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Earl Howe: Perhaps I could just ask a question on the funding of the commission. So far as I know, there has been no indication from the Government thus far about the amount of funding available for the new structures. However, strong hints have been dropped within the Department of Health that the commission will be expected to subsist on even fewer staff than CHCs have nationally. If that is so, given that the commission is to have even more responsibilities than CHCs and that CHCs are already under-resourced, we may find ourselves looking at a system that is completely unable to function as currently envisaged.
It would be very helpful if the Minister could give the Committee at least some indication of the funding and staffing levels that he expects the commission to have. For example, given that the commission's role involves supporting patients forums as well as much else, will there be at least the equivalent of one full-time member of staff per patients forum? Has the Government's thinking advanced to that sort of level?
Lord Hunt of Kings Heath: I am not in a position to respond in the detail that the noble Earl would like. These matters are still being discussed within the department, and of course we are subject to the normal processes of future budgeting. As for the resources
likely to be spent as a result of all the changes that are being made, as I said, I have absolutely no doubt that we shall be spending more resources and that there will be greater public and patient involvement in bodies such as the commission, the forums, the independent advocacy service, the patient advocacy and liaison services and even in local authority overview and scrutiny committees. There will undoubtedly be more resources and more people.Although I cannot give more detail than that, I tell the noble Earl that we shall fund the commission as appropriate to perform its important functions. The commission has an important role to play in helping patients forums to be as effective as possible, and we shall have to ensure that it has the funds it needs to play that role effectively.
Lord Clement-Jones: I thank the Minister for that coda. However, considering how long these proposals have been on the table and the length of the consultation, it is very disappointing that all he can say is that more resources will be available than there are now. That is not particularly reassuring and it does not provide any specifics on the precise nature of the resources. As resources are a pretty important part of the effectiveness of the arrangements, I should have thought that that subject would be uppermost in Ministers' minds. It is regrettable that we must consider the legislation in such circumstances.
We are getting better at rolling our tongues round the phrase "executive non-departmental public body". I am grateful to the Minister for telling us how many such bodies so far are accountable to the Secretary of State. Nevertheless, the Minister's speech amounted to saying, "Those are the constitutional arrangements, and the Secretary of State must have that control because he is accountable for these non-departmental public bodies". That is a very circular argument. There is absolutely no earthly reason why the commission should not be accountable to a Select Committee of the House of Commons or of this place, or indeed to a Joint Committee. The commission does not have to be accountable, ipso facto, to the Secretary of State.
If the Minister wishes to have fewer sleepless nights and worry less about the finances of all these executive non-departmental public bodies, it would do him a power of good to think laterally and perhaps about how these bodies can be made accountable to a Select Committee. That would be a healthy development.
I therefore do not buy into the Minister's constitutional argument, although it was quite novel and I congratulate him on his creativity in coming up with that constitutional view. Nevertheless, centralising power is not a constitutional necessity. It is perfectly possible to decentralise and to do so in a genuine way. I believe that the Government are looking down the wrong end of the telescope with this commission. They have got it completely the wrong way round. It should be a commission that relies from the bottom up on the strength of the community, patients and public on the ground, not on the Secretary
of State's fears. My amendments and those of the noble Earl, Lord Howe, all go in the same direction, which is trying to achieve a from the bottom up aspect.I have no doubt that we shall be discussing these matters further, and I am sure that the Minister is in no doubt about the tenor of our remarks and the direction in which we want to go. In the meantime, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
9.30 p.m.
[Amendments Nos. 138 and 139 not moved.]
[Amendment No. 140 had been withdrawn from the Marshalled List.]
[Amendment No. 141 not moved.]
Lord Harris of Haringey moved Amendment No. 141A:
- Page 86, line 15, at end insert—
The noble Lord said: This is a specific but important point which relates to the way in which the work programmes of the staff who will be employed by the commission and who will support patients forums will be drawn up. I understand that there will be a diaspora of staff working for the commission. Understandably they will have a presence in each primary care trust area and they will relate to the patients forums and other organisations in those areas.
The purpose of the amendment is to ensure that those staff at least carry out a work programme that has been approved, agreed or developed in consultation with the patients forums with which they will be working directly. Otherwise there is a danger that their work programme will be entirely set by the main commission and centrally driven, which is clearly not the Government's intention, which is about giving the patients forums the sort of freedom and facility to influence the local health services that they desire.
The amendment would ensure that those work programmes are developed in consultation with the line management arrangements, the national commission and the patients forums involving lay representatives at local level.
No doubt my noble friend will tell us that that is the intention, but it would be helpful if it were contained in the Bill, because my experience shows that over time, as the original intention diminishes into the past and new arrangements are spelt out, the commission may well take a much more directive view than was initially the case. That might then lead to a situation in which patients forums were not being provided with the support of staff whose work programmes they had some control over.
The amendment is saying not that all the work programmes of the staff will be directed by patients forums, but that they will be developed by the commission and the relevant patients' forums together.
Lord Hunt of Kings Heath: I am grateful to my noble friend. He has raised an important issue. While I do not wish to recommend accepting the amendment tonight, I reassure the Committee that we wish to see a strong partnership between the local forums and the national commission, not the dominance of the local forums by the national commission, which is the fear expressed by my noble friend.
There is no doubt that a very important aspect of the commission's work is to support the work of forums. The support that commission staff give will clearly depend on the individual nature of each forum. For that reason, the forum-related work undertaken by the staff of the commission must be determined by a partnership arrangement between both parties.
We have already said that we shall make regulations about the relationship of the forums with the commission on this point in particular. I do not think that it is appropriate to specify in the Bill the exact nature of the working relationship between the forums and the commission as inevitably it will be a movable feast. We recognise that in the early days of forums there will have to be a different degree of support from the commission as compared with the forums as mature organisations.
I stress two key points. First, we must remember that the commission is the employer of the staff. In that capacity it will have overall responsibility for the work of the staff and be accountable for their performance. Secondly, an important part of the assessment of the staff's performance will be the views of patients forums. The commission's staff will have to show that they performed their role of supporting forums effectively as part of the way in which individual staff will be performance managed. That is one of the ways by which the commission will be accountable to local people; that is, through the work of local forums.
The relationship between forums, staff and the commission is important. But the staff of the commission will also be working with many other bodies and on other issues. While the work of the commission staff will be determined to some extent by the support needs of forums, that will be only one factor that will enable it to set its work programme. It will also take account of other issues that are important to local people that it may get to hear about through OSCs, for example, or through its work with local community groups.
I hope my noble friend will accept therefore that, while I do not go down the route of Amendment No. 141A, I accept that it will be essential to have a close partnership between the commission and local forums where it is quite clear what the role of the staff will be and that there is an appropriate performance management regime in place. A key element of that will be the way in which the commission staff support
"( ) Employees appointed under sub-paragraph (4) who provide support to a Patients' Forum or Patients' Forums established under section 15(1) in accordance with regulations made under section 18(2)(h), shall have work programmes agreed by the relevant Patients' Forum or Patients' Forums and by the Commission."
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