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“There is no restriction, limitation or curtailment of the powers of the patients forum in connection with the word ‘inspect’ as opposed to the powers of LINKs in connection with the words ‘view’ and ‘observe’.”—[ Official Report, Local Government and Public Involvement in Health Bill Committee, 6 March 2007; c. 546.]
That confirmation is helpful but, even if that is the Government’s intention, it is the practice that concerns forum members and the public. People such as the present forum members of Barnet and Chase Farm and Enfield look to the Department’s draft document for the guidance and how it will be followed through in constituencies such as mine.
The document states that LINKs members will not be able to visit
“until they have written to the relevant regulator, indicating their intention to visit a facility, and received a reply—this is to ensure
that there is coordination of activity at local level; it may be that the regulator already plans a visit in which case it will have the ability to request that the LINk holds off, or just as possible joins in with its review.”
One can understand the practical need to ensure co-ordination, but one can also understand why, in evidence to the Health Committee, the Commission for Patient and Public Involvement in Health expressed unhappiness with the draft document and stated:
“In effect the proposals make a mockery of the visiting rights of the new LINks. It appears that before any visit can take place, they will have to write to, and obtain a reply from the regulator, i.e. the Healthcare Commission! This gives the lie to any notion that the LINks will be able to be free and independent in the way that they work, and other proposals will severely curtail the locations which they will be permitted to enter and observe services in delivery.”
The issue is the value placed on the proposed LINKs, and that is at the heart of the amendment. What has attracted hard-working members of forums in my area, and has enabled them to carry out spot inspections of cleanliness and patient management across a variety of services, is their valued freedom and independence. The essence of the Government’s practical guidance is that it challenges the assurance properly given by the Minister that there will be no change in any powers. That is what people care about. That reassurance is vital if we hope to attract many of the same members who have done such sterling work in constituencies such as mine and many others.
Even at this 11th hour, I invite the Minister carefully to consider the amendment that would retain the word “inspect”. It is not just a question of wording. I am worried that the operation of LINKs is being mainstreamed and absorbed, and that the value of hard-working volunteers will be lost for ever. I ask him at least to review the draft document and guidance to provide the proper freedom and independence that will allow the forums to do their sterling work.
5.15 pm
Mr. Woolas: The hon. Member for Billericay (Mr. Baron) began by saying that there were still unanswered questions. I am sorry he feels like that. Having kept a careful note, I suspect that it is not that I have not answered the questions but that I have answered them and he disagrees with some of my answers. However, if any specific points remain I undertake to follow them up.
Mr. Baron: One of the specific questions that I put to the Minister concerned conflict of interest. Under the Bill, a host organisation could provide services yet be part of a body that assesses its own effectiveness. How do the Government propose to address that conflict of interest, about which we have heard relatively little?
Mr. Woolas: There is a huge difference between the host organisation and the LINKs organisation. Were there to be a perceived conflict of interest, it would be for the local authority, in making these decisions, to rule on that. The Bill is devolutionary, because it creates a bottom-up structure that places trust in local authorities. What is important is any conflict of interest between the LINKs organisation and the host organisation. I shall give further information on that.
Mr. Baron: I accept that the local authority will have a say, but that still does not address the central issue regarding conflict of interest. An organisation that provides services may be involved in assessing the effectiveness of its services, and it must be borne in mind that the money that the local authority has been given to fund the operation is not ring-fenced. That adds a certain twist to the whole issue of conflict of interest.
Mr. Woolas: Half an hour ago, the hon. Gentleman voted for an amendment to prevent ring-fencing, yet now he is trying to provide for a ring-fenced budget. My difficulty as Minister for Local Government—I suspect that this has been the case with all my predecessors, and will be the case with all my successors, too—is that Members are happy to argue against ring-fencing in general, but that we should have it in a particular case. At last year’s Local Government Association conference, the right hon. Member for Witney (Mr. Cameron) said that he would abolish all ring-fencing—I will believe that when I see it. The money is provided for the local authority. In the round, based on what we know, we believe that it is sufficient. The Government are not ring-fencing the money because we trust local authorities and believe that by not ring-fencing we will achieve better value for taxpayers’ money.
I am in danger of repeating myself about conflicts of interest. Local authorities, like Governments, face the potential for conflict of interest across the piece. If we devolve more power to local councils, that increases the chances of a perception of conflict of interest. At the moment, the commission is, in effect, funded by the Government, yet its independence is not questioned. Indeed, that independence is one of the virtues that Opposition Members have cited in arguing for its retention. However, the same applies to what the hon. Member for Billericay said about local authorities.
