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Commissioner for Older People (Wales) Bill [HL]

My Lords, when the debate on this amendment took place in Grand Committee, I raised with the noble Lord, Lord Roberts, the issue of its budgetary consequences. I was waiting to see whether he had found a way of addressing the question that I put to him then, so I repeat: commissioners’ recommendations could lead to considerable pressure on budgets. For example, it would be within the commissioner’s responsibilities to make recommendations to a local authority—not necessarily one local authority, but all local authorities—about the services that it provides in certain respects of dealing with elderly people. The same is true of health trusts and even of those services directly budgeted for, funded and delivered by the Assembly itself. Recommendations of that kind could have serious budgetary implications for the organisations concerned. We are not talking about the enforcement of a particular recommendation. The commissioner could—would, I hope—identify areas where there was inequality of service delivery in a health trust, between health trusts or between individual local authorities and then recommend to the Assembly delivery of a uniform service. For example, as I said in Grand Committee, there could be a recommendation that physiotherapy be delivered for female incontinence sufferers across the board, as opposed to the current patchy delivery of that service from one health trust to another. That is exactly the kind of thing that we want the commissioner to highlight, but I question whether he should have a right to enforce a recommendation of that kind, which could have a considerable impact on the budgets of a local authority, a health trust or the Assembly. How will we marry the enforcement of an identified grievance of an individual, as opposed to a commissioner recommending as a result of his inquiries and services that a major new service should be provided for elderly people right across Wales, with considerable budgetary implications? Ultimately, in those instances, it has to be the responsibility of the Assembly, the local authority or the health trust to decide whether that would be the priority. Otherwise, the commission, in a curious way, will begin to assert the democratic rights and responsibilities of people elected at various levels to make decisions on priorities. That is my major query. I was waiting with some interest to hear whether the noble Lord, Lord Roberts, would respond to the point that I made to him.