The government was warned that the abolition of community health councils and its proposals to create care trusts to integrate local authority and NHS functions were opposed by many. Peers from all parts of the lords indicated they would seek changes when the Health and Social Care Bill went into committee stage.
While peers gave a broad welcome to the stated aims of the Bill - and, by tradition, an unopposed second reading - it became clear it would face detailed scrutiny and challenge.
Health minister Lord Hunt of Kings Heath said: 'Care trusts will be new bodies formed out of partnerships between health and social services, providing seamless care for people with care needs that cross professional boundaries.
It is essential that the NHS and local government work together if we are to deliver
seamless care. I want to stress that care trusts are not a takeover of one organisation by another but a partnership of equals. Both partners will need to apply jointly for the establishment of a care trust...
'While a care trust will be based on a primary care trust or NHS trust carrying out delegated local authority functions, its governance arrangements will change to reflect the new role and ensure that local authorities are appropriately represented.
'We want to see govrnance arrangements for care trusts include a minimum number of local authority members which reflect the wishes of local partners within a flexible national framework.'
The power for the compulsory establishment of a care trust was a backstop measure, recognising the government's duty to intervene where the NHS or councils were not adequately delivering services.
Conservative spokesman Earl Howe said despite government claims the Bill was about devolving power from the centre and giving better protection and services for patients, there were swathes of of the measure which took new powers to the secretary of state and the NHS - including the power to force elected local authorities to subsume themselves into care trusts when they did not wish to do so.
Community health councils should be reformed to bring them all up to the standards of the very best.
Earl Howe added: 'But instead, without as far as I can see any coherent reason being advanced, they are to be done away with. In their place we are offered an array of new bodies: ptient advocacy and liaison services, patients' forums, independent local advisory forums, patients' councils and local authority overview and scrutiny
committees, which together are meant to perform the functions that CHCs have undertaken until now.
'Why do the government think that a fragmented system of this kind is an impovement on the single point of entry for patients and the single point of scrutiny that CHSs provide at the moment?'
Liberal Democrat Lord Clement-Jones said his party had 'significant reservations' about the Bill. Care trusts must be genuine partnerships between the NHS and local authorities, he said, adding that he was concerned about the abolition of CHCs and, more specifically, by the way in which their functions were to be redistributed.
Labour peer and council leader Lord Smith of Leigh said local authorities were well placed to provide the scrutiny role of CHCs and needed to contribute to the future development of health services. However, he said care trusts appeared to be NHS organisations and local authorities were concerned about how they would
'NHS organisations reflect the culture within the NHS. Effectively, we can say that it is an 'ill-health' service, geared to dealing with people who have medical problems and medical needs. Health prevention and community care may not stand up to the pressures of acute services within a new care trust, and that is what concerns local authorities,' explained Lord Smith.
Hansard 26 Feb:Column 987-1064