Any organisation that bids to be a host must demonstrate that it is best equipped to win the contract. That must include being able to declare its interests and manage any potential conflicts of interest. The host will be accountable to the LINK and required to follow its direction, irrespective of its own interests. The sort of organisations that we expect to become hosts deal with such issues all the time, as do local authorities. Many of the current providers of staff support to patients forums also provide health and social care services. We know that potential conflicts of interest do not mean that support is compromised in those cases. The quality of the performance is what counts. I accept as a debating point that there may be circumstances in which there appears to be a conflict of interest. However, in practice, one has to strike a sensible balance.
There is a national body and centre of excellence to improve public and patient involvement. However, it will be open to LINKs, if they so choose—I imagine that they will—to create regional and, indeed, national bodies. Their virtue is that they will be bottom-up bodies that provide even greater independence to the national umbrella body.
My hon. Friend the Member for Plymouth, Devonport (Alison Seabeck) was worried that people who live outside a local authority area cannot join a
LINK. I know that she has taken up the cudgels on their behalf and met the relevant body. A LINK is established to consider all the services that are provided in its area. Those outside can join the neighbouring LINK. Provision will be supplemented by the many interested people in Plymouth who are not currently in the forum. We described the position as the Great Ormond Street problem, whereby services are provided outside the local authority area. Our proposals are an improvement on the current situation.
My hon. Friends the Members for Pudsey (Mr. Truswell) and for Luton, North (Kelvin Hopkins) made important points, which were raised in Committee, about the word “significant” and the impact on public-private relations. A change in the service provider rather than in the service provided—for example, the contract to run a GP’s surgery changing from one provider to another—would not significantly change the service. Another example of that is dealing with overcapacity, whereby—taking account of peaks and troughs—five beds are removed from a 10-bed ward in which only five are ever used. My hon. Friend the Member for Luton, North is therefore right that the definition of “significant” is important.
However, amendment is unnecessary. Significant changes include changes in: patients’ convenience; availability and quality of service; and geography, thereby affecting travel arrangements, and possible eligibility. Statutory guidance, which has the power of statute, will be issued after we have consulted on the changes.
Kelvin Hopkins: Transferring a service—for example, scanning—to the private sector is what I mean by “significant change”. Such a change is genuinely significant and we want to be able to consult and be consulted about that.
Mr. Woolas: I am trying to make the point that the change in the service rather than that in the service provider is important. Let me reassure my hon. Friend. One of the difficulties in the debate is that we are comparing existing scrutiny arrangements in the health service with proposals that cover health and social services. Points have been made about inspection and viewing. At the moment, patients forums do not view social services. We are talking about going into people’s homes—residential, shared homes and individuals’ homes. The comparison is therefore invalid.
We are trying to create a scrutiny and accountability structure that considers the patient, not the building or institution. All Members of Parliament recognise that, when constituents come to us with a problem, the interaction between public agencies and other providers most often causes the problem—for example, a stroke victim’s treatment by the ambulance service, accident and emergency, the hospital, those responsible for aftercare, the benefits office and so on. We are trying to provide for accountability and scrutiny in the round in terms of patient and public involvement.
Mr. Truswell:
May I take the Minister back to the example I cited of the independent sector treatment
centre? The concern in west Yorkshire about such a centre was that it would be a transfer not just of services but of resources, which would undermine the ability of existing NHS trusts to provide services to other patients. The Minister seems to argue that people would not regard that as a significant change, but I have to tell him that people in west Yorkshire and Leeds would view it as a significant change.
Mr. Woolas: But that is not the argument that I am pursuing. We are not debating the entirety of how health and social care should be held to account. What we are debating is the best mechanism for looking at the provision of services from the patient’s point of view. It is therefore the provision of the service, not the service provider—effectively, the interface with the patient—that we believe is important.
Time is pressing and other hon. Members want to speak— [Interruption.]
Mr. Woolas: Let me make some progress and we will see whether I have failed to cover the relevant points.
Some hon. Members made a point about the difference between inspecting and viewing, but I rather think that this is dancing on a pinhead. Patients forums and the proposed LINKs are not inspectors of services in the sense that the statutory inspectorate is. Again, however, hon. Gentlemen cannot have their cake and eat it. They cannot on the one hand complain about intrusion into private life, while on the other allowing unfettered access, particularly in the area of social care, but also in respect of medical care.
