My Lords, I would like to place on record my thanks to all noble Lords for the spirit of collaboration and constructive criticism that has characterised our formal and informal discussions leading up to this moment. Your Lordships examined
the Bill thoroughly when it started in this House, and made many excellent proposals as to how it could be improved. Many of these were taken up in the other place, and I believe that we now have a better Bill before us. Noble Lords’ suggestions have influenced not only the Government’s amendments but also the surrounding policy and our proposals for forthcoming secondary legislation and guidance.
In moving the Motion on the first amendments made in the other place, I hope noble Lords will think it convenient to consider a number of others, to which no amendments have been proposed. Many are small technical changes to clarify the provisions further and correct previous oversights. Amendments 1, 12 to 31 and 34 to 36 are minor and technical, and do three things. First, they ensure that cross-references to the Children and Families Act 2014 and consequential changes to it are accurately reflected in the Care Bill. Secondly, they include further definitions in the glossary at Clause 79(1) to ensure maximum clarity. Thirdly, they make further changes to fully reflect amendments in this House to remove the requirement for a transition assessment to be requested.
Amendments 2 and 3 relate to the issue of charging by local authorities and simply clarify the scope of the regulation-making powers, as I set out when we considered this on Report. They ensure that regulations can specify where local authorities do have the power to be more generous and contribute to the costs of an adult above the financial limit, as well as where they do not.
Amendment 4 clarifies that the regulation-making power at Clause 25(13) allows the regulations to specify cases where aspects of the care and support plan, including the personal budget, are not required. We have always been clear that there may be cases where aspects of care planning are not appropriate. An example is the inclusion in a personal budget of costs relating to the provision of reablement. This also reflects current practice and we intend to continue this arrangement through regulations.
Amendment 5 allows regulations to specify where certain costs do not have to form part of the personal budget, and thus do not count towards the cap on care costs. Again, it has always been the intention that some care and support provision, such as reablement, should be provided as a universal, free service and therefore should not be incorporated in the personal budget. This regulation-making power is limited to services that the local authority cannot make a charge for, or chooses not to. There is no way that this can apply to general care and support that the local authority can charge for.
Amendments 6 to 8 allow regulations to make provision for cases where a person with a direct payment has a period of fluctuating capacity, so that the local authority could or should, depending on the circumstances, continue with the original direct payment arrangements. This will provide continuity and prevent the direct payment having to be terminated.
Amendments 9 and 10 are technical amendments that address an uncertainty caused by a drafting omission. They make it clear that deferred payments, whether they are deferred charges or a deferred repayment of a loan, can either be paid back in whole or part.
I turn now to Amendment 32, which provides for a broad regulation-making power specific to appeals of decisions made under Part 1 of the Care Bill. This power gives us the flexibility to provide for a range of options depending on further work to ensure that we achieve the outcomes that people have told us are important to them. We will specify the details of the policy in regulations.
Given the changes introduced by the Care Bill, it is vital that individuals have confidence in the care and support system, and that they are able to challenge decisions without having to resort to judicial review. We held a consultation during the second half of last year on how best we could ensure this. Following this consultation, we have recognised the need for change. Amendment 32 will give us the scope to develop with stakeholders detailed proposals for an appeals system, keeping to the spirit of co-production that has characterised our work on other areas of the Bill.
This is an important and complicated issue and we need to make sure that we take time to get the detail right, drawing on experience from other sectors and ensuring that the changes are aligned with the broader changes to NHS and social care redress following the Francis report and the Clwyd review. We are working actively with our various partners and stakeholders to develop our policy on this, and we will consult further as part of wider consultations on regulations and guidance later this year.
As noble Lords may know, the Delegated Powers and Regulatory Reform Committee today reported on the amendments made in the other place to the Care Bill. It made two recommendations in relation to Amendments 32 and 46, which I am pleased to say the Government accept. Accordingly, I have today tabled Amendments 32A to D and Amendments 46A to E to give effect to those recommendations.
Addressing the first recommendation, Amendment 46B ensures that regulations made on the first exercise of the power in Amendment 32 establishing the care and support appeals process would be subject to the affirmative procedure. The remaining amendments respond to the concern of the committee as to the meaning of the reference to “modifying” an enactment. Our amendments spell out that the power is to provide that a provision of an enactment may apply with modifications. Similar amendments are made to similarly worded provisions elsewhere in the Bill to ensure consistency.
