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Lord Skelmersdale: If that is the case, why does not the Bill say so?
Lord Hunt of Kings Heath: We have certainly made it clear in guidance that this is what we intend to see happen. However, I am not sure that one would necessarily want to constrain on the face of the Bill for all time the necessary administrative arrangements in relation to the publication of plans. The intention, though, is quite clear.
10 p.m.
Baroness Sharp of Guildford: I thank the Minister for his reply. I am not totally satisfied with it because it seems to me that the sense of ownership that I spoke of is an important issue. However, in the light of his reply, for the moment I shall withdraw the amendment and reconsider the issue at a later stage. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Baroness Sharp of Guildford moved Amendment No. 138:
The noble Baroness said: In moving Amendment No. 138, I wish to speak also to Amendments Nos. 140 to 144, 146 and 147. This series of amendments all relate to issues of who shall be consulted by health authorities when they draw up local health improvement plans. We believe that the wording of the Bill as it stands is too vague. The purpose of these amendments is to flesh out consultation arrangements and to ensure that the process is broad and that there are statutory requirements to include certain organisations or kinds of organisations within the process of consultation.
Our main concern in framing these amendments is to ensure that the consultations over the health improvement plans are thorough, inclusive and effective. We reject the approach of Amendment No. 141 in the name of the noble Earl, Lord Howe, because we believe that it is too prescriptive. We do not think that lists of this kind are the right way to handle this issue. Nor do we see why central organisations such as the BMA or the RCN should be included in this process at the local level. There must be some local flexibility. We therefore believe that the right approach is to list--as we have done in Amendment No. 143--the kinds of organisations that should be included.
As is clear, Amendment No. 143 is supported by the noble Lord, Lord Rix, who is unable to be here today. He has asked me to read out his contribution to this debate. The noble Lord wishes to bring a quick example to the Committee's attention to highlight the importance of delivery of public health initiatives to people with learning disabilities. Some of the inequalities in access to healthcare are quite startling. Research by Mencap reveals, for example, that cervical smear testing in women with learning disabilities is as low as 3 per cent. for those living with their families compared with the UK average of 85 per cent. This is clearly unacceptable. We must ensure that groups of and for people with learning disabilities are well represented in the formulation of local health plans of this kind. I beg to move.
Earl Howe: I am all too well aware that Amendments Nos. 141 and 144 tabled in my name fall foul of the Skelmersdale injunction against shopping lists, and I accept the criticism. However, I believe they serve a useful purpose. This is not just a ritualised exercise in listing. What it is designed to emphasise--as has been said already--is that consultation has to be wide and inclusive, and that health improvement programmes cannot just be imposed. There needs to be a sense of ownership on the part of all those directly involved. That comprises a great many groups of people.
Amendment No. 144 specifically refers to universities and schools for medicine and nursing or professions allied to medicine. It does so because one needs to remember how important those are to the functioning of the health service as we know it. If I were to single out one group for special mention, it would be the voluntary organisations because so often it is those groups who represent users and carers who can identify needs and gaps in the current provision, particularly as they affect minority groups or those who may find it difficult to access mainstream services. During the first round of health improvement programmes it has not always been easy for voluntary organisations to contribute as ideally they would wish to do. That is why I believe it is particularly important that their voice should be heard during the process of consultation.
The Explanatory Notes to the Bill make it clear that the process is intended to engage voluntary bodies. The Secretary of State's direction-making powers in Clause 21(5)(a) and Clause 21(6) could be used to ensure that such bodies are involved. But there is a gap here. What mechanisms will there be to ensure that the
Lord Walton of Detchant: I would not wish to anticipate whether the noble Lord the Minister or the noble Baroness the Minister--in tonight's double act--will respond to these amendments. Having said that, I am sure that I can anticipate their response. They will say that these amendments are unnecessarily detailed and prescriptive. The point that has been made by the noble Earl about the involvement of the universities is absolutely crucial. The universities are now playing an increasingly important role, not only in the training of doctors and dentists, but in the training of nurses, physiotherapists, occupational therapists and many other health care professionals, including speech and language therapists. Scientists too are playing an increasingly important role in the NHS as are the medical laboratory technologists and many more.
I know that, at an earlier stage of the Committee's proceedings, the Minister gave us a number of assurances about the involvement of and consultation with the universities. But in some way the important role that they play, like the important role of the voluntary organisations to which the noble Earl has referred, must be acknowledged in the proceedings on the Bill.
Lord Harris of Haringey: Amendment No. 140 stands in my name. It highlights the importance of involving not only community health councils but groups representative of patients and groups representative of carers. One of my concerns is that while the health improvement programme process will be an extremely important one, there is a danger that it will be dominated by institutional structures and by the various statutory agencies. Bringing them together and getting them to talk to each other about these matters is a considerable step forward and of benefit to the local community. It is important that measures are taken which, on the face of the Bill, ensure that there is an expectation that user groups, carers groups and the local community health councils are involved in the process of drawing up health improvement programmes.