Secondly, we hear complaints about over-intrusion by inspectorates. Assuming that patients forums and LINKs were inspectorates, it would be quite right and proper for them to act as gatekeepers to ensure that organisations were not over-burdened. Indeed, Conservative Members supported that proposal. One of the big themes of debate on the Bill has been the allegation—true on many occasions—that there is over-burdensome inspection. One of the measures that we have put in place is the gatekeeper role, so that the main inspectorate—for local authorities, the Audit Commission—can co-ordinate the other inspectorates. Surely the same principle has to apply to LINKs. The hon. Member for Billericay said that we had wasted £120 million in establishing patients forums and then abolishing them. The £120 million that he quotes is indeed the recurrent costs of the years of activities—not the costs of establishing the bodies, so I think that the analogy is unfair.
Mr. Baron:
Let me bring the Minister back to the issue of inspections. With all due respect to him, he is creating a number of Aunt Sallies and then knocking them down. Does he not accept that where patient forums have been successful—for example, in putting the spotlight on cleanliness or quality of food—the power to enter and inspect premises has often been the key? The major concern of a number of patient forum members is that if we do not allow that power to inspect, LINKs will in many respects become toothless organisations, because they will not have the power to monitor services against set guidelines that should
apply to patient care. As many Members have argued, if we take away the inspection powers, it makes for a meaningless organisation.
Mr. Woolas: Let me make two points. First, the debate is being conducted on the false premise that patients forums are perfect organisations, yet by the hon. Gentleman’s own admission the situation is patchy. I supplied figures to the Public Bill Committee and I will not delay the House further by running through them all— [Interruption.] That is not my whole point. The hon. Member for Billericay intervenes from a sedentary position before I have reached the conclusion of my premise. I wish that Conservative Members would listen to the argument rather than to who is saying it.
I have looked into this issue and we debated it in Committee. I strongly believe that the powers of LINKs to enter premises and look at what is going on—whether we call it inspection, observation, viewing or whatever—are still available, but I do not accept the idea that patients forums or LINKs should be inspectors in the formal sense that the Audit Commission is an inspector. They are not—and neither should they be, because they are not qualified to be. They are looking at this from the point of view of lay viewing or lay inspection—let us not have an argument about semantics. The point is that what was asked for was that LINKs should be given the right to enter premises. I can assure the hon. Gentleman that they have that right, and the right to view, observe, monitor and make reports. But we are talking about social care as well as the NHS. We are talking about people’s homes. I know what fun Conservative Members have when anyone dares to suggest that a valuation officer should check that people are paying their full council tax, and it really is going too far to say that there should be unfettered access.
I reject those amendments, and I have made concessions on the points raised in Committee by tabling amendments to satisfy some of the reasonable points that have been made. It is now time to move on, to establish LINKs, to trust local authorities, to have flexibility and to create a body that can hold to account our national health service and the social services from the point of view of the patient, not the provider.
Amendment made: No. 33, page 121, line 25, leave out ‘,varying or omitting’.— [Mr. Woolas.]
Amendment made: No. 34, page 122, line 6, leave out from second ‘area’ to end of line 8.— [Mr. Woolas.]
Amendments made: No. 35, page 122, line 41, leave out from ‘done’ to ‘activities’ in line 42 and insert
‘by a person who, in pursuance of arrangements made under section 172(1), is to carry on’.
No. 36, line 42, at end insert ‘; and
(b) it is done by that person in the carrying-on, under those arrangements, of activities so specified.’.— [Mr. Woolas.]
Amendments made: No. 37, page 123, line 14, leave out from ‘network’ to end of line 16.
No. 38, line 35, leave out from ‘network’ to end of line 38.
No. 39, line 41, leave out from ‘172(2)’ to end of line 43.— [Mr. Woolas.]
Amendments made: No. 40, page 124, line 23, leave out from ‘done’ to ‘activities’ in line 24 and insert
‘by a person who, in pursuance of arrangements made under section 172(1), is to carry on’.
No. 41, line 24, at end insert ‘; and
(b) it is done by that person in the carrying-on, under those arrangements, of activities so specified.’.— [Mr. Woolas.]
Amendments made: No. 42, page 125, line 5, after ‘provision’ insert ‘—
No. 43, line 6, after ‘preparation’ insert ‘by the network’.
No. 44, line 9, at end insert—
‘(ii) requiring the preparation by H of any report that is required, under provision included in the arrangements in pursuance of sub-paragraph (i), to be prepared by a local involvement network but is not prepared by the network; and
(iii) requiring the preparation by H, for each non-networked financial year, of a report in relation to the non-networked activities;’.
No. 45, line 12, leave out paragraph (c).
No. 46, line 26, after ‘report’ insert
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