. However, public law cannot create an enforceable legal duty on private, independent or voluntary providers to require this. We expect local authorities to ensure the co-operation of providers through the contractual arrangements they make with them.
Discharge from an acute care setting is a key interface between health and care and support. At this critical time, care and support must be joined up to prevent unnecessary delays and readmissions that can be distressing to patients, their families and carers. This issue is raised by Amendments 87ZA and 104A, tabled by the noble Baroness, Lady Greengross. Clause 6(5) sets out the high-level aims of the general duty to co-operate, but it does not attempt to provide an exhaustive list of circumstances in which this power should be used. We expect authorities and their relevant partners to co-operate when an individual is discharged from acute care under this clause.
To ensure the safe discharge of a patient from an acute care setting an assessment for care and support should happen before the patient is discharged, not after. Schedule 3 to the Bill sets out clear steps to ensure this. Clause 12(1)(b) already allows for regulations to specify other matters to which the local authority must have regard in carrying out an assessment. Given that this involves setting out procedural detail and related matters, it is more appropriate to set out such detail in the regulations than in the Bill.
Government amendments 87A, 87B, 87C, 87D and 87E would ensure that Clause 7—the duty to co-operate in specific cases—applies in relation to children undergoing transition from children’s to adult services. It was always intended that this provision be used in these cases, as the Law Commission recommended, and as is clear from the Explanatory Notes. These amendments would make Clause 7 explicit on this point, because at present it refers only to adults. I hope that noble Lords will accept them.
The noble Baroness, Lady Wheeler, asked me how the pooled—budgeted—funding would sit with the 10% cuts to local government, and whether that pooled fund will be ring-fenced. To access any of the funding in the £3.8 billion local integration fund local areas will have to develop plans on how they will use the funding. These will be overseen by health and wellbeing boards, made up, of course, of NHS and local government
representatives. Funding will be given only on the condition that services are commissioned jointly and seamlessly between local NHS and local councils. We will transfer £859 million from the NHS to care and support this year—in 2013-14—and £1.1 billion next year, to help the funding pressures in the immediate term.
I hope that I have reassured the Committee of the robustness of the provisions relating to integration, co-operation, and delayed discharges, and that in the light of what I have said the noble Baroness will feel able to withdraw her amendment.