 House of Commons |
Session 2006 - 07 Publications on the internet General Committee Debates Local Government and Public Involvement in Health Bill |
Local Government and Public Involvement in Health Bill |
The Committee consisted of the following Members:Alan
Sandall, Committee
Clerk
†
attended the Committee
Public Bill CommitteeTuesday 6 March 2007(Morning)[Mr. Christopher Chope in the Chair]Local Government and Public Involvement in Health BillClause 153Health
services and social services: local involvement
networks
10.30
am
Dr.
John Pugh (Southport) (LD): I beg to move amendment No.
226, in clause 153, page 109, line 28, after ‘of, insert
‘access
to’.
The
Chairman:
With this it will be convenient to discuss
amendment No. 227, in clause 153, page 109, line 34, at end
insert—
‘(d)
notifying relevant transport bodies of any problems or improvements in
access to care
services.’.
Dr.
Pugh:
As we enter the last rounds, we come to two quite
significant amendments that would introduce issues of access and
patient journey times to the matters to be considered by local
authorities.
There are
major omissions from clause 153 as it stands. A big issue for patients
is not so much the delivery of services but the reconfigurations that
are going on throughout the land, which the Government say will
continue. Medical changes might also dictate that the reconfigurations
continue. Financial pressures and the payment by results system will
also ensure a degree of change. The general policy is to move care from
the secondary care sector to the primary care sector and to centralise
around centres of excellence. All of those factors bound together will
produce a rearrangement of the health landscape in any one area. That
has specific consequences for patients, because it affects their
journey paths to services.
The journey to health care is
often the very core or essence of people’s anxieties. People do
not doubt that they will receive quality services once they get there,
but they sometimes wonder how easy it will be to get there or, in the
case of emergency services, whether they will get there in time. It is
particularly an issue for the elderly, the socially excluded and people
with children. The matter is at the core of debates about community
hospitals, of which there have been many in this place, and of debates
about urban and suburban reconfigurations, but it is often ignored by
the health establishment. Sometimes, public transport authorities and
highways authorities seem to live in a parallel universe to health
authorities, given the limited amount of consultation and interaction
between them.
In my area,
health services were reconfigured and services were moved from one
hospital to another as a result of an extensive medical report, the
Shields report.
In it, Professor Shields said that such changes would create problems in
accessing services, but that those were not problems for the health
service—in other words, the problems could be deposited
elsewhere. However, the changes have created problems for patients, and
if there is to be a genuine and useful patient consultative body, it
must take those problems on board.
I understand
that we are not going to have a stand part debate on the clause, so I
wish to make a few general comments. At the heart of the proposals is
the fact that, as far as I can see, no lever of power is taken out of
the hands of the quangos and given to the community. We are going to
have a long and extensive debate about the shape of the consultative
body, but the fact of the matter is that the lever of power will remain
almost exclusively in the hands of the quangos. I am sure that the
Minister will understand what I am trying to say if I compare the
almost platonic model on which health service governance is based,
whereby governance is left to the experts and is not given or handed to
the people, with the local authority governance model presented in the
Bill. The Department for Communities and Local Government allows the
public, through electoral and other arrangements, to have an
involvement in emergency services, transport, social care and so on,
but when it comes to health services, the approach is altogether
different.
I accept that
the Bill attempts to put a certain amount of power in the hands of the
public in so far as they will be consulted a little bit more. The
Government are inching in the right direction; but they are only
inching—they are moving very slowly. With the amendment I am
trying to persuade them to go a little further. They can take a step by
accepting the amendment, which asks them to take on board a serious
concern for patients—the transport arrangements for getting to
health services.
The
Minister for Local Government (Mr. Phil
Woolas):
I thank the hon. Gentleman for moving the
amendment in such a constructive way. He seeks to amend clause 153,
which requires local authorities to make contractual arrangements to
ensure that local involvement network functions can be carried out in
the relevant areas. Establishment of host organisations is relevant to
that. It might also assist if I remind the Committee that the clause
will oblige local authorities to facilitate LINKs
organisations.
The
clause refers to all local authorities, but clause 159 limits the
applicability of the clause to those with social services
responsibilities, and only English authorities are relevant. In plain
English, therefore, we are not concerned with districts. The LINK
function definition which the hon. Gentleman seeks to amend is
“promoting, and
supporting, the involvement of people in the commissioning, provision
and scrutiny of”
health
and social care services. The hon. Member for North-East Bedfordshire
observed that that should include monitoring as well, and I have
undertaken to consider that, because the Government see the
sensein it.
A second, and important, part
of the function as defined involves
“obtaining the views of people
about their needs for, and their experiences of”
health and social care services. An
additional element involves making those views known
to
“persons responsible for
commissioning, providing, managing or scrutinising local care
services”
and making of
reports and recommendations to such people about how provision of
health and social care services could be improved. As has been
mentioned, a regulation-making power is needed to allow the Secretary
of State to amend, add to or delete such activities. However, my hon.
Friend the Member for Bedford will have something to say about that
later in the debate, and we shall be able to consider it
then.
The
Government believe that it is vital to promote user involvement in
health and social care, because it is only through seeking out the
views and experiences of those who use the services that we shall be
able to improve them. In fact, it is not the only way, but it is a
necessary way—if not a sufficient one. It is also a way to make
services more user focused, which is what the hon. Member for Southport
desires—to look at things not from the point of view of the
provider, but from the point of view of the patient or would-be
patient. In summary, the clause requires that councils with social
services responsibilities make contractual arrangements—we shall
debate later with whom, and how—to ensure that there are means
by which a local involvement network activity can be carried out in the
council’s area.
We are
debating amendment No. 227, which thehon. Gentleman addressed
directly, and amendment No. 226, which would broaden the range of
responsibilities. The hon. Gentleman mentioned the Highways Agency, I
believe, or was it highways
authorities?
Mr.
Woolas:
I am sure that all hon. Members
would echo his views in that respect. It is important that such public
sector agencies work together and in partnership. However, although I
do not disagree with the purpose of the amendments, I do not believe
that they are necessary.
Amendment No. 227 would add the
activity of
“notifying
relevant transport bodies of any problems or improvements in access to
care
services.”
That
is unnecessary because the clause provides that the key organisations
that will receive reports and recommendations from LINKs are the
commissioners, providers, managers and scrutineers of care services.
LINKs will certainly collect information that is important for other
organisations too, and there is nothing in the Bill to prevent them
from passing that information on. LINKs, in the first instance,
could—I would argue that they should—report any access
problems to the commissioner of those services so that it can take
account of those matters in its commissioning decisions and when it
influences other local partners through mechanisms such as local
strategic partnerships. LINKs will also be able to refer matters of
concern, such as accessibility, to the relevant overview and scrutiny
committee. Therefore, I agree with the intention of the hon. Member for
Southport, but argue that it is already covered.
