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Amendments Nos. 131 and 132 might provide an opportunity to restrict the ability of the Secretary of State to impose limitations on the rights of LINKs to enter and view or inspect premises. However, there is still time for the Minister to make a commitment at the Dispatch Box not to fetter the right of LINKs to make spot checks on premises that they are entitled to enter. It is absolutely right to say that we have not had a satisfactory explanation of why the Government seem so concerned about the ability of LINKs to enter and inspect. I would welcome the Minister’s response to that point.
I now turn to perhaps the most important part of the debate. Conservative amendments Nos. 80 and 81 would save patients forums from abolition. They reflect a number of concerns and observations that we have about the manner in which the Government are proceeding. There are too many questions about LINKs that the Government seem either unwilling or unable to answer. Issues such as the composition of LINKs, the potential conflict of interests and the right
to inspect have not been properly addressed. For that reason, we believe that it is unwise to abolish what presently exists, and works increasingly well, and to replace it with a structure about which we have many doubts.
First, let us not be fooled by the talk of building on forums or turning forums into LINKs. The truth is that forums are being abolished and LINKs are being created from scratch. When community health councils were abolished, many hard-working volunteers were lost to the system. Too little of that expertise made the transfer to patient forums. I fear that the same mistake will bedevil LINKs. Ministers have said that they hope that patients forum members will be included in LINKs. I have heard that many times from the Minister. But such inclusion cannot be guaranteed. It is in the gift of the host organisations. We do not want to lose the body of expertise that has been built up over the last four years.
Secondly, I remain concerned that funding from the Department of Health might be prevented from reaching the front line of patient and public involvement. The money given to local councils will be targeted, but crucially, it will not be ring-fenced. The expert panel that developed or helped to develop the idea of LINKs did not propose that funding would be handled in that way. Money intended for health could end up being siphoned off by local government, which could be under financial pressure in relation to a whole range of issues. I challenge the Minister to explain, even at this late stage, how that can be guarded against. If the Government are serious about targeting the money, why should it not be ring-fenced?
Thirdly, although the focus of LINKs is understandably local, the Government have shown a complete lack of leadership on the question of a national voice for patients. Ironically, after years of delay, the patients forums have finally persuaded the Commission for Patient and Public Involvement in Health to help them to develop a national organisation, but if patients forums are abolished, it looks as if that national organisation will be abandoned. LINKs would put nothing in its place.
Finally, questions of accountability have not been answered. It is not clear what sanctions exist if the LINKs are not performing well. Patients forums are ultimately responsible to the commission, which is an independent body. I accept that we do not want to give too many organisations a lever of undue influence over the LINK or the host organisation, but clearly there must be accountability when it comes to the use of public money, and what is done in the name of local people. That accountability is sadly lacking. Patients forum volunteers up and down the country have worked hard, despite some of them being badly served by patchy administrative support and hesitant leadership from the commission. Given our reservations, I would like to test the opinion of the House on amendment No. 80.
I should say a few words about amendments Nos. 82 to 85, which seek to challenge the inclusion of the word “significant” as a qualification on the duty to consult. Our fear is that that represents a mechanism by which consultation can be restricted, rather than enhanced. Ministers have said that a threshold is needed to prevent mischievous or vexatious interpretations of the
duty and to avoid consultation fatigue on trivial changes. However, I am aware of no specific examples—none at all—of that being a problem under the current arrangements, which, as far as we are concerned, do not include such a qualification.
Indeed, it is difficult not to be a little sceptical about this measure, because the definition of what is significant is often controversial; it is a very subjective term. Some of the examples given by the Minister in Committee, such as a reduction in the number of beds in a hospital or changes to a GP’s opening hours, might well be considered significant by patients, but not by the health service bureaucracy. The last thing we ought to be doing is setting the scene for legal wrangling, when the promise of the document “A stronger local voice” was to clarify the duty to consult.
In conclusion, the Government have failed to make the case for LINKs. Too many of our questions remain unanswered. There may be a need to improve patient and public involvement in health by enabling more people to get involved in more flexible ways and to join up health and social care. However, that could and should have been achieved by reforming patients forums and building on their expertise, rather than abolishing them and starting from scratch. Too much taxpayers’ money is being wasted, and perhaps more importantly, too much expertise risks being wasted.
