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I pay warm tribute to my noble Friend Earl Howe for his dedicated, relentless and ever courteous work on the Bill in the other place and for the concessions he extracted from the Governmentit is fair to say that at
times he forced them, albeit only by force of argumentwith the support of Liberal Democrat peers, notably Baroness Neuberger in respect of part 14.
I also want to pay tribute to my hon. Friend the Member for Billericay (Mr. Baron), who so ably took this Bill through its Commons stages for our party. Its final, better shape is due in no small part to his energy, arguments and sincerity and the breadth and depth of contacts with patients and representative groups, to whom he listened carefully, and whose views on improvements he reflected in his considered approach. It would have been nice if the Government, under the Ministers predecessor, had listened a little earlier in the process. However, from that responsibility the current Minister is unquestionably absolved.
It is important to note in addressing this group of health-related amendments the unfortunate approach that the Department tookunder previous managementin sitting for so long on the responses to their consultation on the abolition of patient and public involvement forums. The wisdom of many PPI volunteers might have been woven into the Bill at an earlier stage, had the Government not sought to silence dissent in this manner.
Of course, the Government are no strangers to quashing consultation, in the form of turning down the volume on patient and public involvement. Members will recall the three-page personal apology that I received from the then Prime Minister in 2000, when the axing of community health councilson the basis of a consultation that, in effect, never happenedwas announced in the NHS plan issued on the last day before the summer recess. Our subsequent campaign secured a years stay of execution, which was vital in forcing the Government not to throw out the experience and expertise of the excellent volunteers dedicated to so many high-performing CHCs. That is an important point in the context of the transitional arrangements that we have just agreed to, in the form of key amendments from the other place.
Tom Levitt: The hon. Gentleman is right to give credit to those who have contributed so much through CHCs and then PPI forums. However, does he accept that not every CHC was equally good, that they lacked coherence, and that there was a lack of scrutiny of operation? Today, the circumstances are different. Local authorities have a much improved scrutiny role, and there is a big grey area between health and social services and health care in general that needs to be subjected to that scrutiny. That is why things had to change, and the Bill now includes a mechanism to ensure higher standards of scrutiny across the board.
Mr. O'Brien: I accept that, as one might expect, the performance of CHCs was patchy, but the vast majority performed very well with well-qualified, well-trained and experienced people. Of course, there were exceptions to that rule. I will address a little later the national linkand, therefore, the national voicethat can be effective in helping to improve health care.
It remains unfortunate that the Government decided to introduce these provisions in a portmanteau Bill,
rather than in a Bill specifically sponsored by Health Ministers. Conservative shadow Health Ministers here and in the other place have achieved much in making this Bill workable, but we might have had a more effective discussion of the arguments at stake if the Bill had had a pure health and patient focus. I must put on the record that our support for these amendments is also without prejudice to our NHS autonomy and accountability Bill. In keeping with our commitment to avoiding organisational upheaval, we would not abolish LINks, but we would seek to give them enhanced inspection powers and independence from local authorities. The Bill as amended gives them their own budgets, which is a step in the right direction, but not enough.
The amendment to clause 223 on co-operation between LINks is a welcome concession from the Government. Although it does not establish a national voiceto return to the point made by the hon. Member for High Peak (Tom Levitt)as robust as the Commission for Patient and Public Involvement in Health, or the health watch body that we will seek to establish through our NHS autonomy and accountability Bill, the Governments recognition that an exclusively local voice is simply not effective is welcome. We wait, however, to see whether this amounts to anything in reality. We lost something of a national voice when we lost CHCs, and I share the hon. Gentlemans hope that that absence will be addressed. We have searched in vain in any of the Governments more recent pronouncementsnot least the new health and social care regulations, announced by the Secretary of State todayfor comfort that such a move will happen. We had hoped that he would remind us how wonderful it would be to have some scrutiny that was independent from the national health service. All of us remember the wonderful work done by CHCs when they produced important and influential national reports, such as the one on bedwatch.
