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6.43 pm
Mr. John Baron (Billericay) (Con): I agree in some measure with much of what the hon. Member for Leicester, South (Sir Peter Soulsby) had to say, particularly on the point that if we are to have good councils, we must have good councillors. However, the situation will improve only when we give councils and individual councillors more power in respect of decisions affecting their local communities. At the moment, we are falling some way short of that.
If I may, I would like to confine my remarks to part 11, which in my view would bring about a radical change within the NHS. It would fundamentally alter the structure of public and patient involvement, most notably with the scrapping of patients forums, which the Government put in place only four years ago. Indeed, the creation of patients forums and the Commission for Patient and Public Involvement in Health was hard won by the Government in the face of strong opposition in the House and elsewhere. The forums replaced community health councils which, by and large and in many parts of the country, had worked very well.
It is therefore, in my view, disgraceful that measures to replace patients forums with local involvement networks have been tagged on to the end of what is already a long and contentious Bill that deals with local government rather than health. Indeed, the Bill does not even include the word “patient” in its title. It is almost as if the Government were trying to sneak these measures in, hoping that no one would notice. If that is the Government’s intention, they are, I suggest, badly mistaken because there is deep-felt anger in the country about how the Government have conducted their reforms on public and patient involvement.
The fact that no health Minister will be accountable to the House for the measures in the Bill reflects, I would suggest, the low priority that the Government
accord to the issue. It is an insult to patients forum members and other stakeholders that so little parliamentary scrutiny of this radical overhaul is taking place. I can understand the Government’s embarrassment, however, as their track record on this subject has not been good. Community health councils were scrapped and patients forums introduced about four years ago.
Clive Efford: Before the hon. Gentleman goes any further down the road with community health councils, some of us have long memories and served on them in the past. It was the Conservative Government who froze their budgets and cut the money that CHCs used to communicate what they were scrutinising to the wider public. The hon. Gentleman should be careful before applauding the work of CHCs, because his Government did not have a good track record of supporting them.
Mr. Baron: What I would say is that the CHCs were operating very well when we left office and they continued to work well during the first few years of the Labour Government. That is why there was such widespread opposition to the Government scrapping them when they did. A lot of expertise in CHCs was lost at that time, which is why the patients forums got off to a very bad start. Once established, patients forums were not provided with the administrative support that they needed, which compounded the original error. As a result, the turnover of membership has been high. Meanwhile, the Commission for Patient and Public Involvement in Health has cost more than £120 million to set up and run over the last four years and will cost even more to abolish, whereas CHCs did not require such a costly body to oversee their work.
One of my concerns is that the hard work and expertise contained within patients forums now risks being lost by a Government intent on replacing them with LINKs—a matter that one or two Members have already raised. The qualifications for individual membership of LINKs are not set out in the Bill, but left to the discretion of a host organisation. There can therefore be no reality to the Government’s claim that LINKs will build on the work of forums or that forum members are being encouraged to participate in the new arrangements. In particular, the specialist knowledge and skills of patients forums attached to such specialisms as mental health and ambulance services risk being lost—a terrible waste. The Government risk repeating the mistake that they made when they scrapped CHCs, for far too little of the expertise contained within them was transferred over to the patients forums. As a result, the patients forums did not get off to a good start; and the Government risk making the same mistake again.
The Minister of State, Department of Health (Ms Rosie Winterton):
I would like to clarify a point. We have made it very clear that we hope members of patients forums will transfer over to the new LINKs. We have also made it very clear that if LINKs decide that some of their people want to specialise in mental health, for example, they should be able to do so. It is important to provide a basis on which people can bring their expertise generally to the
LINK, but there is absolutely nothing to stop people specialising if they want to. I hope that that is helpful to the hon. Gentleman.
Mr. Baron: I thank the Minister for her intervention, but the problem is that that approach was adopted when CHCs were scrapped and very little expertise transferred over to patients forums. I would remind the Minister that qualifications for individual membership of LINKs are not set out in the Bill, but left to the discretion of the host organisation. That will make it difficult for the Government to claim that LINKs will build on the reforms and the work of the forums. If the qualifications are not set out in the Bill, members of the patients forums will not know where they stand.
Qualifications for membership are not the only details missing from the Bill. In fact, the Bill is extremely vague on a number of points. Local involvement networks will not be created as statutory bodies, with statutory powers. It is merely a name given to certain nondescript arrangements, set up by a nondescript host organisation to carry out activities that will be entirely subject to change at the Secretary of State’s whim.
Ms Rosie Winterton: I want to pick up on the point about qualifications. We do not want to be prescriptive from the centre. The hon. Gentleman’s idea of setting down qualifications would exclude people from the process. We want as many people as possible to join LINKs, so saying that x, y or z is always necessary for someone to become a member of the LINK is not right. We want discretion locally, so that people can get as many others involved as they can. I hope that that is helpful.
Mr. Baron: Only time will tell. All I suggest to the Minister is that such a vague approach was adopted when scrapping the CHCs, and far too few individuals from CHCs made their way across to patients forums. The general view afterwards, looking back with hindsight, was that too much expertise was lost. In many respects, I hope that I am wrong, but we will see whether things transpire as the Minister believes.