It is also worth recognising that if these programmes and plans are to mean anything they will lead to resources being shifted from one area to another between priorities. Locally, this might be very controversial, and the achievement of long-term national and local priorities--particularly in the reduction of health inequalities--may mean that established services have to be reconfigured or cut if further resources are not identified. For that reason it is particularly important that the groups set out in my amendment are fully involved and that there is a clear expectation set out on the face of the Bill that they will be involved in order to ensure that there is public support and consent for the changes which will come forward through this process.
Lord Rowallan: I, too, rise to support the amendment of the noble Baroness, Lady Sharp of Guildford. It is
Lord Hunt of Kings Heath: As the noble Earl said in speaking to his amendment, we have returned to the subject of lists and the "shopping list" phenomenon described so eloquently on the first day of our deliberations in Committee. Many of the lists that are before us reflect the dangers that we have already discussed. There are very few proposals on which I take issue in principle. Indeed, some of the amendments, in particular Amendment No. 143 tabled by the noble Lords, Lord Clement-Jones and Lord Rix, bear a striking resemblance to aspects of the guidance that the department has already issued on this subject. Indeed, if one were to be drawn further into the list business, one might say that important groups of NHS staff still appear to be missing from the amendments as tabled. While the noble Lord, Lord Clement-Jones, has done justice to the dentists, pharmacists might have good cause to feel hard done by, as none of the detailed definitions appears to cover them.
Turning to general principles, this debate has brought out the importance that we all attach to seeing health improvement programmes developed and implemented through arrangements that are truly inclusive. That is entirely what the Government want to achieve. The existing guidance points out to the wide range of local stakeholders that we wish to see all staff engaged, not merely professional representative bodies: voluntary groups, users, carers, the wider local community and other partners such as universities, local schools, employers and others. We could not have been clearer in the message that we have given to the National Health Service.
We have also made it clear that we are looking for full involvement, not the traditional type of NHS consultation, which I have known and loved for so many years; namely, brief consultation on a plan that is all but finalised. We wish to see active participation right through the process of assessing local needs, identifying the best way to respond to national and local priorities and developing firm plans for action. I am convinced that that will mean new ways of working. Through health action zones and other means we are already encouraging innovative approaches to partner and community involvement. And we are supporting health authorities and others in developing the skills that they need to acquire in order to achieve that. Many local authorities have valid experience in community involvement which we hope that they will bring to the table of discussions and joint working between the health service and local government.
The amendment proposed by the noble Earl, Lord Howe, draws particular attention to the importance of ensuring proper links to the universities and to the wide arrangements for the education and training of those
It is our intention that those links should be strong. Indeed, I do not believe that the NHS could hope to be successful in the future unless it had very strong links with universities and institutes of higher education, to which we look for so much support, collaboration and co-operation.
Equally, it is critical that the service needs identified by the health improvement programmes feed into the planning of education and training programmes, so that staff numbers and skills match local needs. We want the process of achieving partner involvement to be transparent. That is why we have already asked for health improvement programmes to record not merely those who have been involved in their development but how they have been involved and what plans there are to build on that in the future.
We recognise that developing strong partnerships may take time. We have asked that the first improvement programmes include an honest account of what has been possible for this first round, and where more remains to be done. We shall monitor progress on this matter very closely.
The subject of learning disabilities was raised, which I am sure would have been raised by the noble Lord, Lord Rix, had he been able to be present. We have asked health authorities to take particular care to involve groups who have tended to be under-represented. We fully recognise that learning-disabled people have often fallen into that category. As I have previously explained, with the opportunities of a three-year rolling programme and a new approach to involvement, we very much hope that we have the process with which to be able to achieve that.
I hope I have made clear the Government's commitment on this front. I would add that, over and above the general concerns that have emerged about lists of organisations, I have some particular concerns in this instance. I believe that there is a real risk of highlighting some local players rather than others, while an attempt to be comprehensive seems doomed to failure. Equally, we do not want to see health authorities checking exhaustively that they have made contact with every player on a national list in a "tick-the-box" mode. I believe that that has been the traditional experience of NHS consultation, which has not worked very effectively in the past. I believe that our effort is injecting into the NHS a new spirit of real participation with the kind of organisation and players that Members have mentioned tonight. We want to see them grasp the spirit of inclusiveness and work out imaginatively who needs to be engaged, and how they can be engaged, in different elements of the process. For example, local businesses and employers may be key players on some local issues but have much less reason for involvement in others. Different community and voluntary groups, and different users and carers, will have their own special interests. This is precisely the kind of detail that
Clause 21(5) enables the Secretary of State to issue directions should there be difficulty in securing proper involvement either nationally or locally. I believe that the arrangements I have described mean that we shall be able to monitor progress and act if need be. That is why the power is there.
I hope that the assurances I have been able to offer and the safeguards available will meet the concerns that have prompted these amendments.
Page 16, line 10, at end insert--
("( ) Health Authorities shall before drawing up any plan under this section consult relevant voluntary and community organisations, including in particular organisations representing carers.").
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