Amendment No. 226 similarly
aims to extend the activities to explicitly include obtaining
people’s views on their access to services. However, that is
already captured in subsection (2)(b), which refers
to
“obtaining the views
of people, about their needs for, and their experiences of, local care
services.”
A key part of obtaining people’s
views on access to services will be the extent to which their needs
have been met and how they have experienced the services they have
received. My hon. Friend the Member for West Ham gave a very good
example of the practical impact of that. In a survey of her community,
it was pointed out that access to the local GP was not being used to
the extent that the health service expected; instead, patients were
travelling a further distance to use the hospital. When asked why that
was the case, people pointed to the blindingly obvious fact that there
was a bus route to the hospital and none to the GP. Access to services,
as the hon. Member for Southport says, is the type of issue that
Members of Parliament deal with, but it is more commonly dealt with by
local councillors. The example of my hon. Friend the Member for West
Ham graphically illustrated that point.
The point that the hon.
Gentleman makes about access to services has been well heard. It is
part of the rationale behind the framework that we have created to
solve those problems. That is why I believe that the clause as it
stands covers the desirable consequences that the hon. Gentleman seeks.
I ask him, therefore, to consider withdrawing his
amendment.
Dr.
Pugh:
I thank the Minister for
that clarification. I think that what he is saying is that the phrase
“experiences of” in subsection (2)(b) includes
experiences of getting to the services as well as going through the
services. Therefore, I am prepared to consider withdrawing the
amendment for the moment, but I will seek further clarification on the
matter from other colleagues at a later stage. However, what I would
emphasise is that the problems are often unsolved in particular areas,
and it is not clear who owns the problems. I have sat in debates in
which members from Hertfordshire, for example, have complained about
the reconfiguration of their services. They have drawn attention to the
fact that when the health service directs some patients to Watford, it
is completely unaware of problems caused by football traffic, for
example—although that problem might be reduced next
season.
My point is
that the problems are genuine and widespread, but when they do occur,
it is not obvious whose job it is to resolve them. There can be a
certain amount of buck passing in which the health authority puts the
onus on the transport authority to produce a better bus service, for
example, but the transport authority then says that it was not advised
properly when the reconfiguration first went through. The holes in the
Bill as it stands leave certain problems unaddressed. None the less,
for the moment, I beg leave to withdraw the
amendment.
Amendment,
by leave,
withdrawn.
10.45
am
Alistair
Burt (North-East Bedfordshire) (Con): I beg to move
amendment No. 197, in clause 153, page 109, line 34, at end
insert
‘and to patients
and the
public’.
The
amendment relates to the powers of LINKs to publicise their work. There
is concern that, if the Bill does not specifically mention that, there
may be a supposition that all the LINKs do is to report to the
commissioners because that is all that is mentioned. The Minister of
State, Department of Health, the right hon. Member for Doncaster,
Central (Ms Winterton), sent the Committee a helpful note on how she
envisages LINKs with work. Indeed, in the draft policy statement, under
the section entitled “Make reports and recommendations and
receive a response within a specified timescale”, the right hon.
Lady sets out what she intends to put in regulations. The draft
states:
“The
regulations will specify the LINks’ power to make reports and
recommendations and will specify...who they can make them to—NHS
and social care commissioners and providers in their geographical
area”—
and nothing
else.
The
straightforward reason why the matter has not been mentioned might be
that it is intended that the work of LINKs should be published and, if
they want to bring something to the attention of commissioners and
others, they should feel perfectly free to make that information
available to the public. However, that is not in the Bill. If
regulations are tight and specify not a permissive power regarding to
whom the LINKs may make submissions, but a restrictive power so that
they make reports and submissions only to certain bodies,
patients’ ability to make clear to the public what is going on
will be stifled.
The
purpose of the amendment is to draw out from the Minister a clear
statement either that there will be an expectation that LINKs and other
bodies will report to the public; or that the Government will make that
clear by putting it on the face of the Bill. Naturally the
accountability of LINKs to the public needs to be tested, which is a
good reason for publication, but the accountability of the bodies that
they are looking into on behalf of patients should be clear to the
public. I should be grateful if the Minister will explain what he
thinks and say whether my concerns are unnecessary or whether it would
be helpful to have such a provision in the
Bill.
Patrick
Hall (Bedford) (Lab): I rise to speak to amendment No.
182. If you will allow me, Mr. Chope, I too wish to make
some wider
remarks—
Dr.
Pugh:
I endorse amendment No. 197.
Sometimes patient groups are not properly representative of patients as
a whole. By having them refer back to the wider patient groups, there
would be a more representative
function.
Mr.
Philip Dunne (Ludlow) (Con): To add a rider to that, will
the Minister clarify whether ambulance trusts would be included in the
scope of local services? As ambulance services have been regionalised,
there is in relation to access to acute hospitals concern about whether
ambulance services are capable of being scrutinised by LINKs through
this process.
Mr.
Woolas:
The answers to the questions are
yes, yes and yes. Ambulance trusts are covered, as is clearly
desirable. The hon. Member for Ludlow makes the point that they cover a
wider area than the local authority. It is, of course, up to the
contractor bodies to make arrangements across the area of the ambulance
trust. That is one reason why we need to be flexible. Similarly, a
primary care trust might extend beyond one of two local authorities. In
some cases, local authorities are not coterminous with PCTs. The
Government, through their consultation on the reconfiguration of PCTs,
faced criticism in respect of that exercise and chopping and changing,
but part of our objective was to ensure greater geographical
coterminosity between PCTs and local authority areas. My colleagues at
the Department of Health consulted in anticipation of the policy that
we have now brought forward. That is joined-up Government, although it
did not look like it at the time. Seriously though, there is 80 per
cent. coterminosity in England now. The answer to the point that the
hon. Gentleman made about ambulance trusts is
yes.
The
hon. Member for Southport makes the valid point that part of the
objective for LINKs and health scrutiny is to involve not only
patients, but those who may have been or still are patients. The hon.
Gentleman’s point is important. However, I shall resist the
amendment and will give my reasoning for doing so in a
moment.
It
is clearly desirable to achieve what the hon. Member for North-East
Bedfordshire is talking about. We expect that LINKs will publish such
information in a way that makes it available to its public. Clause 158
sets out the process for the annual report, which it is desirable to
include in the Bill. It is quite common, as hon. Members will know, for
us to receive hefty envelopes containing annual reports that Parliament
has required various bodies to produce. We want to provide those bodies
with flexibility, so we do not wish to go further and specify the
information and the process of providing it, but we do expect them to
provide the relevant information and we intend that that would be
covered in the notices and guidance that we
issue.
