Health and Social Care Bill

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New Clause 14

Provision of information by Auditor General for Wales
‘(1) The Auditor General for Wales must, on request, provide the Commission with any information it may reasonably require for the purpose of making comparisons, in the exercise of its functions under section 50 so far as relating to health care or English NHS bodies, between English NHS bodies and Welsh NHS bodies.
(2) In this section “Welsh NHS body” has the same meaning as in Part 3 of the Public Audit (Wales) Act 2004 (c. 23).’.—[Mr. Bradshaw.]
Brought up, read the First and Second time, and added to the Bill.

New Clause 8

‘(1) The Commission shall establish and maintain a committee to be known as “HealthWatch”.
(2) HealthWatch shall consist of—
(a) a chairman appointed by the Commission; and
(b) such other members appointed by the Commission as the Commission think fit.
(3) The chairman appointed under subsection 2(a)—
(a) shall be a non-executive member of the Commission
(b) but is not to be chairman of the Commission.’.—[Mr. Stephen O'Brien.]
Brought up, and read the First time.
Mr. O'Brien: I beg to move, That the clause be read a Second time.
The Chairman: With this it will be convenient to discuss the following: New clause 9—General duty of HealthWatch
‘It shall be the duty of HealthWatch to further the interests of patients and the public in relation to the provision of health services in England.’.
New clause 10—Functions of HealthWatch
‘(1) HealthWatch shall make arrangements for ascertaining—
(a) the state of public opinion about the manner in which health services in England are provided,
(b) the views and experiences of patients in relation to the provision of health services in England; and
(c) the views and experiences of patients in relation to the handling, by commissioners and providers of healthcare services, of complaints made to them by such patients.’.
New clause 11—Local Involvement Networks.
‘(1) HealthWatch shall be regarded as an “English network” for the purposes of section 222 of the Local Government and Public Involvement in Health Act 2007 (c. 28).
(2) HealthWatch may make such arrangements as it thinks fit for consultation with Local Involvement Networks.’.
Mr. O'Brien: It does not matter how many times one does it; returning to a discussion of many days or weeks ago is the most challenging part of the procedure. At least we have reporters if I have got any of that wrong.
We have had an important discussion on public and patient involvement. That is something that is of great concern across the House and I do not intend to seek to embarrass or press in a partisan way. As hon. Members are aware, there is a proposal, which happens to come from the Opposition, to establish an organisation called HealthWatch. I have urged the Minister to look seriously and carefully at what my party proposes. We have worked very hard on this matter: we have discussed it with a lot of people and we have made a commitment to establish HealthWatch, a national consumer voice for patients and service users. Having had many discussions about local involvement networks with patients and public involvement throughout the Committee stage, we are very grateful, and I genuinely mean that, that the Minister has undertaken to look at the matter again. His commitment is welcome.
I will not unduly delay the Committee although we are not particularly rushed. New clause 8 seeks to establish HealthWatch as a committee of the CQC and makes provision as to its constitution. New clause 9 is established to
“further the interests of patients and the public in relation to the provision of health services in England.”
New clause 10 would require HealthWatch to ascertain:
“the state of public opinion about the manner in which health services in England are provided...views and experiences of patients in relation to the provision of health services in England; and...the views and experiences of patients in relation to the handling, by commissioners and providers of healthcare services, of complaints made to them by such patients.’.”
New clause 11 would establish HealthWatch as an “English network” for the purposes of the Local Government and Public Involvement in Health Act 2007. I do not know whether any members of this Committee served on the Public Bill Committee for that legislation, but I should have checked, given that there has been genuine interest from many hon. Members present. HealthWatch would use existing legislation to achieve the aim of having a national representative body for local involvement networks.
Contrary to the Minister’s assertion that our proposal is opposed to the bottom-up, organic approach—he will recall that discussion—LINKs would be the drivers. HealthWatch would give them the power to engage with policy at national level, which they are denied by the Government. That is the essential part. I am sure that Committee members will recall the importance of the old community health councils and the bed watch publication. That had a major impact on the way in which Governments thought about the patient experience, what needed to happen and priorities. Indeed, in their early years in office, one of the Labour Government’s priorities was capacity issues.
With the new clauses, we aim to deliver on our commitment to establish a national consumer voice for patients—HealthWatch—to provide them with support at a national level, to provide leadership to LINKs at a local level and to incorporate the functions of the independent complaints advisory services. That is very important. We have had many discussions on concerns about the capacity to process complaints, assuming the Bill becomes an Act, and the capacity of the complaints handling system. Today’s memorandum helped to put a little more flesh on the bones regarding complaints issues. That welcome and important document has been placed on the record as a memorandum.