I would also like to draw the Houses attention to the new clauses inserted after clauses 223 and 227. The former makes provisions for governance of LINks and the latter for transitional arrangements to cover the period between the abolition of PPI forums and the establishment of LINks. I am grateful to the Under-Secretary of State for Health, the hon. Member for Brentford and Isleworth (Ann Keen), who met my noble Friend the Earl Howe and acceded to the force of his arguments on those points.
It was important to avoid the danger that LINks would simply be a collection of more random people who would volunteer, thus the amendment wrested from the Government was to ensure that the Bill defines a system of governance: decision making; representation; authority; bodies having their own budgets; and a commitment for regulations to be amended accordingly. Again, that does not go as far as we would have liked to establish true independence. Those who are feeling most vulnerable, who need support and scrutiny of how the health service works in their case, need to be able to trust the bodies. Independence invokes trust more readily than something that is not seen to be independent.
On the latter new clause on transitional arrangements, our concern remains that there are no provisions for ensuring that local authorities discharge
their duty to put in place transitional arrangements. I would be grateful if the Minister could assure us that he will take personal responsibility for the provision of adequate scrutiny in the transitional period.
We have continuing reservations about the extent of the power and independence of LINks. We welcome part 14, as amended, and we of course congratulate my noble and hon. Friends on the important concessions that they have obtained from the Government. They were outlined in the Ministers statement, and it cannot be often that he has to list at least 10 amendments that have been the subject of considerable debate. It is important to recognise that we will continue in the next Session the debate about the accountability that will be the subject of the scrutiny apparatus for the NHS, and about how local government and people, particularly patients, are involved. That will be done through what we anticipate will be the health and social care Bill and our own NHS autonomy and accountability Bill. I confirm that, in the light of that, Conservative Members do not intend to divide the House, and we trust that this part of the Bill will speed on its journey.
David Taylor (North-West Leicestershire) (Lab/Co-op): The hon. Member for Eddisbury (Mr. O'Brien) referred to the scale and frequency of organisational change in the NHS and the damaging effect that it can have if it is done unnecessarily. My hon. Friend the Member for High Peak (Tom Levitt) was guilty of flawed logic when he talked about the replacement of the community health councils. Leicestershires CHC was good and effective; it was widely understood, approachable and achieved a great deal. He suggested that the fact that not all CHCs were as good and effective was justification for the removal and replacement of all CHCs. I do not accept that for a moment. More should have been attempted to bring the quality of work of poor CHCs, as he would see it, up to a reasonable standard.
Tom Levitt: That was only one of the issues that I raised. More important is the fact that local authority involvement in social care is now totally integrated with health care. It is therefore important to have local authority input and a wider remit than the CHCs could have, along with the mechanism to ensure that such bodies are all of good quality.
David Taylor: There is more merit in that particular justification, but the first one that my hon. Friend chose to use was not especially strong. It is an approach that has been used elsewhere in Government: in the coerced stock transfer of council houses away from good housing authorities because a number of authorities have not been adequate in the past. The same also applied in relation to the PPI forums in Leicestershire, which followed the CHCs. They, too, were effective, well supported by volunteers and professionals. Over the years that they existed, they did an exceptionally good job. I have some contacts with key people at the head of those PPIs, some of whom are former work colleagues, and I do not accept that it was necessary to scrap them, but the Bill will do just that.
I have been fact finding about the attitude of the volunteers involved in the PPIs to see what they think
of the Bill now it has reached the final leg of its passage through Parliament. There is good news for the Minister, and I know that he would expect that. The broad view is that the Lords have made some useful improvements in this section of the Bill, but I seek assurances from the Minister in three specific areas. If he is unable to respond immediately, because the information is not available or the time is not sufficient, I hope that he will write to me with the reassurances that I seek.