Alistair
Burt:
No one would want an already bulky document at the
annual general meeting to include all the individual reports that LINKs
may have wanted to produce on their work during the year. The draft
note from the Minister, which we have seen, does not include reference
to publication. If the Minister took back to his colleagues the
suggestion that the draft guidance should make explicit the need to
make those reports public, that might do the
job.
By talking
about heavy, burdensome documents, the hon. Gentleman has pre-empted
the second paragraph in my speaking notes, so I shall not bore the
Committee any more than I have done. I ask him to consider my remarks
and to withdraw the
amendment.
Alistair
Burt:
To have wrung a concession from
the Government at seven minutes to 11 makes this an early champagne
moment. We will bank that, as Anne Robinson would say, and move on to
the next amendment. I beg to ask leave to withdraw the
amendment.
Amendment,
by leave, withdrawn.
Alistair
Burt:
I beg to move amendment No. 198, in
clause 153, page 109, line 35, leave
out subsection
(3).
The
Chairman:
With this it will be convenient to take
amendment No. 182, in clause 153, page 109, line 36, leave out
‘or omitting any
of’.
“The
Secretary of State may by regulations amend this section for the
purpose of adding to, varying or omitting any of the activities for the
time being specified in subsection
(2).”
That
is a wide power that would effectively render neutral the discussions
that we have just had about what LINKs should do, because, no matter
what the Bill says, if the Secretary of State decided in
future—perhaps after complaints from health authorities or
others—that the powers given to LINKs are too extreme, then
instead of returning to the House to agree primary legislation to
change the Bill, the Secretary of State may, by order, simply remove
those powers.
It is
not just we who are concerned about this provision. I should like to
quote two other bodies. In relation to subsection (3), the London
Network of Patients’ Forums said in its
briefing:
“This
is far too wide. It gives the present or any future Government of any
political complexion the power to abolish all involvement of people in
commissioning, providing or scrutiny of local care
services...without further recourse to Parliament. It was probably
drawn by an overzealous
draftsmen”—
I hear
hon. Members say, “Surely
not.”—
“but
it reminds one of the original proposal to abolish the Community Health
Councils...without replacing them. It was parliamentary pressure
that caused the Patients’ Forums to be created as a replacement
of the
CHCs.”
The
London network is plainly concerned, but the Commission for Patient and
Public Involvement in Health is, too. I draw the Minister’s
attention to its briefing, which specifically raises concern about this
clause:
“Clause
153(3) gives the Secretary of State power to make regulations to add
to, omit or vary any of the activities above for the time being,
whereas the legislation establishing Patients Forums...gave the
Secretary of State no power or limit to vary the functions of PPI
forums.”
It
continues:
“The
Bill does not give the Secretary of State power to make regulations on
any other important matters, such as membership or governance rules and
would therefore have no ability to intervene in the future, without
amending the primary legislation, even if significant problems or
concerns rose on such
matters.”
Why
is the power in the Bill? What is the reason for the concerns of the
CPPIH and of members of patients forums? I should be grateful if the
Minister explained why this wide-ranging power is in the
Bill?
Patrick
Hall:
As you can see, Mr.
Chope, I am following the Committee’s orchestral score a little
more carefully now, although I was in danger of being distracted by yet
another reference to a champagne moment by the hon. Member for
North-East Bedfordshire. They keep clocking up. I hope that careful
note has been taken of that so that we are rewarded at the
end.
I was asking
you, Mr. Chope, if I might range a little wider, as you have
kindly allowed others to do, as I would like to acknowledge the good
and hard work of
patients forums’ members up and down the land. I have met a
number of patients forums’ members through the all-party
parliamentary group on patient and public involvement in health,
assisted by the Commission for Patient and Public Involvement in
Health. We recently held two sessions, one in Parliament in October and
another just outside this building last January, to enable patients
forums’ members to have their say and to express their hopes and
fears about LINKs. The week before last, I also had a meeting with
members of the Bedfordshire patients forum.
It is remarkable that there are
threads and strong issues held in common right across the piece. I was
struck by the energy and commitment of the people. They are volunteers
and they contribute a great deal of time and effort. They are also very
well informed and their views are worth listening to. That is the
purpose of having an all-party group—to hear what people outside
this House have to say. Indeed, that is also the basis of our job as
Members of Parliament. Those people wish to serve the community for the
common good and have sought to do so through the mechanism of patients
forums. Whatever happens, we must take great care not to lose the
commitment, energy and qualities of people who are understandably a
little concerned about what will happen. There is a role, and there
will continue to be a strong and growing role, for patient involvement
in health, whatever mechanism is designed to deliver it.
We should
approach this matter from the viewpoint of the ground upon which we
stand and build from where we are. There is a lot of perplexity among
patients forums’ members about their abolition—it is
indeed abolition that we are talking about. Although no one at the
Bedfordshire forum meeting said that they loved what is happening, I
was none the less encouraged to find that the forum had prepared a
paper, a copy of which I will pass on to Ministers, especially those in
the Department of Health, expressing the view that although the page is
a little blank—the canvas is sketchy and almost
empty—that provides an opportunity to help to shape what will
happen. I thought that that was an optimistic and positive
view.
11
am
I
hope that my hon. Friends fully understand patients forum
members’ disappointment, particularly with the decision to
abolish the forums, and that Ministers will welcome their positive
suggestions and others’ about the road to take. My approach to
part 11 will be to seek through a number of probing amendments to
encourage debate and thought and to encourage the Government to help us
to colour in the many gaps on the canvas, because it is difficult to
identify the architecture.
Last Thursday
during our afternoon sitting, the hon. Member for Hazel Grove sought to
gain the sympathy of the Committee by admitting that he had been too
busy to have his lunch. I said nothing at the time, but at lunch that
day, I was given for the first time a copy of a long-awaited draft
model contract between local councils and host organisations, together
with a restricted set of papers dealing with how LINKs will function.
The bundle made reference to promised guidance on governance and
“engagement activities” that will be published only when
the Bill receives Royal Assent. That rich larder of information served
as my lunch. I did not eat it, but I
did not have time to eat anything else. I am sure that I will now have
some well earned sympathy, and perhaps another notch up on the
champagne
later.
Although some
time has elapsed since Thursday, I must confess that I have not read
those documents from cover to cover, although I have had the
opportunity to examine them more. Looking at them, I have no doubt that
the Government have strong ambitions for LINKs, that hosts will play a
strong role and that there will have to be a lot more consultation
before the architecture is built more clearly. There is a lot more to
be done. It is important to consider the documents in the context of
the amendments. Nearly all the amendments moved were prepared and
tabled before we knew of the documents. None the less, our debate will
be important.
