Threat of enforced mergers set to recede

The government looks likely to remove compulsory care trusts
from the Health and Social Care Bill in what is being seen as
another significant concession.

Under the original version of the bill, the health secretary
could impose care trusts where local services were deemed to be
failing. The new concession from the government would be far less
prescriptive. It would require failing bodies to work together
under the flexibilities of the Health Act 1999, including joint
commissioning and pooled budget arrangements.

Junior health minister Lord Hunt told the House of Lords during
the bill’s report stage last week that he was “prepared to consider
the merits of retaining the powers to require the use of Health Act
[1999] flexibilities but without the ability to compel local
authorities to take the next step and enter a care trust”.

John Ransford, head of social affairs, health and housing at the
Local Government Association, said the proposed change would
increase local partnership flexibility and “allow local partners to
make arrangements that suit their needs”.

He said the move also “underscored absolutely that [care trusts]
are voluntary bodies and that it is up to local authorities and
health authorities to sign up to them”.

Lord Hunt told the House that he would return to the third
reading of the bill, due to take place this week, with proposals
that “take account” of the issues raised concerning care trusts as
opposed to other partnership arrangements.

Liberal Democrat peer Lord Clement-Jones agreed to withdraw his
proposed amendment to leave out the clause on compulsory care
trusts to consider the new position.

“I believe that the minister’s reply contains a significant
element of concession,” Lord Clement Jones said. “To restrict the
compulsory powers to Health Act flexibilities would certainly limit
the ambit of the clause in a helpful way and would make clear what
is intended -Êthat the power is an option of last resort.”

Amendments to the clause relating to voluntary care trusts were
also withdrawn following assurances given by Lord Hunt during the
debate, particularly in relation to accountability, the nomination
of elected members, and control of charging policy.

“Local agreements will need to cover the extent to which the
care trust board can make policy decisions when, for example, it
needs to seek the local authority’s consent and how the ongoing
performance monitoring arrangements will be handled,” Lord Hunt
agreed.

“Some decisions will remain with the local authority and the
care trust will need some way of feeding in its views on these
issues to the authority.”

However, the whole bill could fail to reach the statute book
unless MPs accept an amendment passed in the Lords last week
against the proposed abolition of Community Health Councils.