Instead, the Government seek to abolish the system that they put in place only four years ago. They are betraying the hard work and dedication of volunteers, who do not understand what they have done wrong or why they are being got rid of. If the system of patients forums has failed, it is only because Ministers have made mistakes. They should not be allowed to walk away from those mistakes without being called to account in the Division Lobbies of this House.
We have sought to improve LINKs and make them workable, and I believe that the Government’s amendments would, to a certain extent, help to do that. However, key questions still have not been answered about the composition, membership and governance of LINKs, about their rights to enter and inspect premises and about the relationship between them and the host organisations. Crucially, I do not believe that LINKs represent continuity and retention of expertise within patient and public involvement in health. They represent careless reorganisation and uncertainty—something that the NHS has had far too much of in recent years. For that reason, Madam Deputy Speaker, and with your permission, my colleagues and I will call on the House to vote against the abolition of forums by supporting our amendment No. 80.
Kelvin Hopkins: I support amendment No. 249 to clause 182, in my name and those of my hon. Friends the Members for Blaydon (Mr. Anderson), for Pudsey (Mr. Truswell) and for North-West Leicestershire (David Taylor). This simple amendment is about fairness, accountability and ensuring a level playing field in consultation. In Committee there was a welcome acknowledgement by Ministers that the Government would ensure that health commissioners included clauses in contracts with independent health care providers, obliging them to allow LINKs access to premises. That is important, and we look forward to seeing the guidance that will accompany the legislation.
As we know, however, there is a difference between providing guidance and having something in black and white in the Bill. Unfortunately, the Bill does not achieve a level playing field regarding the scrutiny to which health providers will be subjected, whether by LINKs or by local authority overview and scrutiny committees. The Government’s choice agenda will mean that health services are increasingly likely to be run by providers from the private and voluntary sectors. I have strenuously opposed the privatisation of our health services, and will continue to do so; nevertheless, it is happening. I want to ensure that local people can hold service providers to account, because that has never been more important.
We need to strengthen health scrutiny arrangements, not weaken them. In contrast to what my hon. Friend the Minister for Local Government said earlier, last month the Health Committee’s report on patient and public involvement highlighted a number of the problems in the Bill. Arguably the most important point made by the Committee was that the Bill weakens consultation by restricting to “significant” decisions the obligation to consult local communities under section 11 of the Health and Social Care Act 2001, now section 242 of the National Health Service Act 2006.
Clause 182 concerns the definition of “significant”. Two areas are already included: the manner in which services are delivered and the range of health services available. That is helpful, but it is not enough. The amendment would add a third tier to the definition: whether the ability to scrutinise services is affected. In effect, that would mean that if provision of a given health service was to be transferred to an organisation or company that was not subject to the same levels of scrutiny as the NHS, the public would have the right to be consulted on whether they wanted the change.
The Select Committee also criticised the fact that too many sham consultation exercises are carried out in the health service. Patients and the public want and need to be actively involved in the delivery of their health care, and engaged by meaningful consultation. The more that we as Members of Parliament can do to facilitate that, the better.
I, too, have been concerned about the changes in patient representation. I was more than uncomfortable about the abolition of community health councils. In Luton, we had a shop front in the town centre where patients could go in and talk to people; they did not have to write a letter or engage in any difficult communication. What they wanted to talk about was dealt with face to face over a counter in the town centre. That has now gone, replaced to some extent by the patient advice and liaison service in the hospital and by PPI forums.
Luton has a strong PPI forum, led robustly by my very good friend and constituent, Mrs. Josephine MacLean, who keeps the local health service on its toes; that is her job. However, her position is to disappear and I am concerned about that. I want to make sure that the replacement is at least as robust, and that people like Mrs. MacLean, who have the interests of patients and my constituents at heart and fight for them, will have a role in the new arrangements and will be able to take a strong position on both the remaining public sector part of the national health service and on any services that move to the private sector.
I suspect that the private sector is not keen on having strong patient representation. It does not want to be so accountable. Perhaps it prefers to rely on market forces—after all, under the choice agenda, if something does not work with one provider, one goes to another—but that is not good enough. Private providers will get away with murder unless they are held to account through some sort of local patient representation. We must have robust representation. I hope that the Government will take note of that point and accept my amendment.
