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However, we need to think through the administrative arrangements, the resourcing and the governance issues with regard to LINKs in order to understand how independence is to be secured and how accountability is to be made clear. My right hon. and hon. Friends on the Front Bench will understand that the Government’s intention to consult on these and a number of other related matters risks giving rise to a period of greater uncertainty and speculation on some crucial questions. That is inevitable, although hopefully
it will not last too long. Having more uncertainty and speculation on some of these matters is not satisfactory.
I am not upset at the thought of there being one LINK for every local government social services area in the country. I understand that that would mean 152 LINKs, instead of well over 400 patients forums. However, it is essential that they be rooted in the local authority area and that they be local. I am not certain that that would be guaranteed, because, in carrying out its duty to establish a LINK, a local council will have to tender for an outside body to do that on its behalf. I do not think that it is likely that there will be 152 outside bodies, waiting to be tendered to operate in those council areas and to set up a LINK. If a regional or a national organisation does that in some places, which is likely, we will need to ensure that local sensitivities and the shape of local areas are sufficiently respected and understood.
With regard to the power to inspect health and social care facilities, I think that the concerns expressed by forum members are largely met. Earlier in the debate, there was some probing of the meaning of the words used, but in clause 156, there is a commitment that LINKs will have such powers, and that answers many of those concerns. Okay, so the wording is
“to enter and view, and observe”,
but in general terms, people will understand that to mean inspection, although it is a legitimate issue for further debate in Committee. That is not necessarily the same inspection that would be made by an expert group that was statutorily empowered to take a particular route, but in general terms, many of the forums’ concerns are answered in clause 156.
Mr. Baron: Further to that point, why does the hon. Gentleman think that the words “inspect” and “inspection” were not used at all in the Bill?
Patrick Hall: That is one of the questions that we can ask Ministers, and one of the points that we can pursue in Committee. It is a perfectly legitimate point, but I will not get hung up about it right now. The important thing is that LINKs will be able
“to enter and view, and observe”.
A more important point that the hon. Gentleman could have picked up on is the fact that the provision applies to public sector bodies only. Independent providers will only be required to allow inspection. The same applies to the requirement to give information. Under the Bill, both requirements are concentrated on public bodies.
With regard to independent providers, my understanding is that the inspection and provision of information will happen only if requirements to that effect are written into the contracts arrived at between the public-sector commissioner and the independent or other-sector provider. I understand that there are more than 28,000 contracts between public-sector commissioners and private or other-sector providers of social care, so there is a real problem with how inspection information will be delivered, until the contracts are amended or renewed. That question needs to be addressed in the next few weeks.
Ms Rosie Winterton: I should like to try to address some of the issues on that point, and say why it is important that we should consult widely on the matter. In some cases, for example in the independent sector, the premises that we are talking about might be people’s homes—an instance might be residential homes—because some social care can be delivered there. We have to respect the sensitive issues around going into someone’s place of abode, and social care increasingly takes place in people’s homes.
Patrick Hall: I am grateful for that helpful intervention, but on that subject, one of the Bill’s strong points is the embracing of social care as well as health issues, and therefore the principle of being able to get information, and visit or inspect, should apply, too. I take on board the fact that there are extra sensitivities, but if my point is not addressed, it will seem as if an inferior role can be given to many social care providers.
On the national dimension, although no one would want a huge, unwieldy bureaucracy, there will be a need for LINKs to communicate, learn from each other and benefit from best practice. Such a facility should be there from the start; we should not tack it on later, simply because it is obvious that we must do so. I would like the Government to take that on board right now. I understand and support the proposed functions of LINKs, which are neatly set out in clause 153(2). In fact, reading the provisions on that subject—they are set out in simple and straightforward language, which is welcome—I do not see how patient and public involvement in health and social care could function at all, unless it is on the basis of the words in clause 153(2). I am therefore at a loss to understand why, under subsection (3), all or part of subsection (2) may be amended, or even omitted, by the Secretary of State—subject, however, to consultation, as is pointed out in subsection (4). The drafting of subsection (2) effectively allows the Secretary of State to abolish LINKs at some stage in the future. I ask my right hon. and hon. Friends on the Front Bench to address that.
I shall comment briefly on how LINKs might work, and on the issue of membership, which has been raised by other hon. Members. I accept and agree that the Government do not want to dictate, or to be heavily prescriptive about everything that happens in the country, from the centre. They do not want membership to be pre-approved by another body, and that is absolutely fine. None the less, there is surely a need for some detail and shape. We need something to look at, so that we can discuss, understand, and hopefully improve LINKs, and I hope that that will emerge in Committee.
The Government rightly recognise that the patient and the public are represented not just by patients’ forums, but by hundreds of bodies across the land, many of them voluntary organisations, dealing with all kinds of issues, and some of them are very specialist. Beyond those bodies, there are of course millions of members of the public who dip in and out of health and social care concerns, and they should not be ignored by the system, either. There must be some structure. Presumably, there will be a LINK committee of some sort. The Bill does not say how that would be devised, but at some point before the legislation
completes its passage through this House and the other place, there will have to be a sharper focus on how LINKs could be delivered.
