Establishing representative national and regional fora to contribute a reasoned collective consumer perspective to the process of reform could well improve both the efficacy and legitimacy of that reform.
The Care Quality Commissions...priority will be to safeguard service users and help improve their experience of health and adult social care servicesrecognising that it can only do this effectively by involving them.
underpinning the design of a regulatory framework
regulatory system should focus on the needs of the patients and the public.
It would be useful if there were an explicit expectation that the new care Commission had a relationship with Local Involvement Networks.
The Government are giving a vote of no confidence to their own system by leaving LINks out of the Bill, which is another nail in the coffin of genuine patient and public involvement. As I said, that process began with the abolition of CHCs. We are disappointed that the Government have not used the opportunity offered by this Bill to steal our policy of creating HealthWatch, a national consumer voice for patients. HealthWatch would provide support to patients at a national level and leadership to LINks at a local level. It would incorporate the functions of the independent complaints advisory body; make representations to the NHS board on such things as the closure of NHS services; and, subject to consultation, it would have a statutory right over guidelines issued nationally concerning the care NHS patients should receive and over decisions that affect how NHS care is provided in an area. Hopefully, the Government will support us
when we introduce our NHS autonomy and accountability Bill. That would be welcome, and consistent with what the Government are purportedly seeking to achieve.
Now that the Government amendments have been accepted, I am concerned that the door is open for any group that claims to speak on behalf of members of the public to harangue the new commission, or engage it in some difficult dialogue. We also note that there is no duty to consult, only the weak phrase have regard to. That weakness is repeated in relation to other organisations mentioned in the Bill. The hon. Member for Luton, North, who has studied the matter carefully, pointed out in Committee that clause 103, which deals with the OHPA, is entitled Duty to consult and contains the phrase seek the views oftwo very different things. A similar wording is used with regard to the CHRE. The title of clause 112 talks of a duty to consult, but again we find the phrase seek the views of in the text of the clause.
Our amendments would beef up the consultation carried out by such bodies by including LINks. I commend the amendments standing in my name and those of my right hon. and hon. Friends, and Members from the Labour and Liberal Democrat Benches. This is a genuine cross-party approach to the matter, so I hope that the Government will feel persuaded.
Kelvin Hopkins: I have agreed to attach my name to the amendments, alongside that of my hon. Friend the Member for North-West Leicestershire, because Members in my party have been concerned about the strength of patient representation for some time, and it is right that those concerns are raised from time to time so that the Government are made aware of them. The abolition of community health councils and the switch to the patient and public involvement forumsand now to LINksshow that the Government are concerned about patient representation, but I am not sure whether they want to strengthen it, or have had pressure put on them to weaken it in some way.
I know that the then health authority perceived the community health council in my area to be a nuisance. The primary care trust has regarded the patient and public involvement forum in our area, especially its chair, as a nuisance. However, patients representatives should be a nuisance. If they make a lot of noise, perhaps there is a basis for what they are doing. I hope that my hon. Friend the Minister and the Government will reconsider giving a role to LINks in the way in which the amendments suggest. Perhaps they will table their own amendments if the ones that we are considering are defeated.
I repeat a point that I have made several times about local authority democratic accountability. When most long-term care homes were in the public sector, there was recourse to local councillors and local democratic representation. With privatisation and subsequent institutional reform, that local democratic accountability was lost. Indeed, many families now come to their Members of Parliamentmore than one constituent has approached meabout problems with care homes. There should be a stronger role for patient representation and I hope that that view can be accommodated in the Bill before it receives Royal Assent.
Local involvement networks are the Governments proposed solution to public and patient involvement. If they are as good as they are cracked up
to be, and are to deliver all that the Government claim, why does the Minister not accept the amendments, which would strengthen the role of LINks? Are the Government not 100 per cent. convinced that LINks will prove an effective system?
The Select Committee on Health looked into LINks and public and patient involvement, and it was apparent that, despite the expertise of the range of experts who came to speak to us, there was no clear idea about the final structure of LINks and how they would work in practice, or even what their functions would be. There was disappointment that some of the functions of the old CHCs were missing. That could be explained by the mantra that we want local solutions and that they will be different in different areas. I subscribe to that point of view to some extent. However, I was struck by the uncertainty about how LINks would work.
In the next couple of years, while the networks find their way, it could be said that we face a democratic deficit. Perhaps the Minister can reassure us that our concerns about how LINks will work are unfounded and that they genuinely are the best thing since sliced bread. If they are, there is no reason for not accepting the amendments.
Mr. Bradshaw: The amendments lead us into territory that is familiar to those of us who sat through the Committee proceedings: the role of local involvement networks. The amendments again try to put LINks on the face of the Bill, in the provisions for the Care Quality Commission, the Council for Healthcare Regulatory Excellence and the Office of the Health Professions Adjudicator. Let me first deal with amendments Nos. 131 and 136.