I will
also fall for the assumption made by the hon. Member for Hazel Grove
that the words on the face of a Bill mean what they say—that the
English used means what I understand English in common-sense terms to
mean. That is why I am pressing amendment No. 182. I shall assume, as
subsection (2) says, that the purpose of LINKs is to promote and
support
“the involvement
of people in the commissioning, provision and scrutiny of local care
services”,
to
obtain
“the views of
people about their needs for, and their experiences of, local care
services”
and to make
such views known in
“reports and
recommendations...to persons responsible for commissioning,
providing, managing or scrutinising local care
services”.
That
seems absolutely fine. I do not know how else one could describe in a
nutshell what a public involvement organisation should do, whatever one
calls it. That is fine, but as has been mentioned, subsection (3) risks
undermining that function entirely. The Conservatives wish to delete
the subsection altogether, but I think that that would be too
restrictive. It is sensible to be able to vary or perhaps add to the
measures. Indeed, when they are established, LINKs might wish anyway
for a mechanism to do so without going through all kinds of
complicated, time-consuming bureaucratic procedures.
However, to
allow the Secretary of State to omit any of the activities in
subsection (2), even if they must consult on that omission, seems
inappropriate. It goes too far. It could send a negative or
destabilising signal at a time when people need to be reassured that
there will be a firm foundation for patient and public involvement in
health. My amendment seeks to reduce that uncertainty. I look forward
to the Minister’s
response.
Dr.
Pugh:
As I understand the amendments, they are very
different. Amendment No. 198 would ensure that the powers defined in
the Bill could not be varied by the Secretary of State, while amendment
No. 182 would just ensure that they could not be varied to omit any of
the LINKs’ existing functions or roles. The ministerial
position, in contrast to the amendments, appears to be to reserve the
right in subsection (3) for unfettered varying.
I am in favour of the Secretary
of State’s having some power to add to and to refine
LINKs’ powers. I do not anticipate that he would give LINKs
extreme power, as the Conservative spokesman suggested—I
think that, if the Government did that, we would be amazed—but
there is clearly a drive in the Committee to understand what the
variation might mean, given that no guidelines have been laid down on
it. The most acceptable outcome, from the Liberal Democrats’
point of view, would be variation governed by certain guidelines and
restrictions.
Robert
Neill (Bromley and Chislehurst) (Con): I support my hon.
Friend the Member for North-East Bedfordshire. I referred in our
discussions last week to some of the concerns raised by my patients
forum, and this is one of them. There was concern that part of the
unspoken, hidden rationale was the feeling that successful patients
forums had rubbed people the wrong way.
If patients forums or the
proposed LINKs are to do their jobs properly, it will sometimes be
necessary for them to deliver messages that are
uncomfortable—uncomfortable for health service managers, for the
Department and maybe for local authorities. They must be able to do so
in the full confidence that, if their messages are
uncomfortable—if they sometimes say things that are harsh but
necessary—there will not be a tendency, as sometimes happens, to
say, “Let’s get rid of this rather awkward, turbulent
priest and be done with it.”
There is a suspicion at the
moment that that is partly what has happened to the current patients
forums. If they are to be successful in the guise of LINKs, they must
have guarantees of independence. There is a concern about independence
of funding, to which we can return later, and about how they will have
the independence to inspect rigorously without being obstructed. There
is also a concern that their functions should not be chopped and
changed in a way that could at the very least emasculate their
effectiveness.
I am
sure that that is not in the minds of the Ministers here today, but who
knows how such things will proceed? There are always pressures, and
although I appreciate that the ability to remove the turbulent priest
by statutory instrument is an improvement on Henry II’s method,
the principle is just as unpleasant and inconvenient. If people are to
have confidence in the volunteers whom we want to involve, surely they
are entitled to know that the goalposts will not be changed as
punishment for being effective and delivering harsh but necessary
messages.
Mr.
Woolas:
I am not sure that I like the Henry II example. I
am searching the cellar for some
champagne.
I
shall explain what the Government are trying to do in clause 153. The
experience of the patients forums, as the Government acknowledge, was
that their role and functions were too tightly prescribed in primary
legislation. Changes in health that occurred more quickly than some
might have expected meant that the forums were unable to adapt to fit
the changing circumstances and their working environment as well as
they and we would have liked. Therefore, it is important to retain the
power to amend the specified activities. That is not unusual when
establishing bodies. It will enable Parliament to adjust the role of
LINKs on proposals from the Secretary of State when they are necessary
to reflect changes in
health and social care. I agree with the hon. Member for Bromley and
Chislehurst in that we have to pass legislation for a sustained and
unforeseen period, not only for circumstances as they exist. It is
perfectly possible that new functions and areas of health and social
care will come about as a result of technological developments, or as a
result of localised changes and the devolutionary powers that health
and social care services have.
I reassure the Committee that
both Houses of Parliament will make the decision on future proposals,
which will be subject to the affirmative procedure. Our intention is
for LINKs to remain up to date, which is why we wanted subsection (3).
As I said, it is not unusual that Parliament and the Secretary of State
should retain such powers.
The Committee
has a problem with the word “omitting”. The intention of
having that word in subsection (3) is to account for possible changes
in local circumstances, or for functions that are carried out at the
moment but which might not be necessary in the future. I was told, when
I entered Parliament, that it was still illegal not to practise archery
on a Sunday. I have always believed that post-legislative scrutiny
should get rid of laws as well as build them up. That was the entirely
honourable intention behind the word “omitting”. My hon.
Friend the Member for Bedford and Opposition Members have identified
circumstances in which the power may cause disquiet among the people
that we are trying to encourage, but mention of Henry II is going too
far.
Robert
Neill:
I am sure that the Minister has the genesis of a
Henry V in him. Perhaps he will come a little further with his
reassurances.
Mr.
Woolas:
My general rule on kings is that if they were
Lancastrians, they were probably good guys.
I agree with hon. Members in
that there is a problem with the word “omitting”.
However, we need the power to vary the specified activities subject to
the parliamentary procedures to which I referred.
There is a slight difficulty in
the wording of amendment No. 182. Should we accept it, the clause would
not read properly because of the comma—a tiny, technical point,
but striving for perfection is a good thing. The Government agree with
the intention of amendment No. 182 as regards the word
“omitting”. However, we believe that amendment No. 198
goes too far because, if accepted, the Secretary of State and
Parliament would not be allowed to bring the measures up to date when
circumstances require. There is also the issue of how LINKs will
develop. They may be required for support functions such as training
that are not prescribed but which may become necessary. I would like,
with the patience of the Committee, to find a way of getting rid of the
word “omitting” while making the Bill read
well.
Dr.
Pugh:
The Minister is clearly trying to tidy up and give
assurances and all of the things that it is desirable for a Minister to
do on such occasions, but he is suggesting that the Secretary of State
will not usethe powers without the affirmative resolution of
the House. If that is the case, why is there a problem with putting
that in the Bill?
