Clause
153
Health
services and social services: local involvement
networks
Alistair
Burt (North-East Bedfordshire) (Con): I beg to move
amendment No. 196, in clause 153, page 109, line 26, at end
insert—
‘(aa) monitoring the
quality of the delivery of care
services;’.
It
is good to see you in the Chair, Mr. Benton. I apologise to
the Committee for being absent for the last couple of sittings. I was
in the holy land of Israel, once memorably described by David Vine, the
BBC sports commentator, as a Mecca for tourists. Sadly, I have to
report to the Committee that the seriousness of the issues being dealt
with over there and the stubbornness of the sides involved make a
return to the bonhomie and the present discussions of this Committee
very welcome. It puts all our deliberations in this country into some
sort of perspective. It is nice to be back and good to see
colleagues.
This
amendment begins the discussion on part 11of the Bill which
deals with patient and public involvement in health and social care.
Members of the Committee have received a great deal of information
about this from various bodies. They all have specialist knowledge in
this area and have been generous with their time and expertise in
briefing us for this part of the Bill. I shall ask for your generosity,
Mr. Benton, in dealing with this amendment. I will not
discuss all aspects of the concerns that members of patients forums
have about the Bill, but if I could include one or two general remarks
it would save repetition when we debate later
amendments.
We have all
been a little taken aback by the vehemence of the concerns expressed by
those involved in patients forums and the concern with which they have
approached us in relation to this part of the Bill, which does away
with patients forums and substitutes for them a new creation called
LINKs. Part of the reason for their concern is that there is some
history here which is relevant to the amendment and the power of
patients forums to monitor the activity for which they are given
responsibility. Part of the history of that concern is related to the
way in which patients’ representatives feel they have been
treated over a period of
time.
The Committee
will remember the evidence given to it at the beginning of the witness
sessions by Elizabeth Manero and Sally Brearley of the social
enterprise body, Health Link, and the worries that they expressed
during the course of their evidence. I shall quote, as I have quoted
before, from Elizabeth Manero, because she puts it very clearly and
sets down a marker that we should take into account and that will guide
us through these discussions. She said:
“The other day, I met
someone from my local patient and public involvement forum who was
involved in mental health and who talked about the despair and
disillusionment of the forum members, many of whom are mental health
service users. They had found, yet again, that they were told,
‘You are really great; you are doing a great job, but we are
going to get rid of you.’ The
message that comes across from that is, ‘We are going to get rid
of you’, not ‘You are an excellent resource.’
Actions are judged more than words, and all the other reassurances
about the quality of the forums, which I thoroughly endorse, are
undermined entirely by abolition.”——[ Official
Report, Local Government and Public Involvement in Health Public Bill
Committee, 30 January 2007; c.
56.] Elizabeth was moved to quote
from Brecht’s poem “The Solution”, in which he
raises the possibility of a Government, disappointed with its people,
abolishing the people and electing another. That was an ironic
statement if ever there was one—a statement that we would all
agree was a strong one to refer to in the present
context.
Patient
representatives have not been alone, however. A number of hon. Members
of all parties spoke on Second Reading, and made clear during the
witness sittings their own concerns about abolition of forums and the
manner of that abolition. As I have said, there is history in all this.
The guide to the Bill prepared by the Library includes, on page 91, a
quote from Melanie Johnson, who was then Under-Secretary of State for
Health. In July 2004, she said that forums were the cornerstone of
patient and public involvement
and:
“They will
not be abolished, nor will their independence be
undermined.”
Incidentally,
if it has not been done before, this is an appropriate time to pay
tribute to the Library staff for their excellent work in producing the
entirely bipartisan and neutral research papers that help us so
much.
The same changes
have happened before, when community health councils were abolished
some years ago. Patient representatives feel marginalised by processes
whereby they are first involved in the health service, and then let go;
by situations being adjusted without proper consultation; and by not
being involved in the decisions that are made about them. It is clear
from all their submissions to us that they strongly believe that the
measures in the Bill, and the first amendments, justify concern. I
shall elucidate the nature of that concern as we proceed through the
clauses and amendments. However, the patient representatives believe
that there will be a dilution of the powers and expertise that they
have and that they would like to bring to the service of those involved
in health care provision in future.
Tom
Levitt:
Pausing only to point out that Jerusalem contains
the third most holy shrine in Islam, may I point the hon. Gentleman to
the questions put to the Minister of State, Department of Health, my
right hon. Friend the Member for Doncaster, Central(Ms
Winterton), in the fourth scrutiny sitting? In that sitting, I raised
the use of the term “abolition”, because it is a term
that causes alarm and concern despite being merely the necessary legal
description of a process of change. In her reply to my question, my
right hon. Friend said that there was no reason why that process could
not be seamless. The only reason that the change is necessary is
because of integration with the now well-established scrutiny powers of
local authorities.I agree that it is unfortunate to have had
two fundamental changes in a relatively short time, but I hope that the
changes that will take place during the next 12 months or so can be
regarded as part of a process, rather than as abolition and as starting
from scratch, because they do not amount to
that.