As we specified in the previous debate and in Committee, we all want the Care Quality Commission to have a clear duty to engage with and be responsive to interested parties. I was therefore pleased to move Government amendment No. 62 to clarify the issue. In Committee, we discussed hon. Members desire for the CQC, the CHRE and the OHPA to be independent. However, the amendments would prescribe the bodies to which those independent organisations should pay regard. That is not a sensible way to proceed. Government amendment No. 62 makes it clear that the CQC should have regard to the views of organisations that represent patients. As the hon. Member for Romsey (Sandra Gidley) said earlier, there may be specialist care investigationsfor example, organisations might want to pay regard to the users of mental health services or other specialist groups. We do not believe that limiting the groups to which they should pay regard to LINks is sensible. That does not mean that we do not have confidence in LINkswe have every confidence that they will do an excellent job and we expect the CQC to work closely with them.
Sandra Gidley: The Minister has demonstrated why the concept seems so nebulous. Some people argue that all the groups to which he said that due regard might be paid would have a feeding-in mechanism through LINks. Does he now claim that that is not the case?
No. They may well do that and I hope that they will. I do not intend to extend the debate to become one of those that we held at length when
LINks were established. The hon. Lady made a good point earlier that some patients and some patient and user organisations sometimes resent other organisations speaking on their behalf. We do not want to prescribe that the CQC should pay regard only to LINks, and not to other patient and user organisations.
Although Government amendment No. 62 was tabled in the same spirit as amendment No. 131, it has the distinct advantage of leaving the door open for other representative groups and for leaving it to the independent commission to determine for itself the most effective way in which to engage appropriate groups. Given the amendment that we have just accepted, we believe that amendment No. 131 and consequential amendment No. 136 are unnecessary.
Amendments Nos. 132, 133, 134 and 135 would insert into clauses 103 and 112 a duty on the Council for Healthcare Regulatory Excellence and the Office of the Health Professions Adjudicator to seek the views from time to time of LINks in addition to other bodies. Amendment No. 137 is simply a consequential amendment to define Local Involvement Network in clause 122. Under the Bill as drafted, the CHRE and the OHPA are both required to consult public and representative bodies on exercising their functions. We believe that those independent bodies are best placed to decide from which other bodies they should seek views.
Indeed, the council has already embarked on a programme of work, which will lead to the implementation of a patient and public strategy. That is being designed to ensure that the council can fulfil the proposed statutory function of becoming an authoritative voice for patients.
I reiterate what I said in Committee about arrangements between LINks and the CQC. Although we want to encourage strong relationships between LINks and their key stakeholders, including the CQC, the CHRE and the OHPA, we do not believe that it is appropriate to dictate to those statutory and independent bodies the way in which they should involve LINks in inspections or consultations. I hope that, given our discussion, the hon. Member for Eddisbury (Mr. O'Brien) will withdraw the amendment.
There is a need to recognise the theme of a long absence of understanding the issue at stake. When community health councils were axed, they were regarded by some as a nuisance, which probably means that they were doing their job. Some were not very good, but the vast majority were perceived as doing a good job. They were seen to be independent and therefore to be trusted by people who needed help when they felt most vulnerable and needed to have their hand held when charting their way through the confusing and labyrinthine process of NHS complaints.
LINks are the ultimate successor bodies that we are now faced with. If we could feel that they were being given the necessary importance by being included in the Bill, it would seem that the Government were at last addressing the grave concern that so many of us have about the lack of importance and independence given to representing patients and their concerns, particularly
when things are going wrong with the NHS. Most often, those who have a concern about the NHS have a continuing need of it and are most anxious not to get offside with the very people from whom they think they need an immediate and expert public service. Taking the opportunity to demonstrate how much they are committed to patient and public involvement in that way would be the proper manner in which the Government could reflect that commitment.
The Government now have a real opportunity to pick up a policy that they have been urged to adopt, but which they again seem to be resisting, and which we have articulated at length elsewhere and now in a draft BillI hope that I will be able to persuade the Minister and his colleagues to support the NHS accountability and autonomy Bill, in which we have a designed patient and public involvement system through HealthWatch, a good model that, despite the Ministers disparaging so far, I hope will be picked up.
It is vital to recognisenot least because the amendment was not just tabled by the official Opposition, but co-sponsored by Government Members and the Liberal Democrats spokesmanthat the House now has an opportunity to vote, with a heavy heart and some displeasure, against the Government for not seeking to pick up on a sensible, measured and appropriate way of handling such an essential issue. This is an opportunity to ensure that that is well understood in the Bill, and I shall therefore press my amendment to a Division.