Health and Social Care Bill

My Lords, I am grateful to the noble Baroness, Lady Hollins, for her typically knowledgeable contribution to today's debate. I hope she will accept that the Government are committed to improving the health of people with learning disabilities, to help them both to live longer and to stay healthier for longer. The Bill aims to drive improvements in outcomes by establishing clinically led commissioning, by giving patients a stronger voice and by embedding quality improvement and a reduction in health inequalities at all levels of the system. We debated these amendments in Committee and I have since exchanged correspondence with, and met, the noble Lord, Lord Rix. I understand and share his concern, and that of the noble Baroness, that there should be robust arrangements for commissioning services for people with profound and multiple learning disabilities, and for people with complex needs or challenging behaviour. I am afraid that it may disappoint the noble Baroness to hear that I still believe that the amendments are unnecessary. However, in saying that, I hope that I can reassure her about the reasons why. On Amendment 37, the regulation-making powers in new Section 3B are already broad enough for the Secretary of State to require the board to commission these services. The current intention is that the regulations under subsection (1)(d) will be used to give the board responsibility for commissioning specialised services for rare and very rare conditions. The current specialised services national definitions set will form the basis for the services included in these regulations. These will include a number of services for people with profound and multiple learning disabilities, and people with complex needs or challenging behaviour. The services that are not considered specialised will be commissioned by CCGs, although in practice there will need to be close collaboration between the board and CCGs to ensure that patients receive a seamless service. I do not agree that it would be appropriate to make a particular exception and specify services in the Bill that the board may be required to commission in relation to a particular protected characteristic. Those kinds of detailed requirements are more appropriate in regulations. I would like to reassure the noble Baroness that we are working with clinicians to define these services through regulations that Parliament will have an opportunity to scrutinise. However, I think we can all agree that the collection and dissemination of more accurate and meaningful information about health services is important to understanding and improving health and care outcomes for the whole population, as well as for specific groups of patients. I fully support the intentions behind Amendment 55, but I am confident that the work currently being undertaken by the Government and the Health and Social Care Information Centre to explore the extent to which indicators in the NHS outcomes framework can be disaggregated to show disability will meet the noble Baroness’s aims. Our information strategy for health and social care in England will be published in April, and I can tell the noble Baroness that it will clearly state that data sets need to include inequalities data. I would be happy to write to the noble Baroness when the information strategy is published to set out how we see the strategy tackling inequalities. Allow me to end by addressing the points the noble Baroness has made in relation to NHS complaints advocacy. Clause 184 has the effect of transferring a duty to commission independent advocacy services for NHS complaints from the Secretary of State to local authorities. Under these arrangements, a local authority would decide from whom to commission these services. It could be a local healthwatch organisation or another provider. I am grateful to the noble Lord, Lord Rix, for welcoming these proposals in Committee. First, let me say that I agree with the noble Baroness’s observation that effective advocacy is particularly relevant to the needs of disabled people, including those with a learning disability. The scope of independent advocacy services is potentially wide, but local authorities should have discretion to determine what arrangements are right as they know their local areas best. We do not believe it would be appropriate to require them to make arrangements for the provision of unlimited assistance. However, we should bear two things in mind: first, that in discharging their obligation, local authorities would have to act reasonably; and, secondly, that Clause 184 would enable the Secretary of State to give directions to a local authority about the exercise of these functions if the Secretary of State felt it necessary to do so. I hope the noble Baroness, Lady Hollins, will be reassured by this, and that, in the light of the explanations I have given, she will be willing to withdraw her amendment.