11.15
am
Mr.
Woolas:
I am reliably informed that that is in the
Bill—when I find it, I will let the hon. Gentleman know where.
The hon. Gentleman made a fair point, but provision is made for the
matter to be subject to the affirmative
resolution.
Alistair
Burt:
Is the Minister suggesting that he will, in due
course, introduce a new clause that will remove the word
“omit”?
Mr.
Woolas:
Yes, I shall do that. It will also remove the
comma, so that it reads properly. I should also like to take this
opportunity to ask the hon. Member for Southport to consider clause
170, which relates to the point that he
made.
I hope that the
hon. Member for North-East Bedfordshire will consider asking leave to
withdraw the
amendment.
I am also
relieved about the comma, the least said about which in future, the
better. My hon. Friend the Minister was going to deal with the comma
and the omission. On reading clause 153(2) it is difficult to imagine
how patient and public involvement in health and social care could be
carried out by omitting any of the requirements. Powers on variation
and flexibility are included in the measure. In view of my hon.
Friend’s intelligent, generous comments, I shall not press my
amendment.
Alistair
Burt:
I endorse what the hon. Gentleman
said. It is a good moment for Bedfordshire all round, in respect of the
clause and the Bedfordshire amendments. However, I should be grateful,
knowing what the English language is like, if the Minister made it
clear that there is no way in future that the term
“variation” would be deemed to include omission. If he
did so, that would deal with the point. In theory, “vary”
could mean anything. I forget whether Committee debate can be used in
the courts to indicate what was in Ministers’ minds at the time
that legislation was passed or changed. I am clear what the
Minister’s intention is, but it might be helpful if he said
it.
Patrick
Hall:
There is always doubt, with the English language or
any other language. I have checked the “Concise Oxford English
Dictionary”, which defines “vary” as to change,
make different, diversify and also to suffer
change.
Alistair
Burt:
I am grateful to the hon. Gentleman. However, I
would still find it helpful if the Minister made clear what we know his
intention is.
Mr.
Woolas:
“Vary” in law
carries a different meaning and definition to “omit”.
“Vary” implies changing from one thing to another, not
simply stopping doing things. I will undertake to make that
clear.
Alistair
Burt:
I am grateful. That tidies things up and deals with
the main point of our amendment, which was to cover the point raised by
the hon. Member for Bedford. With the Minister’s assurance, I
beg to ask leave to withdraw the
amendment.
Amendment,
by leave,
withdrawn.
‘(4A) The
Secretary of State shall make payments to each local authority that are
in the opinion of the Secretary of State sufficient to cover the costs
incurred by that local authority in making contractual arrangements
specified under subsection
(1).
(4B) Nothing in this
section shall prevent a local authority making contractual arrangements
under subsection (1) so as to ensure that the activities specified in
subsection (2) are carried on to a greater extent than would be the
case if the arrangements were to cost no more than the payments made
available under subsection
(4A).
(4C) The Secretary of
State must send to the Comptroller and Auditor General within sixty
days after the end of the financial year a statement showing the
payments made to each local authority under subsection (4A) and the
costs incurred by each local authority in making contractual
arrangements under subsection
(1).
(4D) The Comptroller and
Auditor General must examine, certify and report on the statement
provided by the Secretary of State under subsection (4C) and must lay
copies of the statement and of his report before
Parliament.’.
The
amendment has a number of aims. It provides, first, that the Secretary
of State should make available to local authorities sufficient funds to
deliver effective local LINKs; secondly, that councils are welcome to
be generous and to add to that sum if they wish; thirdly, that
information about the funding made available to each local authority
should be open to scrutiny by the public, councillors and Members of
Parliament; and, fourthly, that local authorities should use the
funding that is made available by the Secretary of State to support
LINKs and hosts, not for other purposes. The amendment is designed to
meet concerns raised by forum members and by others.
Ministers
have said, and it should be repeated, that patient and public
involvement in health and social care will involve a vast number of
people and organisations—not only the patients forum members.
Concerns have been raised across the piece that, as is often the case,
funding will be insufficient. Whatever the state of the economy or of
the settlements for local government, local councillors—I have
been one—always say that funding is insufficient. Unless things
are nailed down there is a temptation to use funds for other purposes,
and the fear is that the funding for LINKs will not be ring-fenced and
could be used for other purposes. I accept that there might be more
that is wrong with the amendment than merely a comma. It probably would
not succeed in achieving ring-fencing, but its purpose is to generate a
debate and probe the issues.
A lot of the
talk about costs is speculative, and I would appreciate some guidance
from Ministers on the funds that might be made available. If that is
too much to do now, perhaps the Minister could write to me later.
All sorts of figures are being bandied around. For example, it is being
said that community health councils cost, in their last one or two
years, an average of £150,000 each. People have said that each
LINK, and each host that sets one up, will get that amount, but I do
not think that that can be correct, because there were many more
community health councils than the proposed 152 LINKs. The amount that
is currently spent on patient forums is also being mentioned. I believe
that that is £26 million, which equates to £170,000 per
new LINK. If the central costs of the Commission for Public and Patient
Involvement in Health are added to that—I am informed that they
are £1.5 million—the average figure increases to
£184,000 per LINK. The commission itself estimates that an
average budget of £400,000 will be required for LINKs to carry
out the vast range of tasks that have been set for them—tasks
that we have just discussed. That would produce a national total of
more than £60 million.
Whatever happens, LINKs will
not come cheap, and there will be high expectations of the new system.
They will cost money, and people will want to see that money being used
cost effectively. Whatever the amount is, it will all be needed for
LINKs, and it will not be acceptable for it to be frittered away in
other directions. The amendment is intended to avoid
that.
Tom
Brake (Carshalton and Wallington) (LD):
Does the hon. Gentleman agree with ring-fencing in
principle? Is it the appropriate way for local government finances to
be managed? I admit that it is an unlikely scenario, but I encourage
him to consider a situation in which LINKs had worked so
effectively—with embedding of processes in parts of the health
service—that they were no longer required. The hon.
Gentleman’s amendment would mean that there would have to be a
certain amount of spending on them nevertheless. Will he consider
that?
Patrick
Hall:
We may have a clue as to whether it is needed after
a few decades of studying how the new system has worked. However, I
find it difficult to imagine that there will cease to be a need for
patient and public involvement in health and social care—I
really do not see that need disappearing. Given the pace of change in
the welfare system—technological, scientific, medical and in
other ways—I envisage an increase in the need, rather than a
decrease.
The
principle of ring-fencing ensures that taxpayers’ money, which
comes from the Government for these purposes, is delivered through
local councils to host organisations. There is a specific purpose for
the money and, in principle, I do not see any harm in ensuring that the
money is delivered for that purpose. Ring-fencing is the sort of
mechanism that has occasionally been used before to ensure that a job
is done. The purpose of the amendment is to ensure that we have the
opportunity to debate that matter and to hear what the Government are
thinking.
