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
HealthWatch
‘(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.
The first issue I have is that
it does not come with any costings. That has an effect. We have real
issues about increasing the burden on local authorities at the very
time when their finances are under increasing and continuing pressure,
particularly in the area of social
care. The hon. Lady and I have regularly had quite serious disputes,
both in Westminster Hall and at other times because of her confession
that the free personal care promise made by her party, first in
Scotland and then as part of their last national election campaign, was
a lie. That was something she agreed and confirmed on the Floor of the
House, and I have been regularly reassured that it is in order to use
the word. 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.
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.
Ordered,
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.
| 