The amendments also ensure that where any regulations relating to the appeals process make provision that provides for a provision of an Act of Parliament—that is, primary legislation to apply with modifications—then such regulations must be made using the affirmative procedure. Again, in the interests of consistency, similar amendments provide that certain other regulations under the Bill—which might also provide for the modification of the application of an Act of Parliament —should be made using the affirmative process.
I turn to Amendment 33. Feedback from local authorities is that it would make sense for them to have the flexibility to be able to delegate functions relating to direct payments if they so wish. We agree, and have accordingly tabled an amendment to remove the prohibition around this.
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I now turn to amendments made in the other place to Part 2. Amendment 37 relates to the fit and proper person test. The department has recently consulted on a new requirement for registration with the CQC which will specify that directors of registered providers will need to be fit and proper persons to fulfil their role. This will fill a gap in the current arrangements for accountability to the CQC. It is our intention that the regulation will come into force in October. The key responsibility for the fitness of directors will continue to lie with providers themselves, but the new requirement will enable the CQC to form its own judgement about the fitness of directors. In cases where the CQC cannot be assured that a director is fit, it will be able to either refuse registration or place a condition on the provider which would require the removal of that director. It is only right that in such cases the individual director, as well as the registered service provider, has a right of appeal against the CQC’s actions. This new clause introduces a right of appeal to the First-tier Tribunal for individuals who are removed from their post as a result of action taken by the CQC.
The Government made changes in this House on Report to clarify that the CQC will only undertake routine performance assessments of the provision of regulated activities. Amendment 38 is consequential to this, removing a remaining reference to local authorities that could be confusing.
Moving on to Part 3, government Amendment 39 relates to the remit of the Health Research Authority. It makes explicit that the HRA’s functions do not generally extend to research which relates to children’s social care alone. It has always been our intention that this body’s functions relate to health research and adult social care research. The amendment clarifies that remit, ensuring that it is clearly and accurately defined.
These changes reflect our determination to get the detail of the Bill absolutely right, rather than a change in policy. I hope these amendments will receive the approval of the House without the need to detain ourselves long.
Amendment 44 establishes the Better Care Fund to promote joint working between the NHS and social care. Amendments 47 and 51 ensure the title and commencement reflects the Better Care Fund provisions.
The Better Care Fund combines £3.8 billion of NHS and local authority funding, which will be jointly invested in integrated care. Successive Governments and leading health professionals have talked about joining up health and social care for decades. The Better Care Fund is a major step to making this a reality and transforming the way people are cared for closer to home. Despite recent news coverage suggesting the contrary, the Better Care Fund has not been suspended, and in every part of the country the NHS and local government are sitting down together and agreeing plans for integrated health and social care.
We have set aside time to make sure that all areas have developed comprehensive plans for joined-up care. The better care plans start from April 2015, and as I mentioned at Oral Questions, we asked for early versions to be completed a year in advance so that we could review and check their level of ambition and test
how they would be delivered. That is what is happening now. Although plans remain under development, we can all be encouraged by early indications that many areas are choosing to pool additional funding, meaning they will join up the funding and commissioning of an even wider range of services. The Local Government Chronicle reports, for example, that seven authorities—Hertfordshire, Lincolnshire, Dorset, Sheffield, Sunderland, Bournemouth and Poole, and Salford—plan pooled budgets in excess of £100 million.
Amendment 44 creates the legal framework for NHS involvement in the Better Care Fund by ensuring that CCGs pool budgets with local government for use on integrated care. It is primarily enabling legislation because the mandate will include objectives and requirements for how the fund will operate. The amendment enables the mandate to specify what funding the NHS should contribute and the need to work with local government.
NHS England will ensure that the pooling happens between CCGs and local authorities. It will have powers to tell CCGs what amount to include in the pooled budget and will release the funding only once it is satisfied that there is a robust, locally agreed integration plan. It could also attach other conditions to the funding, including performance objectives such as improved patient and user experience and reduced emergency admissions. A new duty requires NHS England to use these powers in the combined interest of health and social care.
The Better Care Fund is a crucial part of the wider change needed in the way in which the health and care systems work together to secure better care for people. Work is well under way with the development of local plans and this legislation will support those plans to become a reality. With that lengthy explanation, for which I apologise, I beg to move.