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Local authorities will have a duty to make contractual arrangements for the involvement of people in the commissioning, provision and scrutiny of health services and social care. That will allow the funding stream to go straight to the local level, ensuring that as much money as possible is available to fund front-line activity. The abolition of the Commission for Patient and Public Involvement in Health is one element of the overall drive to reduce the arm’s length body sector, releasing centralised funding to the local level.
Robert Neill: I am grateful to the Minister for his courtesy, as ever, in giving way to me.
I understand the way in which the funds will reach local authorities—I see the logic behind that—but perhaps the Minister could help a constituent of mine, who feels that if the purpose of LINKs is effectively to scrutinise social services and their involvement, that will be difficult if social services departments are brought into the organisation and the setting up of the LINKs. What safeguards will be provided to ensure that that process is genuinely arm's length, and LINKs have enough robustness and capacity to ensure their independence in such circumstances?
Mr. Woolas: As ever, the hon. Gentleman has made a measured contribution. There are two answers to his question. I have thought about this a good deal.
The first answer is that the local authority establishes the host, which is independent. The host is then responsible for ensuring the existence of the LINK, so the process is at two removes. It could be argued that the existing arrangement, whereby central funds effectively fund the commission, means that it is not independent from Government, but that is not my experience. It is robust in its independence, and rightly so.
The second answer is that the same argument could be used in relation to overview and scrutiny. It could be said that local authorities hold themselves to account through overview and scrutiny committees, whose activities are funded by local authorities. I think the hon. Gentleman will just have to trust local authorities, as I do.
Robert Neill: I am grateful to the Minister for that helpful reply. The only difference, I think, is this. The people who make up the LINKs are often in the voluntary sector, and will not always have the same degree of experience and support as back-bench councillors, or the leverage that they can employ in dealing with overview and scrutiny arrangements. What safeguards can be introduced to ensure that the LINKs are not overwhelmed by the host?
Mr. Woolas: That too is a reasonable point. I think independence can be guaranteed though the active encouragement of the voluntary sector that is behind the measure. The relationship will require the local authority to establish a host, and the host will be required to ensure, through a fair process, that a LINK is established. But there is an interface, and if we are to involve the voluntary sector, as I think we all want to do, we must reconcile the issues.
Part 13 of the Bill clarifies and strengthens the current legislation on health service consultation, and requires NHS organisations to involve and consult. We intend to give primary care trusts a new statutory duty to respond to local people, explaining the activities that they are undertaking as a result of what people have said throughout the year. There will be a structured process whereby commissioners will publish regular reports of what they have done differently as a result of what they have heard, and explain why they may not have pursued some of the suggestions.
Mr. Paul Truswell (Pudsey) (Lab): My hon. Friend will be aware of concerns that the Bill diminishes and dilutes the obligation on health bodies to consult on service changes. Will he assure us that that is not the case?
Mr. Woolas: I can, and I know of my hon. Friend’s interest in the matter. The Bill does the opposite; it strengthens the obligation. In developing these LINK bodies, and in the wider context of bringing together local authorities and other agencies, we are trying to provide a much stronger interface between the voluntary sector and the statutory sector. In committee, I described it as the interface between participative democracy and representative democracy. This is why I earlier described the process as a marathon, not a sprint. However, the general direction of travel is that which my hon. Friend desires.
Amendment No. 32 would add to the activities that it is proposed LINKs will be able to undertake. It will enable LINKs to monitor and review the commissioning and provision of local care services. In Committee, the hon. Member for North-East Bedfordshire (Alistair Burt) proposed that LINKs should have a role in monitoring services, much as patient forums did before. It was suggested that the role of monitoring was proactive. I agree. We have always thought that LINKs should be proactive in seeking the views of people, promoting their involvement and monitoring the commissioning and provision of services. The amendment is intended to clarify that role. LINKs will be able to monitor the range and quality of care services using the intelligence that they have gathered as well as their power to enter and view services. They will be ideally placed to make reports and recommendations to those responsible for care services.