Furthermore, I suggest—certainly to the Minister of State, Department of Health, the right hon. Member for Doncaster, Central (Ms Winterton)—that the proposals have been developed without regard to the views or concerns of patients forum members. In large part, they have been ignored. For example, no patients forum member sat on the expert panel that reported to Ministers last year. Of course, forums have tried to make every effort to raise serious concerns about the plans, but the Government are now pushing ahead against their wishes.
Mr. Kevan Jones: Does the hon. Gentleman agree that the fundamental problem with this so-called reform, like a lot of things that the Government have done in health in trying to get local people involved locally, is the fact that the organisations will have no teeth—they will have no power to do anything? How can people be encouraged to serve on something that will not make any difference?
Mr. Baron:
I agree with that in large part, and I want to come to that in a moment. Without real teeth, what
is the incentive to serve? The Government must take on board that fact. The problem is compounded by the fact that a lot of patients forum members feel as though they have been completely ignored. I can speak only for the local patients forum members, and they feel that they have been completely sidelined, as though they do not exist and as though their expertise counts for nothing in this process. That is a bad mistake, and it does not bode well for the Health Minister’s claim that, suddenly, that expertise will find an easy path into LINKs, when existing patients forum members are being completely ignored in the reform of patient and public involvement.
Richard Younger-Ross (Teignbridge) (LD): Would the hon. Gentleman be surprised to find out that, in Devon, when the PCT was considering making cuts to services and to minor injury units and reducing the number of community beds temporarily, the forum was not consulted? The disenchantment felt by those members is quite severe. They wonder why they are there if no one talks to them about such proposals.
Mr. Baron: I agree with the hon. Gentleman. Again, I repeat that it does not bode well for the Health Minister’s argument to suggest that such expertise will be embraced, given that the existing expertise is completely ignored when the structure of the reforms is being considered. We hear that not just from local patients forum members, but from others across the country as well. However, I must move on, because I know that many other hon. Members want to contribute to the debate.
We have a number of concerns about the proposals, and I shall start with independence. For any system of involvement to be credible, it must be independent of the NHS, local government and other social care providers. Patients forum members are concerned that local authorities will have an undue influence over LINKs, for they will be financially accountable to the council yet will be expected to monitor some of the services provided or commissioned by the council—a clear conflict of interest, compounded by the fact that funds for the creation of a network will not be ring-fenced.
Patrick Hall: I take the issue of independence seriously, but the hon. Gentleman should bear in mind the fact that CHCs came under the umbrella of health authorities, yet they were not accused of not being independent.
Mr. Baron: Yes, except that there are one or two differences, including how CHCs were funded. In answer to the hon. Gentleman’s specific point, let me quote the patient and public involvement forum for Northampton PCT:
“Independence is one of the stated objectives yet the independence PPI Fora are being replaced with bodies controlled by powerful local authorities under significant political influence.”
That concern is being expressed by patients forum members up and down the country, as he well knows. I ask the Minister why the funding for LINKs will come through local councils at all, when the expert panel responsible for developing the LINKs concept included no such recommendation to the Minister.
Ms Rosie Winterton: One of the clearest things that came from our consultation on the future of patients forums was that forum members felt that not enough resources went direct to the front line. Therefore, if we were to release the resources that currently go to the commission at the centre, we had to find a mechanism to enable money to go directly to patients forums. Local authorities are a very good example of how contracts can be let to voluntary organisations independently to run the LINKs. More money will therefore go to the new LINKs through the auspices of the local authority, while preserving their independence.
Mr. Baron: I hear what the Minister is saying, but the fact remains that many of those who were consulted—certainly, a lot of patients forum members—do not understand why the funding must take such a route. When the expert panel responsible for developing the concept of LINKs included no such recommendation, it certainly brings into question the Minister’s reasoning on why the funding should take that route.
Let us briefly discuss one or two other concerns that Opposition Members have about LINKs. A further concern of ours relates to the powers of inspection. Where patients forums have been successful—for example, in putting the spotlight on cleanliness or the quality of hospital food—the power to enter and inspect NHS premises has often been the key. However, the Bill seems to contain, at best, a watered-down version of that power—a power to enter and view.
Of course, it is impossible to tell how useful the new power to enter and view premises will be, since precise arrangements will be left to the Secretary of State’s discretion in making the regulations. However, CPPIH has expressed concern that the qualifications and conditions set out in the regulations could have the effect of weakening the power to enter premises. The words “inspect” or “inspection” do not appear anywhere in part 11, whereas they were key to previous PPIH legislation. The patient and public involvement forum for the University Hospitals of Leicester said:
“The inspections and service reviews which have had such strong impact on improving patient care have depended on the statutory powers. To discard a programme of over 20 inspections a year by trained and experienced Forum members is a retrograde step, damaging to patients and the public.”
