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Lord Filkin: It will come as no surprise to the noble Lord that such matters form part of the Budget considerations and will form part of the considerations for the Comprehensive Spending Review itself. Whenever it imposes a new duty on local government, the DTLR is under an obligation to make an assessment of the resource impact of that duty. Therefore, from April this year it will form a part of the SSA settlement made to local authorities. In the future, these will be matters considered by the Comprehensive Spending Review.
Baroness Carnegy of Lour: If the Government do not know whether a local authority is going to do this and, if it does, to what extent it will undertake the new role, how will they know what resources to make available?
Lord Filkin: There are traditional negotiations and discussions between the finance specialists at the Local Government Association and the finance specialists in the DTLR. Without going into excessive detail, between them they attempt to estimate what will be the cost burden of such new functions.
We should recognise that, in these matters, local authorities are free to set their own priorities as regards where they put the burden of their expenditure. Thus
there are traditional expenditure negotiation routes between the LGA and the DTLR to make such assessments.
Lord Clement-Jones: Perhaps I may ask a further question. Is there any intention to gather information about the resources devoted by local authorities to the functions of overview and scrutiny? The argument that is current, with which I agree, is that the full vigour may not be applied by every local authority to the role of overview and scrutiny, which will be reflected in the resources the authority devotes to it. However, I think it is important for information about the resources devoted to the role to be made available in future financial years.
Lord Filkin: Speaking as one who knows and loves local government very well, I can guarantee that authorities will say that they do not have sufficient resources. It would be a strange world if they did not do so. More seriously, however, I am pretty confident that the DTLR has under way two research studies on the operation of overview and scrutiny committees, given that this is such a substantial and important new development for local government. I can do no more than say that we shall draw to their attention the interest there might be in monitoring the resource impact as a part of those studies, if the terms of reference of those studies make that possible.
Earl Howe: I am most grateful to the Minister for his full reply. I was pleased to hear him confirm that the Government are fully in favour of promoting joint co-operation between patients forums and overview and scrutiny committees. I agree that the system being set up in relation to OSCs has the potential to perform a useful function, but the question I ask is why, for the past 20-odd years, it has been appropriate to give local communities a guarantee that their health services would be scrutinised, but now that is no longer appropriate. I do not know what has made that unnecessary.
As I said earlier, I want to see the new system working well, because as the Bill is drafted, at least on the face of it the proposals will give us a less robust system than we have at the moment. There is no guarantee that overview and scrutiny committees will scrutinise health issues and no redress if they do not do so. One can imagine all kinds of things interfering with the best intentions. Priorities always have to be set and agreed at local government level and party politics play a part. One can envisage the system perhaps not working as smoothly as the Minister has made out. On the basis of what he has said, we can only hope that the intentions will be borne out.
Lord Filkin: It may help if I give some illustrations of the range of areas of interest between local government and the health of communities which make it almost inconceivable that overview and scrutiny would not be treated seriously, albeit it in different ways in different areas and treating certain issues more frequently.
Overview and scrutiny committees will not duplicate what the patients forums will do. It would be surprising if they spent large amounts of time looking at whether emergency care functions in A&E were working well in a local hospital. Clearly the patient forum is much better placed to do that. On the other hand, one would expect that they would look at issues affecting public health—for instance, smoking cessation campaigns, promotion of positive health, the impact of transport facilities on health and the impact of a range of other issues such as housing conditions, housing and insulation on health. They would look across the piece at how, for example, disabled people may be being treated in the community and how that interconnected with health.
They will help the health service not simply by looking again at a particular function of the NHS—which the patients forums may do—but by looking thematically or from the point of view of a particular interest, a particular group of people or a particular service with which they themselves are concerned, by seeing the interconnection with the health service and by recognising the need to strengthen those interconnections more effectively for the public.
There are myriad connections and interests. The committees will not carry out these functions in the same way but it is most unlikely that they will not see them as important functions.
Earl Howe: I thank the Minister for that additional clarification. It was very helpful in fleshing out our understanding of what the overview and scrutiny committees will do. I shall read carefully what the Minister said between now and Report stage. For the time being, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendments Nos. 120 to 126 not moved.]
[Amendment No. 127 had been withdrawn from the Marshalled List.]
Clause 19 [The Commission for Patient and Public Involvement in Health]:
Lord Clement-Jones moved Amendment No. 128:
- Page 24, line 21, after "Commission" insert "shall represent the interests in the health service of patients and the wider community and"
The noble Lord said: Amendment No. 128 and the associated amendments seek to ensure that the new proposed Commission for Patient and Public Involvement in Health is not limited in its functions.
There are enough experts and noble Lords with a local government background in the Committee today to know that statutory bodies are able to carry out only activities and functions conferred on them by statute, otherwise they would be acting ultra vires. They are powerless to extend their own remit. Any act they perform which is outside the limits placed on them in legislation will be subject to legal challenge.
At present, community health councils and the Association of Community Health Councils are able to carry out a wide variety of activities because the enabling statute provides that each CHC is to,
- "represent the interests in the health service of the public in its district and . . . to perform such other functions as may be conferred on it by virtue of paragraph 2 below".
- "advise Councils with respect to the performance of their functions, and to assist councils in the performance of their functions; and . . . to perform such other functions as may be prescribed".