Dr.
Pugh:
We support the thrust of
the amendment if not its actual fine detail. I think that it will be
well received by treasurers of local authorities who are used to local
authorities being given extra responsibilities and then being told by
the Secretary of State that the cheque is in the post. Sometimes they
have difficulty
finding the cheque for the sum that they incurred when they took on the
new responsibility. It seems to me that the hon. Member for Bedford is
suggesting housekeeping measures that will have to be agreed to at some
time anyway. It is really a question of how it is done and whether it
is done by adding a schedule to the Bill, by making provision elsewhere
in the Bill or by a Minister—or more probably a civil
servant—on a Friday afternoon. I think that I prefer the hon.
Gentleman’s solution to the
problem.
Tom
Levitt (High Peak) (Lab): Mr. Chope, I hope
that you will give me licence to raise one or two points that might
more properly be discussed on clause stand part. I will refer to the
amendment, but I understand that it is not your intention to allow a
clause stand part debate.
I would be grateful if the
Minister confirmed for me that when the amendment refers to local
authorities, that means local authorities with social services
departments. In two-tier areas such as my own, that would be the county
council rather than the district
council.
The
Minister pointed out that approximately 80 per cent. of PCTs are now
coterminous with local authorities. In my constituency, our PCT is one
of the 20 per cent. that are not. In Tameside and Glossop PCT, Glossop
comes under Derbyshire LINK, and the rest of the PCT area comes under
Tameside metropolitan borough council’s LINK. In those
situations, the local authorities and the LINKs must be obliged to talk
to each other if they are discussing services and constituents who live
in their area. That leads me to ask another question: if someone lives
in Glossop, and therefore comes under Derbyshire county council and
Derbyshire LINK, but uses a service in Tameside, which is within the
same PCT but outside their LINK area, would they take their problem to
the Derbyshire LINK, which covers where they live, or to the Tameside
LINK, which covers the area where the facility is provided? In other
words, are the inspections on behalf of the residents or of the
facilities?
My final
point relating to that and the amendment is that the administrative
costs in those LINKs that are dealing with more than one PCT area will
presumably be significantly higher than those in which there is a
one-to-one relationship. Will the Minister give an assurance that where
LINKs have to deal with more health bodies than would be the case in a
coterminous situation, the additional funding will be
supplied?
Mr.
Dunne:
I share the concerns raised by the hon. Member for
High Peak, particularly in relation to LINKs covering a relatively
narrow geographical area. The issue that comes to my mind is of
services that go beyond the scope of the general PCT. I refer here to
specialist services. In my area, for example, the mental health service
has been taken out of Shropshire County PCT and now comes under the
South Staffordshire Healthcare Trust, which has responsibility not only
for mental health services within South Staffordshire but also across
the Prison Service. I understand that the trust looks after mental
health services in more than50 prisons, including on the Isle
of Wight. Has the Minister considered how a trust that develops
activities way beyond its historic area will interact with LINKs?
In particular, has he given consideration to how LINKs can fund their
activities if they wish to go across
boundary?
11.30
am
Finally,
I wish to ask the Minister from where will the funding come? As it is
to come as a result of the Bill, I assume that it will come from his
Department. Was the £26 million of PPI forum funding to which
the hon. Member for Bedford referred a Department of Health budget? Can
all local authorities be secure in the knowledge that the funding will
be provided to them through their relationship with their own
Department rather than from the Department of
Health?
Robert
Neill:
I want to reinforce my hon. Friend’s point
about prison medical services. I practised as a barrister in the
criminal courts for 25 years and I sometimes had a great deal to do
with the recipients of prison medical services, so that strikes a
important chord. There is real concern among legal professionals, the
judiciary and the probation service about the variable quality of
medical services in prisons, how they are provided and their
accessibility. There is a difficulty with transparency and patient
voice in prison medical services. I do not expect the Minister to have
an answer now, but I flag up the matter because it is of real concern,
particularly given the linkage and the large number of people in prison
who suffer from mental health
problems.
There is
concern about the difficulty in finding means by which we can keep up
consistent pressure to improve the quality of services, especially
when, for example, prisoners on remand may be moved from one
institution to another and therefore come under the care of more than
one trust as the provider. There is a complete lack of transparency and
accountability in those circumstances. People in prison, by its nature,
often do not have the constituency base to argue for them that there is
in the general
community.
Tom
Brake:
Last week, I visited a prison and saw its medical
services. Does the hon. Gentleman agree that the cost implications for
LINKs set up in an area with prisons are significant? The process of
consulting prisoners will clearly be more challenging than consulting
the public
generally.
Robert
Neill:
Indeed—the hon. Gentleman is absolutely
right. LINKs may not be the solution for prison medical services, but
we must have something that will safeguard the interests of prisoners,
either on remand or convicted, who are also patients. Inadequate
treatment of a number of problems, particularly mental health, is
sometimes a significant trigger in reoffending, as we all know. It is
important that the matter is taken away and looked at and, perhaps
before the Bill is discussed on Report, we can receive more assurance
about how overview and scrutiny of medical services in prisons will be
dealt
with.
Mr.
Woolas:
I thank hon. Members for their comments because
they really show the value of Bill scrutiny. Many of the points that
have been made and the questions that they throw up provide reasons why
the precise prescription in the amendment is not desirable. I think that
my hon. Friend the Member for Bedford accepts that. The arguments that
have been made are very pertinent to the consideration of the
Sustainable Communities Bill. In essence, we have heard the experience
of Members of Parliament in the real world and how we have to adapt to
that to make mechanisms
work.
Members of
Parliament make representations on behalf of their constituents to
service providers that are sometimes at the other end of the country or
overseas. They sometimes make representations on behalf of people whose
last known address was in their constituency, but are now overseas or
serving “at Her Majesty’s pleasure”, if I could
put it that way. The arrangements are important and I am grateful to
members of the Committee for raising
them.
I confirm to my
hon. Friend the Member for High Peak that we are talking about social
services authorities. Two-tier district authorities that do not provide
social services would not be covered. In consideration of his point
about what we do in areas that are not coterminous, I was casting
around for the most difficult example in the country; I then realised
that it was Glossop in Derbyshire and in the same thought, realised
that my hon. Friend the Member for High Peak was on the
Committee.
Those
Committee Members who know that part of the world will know that there
is a natural community in the north-west of Derbyshire that pulls
towards the Greater Manchester area in terms of travel-to-work
arrangements, but that the rest of the constituency of Derbyshire pulls
towards the rural and beautiful county of Derbyshire. Indeed, my hon.