Alistair
Burt:
I hear what the hon. Gentleman says. In fairness,
however, he made exactly those points in questioning Elizabeth Manero
and Sally Brearley in the witness statement sitting, and we are now
some three weeks beyond that stage. I have not noticed that we have
received, in answer to the requests for reassurance sought by the hon.
Gentleman from the Minister, information from those who previously
lobbied us that their fears have been dealt with and that they regard
everything as okay. On the contrary, they have continued to express
their concerns about the way the measure is being progressed,
specifically on a number of particular powers and offices that they
expect to carry out.
The hon. Gentleman is entitled
to make his point. However, if the matter had been dealt with to the
satisfaction of those who are lobbying us, if they regarded the
transition as seamless, and if they accepted the Minister’s
assurances at face value, we would not have had the continuing
representations that many of us have had.
Dr.
Pugh:
Surely, like me, the hon. Member for North-East
Bedfordshire must find slightly implausible the suggestion that all we
have is an existing organisation given a new function—a seamless
transition. What we have is a new organisation defined with a different
structure and a different set of responsibilities. That is
abolition.
4.15
pm
Alistair
Burt:
The hon. Gentleman has made his own point and one
with which I thoroughly agree. That is the point. It is not the
seamless carrying on of the existing forums. They have been turned into
something quite different. It is those very differences that lead to
the amendments and the concerns, which we will be
discussing.
Tom
Levitt:
The hon. Gentleman will be aware that the way in
which local authorities are organised means that there is a bigger area
of grey between the fields of health and social care than ever before.
Is it not therefore right that the method of scrutiny and patient
intervention and involvement should reflect that huge area of overlap
between local authority and health service
responsibilities?
Alistair
Burt:
The hon. Gentleman is taking us into the substance
of part 11 as a whole. I do not want to get into the general discussion
because, rather like an onion, the various layers will unpeel as we go
on. To make the point, if what he said held water with those who are
most closely involved, we would not be engaged in the discussion of the
clauses that we are going to be engaged in. He is entitled to put his
point, one that I have no doubt the Minister and his loyal colleagues
will be making equally strongly. However, to judge from some of the
amendments tabled and from previous comments, I suspect that not all
the hon. Gentleman’s colleagues share his belief that all is
sorted.
I will make
one response to the general point the hon. Gentleman has raised about
the expansion of LINKs theoretically encompassing a very large number
of people and thus diluting the very special patient
voice which exists through the forums. The forums maintain that they
are patient representatives, not collections of organisations with
connections to the health service. They are not diluted by having a
number of health professionals sit on their bodies. They are patient
representatives, which is what has given them the voice which they
believe provides such an important point of reference in the monitoring
of health services. The central point of their concern is whether that
will be lost. Notwithstanding the different provision of health
services, a distinctive voice is going to be lost in some manner. It is
for the Minister to convince us all, during the discussion on the next
few clauses both today and next week, that that is acceptable. However,
I maintain that the views expressed to us suggest that there is doubt
about that. Let us
turn, if we may, directly to amendment No. 196 which seeks to add the
phrase
“monitoring the
quality of the delivery of care
services”.
The aim is to
ensure that a particular type of expertise will not be lost. Forums
have told us that they clearly regard their function not as
cheerleaders for services, people eliciting views about services or
making private reports for service providers—we will come onto
that in a moment—but as people who monitor the quality of
services. By their presence, they make service providers think
carefully about what they are doing because they are dealing with those
who directly represent service users. The concern is that the power to
monitor has been taken away. This amendment seeks to put that back
in.
We also believe
that monitoring is a proactive role, not simply a passive one. Without
the remit to monitor, the power of entry—we will discuss later
whether it should be one of entry or to inspect—will be just
that: the ability to enter premises and gather views rather than take a
more proactive role, one which the term “monitoring”
implies. Monitoring also gives substance to what members are to do. As
we will hear later, it is difficult enough for forums to attract
members at present; they will maintain that they have been messed about
in the past and that they need a dedicated core of people who build up
expertise in order to be able to do their job. People must have
something positive to do. It is not a matter of getting a group of
well-meaning volunteers to sit around, be told things about the health
service, nod knowledgeably and go away; these are people who want to do
something.
