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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(Afternoon)[Mr. Christopher Chope in the Chair]Local Government and Public Involvement in Health BillClause 154Arrangements
under section
153(1)
Amendment
proposed [this day]: No. 201, in
clause 154, page 110, line 17, at
end insert
‘and who does
not commission or provide local care
services’.—[Alistair
Burt.]
4.30
pm
Question
again proposed, That the amendment be
made.
The
Chairman:
I remind the Committee that with this we are
taking the following: Amendment No. 183, in
clause 154, page 110, line 17, at
end insert—
‘( ) In making
arrangements, A may select as H either the National Health Involvement
Network or such other person who in the opinion of A is able to deliver
such an arrangement under section 153(1) so that it meets the general
duty as set out in section 3 of the Local Government Act
1999.’.
Amendment
No. 184, in
clause 154, page 110, line 27, at
end insert—
‘( ) The
arrangements must provide that a local involvement network is provided
with the staff, premises and resources that are necessary in the
opinion of A for the local involvement network to carry on in
A’s area activities specified in section
153(2).’.
New
clause 15—National health involvement
network—
‘(1) There
shall be a body corporate to be known as the National Health
Involvement Network to exercise the functions set out in section 153(2)
to (5).
(2) The National Health
Involvement Network has the following
functions—
(a) advising
the Secretary of State, and such other bodies as it may consider
appropriate, about arrangements for promoting the involvement of people
in the commissioning, provision and scrutiny of care
services;
(b) representing to
the Secretary of State, and such other bodies as it may consider
appropriate, and advising him and them on the views in England of
people about their needs for, and their experiences of, care
services;
(c) representing to
the Secretary of State, and such other bodies as it may consider
appropriate, and advising him and them on the views of local
involvement networks in England on their activities as respects section
153(2);
(d) facilitating the
coordination of the activities of local involvement
networks;
(e) advising and
assisting local involvement networks in England;
(f) setting quality standards relating to any aspect
of the way local involvement networks exercise their functions,
monitoring how successfully they meet those standards, and making
recommendations to them about how to improve their performance against
those standards;
(g) promoting
the involvement of people in the commissioning, provision and scrutiny
of care services;
(h) such
other functions in relation to England as may be
prescribed.
(3) The Secretary
of State shall by regulations make further provision in respect of the
National Health Involvement Network and these may include such matters
as status, powers, membership, appointment, staff, payments to,
accounts, audit and
reports.’.
Patrick
Hall (Bedford) (Lab): We have had the opportunity to have
lunch, and I shall now conclude the remarks that I was about to make
when we adjourned.
My
hon. Friend the Minister has approached the Committee’s work
with an open mind, and has been helpful and honest. It was not that
that was new this morning, because we have been getting used to his
approach throughout the Committee, but he injected the new and
enlightening suggestion that Ministers should agree with proposals that
they advocated. The hon. Member for North-East Bedfordshire showed some
surprise at that suggestion, and I wonder what his reaction would be if
I mentioned the Child Support Agency. Perhaps that is a little
unfair.
Alistair
Burt (North-East Bedfordshire) (Con): The hon. Gentleman
was reading my expression as I was being teased. We had the tantalising
prospect of the Minister announcing that he was thinking through a
colleague’s policy before concluding whether it was right. That
raised the prospect in our minds of him going to the Department of
Health, knocking on the Minister’s door, and saying,
“Rosie, I just can’t do this.” He then let us down
by saying that having thought the matter through carefully,
surprisingly, he agreed with his colleague. That was the surprise that
the hon. Member for Bedford
detected.
Patrick
Hall:
Even more enlightenment is shining upon us today,
and I thank the hon. Gentleman for his
comments.
Turning
to the matters of greater substance that are before us, and the need to
set up a national top-down body—that is proposed in my
amendment—I understand the arguments and the logic for not
accepting that, but the need for a national dimension to assist local
involvement in health networks in doing their job remains, and the case
for that is strong. On day one of LINKs’ existence, there will
be no such body, and if they eventually get together and create a
membership organisation, they will need the resources to do so. I urge
my hon. Friend the Minister to bear that in mind. Funds must be
sufficient for that
task.
My
hon. Friend did not have time to deal with the issues that I raised on
amendment No. 184, and perhaps they can be looked at elsewhere. The
question in my mind, having dangerously dipped into the draft contract
documents that were made available last week, is whether
it might be possible for the role of the host to be more significant
than that of the LINK. We shall have to explore that further, but there
has been sufficient movement on these matters and acknowledgement of
their importance for me not to press the
amendments.
Alistair
Burt:
The Minister addressed his hon. Friend’s
amendments well, but I just want to indicate the purpose of my
amendment No. 201—he may want to intervene—because I
stumbled over it, and he may not have picked up its
purpose.