Firstly, because LINks are based on local authorities, there is a serious risk that the excellent work done by some of the PPIsI instance an acute PPI forum, the foundation ones and those for mental health trustsin Leicestershire, and no doubt elsewhere, will be diluted or lost in the creation of the LINks. I hope to hear more from the Minister about how he intends to ensure that LINks set up joint arrangements to maintain and enhance the work that has been so well received and of such a high standard in my area.
Secondly, the Bill is vague, perhaps inevitably so, on the membership of LINks. It would be impractical for that to continue for a lengthy period. Will the Minister say what the nature of the guidance will be to circumvent that problem? We cannot be certain that LINks, with their new membership, will be as effective as the bodies that they are replacing.
My third and final point is that various reassurances were given, and promises made, in the other place about how the governance of LINks will be robust and improved, and that firm guidance and detailed regulations will be provided to bring that about. I would like to know the Ministers intended approach to that and the proposed sequence of events.
We are on community health councils mark 2, to a certain extent, and no one wants LINks to be set up to fail. It is hugely important that they have the scrutiny role that their two predecessor organisations were designed to bring to the NHS, but much depends on the guidance and regulations. They will probably be floated in late on a Thursday evening and go undiscussed by the main Chamber, but we want to know what the Ministers approach will be and how he intends to avoid the risks and concerns to which I have briefly alluded.
Andrew Stunell: We welcome the 10 shuffling steps forward that the Minister has made on this issue. I also wish to record my thanks to Baroness Neuberger for the work that she and her team did in the other place in conjunction with other Members. It has been a sorry tale and, as has been said, hearts were broken when community health councils were abolished. As I recall, a sharp Labour rebellion led to the introduction of PPIs and all that went with them. They were a step down from CHCs, but not actual abolition. We now seem to have taken a further step away from that original concept. Perhaps the Government are now finishing the job that they could not get past their Back Benchers when they first got rid of CHCs.
Nevertheless, I recognise that the Government have acknowledged some of the weaknesses in their original proposal. In Committee, we discussed the problem that arises with tertiary medical facilities. I spoke about Manchesters Christie hospital, a specialist tertiary
cancer hospital that would be beyond the reach of individual LINks that are pinned to local authorities geographical areas. I take it that what the Minister is now saying about regional, sub-regional and national collaboration between LINks is designed to respond to that problem.
Subsequent to that discussion, I have received representations about how the north west ambulance service would be dealt with under the new system. Again, I hope that the Minister will have the opportunity to reassure the House that the Bill will respond to such problems.
There is a contrast between the Governments response to consultation on these proposals and their response to consultation on earlier parts of the Bill. In the earlier part of the Bill, they dismissed popular opinion in preference to what they considered to be professional insider opinion that knew what it was talking about. One can understand that argument even if one does not agree with it but, in respect of this part of the Bill, the Government have rejected the professional argument as well.
One has to wonder what the Government thought that they were doing when they brought the Bill forward in the first place. It was supposed to be based on the experience of those who know about monitoring and delivering health, but this proposal is a step away from that common-sense approach, not one towards it. If the Minister has the opportunity, I hope that he will let us know how the changes will improve the checking and inspection of NHS facilitiesanother issue that was strongly contested.
Dr. Richard Taylor (Wyre Forest) (Ind): I welcome the changes that have been made, but still have two concerns. First, Lords amendments Nos. 181 and 182 deal with rights of access to LINks, and I hope that the process of authorisation will not be so difficult that it puts people off becoming members. Secondly, I am very worried that Lords amendment No. 182 appears to enable any care organisation that wants to to keep lay monitors out. An organisation like that could be precisely the one that needs a lay visit.
My other concerns have been outlined by the hon. Member for Eddisbury (Mr. O'Brien). The transition arrangements seem liable to leave a gap between the end of PCT forums and the beginning of effective LINks. I hope that that problem can be addressed. In my area, the PCT forum will go on working until the LINk is in place, but it will no longer have the powers that it has at present.
That the draft Renewable Transport Fuel Obligations Order 2007, which was laid before this House on 9th October, be approved. [Mr. Watts.]
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