Part of the
discussion has been about what councillors feel now. The argument is
that because the nature of councils has changed and their powers are
different, it has become more difficult to recruit councillors because
some feel that they do not have a proper job to do any more. That is
something that every member of the Committee
understands.
The same
point is made about the forums: members must be given something proper
to do. They must not be seen by the public, the press and health
services as well-intentioned, well-informed patsies who go around
masquerading as people who can take a serious part in the provision of
health care services. That is the gist of their concerns. The amendment
would ensure that monitoring the quality of services would become a
distinctive part of what LINKs will be about in
future.
Dr.
Pugh:
Clause 153 will create a strange beast, which we do
not yet recognise as it does not exist, and it will apparently have the
potential to morph into all sorts of exciting things that the
Government hope will serve patients and the NHS ever better. That is
the rationale for the change, which is not expressly said to be to
negate the work of an already troublesome body that is a thorn in their
side. It is said not to be a reflection in any way on the performance
of that body; it is thought to be a progressive development. However,
it is very difficult to grasp what it will look like and how it will
function. Trying to get one’s hands on exactly what the new
institution will be like is a bit like knitting fog.
I was grateful for the policy
document that was sent to us prior to this sitting, which endeavoured
to spell out further what was involved. It does not altogether pre-empt
all my criticism, most of which I will save for the stand part debate,
neither does it give the reassurance that would completely reassure the
critics on Second
Reading.
There is a lot
to be said for amendment No. 196, which endeavours to flesh out what is
very ill defined; I could think of many other areas in which such
fleshing out is required. The clause talks about
“involvement”, but it does not specify what that might
itself involve. Monitoring is something that we would want such a body
to do. Most health services are very well monitored already in a
professional capacity by a variety of different inspectors and service
deliverers. We are talking about monitoring in respect of the
patients’ experience.
Alistair
Burt:
We can expect to hear from the Minister that the
very nature of monitoring means that he wants to reduce it in some way
to reduce the pressure. Is not the whole point that this is monitoring
by those who represent the users of the services, so it is unlike any
other monitoring or auditing? That is why it should remain as a
distinctive part of what people are asked to
do.
Dr.
Pugh:
I thoroughly agree with the hon. Gentleman, who
cited the example of mental health services, where the experience of
users and of people delivering the service can differ markedly. We
could all figure out if we were medical practitioners what the
experience of a patient might be in an operating environment or a
hospital bed, but to have a concept of what it is like for the user of
a mental health service is not easy to establish. It can be done
effectively only by a group that can monitor effectively. I support the
amendment.
Several
hon. Members
rose—
The
Chairman:
Order. Before I call the next speaker, it is
right to mention to members of the Committee that I will not at this
stage be allowing a standpart discussion because we have
already, quite appropriately, gone into the issues. I ask anybody who
intended to speak in a stand part debate to make a contribution now,
because there will be no formal discussion on that
basis.
Sir
Peter Soulsby:
I understand, as do other hon. Members, the
concerns expressed by patients forums and their members. Such people
see the word “abolition” in the Bill and understandably
fear that their experience, expertise and commitment will be lost as
part of that process. Many of those people feel undervalued and to some
extent marginalised by the process that has led to the measures in the
Bill. They feel that there is no guarantee, despite the reassurances
given, that they will be able to continue the work they have done, or
that they will be engaged in the work of the new LINKs. As other hon.
Members have reminded us, those people will have in mind the abolition
of community health councils and all the fears attached to
that.
There are two
issues about which I hope the Government will reassure us. The first is
about the powers and responsibilities of the new LINKs and whether they
will be as effective as the Government intend. The second issue is
about the arrangements for existing forum members and their ability to
continue their work, and whether they will have opportunities to
undertake the work they do on behalf of users of health services within
the new LINKs structures.
Mr.
Dunne:
I begin by expressing my condolences to the
Minister for having to incorporate these measures within his Bill.
Clearly, the measures extend beyond the remit of the Department for
Communities and Local Government into that of the Department of Health.
Given the consensual approach that he has taken to the Bill, it behoves
us to act reasonably when we come to making criticisms of certain
aspects of it. The clauses we are coming to clearly give rise to
criticism, and the Minister will have to take responsibility for them
even though they are not his responsibility in the first place. I am
sorry that he has been put in that position.
Having said that, it is clear
that what we have before us is a dog’s breakfast, to put it as
politely as I possibly can. I had the opportunity to consult an
existing forum on reconfiguration in my own area and so have some
experience of the difficulties that forums face in representing
patients and other health service users. I therefore have some sympathy
with the Government’s objective of trying to make the forums
work better. However, the Government’s set of proposals is so
ill thought through that I see little prospect of LINKs consultation
groups achieving the objectives that the last groups, which were set up
in December 2003, signally failed to
achieve.