HealthWatch would also make representations on the closure of NHS services, for example. We would have it make representations to the NHS board, and we have published a draft Bill on that, which we hope to have the opportunity to introduce. Subject to consultation, HealthWatch would have statutory rights over nationally issued guidelines on the care that NHS patients should receive and on decisions that affect how NHS care is provided in an area. I urge the Minister to take our new clauses into account as he seeks a way forward for patient involvement in the CQC and our NHS.
My hon. Friend the Member for South Cambridgeshire (Mr. Lansley) has promised to bring our proposals forward as part of our announced NHS Autonomy and Accountability Bill. I hope that this debate has sufficiently whetted the Minister’s appetite for that discussion and that he has no concerns about pride of authorship or the fact that the measures happen to have been proposed by us rather than his Government. It is undoubtedly the right way forward for our NHS. On that basis, I commend the new clauses to the Committee and very much hope that the Minister will regard them as a useful addition that will improve the Bill as we speed its passage through Parliament.
Kelvin Hopkins: I reiterate my concern that the representation of patients should be sufficiently strong and robust both in representing patients as a group and providing access for individual patients with particular problems. I am also concerned about access to advocacy. Some Labour Members will be watching carefully to see how the new arrangements work in practice and to ensure that patients have proper representation in every way necessary and appropriate. I hope that my hon. Friend the Minister will take note of our concerns that the new machinery should work properly. If it does not work so well, we will look forward to more reforms in the future.
Mr. Bradshaw: I am sorry to tell the hon. Member for Eddisbury that we think the HealthWatch idea is as flawed as other ideas in the Conservatives’ draft Bill, such as giving over the running of the health service to an independent, unaccountable national quango. The reasoning behind the new clauses appears to be that the committee will represent patient and public views to the commission more effectively than the local involvement networks—or the regional or national networks that they might choose to establish with the Care Quality Commission—might otherwise be able to achieve.
The re-establishment of a centralised body, especially one that sits within the Care Quality Commission would undermine our move towards more local determination, flexibility and responsiveness. It would also go against the conclusion of the arm’s length body review in 2004, which recommended the abolition of the Commission for Patient and Public Involvement in Health—a not dissimilar body to the one being proposed as part of the wider Government agenda to move resources from centralised bodies to the front line.
LINKs should be given time to determine their own way of being represented regionally and nationally if they wish. Together with other changes we are making such as the complaints reform to which the hon. Gentleman referred, that will more than cover the function set out in the Bill for HealthWatch and ensure the representation of the public and patient voice to the new regulator, as my hon. Friend the Member for Luton, North so eloquently advocated.
Mr. O'Brien: I put it on the record that we do not accept the Minister’s analysis of the approach advocated by our NHS Autonomy and Accountability Bill but there may be a future opportunity to consider it in detail. I recognise that the soundbite used in relation to it has been repeated.
I pay tribute to the hon. Member for Luton, North, who did not necessarily support the new clause, for his consistent approach to patient involvement and the level of advocacy that needs to be established. He and I have shared a view on that issue over at least eight years since we looked very closely at what was happening when the community health councils were abolished, as it was one of their key roles. The independence and trust that they enjoyed led to advocacy that worked, which was especially helpful to those in a very vulnerable situation. Our HealthWatch proposal, which is contained in the new clauses, is intended to try to replicate that aspect of the CHCs.
I do not want to press the hon. Gentleman to make a decision and I recognise that the Government are taking a view on these matters. The point is well heard as well as well made and the best I can do is hope that if we continue to take opportunities to press these ideas, the Government will one day realise that they are not intended to be something that they should resist, but something that they should embrace. That would be one of the best ways of demonstrating that there is a unity in many of our objectives for making sure that the NHS is not only robust and well designed but that its priority is to serve patients from the very first to the very last and to improve their lives through better health.
I beg to ask leave to withdraw the motion.
Motion and clause, by leave, withdrawn.

New Clause 17

Minimum guaranteed outcomes
‘(1) The appropriate authority shall by regulations make provision—
(a) specifying circumstances in which it will be necessary for a local authority to provide social care support (including any form of practical assistance and equipment) to a disabled person; and
(b) specifying the minimum outcomes each local authority shall secure for all disabled persons in exercising their duties under social care enactments.