The
clause makes it clear that a local authority could not be a host
organisation, but does not make it specifically clear that any other
provider of care services—such as a national health service
organisation—could not be a host organisation. The point of the
amendment is to indicate that it would be just as awkward for the
independence of LINKs if they were hosted by an NHS or any other
organisation providing services as it would be if they were hosted by a
local authority.
That
is the purpose of my amendment, and I would be grateful if the Minister
could help me out on
that.
The
Minister for Local Government (Mr. Phil
Woolas):
The hon. Gentleman makes an important point. The
amendment would insert the
words
“and who does not
commission or provide local care services”.
Clause 154 does not allow a local
authority or an NHS trust to be a LINK. It is possible as we stand that
the host may be a local health
organisation.
Alistair
Burt:
I appreciate that. In that case,
my amendment has not been covered. The point of the amendment was to
say that the same logic would surely apply. If the Minister and the
Department did not feel that a local authority was an appropriate host
because it also provided services, surely it would be equally logical
that, as well as not being a LINK, other such organisations should not
be a host either. If the Minister and the Department do not agree, I
will welcome an explanation of why there is an inconsistency between
the two. I am not satisfied that the point has been dealt
with.
Mr.
Woolas:
The hon. Gentleman has a point. I think that that
will be covered in the next group of amendments. We may be able to
debate it and seek the views of the Committee at that
point.
Alistair
Burt:
In view of that, we can always consider the point
further, so I beg to ask leave to withdraw the amendment.
Amendment, by leave,
withdrawn.
Dr.
John Pugh (Southport) (LD): I beg to move amendment No.
228, in
clause 154, page 110, line 26, at
end insert—
‘(h) any
organisation providing local care
services.’.
The
Chairman:
With this it will be
convenient to discuss amendment No. 229, in
clause 154, page 110,line 29, at
end insert—
‘(7) No chair of
an organisation listed under subsections (4)(d) to (4)(h) shall also be
a leader of a Local Involvement Network.’.
I have a lot of sympathy for
the Minister. He has been endowed with the brilliant idea of LINKs by
the Department of Health, and has done his best to explain it with as
much clarity as possible. The idea remains fundamentally unclear to a
number of us. I understand that a LINK is an organisation that can
morph—I think the Minister used the word
“flexible”. In other words, it can co-opt people as and
when it wants; it is a moveable feast. It is not like a forum or a
community health council, with an established or defined
membership—a core membership was the expression used by the hon.
Member for Bedford—but it is said to be more versatile, more
potent and more effective in some ways. We all find the absence of
defining regulation just a little worrying. I accept the
Minister’s response, which was that all will be defined by some
sort of contractual arrangements when LINKS are established. As we are
unfamiliar with the contracts that will be established, we are none the
wiser about what a LINK will be.
We seem to know what a LINK is
not, and what it cannot be. A list of conditions in paragraphs (a) to
(g) gives various things that it definitely is not. That list is a
mixed bag, which covers providers, commissioners, some things that are
trusts and some that are not, but it does not seem to be complete.
Private providers, who are now clearly part of the health service, are
omitted. That might have been what amendment No. 201 was getting at. I
will not go over the arguments in connection with that. There seems to
be a benefit in specifying a level playing field, even though I think
it pretty unlikely that any private provider would wish to become a
LINK or would be acceptable as one.
Amendment No. 229 follows up on
a point raised by the hon. Member for North-East Bedfordshire, which is
the spectre of Joe Public coming along to his first LINK meeting and
finding himself surrounded by health officials, health professionals
and health apparatchiks of one kind or another, and feeling restrained
in what he could say. The legislation lays out quite clearly that
trusts cannot be LINKs, but it does not seem to lay out so clearly what
trust members can be or cannot be. I have had occasion to observe that
people who belong to one quango reappear almost magically in another.
If they are affiliated to one organisation, they get themselves
affiliated to an associated organisation.
Amendment No. 229 attempts to
make it clear that, whoever is on the LINK, it will not be people with
a prominent position on any of the trusts. In considering the matter, I
decided that there is not an overwhelming case for excluding all trust
employees, because an awful lot of people work for the health service
in one capacity or another; the result would be the exclusion of
enormous numbers of people and of a wide range of relevant
expertise.
The
hon. Member for North-East Bedfordshire alluded to the fact that there
are occasional possibilities for conflicts of interest. For example, if
a midwife were a LINK member—I cannot see why she should not
be—what would be the appropriate course of conduct if the
subject of discussion were the closure of maternity units? Likewise,
what would be the appropriate course for ambulance people if the
positioning of an accident
and emergency department were under discussion? Those are relevant
issues, and amendment No. 229 is intended to probe how conflicts of
interest will be
addressed.
Amendment
No. 228 would add what I believe to be a necessary completing provision
to the proposed legislation. If health providers are to be excluded in
general, let us exclude all of them, rather than just those that are
NHS trusts.