At the same
time, the proposals will serve to alienate some 4,500 individuals who
gave of their own time to help and support the forums. From the
conversations that I have had with those currently involved with
patients forums, it is highly unlikely that they will wish to volunteer
to help out with the formation of LINKs, given the way in which they
have been treated and the way in which the Government still are
changing the rules about the involvement of forums in, as it were, an
interregnum period. My understanding is that every time the Government
think about the matter, they decide to extend the period over which the
forums will continue to exist in the hope that some forum members will
remain and that they will then volunteer to join LINKs as and when they
are established. The proposals are muddled from start to
finish.
An issue that I would wish to
raise as part of my stand part contribution is that of governance.
There will be powers, which we shall go on to discuss, that are
different from the current powers residing with the overview and
scrutiny committees, not least thepower to enter and inspect.
That power is probably appropriate, but it is a statutory
responsibility. The way in which LINKs will be established and
supervised appears to be a complete free-for-all. I am sure that the
Government will argue that it is yet another example of their attempt
to devolve power to local communities and that it will be up to local
communities to decide how they want to do
things.
4.30
pm
Mr.
Woolas
indicated
assent.
Mr.
Dunne:
The Minister nods his assent. In some respects, he
has my sympathy but we are dealing with statutory powers, so there must
be some kind of oversight or control over how LINKs will operate. The
Bill is virtually silent on the governance of the new bodies. Will he
give some amplification on how that governance will work? For example,
if someone is established as a director, or whatever they choose to be
called, and is a responsible officer for a LINK, where will the powers
reside to remove that individual in the event of some impropriety or
conflict of interest?
Let us take the example of a
private health provider putting forward one of its directors to be an
officer of a LINK and there being seen to be a financial relationship
between the primary care trust and that provider, which is now
supervised by the LINK. Will that be permitted, and what will happen if
it is discovered after the event? There is a whole host of issues on
the governance of LINKS that we do not have time to go into now but
that I do not believe the Government have thought about at
all.
Robert
Neill:
I endorse what my hon. Friend has said. I was
recently in discussion with the local patients forums in my borough of
Bromley. I am sure that all other Members have had the same experience:
they are excellent people who do an awful lot of hard work, but they
were thoroughly disillusioned and demoralised by the way in which this
change has happened. It is very sad that we run the risk of some of
those good people walking away. I hope that they will not, but at the
moment there is not much to give them
comfort.
Although the
Minister has stated that the Department of Health talked about making
the transition seamless, which I accept, that is not the way it comes
across to the people who are involved on the ground. It is fascinating
to examine the written and oral evidence that we have been given and
the evidence that we have picked up from small organisations in our
constituencies. The overwhelming consensus among the thousands of
people involved at the grass-roots level is that the Department of
Health—let us put the blame where it belongs, rather than with
the Minister—has got it wrong. I am sorry to say that I am
inclined to think that those thousands of people are more likely to be
right than the Department of Health. Despite the draft that is
promised, nothing that has come forward so far will reassure those
people. Another concern is
that the folk involved, often in a voluntary capacity, have valuable
links with other organisations in the community. If they walk away,
some of those informal networks, which help to oil the wheels, will
tend to be lost. I also
wished to make a point on the clause stand part debate about the
involvement of local councillors. I appreciate the point about the
desire to strengthen working between patient involvement on the one
hand and the overview and scrutiny committees on the other. None of us
would dispute the fact that that is perfectly sensible. However, I fear
that there is a missed opportunity. Although there is useful work in
the Bill on the involvement of the overview and scrutiny
committees—in other words of councils as a whole—an
opportunity has been lost to involve ward councillors by giving them a
right to consultation on changes in health service provision in their
areas.
The Commission
on London Governance made a recommendation on a cross-party
basis—all three principal parties on the London assembly and in
London Councils supported it—that harps back to our earlier
discussions. It recommended that if we were to strengthen the role of
councillors as local champions, one way in which that could usefully be
done would be if they were entitled to be consulted about
changes—for example, in local GP or dental provision. Armed with
the benefit of a democratic mandate, they could be empowered to take up
the cudgels on behalf of their communities and, because of their local
LINKs, they would be able to work well with exactly those volunteers
that we are in danger of losing at the moment. I think that it is a
shame that we do not have more about that in the
Bill.
Tom
Levitt:
Let us think back to earlier clauses
and the importance of local strategic partnerships and other such
bodies in which councillors—presumably consulting and being
informed by their constituents on an ongoing basis—are involved
directly with health authorities. Is that not where the level of input
comes from councillors in that respect?