(2) Without prejudice to the generality of subsection 1(b), minimum outcomes prescribed under that subsection shall include—
(a) ensuring freedom from physical risk;
(b) ensuring freedom from inhumane or degrading treatment;
(c) the full enjoyment of the right to personal development and to establish and maintain family and other social relationships;
(d) support for participation in the life of the community;
(e) support to participate in essential social and economic activities, and
(f) support to access an appropriate range of recreational and cultural activities.
(3) In this section—
“appropriate authority” means—
(c) in relation to England, the Secretary of State,
(d) in relation to Wales, the Welsh Ministers;
“social care enactments” include—
(i) Section 2 of the Chronically Sick and Disabled Persons Act 1970 (c. 44).
(ii) Section 4 of the Disabled Persons (Services, Consultation and Representation Act 1986 (c. 33).
(iii) Section 17 of the Children Act 1989 (c. 41).
(iv) Section 47 of the National Health Service and Community Care Act 1990 (c. 19).’.—[Sandra Gidley.]
Brought up, and read the First time.
Sandra Gidley: I beg to move, That the clause be read a Second time.
New clause 17 would end the post-code lottery in social care provision and ensure that every disabled person has a clear right to independent living support that meets basic human rights standards. The system we have now means that the entitlement of disabled people to support for independent living varies considerably depending on where they live and whether they meet increasingly high thresholds to qualify for support.
Increasing hardship and exclusion for disabled people and their families and carers is resulting from under-investment in social care. We accept that investment is being made in health but there seems to be a lack of will to reform an outdated and antiquated system. Although there are some good things in the Bill, for example, the extension of direct payments, more could be done. This year, many more disabled and older people will be turned away by social services. [Interruption.]
The Chairman: Order. I am sorry to interrupt the hon. Lady, but there are three or four different conversations going on in the room, and the Official Reporter is having difficulty hearing what she is saying. Perhaps it would help if she could speak up a bit, and if members of the Committee could converse outside.
3.45 pm
Sandra Gidley: I do not feel that I should have to speak up. It is polite to listen.
This year, many more disabled and older people will be turned away by social services because they do not meet the threshold for support. If they are lucky, family and unpaid carers may step into the breach, at great cost to their health, employment opportunities and well-being, as we all know. Instead of rationing according to severity of need, which deprives some disabled people with moderate or low support needs of any help whatsoever, and increases the likelihood of more costly acute health and social care intervention further down the line, the new clause proposes an alternative approach. It would require local authorities to meet minimum outcomes in respect of disabled people regardless of the level of presenting need. That would maximise the opportunities for disabled people and maintain and extend their independence and well-being.
The minimum outcomes would be prescribed in regulations, and, given the import, there would be virtue in making them subject to the positive resolution procedure. Parliament should get the chance to debate fully and decide what a minimum level of support should be.
Examples of minimum outcomes are given in the new clause. They are based on core human rights standards as set out in the European convention on human rights: freedom from physical risk is based on article 2, which deals with the right to life; freedom from inhumane or degrading treatment is based on article 3; and the right to privacy and family life is based on article 8, which encompasses a positive obligation on states to support people in developing their personality and social relationships, and in participating in social, economic, cultural and leisure activities.
Organisations such as the Royal Association for Disability and Rehabilitation hear from many disabled people for whom those basic human rights are denied. Unless and until those rights receive clear statutory underpinning, disabled people and their families will continue to experience daily hardship, exclusion and indignity.
We believe that local authorities are left to flout human rights standards because the Government have failed to spell out clearly what the positive obligations in the convention actually mean. They cannot simply be dismissed by reference to resource constraints, although I would point out that independent living support is frequently cheaper, better and more flexible than traditional support.
The new clause would underpin effective implementation of recommendation 4.4 of the Prime Minister’s strategy unit report, which is accepted as Government policy. That report on improving the life chances of disabled people said that there should be a new system in place by 2012 to deliver independent living. It should include provision for eligibility based on requirements arising from disabling barriers—for example, cash payments for taxis when public transport is inaccessible—and additional requirements associated with impairment. For example, voice-recognition software would enable someone to read text at home and work. Subsection (1)(a) is designed to implement that. The system should also include provision for security and certainty about what level of support is available. That would be implemented by subsection (1)(b).
The new clause would help to create a social care system geared towards prevention and the achievement of beneficial social and economic outcomes in place of the dependency-oriented, increasingly threadbare safety net that exists today. I will concede that the Government want a debate about the future funding of social care, but it must be informed by a clear position on what we want social care to achieve. The Wanless review noted that the impact of current social spending on achieving the Government’s desired outcomes of promoting choice, independence and prevention is unclear. In fact, the review said that the evidence that does exist suggests that the social care system is falling short of those aims.