Mr.
Woolas:
A number of amendments have been proposed on the
issues of who can or cannot be a LINK, on hosts and on conflicts of
interest.
Amendment
No. 228 would include independent sector providers in the list of
bodies that cannot become a LINK. The Government have an open mind on
the amendment, because one can see its purpose exactly. Let us take the
case of a BUPA hospital—not that the Government have anything
against BUPA hospitals. Clearly, there would be an inconsistency if the
clause as currently drafted did not allow an NHS foundation trust to be
a LINK, yet allowed an independent hospital to become a LINK. One can
see that there might be circumstances in which a local authority would
wish to contract in that regard. On the other hand, it might be
desirable to have bodies such as Mind or a voluntary service
organisation as a LINK, the difficulty being that the relevant body
might be a service provider of social care.
The Government have difficulty
with the wording of the amendment. The
phrase
“any organisation
providing local care
services”
is
comprehensive. Bodies such as Age Concern might provide, for instance,
meals on wheels services to a particular neighbourhood, yet be a minor
provider of services in the area overall. Therefore, although the
amendment has a valid purpose, we have difficulties with the
definition.
Amendment
No. 229 seeks to ensure that the chair of any organisation that
provides local care services cannot become the leader of a LINK. Again,
on the face of things, there is a potential conflict of interest in
that situation. However, two arguments present themselves. The first
is, I admit, a weaker argument, which concerns flexibility. In a
certain area, the LINK might want to appoint a respected and
knowledgeable individual who is the holder of a position with a local
care service delivery organisation. The second argument is stronger. It
is that conflicts of interest will be covered by the codes of conduct
to which reference was made in the previous debate. In answer to my
hon. Friend the Member for Bedford, I made the point that the
principles of conduct in public life covered by the Nolan commission
apply.
4.45
pm
Andrew
Stunell (Hazel Grove) (LD): Will the Minister acknowledge
that the strength of the argument advanced by my hon. Friend the Member
for Southport is that the presence of a person listed in subsection
(4)(d) to (h) in the chair of the LINK might inhibit its capacity to
look at a particular service area, even when an interest has been
declared?
Mr.
Woolas:
It may do; it may also do the opposite, because
such a person would carry a great deal of weight. In line with the
policy of being as least prescriptive as possible, we believe that the
codes of conduct in public life are a better way of dealing with the
issue of conflicts of interest. Obviously, local LINKs will take such
matters into consideration when they are
established.
Straying from my brief and
referring to amendment No. 201, the Government want to enable
independent providers to be hosts of LINKs, although we have a problem
of definition regarding whether they should themselves be LINKs.
Whether or not independent providers deliver care services,
demonstrating to a local authority that they can manage any potential
or perceived conflict of interests would be an issue dealt with in the
contract. It is a matter of definition—an inevitable consequence
of the fact that we are trying to introduce a broader regime and to
join organisations. We want LINKs to be as free as possible to decide
how they are governed, and we believe that the codes of conduct are a
better way of addressing that than prescription in legislation. For
those reasons, I resist amendments Nos. 228 and
229.
Dr.
Pugh:
I thank the Minister for speaking to the amendments
on their merits. I appreciate his dilemma, and I am grateful that he
has been so frank and open minded about it. Clearly, there is a problem
with a situation in which an independent provider also functions as an
advocacy body, because one would not want such a body to have its feet
under the table of a LINK. That is something that perhaps members of
the Committee will want to take away and think about, because there is
a problem of establishing a level playing field, and a need to exclude
a BUPA hospital from effectively becoming a LINK.
It has been
entirely appropriate to point the Committee to the Nolan requirements,
which have been used as an argument against previous amendments.
However, the requirements work best when applied to relatively formal
organisations that have an officer whose job it is to advise people
when they step out of line. We are supposing that LINKs will be a
relatively flexible arrangement in that there might not necessarily be
a defined structure or an officer to offer the proper advice at the
proper time. Therefore, while the Nolan requirements are a good answer
in theory, we might get into all sorts of difficulties in
practice.
Mr.
Woolas:
The hon. Gentleman is probing
right to the heart of the principles of the Bill, and I congratulate
him on doing so. In the regime that the Bill proposes, the function of
giving proper advice would be undertaken by the host organisation. Just
as a monitoring officer or a section 151 officer in a local authority
has a relationship with elected councillors, a host organisation would
have a relationship with a LINK. That is common practice in this
country, and I would argue that such relationships are well
established. I think that that answers the hon. Gentleman’s
point.
Dr.
Pugh:
I am grateful to the Minister for that and will go
away to reflect on it. I beg to ask leave to withdraw the
amendment.
Amendment, by leave,
withdrawn.
Clause
154 ordered to stand part of the Bill.
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