There will be LINKs in various different parts of the country, serving different populations. Some of them—in the case of smaller unitary authorities, for example—will serve perhaps 100,000 or 120,000 people. At the other end of the scale, in the county of Kent, there are more than 1.5 million people. For that reason, the bodies will be different in different parts of the country. As to what they will do, obviously they will communicate with existing groups, including voluntary organisations and others, and they will try to communicate with the public, too, perhaps through websites and so on, so that people may opt in. There will be a core of people on LINKs, I guess—I should not have to guess—surrounded by dozens of organisations, and beyond that, thousands of individuals who will get involved now and then. Might all those people and organisations be members of LINKs? We do not know, but it is a fair question to pose.
The answers will not come today, but I have mentioned the sort of details that we will have to address in Committee. Even if we do not need to legislate for every detail, it is important that we demonstrate that we know what we are talking about, and that we understand what sort of landscape we want to view in future, to better deliver patient and public involvement in health. I do not think that any of the proposals are bound to fail automatically, but we need more substance, and I urge my right hon. and hon. Friends to bear that in mind. It has been said to me—
Mr. Baron: Will the hon. Gentleman give way?
Patrick Hall: I was hoping to conclude, but yes, I give way.
Mr. Baron: Briefly, does the hon. Gentleman accept that it does not bode well for greater clarity about qualification for membership, if one considers that patients forum members have largely been ignored up to this point, as regards the structure of the reforms?
Patrick Hall: A great deal of work needs to be done, and as far as I am concerned—I have not heard anything to the contrary—existing patients forum members have a great deal of positive work to contribute to that process. In fact, I have not heard anyone suggest that either those individuals, or their ideas, would not be welcome. Indeed, it is essential that such people are involved in the process. Discussing the absence of firm detail, someone told me that envisaging the way in which LINKs will work requires an act of faith. Yes, that is the case, but we need a little bit more than an act of faith when we legislate in Parliament, as I have said. If we are to encourage innovation and, to use a well-worn phrase, let a thousand flowers bloom, we need to know the structures on which that is to be based.
The process of fleshing out the provision could be assisted by the parallel inquiry that the Health
Committee intends to hold on patient and public involvement next month, while, in parallel, the Bill is in Committee. I should be grateful if Ministers would assure me that the outcome of the Select Committee’s deliberations will inform the Bill, and that the programme will allow that to happen, otherwise it is a waste of parliamentary time. The Secretary of State has repeatedly stated that we live in a time of change and reform. There are concerns about the way in which health services are delivered, so we particularly need effective patient and public involvement, hopefully on an informed basis, as that will help to deliver the improved and reformed health services that we want. As those changes take place and as the new PPI process is not yet clear, we must consider how we will undertake the transition from patients forums. It is therefore important that strong signals are sent on transitional arrangements. I urge my right hon. and hon. Friends to reflect carefully on those matters and to introduce a framework for LINKs that is sufficiently detailed to generate a more positive debate on the way in which PPI can be better delivered.
7.22 pm
Dr. Richard Taylor (Wyre Forest) (Ind): I feared that part 11 would be rather neglected, so I am delighted to follow the hon. Members for Bedford (Patrick Hall) and for Billericay (Mr. Baron) and concentrate on it. I am delighted, too, that the Minister of State, Department of Health, the right hon. Member for Doncaster, Central (Ms Winterton), who is responsible for patient and public involvement, is in the Chamber, and I would welcome any contradictions and interventions that she may wish to make.
I am relieved that Members on both sides of the House have reservations about the abolition of patients forums. The hon. Member for Leicester, South (Sir Peter Soulsby) had reservations about their abolition. Surely we could have built on their strengths. I remind the House that in 1641, Lord Falkland said that
“when it is not necessary to change, it is necessary not to change”.
The modern equivalent is the phrase, “If it ain’t broke, don’t fix it.” The measure is another example of unnecessary Government meddling with the NHS. I do not object to change or reform if it is needed and based on completed trials or evidence, but the constant changes over the past 20 years appear to be a case of change for change’s sake, which is intolerable and, in the long run, counter-productive.
I remind the House that we had regional health authorities, which became NHS regional executives, which became strategic health authorities before reverting to regional executives. We had primary care trusts, which became large PCTs—which, in fact, were the same as the abolished area health authorities—and practice-based commissioning is suspiciously like GP fundholding. The Commission for Patient and Public Involvement in Health and patients forums are to be abolished three years after their formation. The CPPIH’s annual review states that the commission was formed in January 2003 and the forums were put in place in December 2003, so they have had only three years and one month in which to establish themselves and work successfully.
The Health Committee produced a report on patient and public involvement in health in 2002-03, in which it stated:
“PPIFs form the cornerstone of the new system for patient and public involvement”.
It cited Sharon Grant, who chaired the Commission for Patient and Public Involvement in Health, and believed that
“it would take at least 3-5 years for PPIFs to be fully operational.”