Amendment No. 33 alters the power given to the Secretary of State in clause 172(3), so that the Secretary of State has the power only to add to the activities of a LINK and not to remove or vary those activities. I hope that Opposition and Government Members will welcome the announcement. That was one of our early champagne moments; I have not forgotten my obligation—[ Interruption]—when we receive Royal Assent. As I said in Committee, the Department of Health will be asked to contribute.
The regulation-making power was originally included to allow adjustments to be made to the role of LINKs where necessary to reflect future changes in the nature of health and social care. We felt that it was important to have this flexibility as we know that patient forums have suffered from being too rigidly prescribed in primary legislation. That has made them, on occasion, unable to
adapt to changing circumstances around them. Again, this issue was raised in Committee. The concern was that the power could be used to restrict the role of LINKs at some future date. That was far from our intention; the clause was intended to safeguard the role of LINKs for the future while making them able to adapt.
Further, it was intended that the regulation-making power would be subject to the affirmative procedure to reassure Parliament that it would not be used without appropriate parliamentary scrutiny. In other words, we would need to get the endorsement of the House to make such a change. As this has proved to be of concern to Members, we have reconsidered the clause. We are eager to demonstrate our commitment to LINKs and we do not feel that it would be necessary or desirable to remove any of the functions of the LINKs as they are currently drafted. Therefore, we are happy to reassure hon. Members by removing the power to vary and omit these activities. The power to add to the activities of LINKs has been retained to ensure that their roles can be adapted in the future.
Amendments Nos. 34 to 54 cover two distinct, but related, areas; Nos. 34 to 41, 49 and 54 relate to what can constitute a LINK. Nos. 42 to 48 and 50 to 53 concern the annual reports. In Committee, concern was expressed that the existing clause 173(2)(b), which states that a LINK could be
“any other means put in place under the arrangements for the carrying-on in A’s area of activities so specified for that area”
could allow a LINK to be an entirely virtual entity. When I first heard of that point I was amused by it, but on considering it I thought that an issue had been raised, in the context of this modern world. The amendment addresses that.
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The clause as drafted would allow for virtual LINKs, but it is of course not our intention that that is how their activities would be carried out. The Bill was drafted in this way to allow some flexibility and to provide a fall-back position in the unlikely scenario that there was no one in an area who wanted to participate in a LINK. It allows a local authority to contract with a host organisation and for the host to provide opportunities—or the means for people—to carry out the LINK activities. In light of the concerns that were expressed about the virtual entity possibility and given that it is not our intention that LINKs should take this form, I introduced amendment No. 34, which removes the possibility of there being “any other means” to establish a LINK. Therefore, they will be populated by people, which is of course what everybody wants—real people, as opposed to virtual people.
This proposed change has led to some significant redrafting of associated clauses; as ever, I am grateful to officials and parliamentary counsel for their diligent work. Amendments Nos. 35 to 41, 49 and 54 are all consequential amendments needed to reflect the change to clause 173(2). They remove references to “any other means”.
The second group of amendments relates to LINKs annual reports. Provisions in clause 177 to do with LINKs reports have also been amended. Amendment
No. 44 in particular adjusts the requirement for arrangements to make provision in respect of annual reports. The responsibility for writing the report will usually rest with the LINK. However, if the LINK does not produce that report—for instance because it has been in place for only a part of the year—it will be the host’s responsibility to produce the report for any missing period. If a host has not been successful in establishing a LINK, the host will report on any activities that have been undertaken for the purpose of ensuring that there are means by which the LINK activities are carried out. It will also report on what sums it has spent in its efforts to establish a LINK.
Although the amendments might appear to take some working through, many of them are consequential amendments that aim to address the concerns expressed by Committee members that a LINK could take an entirely virtual form. They also seek to clarify who should be responsible for the annual report. That is an important point. I think that my hon. Friend the Member for Bedford (Patrick Hall) raised the issue about the timing and scheduling of the establishment of LINKs and the overlap with the existing arrangements. I hope that Members will be reassured by our proposed changes and what I have said about them.