Robert
Neill:
That is one level of the input. However, we have
discussed the fact that some health trusts are not included on the list
of bodies and that they should be. The process would be strengthened if
they were. I still stick with that point. [Interruption.] I am
grateful to the Minister for that. That works at a strategic level. The
point that I am making is that there is also a lower, more local level
in which the ward councillor could have a very useful and legitimate
input into what happens below the strategic partnership
level.
What I have
suggested does not rule out what the hon. Member for High Peak is
suggesting. I take that on board, but I think that we could usefully go
a step further and that is what the Commission on London Governance was
suggesting. As part of that broader strengthening of the existing
democratic process with local councillors, we could give them a right
to consultation on a number of the issues about health service
provision in their wards and communities.
Dr.
Pugh:
Is the hon. Gentleman suggesting an additional tier?
I understand that there are health overview and scrutiny committees on
nearly every major council and there is an obligation to consult them
on a whole range of health issues in that area. Is he suggesting that
something needs to be done in addition to that, a further process of
consultation managed or
otherwise?
Robert
Neill:
I would be very reluctant to create other
tiers, but I would have hoped that, with a bit of good will, it would
not be impossible to achieve my aim. If local councils are given that
right, that could be built into the existing tiers. I understand the
desire to have the local area agreements and the local strategic
partnerships looking at the strategic level. There is nothing wrong
with feeding into that process. For example, the councillors in the
Chislehurst ward in the London borough of Bromley would be consulted
about local changes. They would then be able to feed in their
suggestions. This is not intended to be a large or bureaucratic
process, but it comes as part of the package that we would argue is
desirable in strengthening local councillors as community champions. I
am asking the Minister to consider how the current structure could
accommodate that being taken on board, without, I accept, the need for
us to create yet a further tier of
bureaucracy.
Dr.
Pugh:
I believe that historically local councils had to be
consulted on the distribution of pharmacy services. Therefore, the hon.
Gentleman is asking for something similar to apply in the case of
health services.
Robert
Neill:
That is a very useful analogy. I think that
it could be done with a fairly light touch. The key thing is the right
to be involved. When the Greater London Authority Bill was discussed, a
number ofus raised concerns about the way that local ward
councillors are sometimes, perhaps more by accident than design, kept
out of the loop in the developmentof safer neighbourhood
powers. That would be undesirable if it was to become entrenched.
Similarly, it would be desirable if we could get into a culture that
gets local councillors into the loop over local community health
facilities because they would have a great deal to contribute. That is
the point that I was raising. I hope that the Minister will be able to
give us some reassurance.
Alistair
Burt:
Before my hon. Friend ends his speech, and bearing
in mind that he was making remarks that would have formed part of a
stand part debate, would he be good enough to ask the Minister to
consider the fundamental question of why this is being done? We tried
to get an answer from the Minister of State, Department of Health, the
right hon. Member for Doncaster, Central, and we asked the witnesses
who came before us and they could not give us an answer. I asked the
Minister twice and I am not certain that I got an answer. As he now has
the bridge in relation to this particular matter—I do not know
during which amendment it will come up or during which part of the
debate—I would be grateful if he could be asked the question so
that he can enlighten us now.
Robert
Neill:
I am happy to take that on board. I am sure that
the Minister will accept that there is nothing personal if I lob my
hon. Friend’s question in his direction, but it was exactly the
same question that the people raised with me on the patients forum in
Bromley—why? When the London assembly’s health committee
scrutinised the proposal, people asked, “Well why?”
Nobody has yet given a satisfactory answer to that question. On that
note, I end my contribution by asking it on behalf of my hon.
Friend.
Mr.
Woolas:
It has been my experience that it is always a good
idea to respond to the amendment in a broad debate on a clause by
praising the wisdom of the Chair. I wish to do that to curry favour
with you, Mr. Benton, because the task falls to me to
respond to the amendment, to put the clause in context and to take up
the baton of explaining the policy. I shall certainly also answer the
question that the hon. Member for Bromley and Chislehurst
asked.
When the Local
Government and Public Improvement in Health Bill was presented to the
House on 11 December—at least, I think it was11
December, because that was my birthday—I was proud that although
it does not have the snappiest of short titles, it is a hugely
important landmark for local government. As far as I have been able to
establish, it is the first Bill in 50 years to bring the health service
and local government closer together again in legislation. The Bill is
a local government reform Bill, a public involvement in health Bill,
and a local government involvement in health
Bill.
Michael
Fabricant (Lichfield) (Con): That is even less
snappy.
Mr.
Woolas:
It is indeed—I cannot imagine the
“Lichfield Observer” using it as a headline.