We have only just completed three years of that three to five year period, but we are about to abolish the PPIF cornerstone of what we are constantly told is a patient-led NHS. Forums have begun to be successful, and in my area they already have links—I use that word advisedly—with patients, ordinary people, young people in schools, disability groups, and trust boards and managers. They are thoroughly effective and, if they were left to develop, other forums, with the right chairperson and personnel, could become equally effective.
We all expected the CPPIH to be abolished, as the Labour party made a commitment in its manifesto to cut the number of arm’s-length bodies. However, the abolition of forums was not mentioned by the manifesto—all that I could find, in a section on empowering patients, were the phrases, “putting patients centre stage” and “extending patient power”. I was lucky enough to secure an Adjournment debate on the subject in July 2004, on the very day that a Government document on the reconfiguration of the Department’s arm’s-length bodies was published. It said:
“Patients’ Forums will remain the cornerstone of the arrangement we have put in place to create opportunities for patients and the public to influence health services.”
Mr. Burrowes: Does the hon. Gentleman share my concern that the Minister and her Department have set great store by the report by the expert panel that said that inspections by patient and public involvement forums were not taken seriously by local NHS organisations, and thus carried little weight? That is not the case in the hon. Gentleman’s constituency, nor in my constituency, where the forum performs a fine service that does indeed carry weight. Would it not have been a better option to follow the example of good practice set by our local forums, rather than seek to abolish forums?
Dr. Taylor: I could not agree more. There are very effective forums that enjoy a tremendously good working relationship with the trusts in their area. They can, and do, have influence. The Minister who replied to my Adjournment debate repeatedly said that patients forums would remain the cornerstone of patient and public involvement in health.
I should like to look briefly at a few things in the Bill, some of which have been mentioned. It is a good thing that the Bill brings together health and social care in the remit of the bodies that will replace patients forums. Clause 153(2) was mentioned by the hon. Member for Bedford, and like him, I am at a loss to understand clause 153(3), which gives the Secretary of State power to alter everything in the preceding subsection.
Much has been said about the limitations of the right of access. The Minister confused me further by saying that the right of access had to be limited because of the number of people who would serve on the LINK bodies. That brings me back to the efficiency of the present forums. They are the right size for members to have access even to residential care homes, nursing homes and so on. Even if they are called LINKs, we need a small group to act as the central body co-ordinating all those who contribute their views on health and social care. The right of access is crucial.
The Bill mentions the right of referral to overview and scrutiny committees only in relation to social care services. I do not know whether that is an omission. I assume there will still be a right of referral to the health overview and scrutiny committees.
Enough has been said about the concerns about independence. Nothing has yet been said about clause 163, which deals with consultation. The worry is that the clause introduces the word “significant” before describing the degree of change in the health service that would warrant a duty of consultation. The word “significant” weakens the provision considerably.
I agree with hon. Members who have commented on the lack of detail in the Bill. There is certainly a lack of detail about funding. In my Adjournment debate back in July 2004, the Minister responding said:
“The current budget for the commission is £33.3 million. There will be no cuts to that budget . . . We will invest more resources in patients forums, and any savings that accrue from the abolition of the commission will be invested in patients forums and in providing expert advice on patient and public involvement.”
Uncertainty has been expressed about the function of LINKs. Again, the Minister responding to my Adjournment debate said:
“I shall describe how patients forums will be affected. As I said, they are the cornerstone of patient and public involvement. They will not be abolished, nor will their independence be undermined. Rather, the support they receive is to be strengthened. It is key in the new arrangements that forums remain as independent as they currently are, so that they can continue to be responsive to the views of local people.”—[ Official Report, 22 July 2004; Vol. 424, c. 583-4.]
We have also heard mention of the loss of a national co-ordinating body, which is essential.
Andrew Stunell: The hon. Gentleman is making some important points about the Commission for Patient and Public Involvement in Health. I am sure that he was present earlier in the debate when I drew the attention of the House to the views expressed by the commission about the fact that its resources had been trimmed to the extent that it had not been able to perform. Does he agree that that is a lamentable record, which ought to be put right now?
Dr. Taylor: I thank the hon. Gentleman for his intervention. Of course adequate funding is essential; that needs to be spelled out. I hope the matter will be examined closely in Committee.
The Government were wrong to tack the provisions on health and social care on to a local government Bill, but I am delighted that they are getting an airing. It has been said that the Health Committee is about to undertake another inquiry into patient and public involvement in health, and that that will coincide with
the Committee stage of the Bill. That seems rather back to front. As the hon. Member for Bedford said, we hope that the Government will allow time for the conclusions of the report to influence the final form of the Bill.
I remind the Government that there are two aspects to patient and public involvement in health. Patient involvement is a single patient’s involvement with their own care, their own illness and communication with staff. Public involvement means definite, independent, adequately resourced and adequately informed representative groups of citizens, with recognised channels for two-way communication with all commissioners and providers of health and social care in their area. The best forums were beginning to do that. If the Bill goes through, the Government must ensure that their replacement, the LINKs, achieve better public involvement, or the Government will be accused of meddling, and the words of the Earl of Derby about Lord John Russell’s foreign policy in 1864 will again be all too relevant: “Meddle and muddle”.
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