Friend’s mental health trust is shared with other local
authority areas in the Greater Manchester area, including my own.
Therefore, he raises a very good point.
The hon. Member for Carshalton
and Wallington has raised the point about prison medical services. In
those circumstances, other things being equal, the costs would be
higher. That is why we believe that the mechanism of grant distribution
should not be as tightly ring-fenced as my hon. Friend the Member for
Bedford’s amendment would have it.
The amendments and the debates
around this clause strike at the very principles that underpin local
government funding. Promising the end of ring-fenced funding is an easy
way to get a round of applause at the Local Government Association
conference, as the right hon. Member for Witney (Mr.
Cameron) discovered last July. It is a different thing altogether when
one looks at some of the many functions that local government provides,
especially under a regime of devolution and partnership working. In
practice, one applies pragmatics to the deliberations. Local councils,
as has already been said, will always present a gross bill for their
new functions. In my experience, they have never presented a net bill
of the savings as well as the new costs. I do not expect them to do so,
but I always hope that they will. We therefore have to be wary in our
implementation of the new burdens policy—a policy to which the
Government are committed and for which, as has already been
established, we do deliver the money.
We shall deliver the money for
the LINKs function, but one has to be has to be realistic in preparing
new burdens grants and ensure that that they are meeting net costs and
not paying an invoice that has arrived from 150-plus local authorities
around the country. I am not suggesting that treasurers would over-egg
the pudding—they do not need me to suggest that. They put
together the most ingenious, innovative reasons why every one is
unique. Sometimes they are right—sometimes there are real needs,
as described by my hon. Friend the Member for High Peak. It would
therefore not be sensible to make legislation that precisely prescribed
a mechanism that would result in, in effect, a blank cheque. On the
other hand, it is entirely desirable that the functions are properly
financed, both in their establishment and in their operation. Let me
explain how we propose to do
that.
There
are four parts to amendment No.180. The first proposes that a
requirement be put on the Secretary of State to ensure sufficient funds
are available to cover a local authority’s costs in its work to
put in place contractual arrangements that enable the establishment of
LINKs. The intention, as the Committee knows, is that the Secretary of
State will make a grant to each local authority to enable it to fund
its activities to procure a host organisation—those are the
establishment costs—and subsequently to fund the
activities of the LINK itself. We propose that the grant should be made
under section 31 of the Local Government Act 2003. The grant will be
explicitly targeted to provide funding for the purpose of making
arrangements to establish a LINK. In relation to this part of the Bill,
it is Department of Health money that I am spending on the
champagne.
In
making the grant, the Secretary of State will assess what levels of
funding will be necessary for each local authority to cover its costs
and ensure that there are sufficient funds to enable arrangements to be
made to fulfil the activities set out in the Bill. The grant will go to
the council in recognition of the fact that the council has a statutory
duty to fulfil those activities, but will not prescribe the money too
tightly, as ring-fenced budgets in other areas do. That will give the
local authority some flexibility in making arrangements.
In anticipation of the new
arrangements, we are working with local councils and with the Local
Government Association, which is once again carrying out an essential
function on councils’ behalf, to determine the costs associated
with administering and monitoring contracts between councils and host
organisations, which will vary according to the nature of the area and
the local authority’s infrastructure. Funding will be allocated
to local authorities according to a mechanism that takes into account
factors such as variations in size and arrangements with health
care-providing organisations. We believe that to put all that on the
face of the Bill would create a self-fulfilling prophecy of
complications and bureaucracy. At the end of the day, it would not give
the taxpayer the best value for money.
Alistair
Burt:
May I ask the Minister to note that an issue about
formula funding in health care and local authority matters is arising
in rural and semi-rural areas? There is a concern that formula funding
does not properly take into account some of the problems of such areas,
such as distance and isolation. I am keen for him to indicate that any
formula should take into account such issues, because there is a
debatable point about how they are currently handled, and I want that
to be
noted.
Mr.
Woolas:
The ears of my hon. Friend the
Member for Wigan are twitching after that intervention. He represents
Wigan and the metropolitan authorities and he is conscious that if I
answer in the affirmative, the metropolitan authorities will get a
smaller slice of the cake, other things being equal. That is the
problem faced by any Government in distributing funds—a point
that I urge hon. Members to raise with proponents of the Sustainable
Communities Bill, as that fact of basic arithmetic seems to have gone
missing. My answer is yes: sparsity is a factor in the proposed
distribution calculation.
Hon. Members will point out the
apparent differences between the health funding formula and the social
care funding formula. Under the social care funding formula, we take
into account the number of people over 90 in an area, but I believe
that in health funding the cut-off age is 85. That represents a
sensible policy relating to prevention and health. As health and social
care are brought closer together, funding formulas must be rational and
transparent. We all desire that. What we do not want to do in
recognising the different pressures on different areas is to create a
complicated formula, because complicated formulas are the enemy of
transparency and accountability. They are also the enemy of a happy
state of mind for Ministers for Local
Government.
11.45
am
Patrick
Hall:
The formula, complicated or otherwise, is to do with
the amount granted to a local council to set up hosts and LINKs. My
question is not only about whether that amount will be enough, but
whether the money will be used for the purposes for which it is
allocated.
Mr.
Woolas:
The answer is that yes it will. Special grants
over and above the revenue support grant are often described as
ring-fenced. When there is flexibility, the money is given in the
expectation that a council will carry out a function. We do not
prescribe and create a situation in which if x amount of money is
given, it must be spent specifically on certain expenditures because
there are different ways in which functions can be undertaken. For
example, if one wants good use of buildings, one might enter into an
arrangement with a health authority to rent one. Is the money involved
to be accounted for by LINK, or should the accounting of it be
proportionate to the fact that the building might be used by another
part of the health and social care service, or by an independent
tenant?
The formula
and special grant, under the 2003 Act, does not prescribe exactly; it
meets the purposes that my hon. Friend, on behalf of LINKs and the
people hoping to be involved, quite rightly outlined. Can we guarantee
that the money given to a council will be
passed on to LINKs, or does the fact that councils control the money
give them sway over LINKs that may be detrimental to independent
scrutiny and accountability? I give my hon. Friend the assurance that
the mechanisms of the grant-making powers in the 2003 Act are designed
to do the former. That is also why I teased my hon. Friend the Member
for Wigan when he talked about the abolition of ring-fenced grants:
there is a general predilection against them when one talks to local
councils, and a general predilection in favour when one talks to
pressure groups and charities.
The 2003 Act
provides for a mature way in which to fund councils, whereby there is
an expectation that functions are delivered without the unnecessary
bureaucracy that the present and previous Governments have imposed in
the past.
Tom
Brake:
May I bring the Minister back to the subject of
complex formulae? He expressed a preference for simple formulae. Do I
take it from that that the presence of a prison will not influence the
amount of funding for a
LINK?