Subsection (1) places the
obligation to put in place local involvement networks for health
services and social services on the local authority. It is the council
that the legislation, should Parliament agree to it, will compel to
make arrangements for scrutiny and involvement in the monitoring of the
health and the social care services. That is an important point. It is
local government that will be involved in health
care.
Mr.
Woolas:
It is the job of the Opposition to ask intelligent
questions and that is a very intelligent question, which I am going to
answer—not in one word, which could in fact be the three words:
“Because we can”. That would irresponsible and dishonest,
too. The background to the policy proposal in part 11 should be seen in
the context of our earlier debates, particularly on the provisions
dealing with the local area agreements, the duty to co-operate and the
best value duty to inform, involve and consult. The clause brings
together local service provision.
The judgment that the Government
take is as follows. We have representative democracy. We agree with the
hon. Member for Bromley and Chislehurst that elected councillors should
be the fulcrum of local policy making and local scrutiny, and we wish
to ensure
that through the Bill. We are strengthening overview and scrutiny, so
that those councillors can scrutinise health and social care policies
and services. The community call for action that we discussed
previously will empower an individual back-bench councillor to refer a
matter to overview and scrutiny, which includes the provision of health
and care services in their
area. 4.45
pm
I have talked
about representative democracy through elected representatives, but we
now need to talk about participative democracy. The reconnection of
politics and public services to the citizen requires participative
democracy, which must always be subservient to representative
democracy, but is important none the less. The Government are trying to
provide a model for the public, including patients, to participate in
making health services accountable and helping them to improve by
making suggestions. It will then join up that participation and the
scrutiny that follows from it with health and social care. Why?
Because, as we heard from evidence, patients do not distinguish between
providers of services. People do not care whether it is social services
or the health service that provides care.
We must look at the matter in
the round. Through LINKs, we want to provide an interface between
participative democracy in the monitoring, scrutiny and improvement of
health and social care, and representative democracy in the form of
elected councillors. The crucial point is that the interface is
provided through the ability of LINKs and the people in those
organisations to refer those matters to the overview and scrutiny
committee. That will empower the public—patients and users of
the service—to have access to representative democracy as well
as adding to the power they have through LINKs. Hon. Members rightly
have questions, and my hon. Friend the Member for Bedford has tabled a
series of amendments that he believes would improve the set-up, as have
Opposition Members. However, that is our policy on
LINKs.
Alistair
Burt:
I am grateful for the Minister’s explanations
and for his generosity in giving way. I want to expand on the question
“why?”. The follow-up question is: what is it in the
composition of the forums or their conduct that did not allow them to
be expanded to take on a new role in the provision of services through
local authorities? Why did they have to go and why did they have to be
subsumed in the manner proposed by the LINKs? What was so wrong about
what they did that they could not continue to exist with new
powers?
Mr.
Woolas:
As a parent, I have always found the question
“what for?” more difficult than the question
“why?” In practice, the former often requires a
convincing answer, whereas the latter often requires a philosophical
one—normally, “Because I say so”. In logic, that
is what is called the 16th law of the imperative. In response to the
question “what for?”, I say to the hon.
Gentleman—I am really pushing you here, Mr.
Benton—that there are three components to part 11: the
establishment of LINKs; the abolition of the Commission for Patient and
Public Involvement of
Health and the patient forums that flowed from it,
and a strengthening of the requirement to consult patients and the
public. About £28 million is being provided to the commission
this year, and the budget three years ago was about £32 million.
We believe that there is a resource there that can respond to the
changes taking place in the landscape of health and social services,
such as the creation of trusts through the Children Act 2004 and the
creation of a greater local concentration through local area agreements
that will be in place at the end of this month in every local authority
area in England. It is that change in framework and those changes in
the evolution of health and social care that justify the
reconfiguration.
The
second part of my answer is that we can look at change in two ways. We
can keep the name and evolve it, which is a broadly conservative view,
or we can change the name and evolve it, which is the view of the
radical. I try to examine the content and say, “If it
isn’t broken, why are you fixing it?” The question that
the hon. Member for North-East Bedfordshire is really asking is,
“Is it broken?” The system is not broken in the sense
that it is not fulfilling the purpose for which it was set up; however,
it needs, and can now have, a broader purpose. The original legislation
was tightly defined and inflexible.
One hears frustration from
patients forums, and hon. Members have talked about demoralisation. We
know that any change in infrastructure can lead to demoralisation but
my positive message is that the broadening of the role, because of the
change in the architecture of health and social care, gives greater
power and freedoms and a greater remit to the same people.