The economic and social benefits, and cost-effectiveness of independent living support, including the low-level support mentioned earlier, have been well documented in reports published by the Office for Disability Issues. Wanless estimated that an additional £3 billion now needs to be pumped into social care. Even if that investment is not forthcoming, whole-system reform as outlined in the Disabled Persons (Independent Living) Bill currently before the Lords—which includes provision for seamless support and individual budgets—would release major savings which could fund the provisions in the new clause.
Mr. O'Brien: I do not want to detain the Committee long. I have read the new clause very carefully. When something deals with guaranteed minimum outcomes for people with disability, I think that we are all genuinely very exercised as to whether it carries with it a thrust that we should follow.
Indeed, she said that that was the way her party’s manifesto writers like to approach their whole manifesto, something with which I could not possibly disagree, and which I dare say the Minister would also find it very tempting to endorse. [Interruption.] The hon. Member for Leeds, North-West says he wants to go home. It seems quite extraordinary that he does not wish to vote this afternoon.
Greg Mulholland: Just to say—and it has nothing to do with this debate, nor with the nonsense he is talking—that the reason I am not voting is that I have chosen not to vote on my own pay or allowances, and that is a point of principle.
The Chairman: Order. I am sure that the hon. Gentleman would not be tempted down that path. What he does on the Floor of the House is a matter for him later.
Mr. O'Brien: Indeed it is. I have never participated, and never wish to, but I shall be voting for the lower amount this evening.
The Chairman: Order.
Mr. O'Brien: Otherwise I would not be participating, because I think as a matter of principle it is not right that we should have anything to do with our own pay and conditions.
The Chairman: Order. We are not going to have a debate about Members’ pay in this Committee. We will stick to the new clause before the Committee.
Mr. O'Brien: I accept your ruling, Mr. Conway. The reason this was important—and it is important to place it on the record—is that we do not get many chances to scrutinise one another’s promises and proposals, and the Liberal Democrats were making a serious contribution to this. They have form, and the hon. Member for Romsey prayed in aid the approach that her party has taken to social care. She even prayed in aid the Wanless report. That has been prayed in aid by her party in the past when it promised free personal care—a promise that, in their most recent announcement, has been withdrawn as no longer being affordable. It is important to recognise that, in fairness to the hon. Lady, she was at least two if not three years ahead of her party in admitting that the policy was unsustainable and undeliverable—and indeed, was not delivered. On that basis, and on the basis of the fact that there is an absence of costings in new clause—I think the Minister will share that concern—there is an issue here about whether the promises in the new clause are deliverable in reality.
Mr. Bradshaw: I do not want to intrude on the private grief of the Liberal Democrat and Conservative parties, but I will defend the hon. Lady’s right—and indeed the right of any political party or hon. Member—to change her mind. Indeed, the Conservative party changed its mind on policies almost every day, so I do not see what point the hon. Gentleman is making.
I think that many of us have a great deal of sympathy for the sentiment expressed by the hon. Lady, but we have problems with the new clause for reasons I will briefly spell out. First, they would curtail the autonomy of local authorities in the provision of social care services and undermine their ability to deliver the services required by their population with the funding available to them. The Department of Health published “Fair access to care” guidance in 2002, which provides councils with a framework for setting their eligibility criteria based on individuals’ needs and associated risks to independence, and includes four eligibility bands: critical, substantial, moderate and low. When placing individuals in those bands, the guidance stresses that councils should not only identify immediate needs, but those that might increase for lack of timely help.
The second reason why we do not think that the new clause is desirable is that where fundamental reform of the social care system is needed, which is what the hon. Lady was really talking about, it ought to be considered as part of a coherent package. That is why the Government are developing the Green Paper to which she referred. It is an historic advance reflecting the fact that society is changing and will change even more in the future. Dignity and control for those who use the services and their families will be at the heart of the new system. The work on the Green Paper will consider the issues that she raised about eligibility. In the light of those remarks, I hope that she will withdraw the new clause.
Sandra Gidley: I thank the Minister for his comments. The new clause was tabled in an attempt to start a debate on a slightly different approach. I take issue with his comments about curtailing the autonomy of local authorities. Many of us think that local authorities do not have the autonomy that they want, owing to budget pressures and being unable to raise taxation should they wish to in order to meet social care demands. They are forced increasingly to make very uncomfortable decisions—this goes across the political spectrum—to restrict the services that they can offer. We can only guess at the impact of that in the long run.
I shall not detain the Committee further by indulging in cheap cross-party banter. For once, I shall rise above it and beg to ask leave to withdraw the new clause.