Mr. David Drew (Stroud) (Lab/Co-op): I concur with the hon. Gentleman, because my PPI forum members have told me that they feel that this is a question of legitimacy and that, if they do not have the right of inspection, their powers would be completely denuded. I entirely agree with him.
Mr. Baron: Let us be absolutely honest: we do not believe that the Government actually wanted the power to enter and inspect. It was not even included in the original proposals. Only when the Health Minister turned up at a meeting of the all-party parliamentary group on patient and public involvement and got a very strong reaction against the Government’s proposals did they include the power to enter and view. We contend that that falls well short of the power to enter and inspect. There is a big difference, and the Bill does not make it clear that the powers that patients forums have will be matched by those of the new LINKs.
Ms Rosie Winterton: To clarify the issue, I think that patients forums would agree that it is important to make sure that we do not have any duplication between inspection bodies, such as the Healthcare Commission, and patients forums. We listened to what members of patients forums said and agreed that there should be a right of entry to premises. However, it is important to remember that not every member of a LINK would have a right of entry, possibly because of sheer numbers, but also because anybody involved in that has to have a Criminal Records Bureau check. We have kept that back for regulations so that we can continue to consult on how that role can best be carried out. That was a response to the patients forums.
Mr. Baron: The trouble is that the Minister cannot have it both ways. Patients forums have that power to inspect at present and it works perfectly well, even with the Healthcare Commission having those powers as well. What is blatantly clear from the Bill is that the power to inspect seems to have been withdrawn as part of begrudging concession by the Department of Health. LINKs members can only “view”. There is a difference, and I look forward to that matter being fleshed out in Committee. The Minister has not made the case clear and certainly cannot defend the fact that LINKs members have not got those inspection powers.
In short, the Bill fails to deliver what patients want: a strong, independent investigative mechanism to influence decision making and hold public services to account. It fails to create a national voice for patients, or even the capacity for regional networking of LINKs. The Department of Health has talked about a national voices project, but that initiative has been led by the voluntary sector and is currently quite separate from LINKs. Nor does the Bill give patients a direct role in the regulation of health and social care. LINKs apparently lack that function, despite the recommendation from Lord Currie that a function should be created. For our part, we have already consulted on proposals for health watch, an independent national voice for patients, but with a local presence, which would combine the traditional investigative and representative functions of PPIH with those of a modern, consumer-style watchdog. Until the Government join us in embracing that concept, patient and public involvement in the NHS and social care will continue to suffer from the Government’s poverty of ambition. In the words of the organisation, Health Link, a repository of great experience in patient involvement and an authority in these matters:
“Effectively, this Bill consists of PPI designed for the benefit of the NHS, not for the benefit of patients.”
Mr. Deputy Speaker (Sir Alan Haselhurst): Order. The average length of Back-Bench speeches is increasing. That will have a disadvantageous effect on those who are still waiting to catch my eye. Perhaps hon. Members will bear that in mind.
7.3 pm
Patrick Hall (Bedford) (Lab):
I will certainly bear that sensible advice in mind. As we have already heard from a number of contributors, the Bill contains many
good things, not least the facility to allow credible cases for unitary council status to go forward. None the less, I hope that we will not lose sight of—or fail to debate in as much detail as is required, certainly in Committee—the public involvement part of the Bill. I wish to address that subject today, as the hon. Member for Billericay (Mr. Baron) has just done. Out of 14 parts and 176 clauses, only one part—part 11—covers patient and public involvement in health and social care. Although I express a personal view, I also speak as chair of the all-party group on patient and public involvement in health.
In 2000, a national health service plan proposed to abolish community health councils. In late 2003, patients forums were set up, together with the Commission for Patient and Public Involvement in Health. Now, both the forums and the commission are to go, to be replaced at local level by LINKs and at national level by, it would seem, nothing. The all-party group has sought to identify the views of patients forum members on the best way forward. We met a large number of representatives on 30 October in the House and we will meet a smaller number on 30 January. The principal concerns expressed by patients forum members that we have dealt with are as follows.
First, there is uncertainty about the direction of travel and where we are going. Secondly, there are fears that LINKs will not be independent and will be subservient to the political process in local councils. Thirdly, there is the feared abolition of the inspection rights currently enjoyed by forums. Fourthly, there is the apparent lack of a national voice. Fifthly, there is the failure of Government, as perceived by the people we met, to recognise that forums already actively pursue networks, links and local contacts with a variety of voluntary and other organisations in their areas. All those are fair points to raise and need to be addressed in the House, both today and, perhaps especially, in Committee and later.
Personally, as I indicated in an intervention on the hon. Member for Billericay, I do not think that coming under the umbrella of local government necessarily undermines independence. I support local government and I think that it is capable of doing the job properly, but we need to be aware of those concerns and ensure that they are properly addressed. As I said earlier, both for budgetary and overall administrative reasons, community health councils came under local health authorities, although perhaps they were called strategic health authorities at that time. There have been so many changes, I cannot quite remember. However, community health councils were not accused of being the creatures of the Department of Health or local health authorities and so it does not necessarily follow that LINKs would suffer from that same accusation.
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