I acknowledge the point that we
need to carry people with us. Part of the way in which one does that is
to ensure that functions are properly resourced. The hon. Member for
Ludlow raised the net new burdens policy, which applies in this area.
That is an important commitment to
give.
Andrew
Stunell:
The Minister mentioned two ways: the conservative
and the radical. I think that he might be following a third way, which
is the cock-up way. Many Opposition Members feel that the proposals
fall into that
category.
Mr.
Woolas:
I am not going to repeat my conspiracy and cock-up
theory. The approach taken in the Bill provides real substance to the
idea that local people can hold local health and social care services
to account. Hon. Members should be honest and ask themselves this
question: if, when they get back to their constituencies tonight or in
the morning, they were to carry out a random survey of how people could
be involved in influencing the services of their local hospital and
social care services, what is the most common answer that they would
get? I guess that it would be, “I’d ask my
councillor”. The provisions allow for the role of the councillor
and the specialisms and knowledge of the LINKs forums.
I shall give an example of what
is best about patient involvement from my own research. There was a
survey of people in the north-west who used wheelchairs
provided by local health services. They were asked what type of
wheelchairs they would like, where they would like them, how long they
should have them for and how the process should operate. The health
service responded positively to the suggestions the wheelchair users
made, so we were able to make a huge saving in the expenditure on
wheelchairs because fewer were damaged, lost or not returned, and there
was a huge increase in the satisfaction of the wheelchair users. We had
our cake and ate it. Through LINKs and the changes we are making, we
are trying to provide a model that is much more likely to facilitate
that process. I make
one other point, which is very important, before I come to the
specifics. The model of involvement and participation that has been
described in the architecture carries great optimism for the future in
other service delivery areas. What I have said about public
participation in shaping services and advocating them apply equally to
not only health and social care, but transport, education and other
services. I am suggesting quite radical policy to the
Committee.
Dr.
Pugh:
The Minister is right to say that LINKs have an
additional power that patients forums did not have, which is that of
mandatory referral to the overview and scrutiny committee, but I do not
think that there will be dancing in the streets as a result of the
concession of the new power. Essentially, there are many examples
throughout the country of patients forums voicing strong views about,
for example, hospital reconfiguration; they have referred the matter to
the overview and scrutiny committee, which has thoroughly agreed with
the forum and endorsed its criticisms; the views have then gone to the
Minister and that was the end of it. In other words, the process has
not stopped frustration. It is just conned people into thinking that
they could do
something.
Mr.
Woolas:
I note the point made by the hon. Gentleman, as
well as the passion with which he spoke on Second Reading when the
issue was raised. No form of participative democracy can replace the
fact that a decision must be taken. We can certainly improve services
and we can change decisions, but a decision has to be taken. There is
an analogy with petitions, but I shall not go down that railway line
because time is running out, and my Whip and the Chairman are frowning
at me.
I shall answer
the specific point. We believe that the new organisations will enable
genuine involvement ofa greater number of people than is
currently the case. They will ensure that there is a stronger voice in
commissioning, and the provision of health and social care in the local
area. They will take a crucial step beyond the existing powers defined
in legislation of the patients forums by enabling people to have a
greater say over social care as well as health services. I understand
the points that have been made, but we see the provision as a
development of the work of forums in a much wider range of ways than is
currently available to ensure that people have the stronger voice to
which I have
referred.
The explicit
relationship between LINKs and overview and scrutiny joins up the
processes and the local authority will have a duty to make contractual
arrangements, with the involvement of people in commissioning, in
provision and in scrutiny of health services and social care services.
The amendment relates to subsection (2) and monitoring and “promoting, and supporting, the
involvement of people in commissioning, provision and scrutiny of local
care services”
covers the
point made in the
amendment.
The
arrangement that follows allows the funding stream—the money
that is currently made available and will be transferred over—to
go straight to the local level. It will ensure that as much money as
possible is available to fund the front-line activity, the local
activity. The abolition of the Commission for Patient and Public
Involvement in Health is one element of the drive to reduce the
arm’s length nature of the sector and release centralised
funding.
Part 11
clarifies and strengthens the current legislation on health service
consultation, which gives NHS organisations a requirement to involve
and consult. That is a similar point to that made by the hon. Member
for Bromley and Chislehurst. We intend to give PCTs a new statutory
duty to respond to local people by 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 publish
regular reports about what they have done differently as a result of
what they have heard and why they might not have been able to take
forward some suggestions. The process relates to the point that the
hon. Member for Southport made, and to his fear that one might lead
somebody up the hill, and then take them straight back down
again.
The requirement
to respond facilitates the solution to that problem. It recognises that
of course not everybody will be happy all the time. That is an
unachievable objective. I am trying to remember who coined that phrase,
but it was not a Liberal Democrat. It was Abraham Lincoln, was it not?