Tom Brake: I shall not go over arguments made in Committee about LINKs and their funding, representation on those bodies, the fact that there is no national umbrella organisation that will be able to pull together issues that individual LINKs identify, and the fact that it appears that lessons have not been learned from the abolition of community health councils. I shall comment on our amendment No. 75, but first I confirm that if the official Opposition press amendment No. 80, which would delete the clause that provides for the abolition of patients forums, to a Division, we shall certainly join them in the Lobby to support it.
We intend to press amendment No. 75, which stands in my name and those of my hon. Friends the Members for Southport (Dr. Pugh) and for Hazel Grove (Andrew Stunell), to a Division. The Times today contains a topical article that refers to Conservative research on the possibility that half of all A and E units may be marked for closure. That is what our amendment is specifically about. I see the Minister shake his head to indicate that that is not the intention, but I suspect that he would confirm that, according to current Government guidance, the population figure that such units are required to cover is in the order of 450,000. Given the number of A and E departments operating today that do not have a catchment population of that size, we can extrapolate how many the Government might, in an ideal world, want to be taken out of the system.
Amendment No. 75 provides that if a significant change is proposed to health services that would affect their accessibility, all the relevant parties—LINKs, patient groups and transport authorities—should be consulted and they should report the impact in a way that the Secretary of State may determine and thereby put the focus on the impact on patients of reduced accessibility to services.
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When the Minister responds, he will no doubt refer to the debate in Committee and simply say that the matter is covered by proposed new subsection (1D)(a) of section 242 of the National Health Service Act 2006, which is set out in clause 182(2). Our amendment would ensure that there was a much greater focus on the subject, and it would mean that the issue of the accessibility of services was not hidden away in the Bill’s small print. I hope that the Minister will say something positive about the amendment and will accept it; it has been put forward in a constructive manner. If he cannot or will not accept it, it is our intention to press it to a Division.
Mr. Truswell: I shall touch on three issues that hon. Members have already raised. The first is the abolition of patient forums. I am glad that we all resisted the temptation to rehearse the history of community health councils, but I share the view expressed by hon. Members on both sides of the House about the questionable wisdom of abolishing forums. To repeat a point that the Select Committee on Health spelled out clearly, now that we have abolished CHCs and are moving towards abolishing forums, I am left confused about what local involvement in health networks will be like and how they will operate in practice. I am particularly concerned about that. It was certainly true of CHCs and patient forums that people could see what they were getting. I echo the comments of my hon. Friend the Member for Luton, North (Kelvin Hopkins) about the expertise that was developed by CHCs and passed on to forums. That may be lost if we are not careful to give LINKs the sort of focus that hon. Members have talked about.
My second point is about the significance of the word “significant”—a subject that was discussed by the hon. Member for Billericay (Mr. Baron). As I tried to point out in my brief intervention earlier, there are outstanding concerns about whether there will be a great shift in emphasis, as regards both the right to be consulted and the impulsion on health bodies to carry out consultation. Like the hon. Gentleman, I fear that under this part of the Bill some issues for consultation might fall under the radar, either inadvertently or deliberately.
I crave hon. Members’ indulgence while I give a recent example. Wharfedale hospital is not in my constituency, but it serves a great number of my constituents. It has existed for many years, but under the Conservative Government it deteriorated, decayed and lost services. From time to time it was earmarked for closure and we had to fight campaigns against that. Under this Government, it has been rebuilt and it is one of the great achievements that we can point to locally. The new building opened two years ago, but unfortunately, instead of it being used to maximum capacity, its progress has been characterised by the gradual withdrawal of services.
In autumn last year, a 16-bed ward for older people was closed without any consultation. The explanation given by the trust was that it could provide the same level of service to older patients with fewer beds. That may or may not be true, but in the context of the gradual removal of services, and given what local people saw as the diminution of the hospital’s functions, that ward closure was an extremely significant issue for them. Back in the autumn, under existing legislation, it was questioned whether there should have been consultation on what local people regarded as a major issue, so I wonder whether use of the word “significant” in the Bill would allow such issues to drop even further below the radar.