Mr. John Baron (Billericay) (Con): I welcome some of the Minister’s amendments; it is clear that the Government have, to a certain extent at least, listened in Committee, particularly in respect of amendments Nos. 32 to 34. However, it should be said that the measures in part 13 of the Bill would bring about a radical change in the NHS. They would fundamentally alter the structure of public and patient involvement in health, notably by scrapping patient forums. Therefore, it is unfortunate that these measures have been included at the fag-end of a Bill dealing with local government—a Bill that does not even have the word “patient” in the title. Some might conclude that that shows the low priority that patient and public involvement has been given under this Government.
Many would consider this yet another pointless reorganisation. Ministers abolished community health councils in the face of widespread opposition and replaced them with a myriad of costly, fragmentary bodies. Now, only four years after setting up patient forums, the Government are abolishing their own reforms at a cost of about £120 million to the taxpayer. Those figures have been audited. Hard-working volunteers up and down the country are appalled that yet another reorganisation is on the cards, believing it to represent a weakening of the patient’s voice and public scrutiny. We know that they have told the Government as much, but Ministers have still not published the submissions from forums to the document, “A stronger local voice”.
My remarks on the Bill, which reflect the amendments tabled, will focus on a number of key concerns. My first concern is with regard to the role of LINKs as defined in clause 172. The Government have introduced several amendments in respect of points that we raised in Committee. As I said, I welcome those, but we believe that an opportunity has been missed to make the Bill even better. Government amendment No. 32 would add the words:
“enabling people to monitor, and review, the commissioning and provision of local care services”
to the list of local activities. Before that, according to the Government, LINKs would have been nothing more than a conduit for people expressing their views. As we argued in Committee, LINKs should be about much more than that, and I am pleased that the Government agree.
It was always a role of patient forums to monitor services, and that should be allowed to continue. The amendment allows the public to have a proactive role in reviewing and, ultimately, improving the quality of services. That is to be welcomed. Without that function, the right to enter and view premises would be simply another means to gather views, and not a remit to inspect and critically assess health and social services.
There is one further activity that needs to be included in the Bill, and that is what we hope to achieve with amendment No. 76. It would require LINKs to report back to local people as well as to other bodies, such as primary care trusts. The Government’s view is that LINKs are primarily a conduit for local people to express their views about the commissioning and provision of services. We believe that the flow of information needs to be two-way. That is especially important if Government amendment No. 32 is passed, as it is likely to be. LINKs will then have a proactive role in monitoring and finding out about services. The findings should be brought to the attention of local people. They need to hear back about how they are being represented, while the sharing of information generally facilitates patient choice and promotes accountability in the broadest sense. I therefore invite the Minister to accept our amendment.
Government amendment No. 33 is a step in the right direction. It is another concession in response to the point that we raised in Committee, in that it denies the Secretary of State the power to restrict the activities of LINKs. Our fear was that the definition of patient and public involvement included in the Bill could be rewritten entirely by the Secretary of State without having to return to the Floor of the House. It would certainly make a mockery of our careful consideration of the Bill if the House were to approve this part in its current form.
My second concern is about the composition of LINKs, as covered by clause 173. This is one of the vaguest parts of the Bill, and has been the cause of confusion among patient volunteers about future arrangements. Government amendment No. 34 helps because, as the Minister has already highlighted, it removes the possibility of a LINK being a purely virtual arrangement—that is, one without individuals or organisations being directly involved. Clearly, that would be unacceptable. I know that the amendment has been tabled following probing by my hon. Friend the Member for North-East Bedfordshire (Alistair Burt) in Committee, and I welcome it.
The Government amendment, however, still leaves too many questions unanswered, in particular about the rules for membership and the arrangements for governance of the LINK. The Government’s aspiration is clearly to get as many people as possible involved in health and social care by giving them the freedom to
drop in and out of patient and user involvement. However, the larger the LINK becomes, the more infrequently some of its members are involved, and the more difficult and unwieldy it becomes for it to decide on programmes of work and undertake a proactive role in monitoring services.