Through being charged with advising and assisting CHCs, ACHCEW is thus able to benefit from the wide remit afforded to CHCs. If Clause 19 remains unamended, the commission, for example, will be unable to carry out many of ACHCEW's current functions. These include research and policy work; conducting casualty watch type exercises; running or engaging in national campaigns or making donations to those campaigns; campaigning about national changes of policy affecting the health service; commenting on guidance issued by bodies such as the GMC beyond those concerns which may fall within the remit of Clause 19(6); and taking legal proceedings. Activities such as these would be ultra vires.
To some extent, this is the converse of the previous amendment relating to the powers of patients forums at local level. It applies in equal measure in terms of the national scene and the commission's powers at national level. If the Government are genuine in their desire to empower patients and the public, they need to expand the commission's remit.
It would be useful at this stage—there will not be many opportunities to do so—if the Minister could indicate the kind of funding that may be available for the commission in carrying out its powers. Whatever view the Minister has about the width of those powers, we believe that there is a danger that the commission will be under-resourced and not have an adequate staffing level. As the efficacy of patients forums will rely heavily on the staffing provided by the commission, that would be extremely dangerous. It would mean that the new system will not work in anything like the way that the Government hope that it will.
Amendments Nos. 133 and 135 are ancillary amendments which follow Amendment No. 128. I beg to move.
Lord Harris of Haringey: The creation of the Commission for Patient and Public Involvement in Health is a critical change in the Government's proposals and is of extreme importance. I have some sympathy with the amendment moved by the noble Lord, Lord Clement-Jones, but I am slightly confused about the way in which it is worded. It seems to me that subsection (2)(g) almost achieves what he seeks to put into the preamble about the commission's functions.
The only difference is that subsection 2(g) refers to the views of members of the public whereas his amendment refers to the interests of the public.That is an important and critical distinction. I should like to see a situation whereby the commission was able to present its own judgment on the interests of the public and, at the same time, have an obligation to present the views of the public. I am not sure whether the noble Lord has worded his amendment deliberately or whether it is an accident of drafting.
9 p.m.
Lord Hunt of Kings Heath: This brings us to the very important role of the Commission for Patient and Public Involvement in Health. As my noble friend Lord Harris suggested, it is an important part of the whole package of measures designed to improve public and patient involvement. They build on the Health and Social Care Act 2001 and I pay tribute to the noble Lord for his original work in relation to a national body.
It was apparent during the passage of the original Bill that a national body with a remit for overseeing the delivery of the Government's proposals was a missing link from the proposals. The commission will have an important role to play in future as an independent body that operates at arm's length from the department. It will have roles nationally and locally across the country.
In earlier debates my noble friend Lord Harris urged a national body to play a role in encouraging a high standard of performance in relation to local patient involvement bodies. Crucially, the commission will set standards for patients forums and providers of independent complaints advocacy. It will also report to the Government on the implementation of the new structures. The commission will have the explicit role of working in communities to ensure that local people have a say in decisions that affect their health and the health services. It will do that by promoting local consultation exercises—advertising them where they might not normally be advertised; helping people to get involved; giving people the necessary skills and confidence to contribute by organising training courses; and suggesting different ways for them to contribute.
The commission will also have a key role in developing and promoting innovative ways of getting people involved—especially segments of the population who traditionally might not become involved, such as people from ethnic minority groups, older people, people with disabilities and homeless people.
Amendment No. 128 would add the new function to the commission of representing the interests of patients and the wider community. We discussed that particular form of wording in relation to patients forums. The arguments that I used then apply equally to the commission. I do not believe that it is appropriate for an appointed body to be given such an all-embracing power, which should lie with Parliament. The noble Lord suggests too wide a
function for the commission to undertake. It is being established specifically to empower patients and the public, not to speak on behalf of the entire population. The commission's work of empowering the voices of local people will allow real changes to be made.Amendment No. 133 would add a function to provide staff, facilities and services to patients forums. The Bill already makes it clear in Clause 19(2)(d) that the commission will support the work of patients forums. By that we specifically mean that the commission's staff will provide information, briefing, administrative support and help to plan activities. More important is the commission's role in developing the capacity of forums to play their role. I re-emphasise the running of training places; developing the skills and competence of forum members; and devising effective work programmes.
The noble Lord asked about resources. He is premature in terms of receiving a direct response but clearly there would be little point in establishing such a commission if it were not effectively resourced to meet the serious responsibilities being laid upon it.
Amendment No. 135 provides for the commission to exercise its functions by reference to overview and scrutiny committee areas instead of primary care trust areas. There is an argument both ways but the Government's preference for PCTs in the Bill makes clear our commitment to the commission working at local community level. The PCT level is the right one, although of course the commission will feed into OSCs, as the reporting arrangements in the Bill make explicit.
The Bill's reference to primary care trusts spells out the intention that the commission will get into local communities and promote patient and public involvement at the level where front-line services are decided and funded. I well understand why the noble Lord wants to make a link at OSC level but, given the particular responsibilities of PCTs and that they are the principal public health authority, there is a persuasive argument for the commission paying particular attention to the PCT level.
We understand that there are other important connections and that informing the scrutiny process is critical. We have taken account of that in the commission's reporting arrangements. The connection to the performance management of local NHS organisations is also critical, so we have ensured that the commission reports to the strategic health authorities.
I do not apologise for saying that shifting the balance to PCTs and the areas that they cover is important in relation to public and patient care involvement—as to many of the other decentralisation measures, which is a theme running through the Bill.
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