Finally, I echo the comments of my hon. Friend the Member for Luton, North about amendment No. 249, to which my name is attached. There is a real fear that—and it will be so argued—under the Bill as it stands, the simple transfer of services to the private sector will not necessarily trigger a consultation. Let me give a hypothetical example that might become a practical one in due course. I am certainly of the view
that independent sector treatment centres, given their very nature, should not be introduced without major public consultation. It might be argued that that is not so, because there is a level transfer of service and no reduction in capacity. However, on looking at the proposals for an ISTC in west Yorkshire—thankfully, they were ultimately withdrawn—I was very concerned about the implications of their implementation.
The issue was not the level of patient care and capacity—that would certainly have been there—but the proposed transfer of services from the NHS acute trust in Leeds, which would almost certainly have had a wider impact. Resources would have been transferred out of the trust and there would have been implications for its ability to meet its fixed costs, so that would have been an extremely significant move. Perhaps Members can call to mind other such examples of transferring NHS services to the private sector. I therefore seek an assurance that my amendment is not necessary and that this issue, about which I am very concerned, is dealt with in the Bill.
Mr. Philip Dunne (Ludlow) (Con): I want to make two brief comments in support of the amendments of my hon. Friend the Member for Billericay (Mr. Baron). The Government have succeeded in upsetting a large body of volunteers through the manner in which they have abolished patients forums and given up the expertise that was so willingly given in the past two years. That has been a great mistake, and the Government should have recognised that and sought to build on the success of what had been established, rather than abolishing it.
Secondly, I want to support what the hon. Member for Pudsey (Mr. Truswell) said a moment ago. What is “significant” in one area might not be in another. Let me give a local example. Last year, Shropshire went through a consultation exercise, set in train by Shropshire County primary care trust, on the future of services in three of our community hospitals, all of which are in my constituency. The saving of £150,000 was sought from Bishop’s Castle community hospital, which could have led to its closure. It is a small hospital, and in the context of the PCT’s revenues—probably of any PCT’s revenues—£150,000 is a relatively insignificant sum. However, it was hugely significant to the people of Bishop’s Castle. Similarly, a saving of £300,000 was sought from Ludlow hospital, which would have resulted in the closure of half its beds and two of its wards. So, what is significant in a national context when drafting legislation, and what is significant in a local context when implementing that legislation, are very different. Amendments Nos. 82 and 83, which would delete the word “significant”, are therefore entirely relevant. If they are accepted, local areas would be obliged to undertake consultation on matters relevant to them. I therefore urge the Government to accept the amendments.
Alison Seabeck:
I rise to point out concerns that were drawn to my attention by my local patients forum at a recent meeting. It was a lively, extremely thoughtful meeting, and the forum acknowledged that many good measures are being introduced as part of this change.
However, it still has anxieties and it has asked me to voice its concerns directly to the Minister and to seek clarification.
It needs to be borne in mind that the south-west is an enormous region, taking in Cornwall and Devon and the wider area, as well as Plymouth itself, so it is difficult for local authorities to monitor and review the commissioning of local services and their delivery in the locality. The patients forum has done good work in that area. Recently, for example, Cornwall county council scrutinised the work carried out at Derriford hospital in Plymouth. The patients forum gave evidence, but it is their belief that under the new structures that will no longer be possible because of the definition of the area. Forum members are also extremely concerned that only two of the existing members live in the Plymouth local authority area, and that other existing members of the forum will no longer be able to participate in the LINK, which will be based in and around Plymouth and around Derriford hospital, which, because of its size, meets the needs of a much wider area across the peninsula of the south-west.
The second issue is how well the patients forum is embedded in the day-to-day running of the hospital. Members of the forum are involved in the infection control committee, the valuing people group, Plymouth health and well-being overview and scrutiny panel, as well as the care standards group, the bus users forum and so on. They are proactive and therefore on the ball and able to flag up immediately issues that arise in the hospital or are linked to the hospital. They are worried that the new LINK will not be able to be as proactive and responsive because the new arrangements for access and inspection are thought to be far too formal. I would welcome the Minister’s comments.
Mr. Burrowes: I shall speak particularly to amendment No. 78, moved by my hon. Friend the Member for Billericay (Mr. Baron). Without rehearsing the arguments advanced in Committee about the removal of the defined right to inspect, I shall focus on one definition that is important because it goes to the heart of the message from the Government about how they value the new LINKs.
The Minister reassured me and others in Committee when he said that it was not the intention to change any powers by removing the word “inspect”. He went on to say:
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