Mr.
Woolas:
The most extreme example I can remember of an
argument for change to a funding formula in social care involved a
local authority, which said that because it had an above-average number
of blocks of flats with an above-average number of stairs, it took
social workers in the area longer to meet clients than elsewhere. The
hon. Gentleman knows—we have debated this before—that
formulae cannot be too complicated. I said simple formulae, not very
simple formulae; that is important. The judgment will be based on
factors such as the size of an area, the nature of the population,
demographics and so on. It will perhaps also be determined by factors
such as the one he mentions.
For the hon. Member for Bromley
and Chislehurst, I can confirm that prison medical services will be
covered by LINKs. LINKs will make representations about and will cover
prison medical services on behalf of the patient, which is to say the
prisoner, not the prison. Therefore, what matters is how many prisoners
a local authority area has, not whether they are imprisoned in their
local authority. I am certainly not going to suggest that some local
authority areas have more people in prison than others, but hon.
Members will be aware of the delicate
balance.
Alistair
Burt:
I do not want to hold up
proceedings unduly and the Minister may not be able to answer this
question just now. Yarl’s Wood, which is the largest asylum
detention centre in Europe, is in my constituency. It has had some
issues relating to medical and health care. What provision is being
made to ensure that detained asylum seekers and their representatives
have access to health LINKs? I do not expect the Minister to have the
answer at his fingertips, but I would be very happy to receive a letter
on that in due
course.
Mr.
Woolas:
The hon. Gentleman is entirely accurate when he
says that he cannot expect an answer to that question now. None the
less, he makes a good point. Yarl’s Wood is in his constituency
and for many years he has argued—very conscientiously in my
view—on
behalf of the asylum seekers or failed asylum seekers when it would be
easy for him not to do so. I will give him an answer on that important
point. I suspect that it will involve letters around Government and a
flurry of activity, but he makes a good
point.
Tom
Levitt:
I just want to make a helpful passing
comment to the Minister. The issues being raised by the hon. Member for
North-East Bedfordshire are not any different to those in respect of
patient advice and liaison services. When an individual has a complaint
that they want make, they use the PALS procedure. It is already
established that PALS will take a complaint from anyone who lives
within the PALS area.
Mr.
Woolas:
My hon. Friend makes an important point,
and it applies to many representative and advocacy
bodies.
Robert
Neill:
I appreciate the spirit in which the
Minister has approached the question of prisons, and I hear what he
says about funding. My intervention also relates to access, which is a
point my hon. Friend the Member for North-East Bedfordshire has raised
as well. There is concern among the prison population in particular
that prisoners can be transferred between a number of institutions and
moved from the care of one trust that is providing for a number of
prisons into the care of another. There is a long-standing concern
about the handover of prison records to ensure continuity of treatment,
medication and so on. Again, I appreciate that the Minister will not
have the answer at his fingertips, but can we have some assurances in
writing about how LINKs will work to ensure that there is scrutiny of
the prison medical service, and about how prisoners and their families
can get access? Their specialist advisers will need access as well
because they may need the right medical reports to put before a
court.
Mr.
Woolas:
The hon. Gentleman makes a good and fair
point. He will know also of the circumstancesin which a prison
can commission a number of health providers. Even when the prisoner and
patient isunder their jurisdiction, they are not necessarily
in the same hospital. Therefore, I will comply with his
request.
In proposed
subsection (4B), it seems that my hon. Friend the Member for Bedford is
aiming to allow local authorities to spend more on making contractual
arrangements than the allocation provided by the Health Secretary.
There is nothing in the Bill to prevent councils from making additional
funds available for LINK activities. I hope that my hon. Friend
willagree that the amendment is not necessary in that
respect.
I can see
what is being proposed in subsection (4C). It is a means by which a
local council can be identified if it has chosen to use some of the
funds provided on expenditure that is not LINKs related. As I have
said, I think that it is right that local councils be able to spend
funds in a way that best enables them to make appropriate arrangements.
That they have to make the arrangements is what the Bill is designed to
ensure.
When the Secretary of State
makes grants to fund LINKs to local authorities, the amount of the
grant is in the public domain. As it is a special grant, unlike the
revenue support grant, it is possible to identify how much has been
allocated. That is not the case for other items. The most recent
example that occurs to me is the concessionary bus fare scheme, in
respect of which money was put through the revenue support grant
formula. It is not possible to identify specifically how much is being
given in such cases, but it is possible in the present case, which is
the reason for having chosen the funding mechanism that has been
adopted.
It follows
that local authorities will have to account for their monies, and the
monies that they make available to fund LINK activities will be covered
by the annual audit. LINKs will be able to say how much money local
authorities made available to fund their arrangements, and they will
know how much the Secretary of State provided. I imagine that they will
be professional and vigilant in holding any diversion to
account.
The
problem on subsection (4D)—my hon. Friend the Member for Bedford
acknowledged it—is that the resulting process for arranging
statements and national auditing might be too complicated. Money will
be made available to local authorities, and they will be accountable.
They will have to make decisions in line with the thrust of the Bill,
which is designed to give greater local freedoms and flexibilities. The
Government will ensure that grants are open and transparent, and LINKs
will know how much money has been made available.
I believe that the Bill
achieves approximately the right balance, and I hope that my hon.
Friend the Member for Bedford and the Committee will
agree.
Patrick
Hall:
I have listened carefully to the debate, and it has
been helpful. My hon. Friend did not refer to the total sums that might
be available, and I cannot quite understand that. There is a lot of
speculation about whether that total will correspond to the amount
spent on patients forums and on the commission, or be equivalent to
community health council spending. Although the Minister might not be
able to state the amount now, I hope that he will write to me to give a
broad indication.
Mr.
Woolas:
I apologise that I did not answer that question.
The answer is that the amount is not yet known, because we are entering
discussions with local authorities to identify their needs. There is an
obligation to provide sufficient funding, however. The budget for the
Commission for Patient and Public Involvement in Health for 2006-07 is
£28 million. If the Bill passes, that money would be taken into
consideration.
Patrick
Hall:
I thank my hon. Friend for that. I think that many
of people’s understandable fears will be answered when people
consider what he said about section 31 of the Local Government Act 2003
and the special grant nature of the money. Local councillors will also
know that there will be a great deal of interest in such matters as the
time approaches, and I am sure that they will wish to ensure that the
process is properly
handled and that others are watching. In view of all, that I am happy
with my hon. Friend’s response, and I beg to ask leave to
withdraw the
amendment.
Amendment,
by leave, withdrawn.
Clause 153 ordered to stand
part of the Bill.
|
| |
| ©Parliamentary copyright 2007 | Prepared 7 March 2007 |