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National Health Service Reform and Health Care Professions Bill
8.33 p.m.
[Amendments Nos. 116 to 118 not moved.]
Earl Howe moved Amendment No. 119:
- Page 23, line 27, after "Authority," insert "an overview and scrutiny committee or joint committee within the meaning of sections 7 (functions of overview and scrutiny committees), 8 (joint overview and scrutiny committees etc) and 10 (application to the City of London) of the Health and Social Care Act 2001 (c. 15),"
The noble Earl said: In moving Amendment No. 119, I shall also speak to Amendments Nos. 120, 122 and 149.
As the Committee will know, I have criticised the Government's proposals for patient and public involvement on several grounds. Perhaps my most fundamental objection to the new arrangements that are to replace CHCs is their fragmented structure. If we are to minimise the effect of that fragmentation, we must ensure that the bodies tasked with different aspects of the watchdog remit perform the functions that they are supposed to perform and communicate properly with each other. As far as possible, in other words, the system should be joined-up.
The scrutiny function currently undertaken by CHCs is being transferred to the overview and scrutiny committees of the local authorities. The inspection function is to be transferred to patients forums. In another place, the Government helpfully accepted an amendment that gave patients forums the right to refer matters of concern to the overview and scrutiny committees. However, it is noticeable that, under the current wording of the Bill, the OSCs have no specific duty to act upon such referrals. There should be no constraints on OSCs in reaching their conclusions on matters referred to them, but they should have a duty to consider them.
Similarly, when an overview and scrutiny committee receives a report or a recommendation from a patients forum—perhaps following an inspection—there should be no loophole in the law that would give it an excuse to sit back and do nothing about it. It should be required to comment on the report or recommendation. My amendment would confer that duty on OSCs.
The flow of information should be in two directions. In setting about its work, an overview and scrutiny committee may have access to all kinds of relevant information at local authority level that could usefully inform the work of the patients forum. For example, there may be relevant information about the costs or other aspects of private sector contracts or partnership arrangements. My amendment would ensure that the regulations allow for the provision of information by an overview and scrutiny committee to a patients forum. I beg to move.
Lord Clement-Jones: I shall speak to Amendment No. 149, which deals with the question of the duty of overview and scrutiny committees to carry out the scrutiny function. I shall be brief, for we have discussed this already.
We believe that it is a flaw in the original Health and Social Care Act 2001 that there is no duty to carry out scrutiny functions. The Act is simply permissive. Paragraph 1 of Schedule 7 to the National Health Service Act 1977 puts each community health council under a duty to,
- "represent the interests in the health service of the public in its district; and
- (b) to perform such other functions as may be conferred on it".
- "keep under review the operation of the health service in its district, to make recommendations for the improvement of that service and to advise any health authority upon such matters relating to the operation of the health service within its district as the Council thinks fit".
Lord Filkin: The introduction of overview and scrutiny by local government, under the Local Government Act 2000, gives people a genuine say in their local services. In the case of health, that will, for the first time, make the NHS answerable for its performance to locally elected councillors and to the local community, through the local authority. That will go a considerable way towards ending the democratic deficit that has long been recognised as an issue for the NHS. It is relevant to the discussion of the amendments to say how warmly that has been welcomed by local authorities and by local government collectively, through the LGA. It has long been argued for, and the best local authorities have tried to perform elements of it, without a particularly affirmed role. The Government are confident that there will be a positive response, albeit that such things take time to bed in.
A key principle for the Government is the right of the public to expect its concerns over major changes to health services to be expressed through a form of scrutiny process. Local NHS bodies must consult their local authority overview and scrutiny committees on substantial developments of the health service in the council area, as well as on any proposals to make substantial variations to the provision of such services. This in itself is a very major change in terms of recognising the duty to consult and involve. Overview and scrutiny provides a way of ensuring that needs have been properly identified and that services delivered by local partners do promote the well-being of the local communities they are designed to serve.
However, we do not think it necessary to place a duty on local government to scrutinise the NHS with quite the formality that has been suggested. We think it appropriate for local government, in the context of its responsibilities for the well-being of local
populations, to take into account the health services of those people, which of course is why the power was given under the Local Government Act 2000 to promote the overall well-being of local communities. Again, that was very strongly welcomed by local authorities and government when it was introduced.Locally elected representatives should make their own decisions about what scrutiny activity takes place. One cannot believe in local authorities as the representatives of their communities in the diverse circumstances in which they find themselves and then not give them the freedom to make judgments about what areas of health service performance strike them as being of priority for scrutiny at any particular point in time. For that reason, we have provided the power for them to scrutinise the NHS as they deem appropriate.
We have placed duties on the NHS to provide information and to consult with OSCs. Thus the Government have affirmed the importance of the role of the OSCs by those very measures. We shall also set out in regulations the arrangements by which NHS staff will be required to attend OSC meetings. To add further to these arrangements by compelling OSCs to undertake their scrutiny functions would, we believe, be going too far. These decisions are best made by councillors elected by local people.
Concerns have been expressed that some local authorities might not be very serious about these functions. On the one hand, one recognises that all local authorities will go through a period of development and learning, which is why the Government, the LGA and others are serious to see that support and development is given in the shaping of these new roles. I find it inconceivable that the social services authorities, which are the relevant authorities for overview and scrutiny over health matters, would not have very strong areas of concern and interest. Therefore they will treat their overview and scrutiny functions very seriously indeed. One would expect these functions to be high up the list of issues, commanding considerable interest in a local authority. In the remote circumstances that one authority might be slower off the mark than others, I should have thought that it would be castigated by its public for such a gross failure to act as its voice and advocate on health matters.
Amendment No. 119 seeks to give patients forums powers to require information from local authority overview and scrutiny committees. We think this degree of power is too wide and inappropriate. We certainly wish to encourage good communication links between forums and OSCs; indeed, we have already amended the Bill to give forums the power of referral to OSCs.
I would suggest that Amendment No. 120 flies in the face of giving the power to scrutinise the NHS to an independent body. We have always said that local government must take a view on what action to take in respect of its responsibilities for the well-being of local people. It is in this context that decisions and actions taken by OSCs should be governed. Requiring them to
respond to and act upon referrals from patients forums is out of kilter with our whole approach, in that OSCs are not the servants of them. If a local authority OSC believes that a response or action is appropriate, then it is free to do so. Compelling an independent body from the centre is not appropriate.However, we hope and expect overview and scrutiny committees and patients forums increasingly to recognise their overlapping areas of interest. They will have differing functions, but clearly they could provide strong mutual support for one another. The thrust of government advice and implementation will be very strongly to promote that kind of joint co-operation, which the noble Earl, Lord Howe, has quite rightly advocated, underpinning the purpose of his proposed amendment.
In the light of the very strong support expressed by local government for powers of overview and scrutiny over the health service, I do not think that there is a need to go so far as to place a specific duty here, because we have considerable confidence that, over a period of years, this will develop into a powerful and important new way of contributing to improvements in the health service and reflecting the interests of local people in health service provision in their area.
8.45 p.m.
Lord Clement-Jones: I am not an expert in local government matters. Before he sits down, can the Minister explain what consideration has been given to providing resources for local authorities to enable them to carry out their overview and scrutiny role?
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