I think that Committee members are falling asleep, so I shall get on
with it. We intend to provide the primary care trust with the new
statutory duty to respond and the structured process to show, through
reports, what has been done as a result of the process under
discussion.
Part 11 is
also an important step towardsrealising the ambition to
empower local people. The requirement on local authorities to make
contractual arrangements to ensure that there are means by which local
involvement network functions can be carried out, defines those
functions. Clause 153(2)(a) describes
“promoting, and
supporting, the involvement of people in the commissioning, provision
and scrutiny of local care
services”.
The subsection
also defines the functions as,
“obtaining the views of people
about their needs for, and their experiences
of”
health and social care
services; making those views known to
people
“responsible for
commissioning, providing, managing or
scrutinising”
those
services; and making
“reports and recommendations about
how”
health and social
care services might be improved for those same people. The Bill
includes a regulation-making power, which will allow the Secretary of
State
to amend, add to or delete the activities to which I have just referred.
That provision will be subject to a later amendment. The Government believe that it
is vital to promote user involvement in health and social care, because
only by seeking out the views and experiences of those who use the
services will we improve them and make them more focused on the
individual. That is why the clause requires local authorities with
social services responsibility in England to make those contractual
arrangements to ensure that there are means by which LINKs can be set
out. In a two-tier area, it is an obligation not on the district
council, but on theupper tier.
LINKs will provide a flexible
vehicle for individuals and groups, including the voluntary and
community sectors—an important point to which my hon. Friend the
Member for Bedford referred. They will promote public accountability
through open communication with the commissioners and
providers.
Amendment
No. 196 is unnecessary. I support the idea of monitoring the quality
and delivery of care services, but subsections (1) and (2) already
cover it.
Mr. Benton, I am very
grateful to you for giving me such latitude. It is important that the
Committee is aware of the Government’s
intentions.
Mr.
Dunne:
Does the Minister intend to cover my points about
governance in these discussions or later?
Mr.
Woolas:
It may be better if we cover the hon.
Gentleman’s inquiry about governance in later discussions. My
hon. Friend the Member for Bedford may have something to say about it
in relation to his amendment. I am pretty confident that he has, and I
should be grateful if he would nod.
Patrick
Hall (Bedford) (Lab)
indicated
assent.
Mr.
Woolas:
He is nodding.
Alistair
Burt:
It puts Bedfordshire on the map
again.
Mr.
Woolas:
Yes, it gives us an opportunity to talk about
Bedfordshire, about which my bleeper has been going off during the
Committee. If that is satisfactory, in my opinion it would be better to
do it that way. On that point, I ask the hon. Member for North-East
Bedfordshire to consider withdrawing his
amendment.
Alistair
Burt:
We will return to a number of the issues to which
the Minister has referred, and which you have generously allowed us to
debate, Mr. Benton, during the course of the Committee and
on Report. I am not sure that I accept that monitoring quality is
covered specifically, and I think that those involved in the forums
will be disappointed that the Government cannot make that
concession.
Mr.
Woolas:
I take the point about monitoring. There is a
technical problem with lines 26 and 27 of the amendment. I do not want
to be pernickety. We support the point about monitoring, and maybe
there is a way for us to incorporate it.
Alistair
Burt:
That is a generous way to end the afternoon’s
sitting. If there is a way to honour that
specifically—
Patrick
Hall:
A champagne
moment?
Alistair
Burt:
A concession from the Minister on such a matter
certainly qualifies as a champagne moment. We will note that
accordingly, and enter it into the collection of champagne moments, for
which there will be a prize at the end of the
Committee.
Tom
Levitt:
That is very generous of the hon.
Gentleman.
Alistair
Burt:
My experience of such matters when we were in
Government was that the Minister came forward at this stage, not the
Opposition.
Mr.
Woolas:
I shall be grateful if the officials from the
Department of Health note that point. [
Laughter.]
Alistair
Burt:
In view of what the Minister has already suffered
and what he will suffer next week on his colleague’s behalf, I
too think that that matter should be referred to her. In supplying him
with champagne for his activities, she might also consider the rest of
us.
The Minister made a
point that he did not make before about a technical difficulty with the
amendment. Perhaps we could return to monitoring as further discussion
would be helpful, but in any case we will return to it on Report if
need be. On that basis, I beg to ask leave to withdraw the
amendment.
Amendment,
by leave,
withdrawn.
Further
consideration adjourned.—[Jonathan
Shaw.]
Adjourned
accordingly at seven minutes past Five o’clock till Tuesday 6
March at half-past Ten
o’clock.
| 