Motion and clause, by leave, withdrawn.
That certain written evidence already reported to the House be appended to the proceedings of the Committee.—[Mr. Bradshaw.]
Question proposed, That the Chairman do report the Bill, as amended, to the House.
The Chairman: On behalf of myself, and Mr. Hood, I thank the Committee for their co-operation in the consideration of our proceedings. In particular, I thank the Clerks for ensuring that we considered the Bill in good order, the Official Report , and the Serjeant at Arms Department and the police officers for ensuring that our deliberations were kept in an orderly fashion.
Mr. O'Brien: On behalf of the official Opposition, I would like to take this opportunity to thank all those who participated in this Committee. Despite the fact that none of our amendments was adopted, for which we are sorry, we recognise that the Minister has undertaken not only to provide information—some of which he has already provided—but to think through some of the issues that we raised. We might genuinely expect to see that materialise on Report or at other later stages. As I said, although we are sorry that amendments have not been accepted and that we have been unable to secure the evidence that we are seeking on the provenance of the health in pregnancy grant, which is a serious point, we are confident that our deliberations will have helped to improve and clarify the Government’s intentions.
I pay tribute to the contributions of the hon. Members for Luton, North and for Tamworth, and obviously to the Liberal Democrat spokespersons. I also pay tribute to my hon. Friends the Members for Rugby and Kenilworth, for Tiverton and Honiton—she has much expertise—and for Preseli Pembrokeshire, who unfortunately has been detained on other parliamentary business. In particular I pay tribute to my co-Front Bench spokesperson, my hon. Friend the Member for Guildford for the way in which we have sought to hold the Government to account.
Before I pay tribute to you, Mr. Conway, and your co-Chairman, Mr. Hood, I would like to add my thanks to the Officers and the Official Report writers for their work during the consideration of this Bill. It may not be usual, but I want to pay tribute to my expert and very diligent researcher, Sam Barker, who has been very helpful to me during the course of these proceedings.
I conclude by thanking you, Mr. Conway, and your co-Chairman, Mr. Hood, for chairing these sittings in such a way that we have been able to efficiently dispatch matters almost to the minute.
4 pm
Sandra Gidley: Carrying on from where the hon. Member for Eddisbury left off, I would like to thank you, Mr. Conway, and your co-Chairman, Mr. Hood, for your light-touch chairmanship. We had slightly fractious moments this morning, but Mr. Hood dealt with them admirably and kept us on track so that we can all get home to our families this evening.
I would like to thank the Clerks for their great attention to detail and their support and advice, which was always forthcoming and well given. I would like to thank the Minister for being flexible at the beginning when we were trying to clarify what happens in evidence sessions. We appreciate that this is all still new and we have probably learned lessons from that. I think it is a shame that the Minister has resisted all amendments, but I take heart from the fact that he was sympathetic to some of them, so I hope that we might see some Government amendments on Report.
We have had some strange debates on occasion. We have heard about the Minister’s liking for organic coupling, which had us all wondering. The tenor of the debate has sometimes been characterised by a lack of hearing. We seem to have had some confusion over whether the Minister was regarding someone’s comments as iffy or sniffy. This morning, we had a slightly fractious moment when it was felt that an hon. Member had used the word “cheat” when in fact the word “cheap” had been used. I apologise if the bug that I have had has affected people’s hearing in some way, but it has provided some lighter moments to a Bill that has been quite hard going on occasions because of the amount of technical detail.
I finish by thanking the Hansard writers, the Officers of the House and the police officers—even when they get locked out.
Mr. Bradshaw: Thank you, Mr. Conway. I thank you and your co-Chairman, Mr. Hood, for your excellent chairing of this Committee. I would like to thank the Opposition for their careful and close scrutiny of the Bill. The Bill will emerge better from the scrutiny that it has received during the Committee process. I would like to thank the Whips, who have ensured that we were all here at the right times, my parliamentary private secretary and all other members of the Committee for the time and dedication that they have shown in both attending and contributing to our debates. I would also like to thank the Clerks, Committees attendants, Hansard, and the police. Last, but not least, I would like to thank my excellent officials who have served me and this Committee extremely well in helping to provide hon. Members with very timely information so that they have been able to debate issues rather than receiving details in letter form later. Although, some issues have had to be delivered in that form, my officials have done a really superb job of getting information to the Committee in a timely and efficient manner.
Question put and agreed to.
Bill, as amended, to be reported.
Committee rose at four minutes past Four o’clock.
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Prepared 25 January 2008