Therefore, we believe that there needs to be a core group of dedicated members who have training, expenses and support to give leadership, drive and focus to the work of the LINK. Current members of patient forums are good candidates for such a role, but that is not being delivered by the legislation. At the moment, the Bill leaves such matters to chance. There will be some vague arrangement, whereby the host organisation and the LINK will somehow put such arrangements into place. In short, Parliament will vote a large sum of money to set up LINKs without knowing what we are getting in return—and that takes me to my third concern.
It is still not clear how much influence the host is meant to have over the LINK—for example, in determining the governance arrangements—which leaves the way open for a possible conflict of interest. Our amendment No. 77 would ensure that the host organisation was not a provider of local services to be monitored by the LINK; otherwise a clear conflict of interest might arise, because the host organisation would on the one hand be providing a service for the local authority, while on the other hand it would be part of an organisation whose responsibility it was to monitor the effectiveness of that service—my hon. Friend the Member for North-East Bedfordshire made a related point earlier. That would be nonsense, and the conflict of interest problem needs to be addressed. If the Government object to our amendment, it is for the Minister to explain exactly how they intend to require prospective host organisations to demonstrate an ability to manage such a conflict of interest.
In Government amendments Nos. 42 to 52, the Minister introduces the concept of non-networked activities carried out by the host organisation and requires the host to report on them annually. Exactly what are non-networked activities? It is not clear in the measure. Are they activities relating to the formation of a LINK, and if so, will the Minister confirm at the Dispatch Box that they are the only activities that host will be able to undertake independently of the LINK? If not, we shall be creating much uncertainty.
My fourth point is extremely important, and it relates to the right of LINKs to enter and inspect premises. The opinion of current forum members is particularly vexed on that subject; indeed, the Government agreed to include a limited power—to view premises—only after the Minister of State, Department of Health, the right hon. Member for Doncaster, Central (Ms Winterton) was ambushed at a meeting of irate volunteers last autumn, at which I was present. Where patient forums have been successful—for example, in putting the spotlight on cleanliness or the quality of hospital food—the power to enter and inspect premises has often been key. However, the Bill contains only a watered down version of that power—to enter and view.
Our amendment would replace the word “view” with the word “inspect”, because there is a fundamental difference between the two. In our book, “to view” means that one is simply collecting information,
whereas “to inspect” suggests something more—that services are being monitored against set guidelines. The reason given in Committee for the Government’s opposition to our proposal was:
“LINKs members are not inspectors or regulators as covered by the inspectorate regime.” ——[Official Report, Local Government and Public Involvement in Health Public Bill Committee, 6 March 2007; c. 545.]
A fair comment, one might think—but the Government’s approach completely misses the point. I ask the Minister to address this point: there is such a thing as lay inspection, influenced by patients, which is what patient forum members around the country have been doing. They are a critical friend rather than a formal regulator; they build up relationships with members of staff and the management, and their visits are more frequent and spontaneous than those of the Healthcare Commission. That approach has worked well, so it is a shame that the Government are blind to the excellent work of patients forum members in that respect.
Mr. Burrowes: I commend my hon. Friend’s case for the importance of a statutory definition of the word “inspect”. In Committee, we had an interesting debate about the need to pay close attention to definitions, so should the Minister not explain why there is no such definition in the measure? He tried to reassure us that to all intents and purposes LINKs would have the power of inspection as part of their function, but why is there no definition in the Bill?
Mr. Baron: I very much agree with my hon. Friend. We probed the Government on that point in Committee, but as yet we have not had a satisfactory answer, although I hope the Minister will put that right today. In fact, I would suggest that the Government are so blind to the benefit of this approach that their own draft regulations subordinate the few inspection rights that LINKs members have to the work of the regulator—for example, by requiring LINKs to obtain the agreement of the regulator before making a visit and to co-ordinate their work.
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