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When the right-to-buy policy came in in 1979, it was very popular, not least because those who already had the largesse of a tenancy from a local authority had the additional bonus, if they sold the property¬ł of receiving large cash sums. In Edmonton, where I was Member of Parliament, we found over the years that properties that were bought for £7,000 or £8,000 were changing hands for over £100,000 in a very short space of time. The greatest boon that the Government can give, through agencies and directly, is tenancies to those who are desperate for a house. That ought not to include a hidden bonus that, at some time in the future, they will be able to sell it and get hundreds of thousands of pounds. Is the Minister aware of that aggravation and can she say something about readjustments to the present policy? It was a bribe then and it is a bribe now.

Baroness Andrews: My Lords, I shall have to disappoint my noble friend. For very good reasons, we remain committed to home ownership as an aspiration. We have supported the principle of the right to buy, although, over the years, we have changed the conditions. We do not have any plans for changing the terms of the right-to-buy policy, but I know that he will be very pleased by our commitment to new affordable housing: at least 70,000 by 2010; 45,000 new homes each year, or 50 per cent more than this year; and £8 billion over three years. It is a very significant investment, which will help the kind of people about whom he has always been concerned throughout his long political career.

Lord Low of Dalston: My Lords, I welcome the Statement and the Minister’s subsequent remarks about the importance of quality in building and of building for communities, not just housing for its own sake. Does she agree that in the dash for housing it is important not to neglect quality and to remember the importance of the human scale of development? From what she has said, I am sure that she does agree with that, but I invite her to recognise that, if we are to live up to the aspirations of which she has spoken in the Green Paper, a change of policy will be required in certain areas. I am certainly aware of proposed developments in the area of London in which I live where those principles will not be adhered to unless we see a change of heart among those who sponsor them.

I know from travelling around the world, as I do, that it is possible to build high-rise buildings on a substantial scale and yet imaginatively, in a way that is congenial for communities to live in. I have just been to New York where there are in busy streets wonderful refuges of small open spaces with water features and so forth, which make living in those areas a delight, compared with some of the developments of which I have spoken and which are proposed. I

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invite the Minister to recognise that if we proceed with faceless tower-block buildings, we are likely to have the sort of problems that have been experienced in the Paris banlieues on our hands in a generation to come.

Baroness Andrews: My Lords, I could not agree more with the noble Lord. As we said in the Green Paper, we have to ensure that we are as conscious of quality as we are of quantity. We shall certainly expand our partnership with CABE, which we have had over many years, and which has been invaluable in terms of articulating what we think of as good design and quality. I am sure that that will be very successful. The noble Lord is absolutely right about small open spaces. In recent years, one achievement has been the renaissance of our parks. In building new communities, whether in airfield sites or eco-towns, we will have a wonderful opportunity to pioneer new ways of living and new types of community living. I hope that in due course Scandinavians may come here, rather than us going to Scandinavia, to see what can be achieved on sustainability and beauty.

Local Government and Public Involvement in Health Bill

5.55 pm

House again in Committee on Clause 222.

Earl Howe moved Amendment No. 238KC:

The noble Earl said: I shall speak also to Amendments Nos. 238KDA, 238KF, 238KH, 238L and 238LE. One thing that makes people like me suspicious about what is to emerge from the Bill is the phraseology of Clause 222(2). To put it at its simplest, the activities that are described in the subsection are all about process; they are not about outcomes. That pertinent point was raised earlier by the noble Baroness, Lady Neuberger. It is as if all that matters is that someone observes the carrying on of health and social care commissioning and provision and obtains people’s views. What is the point of that activity? The point is to improve the quality of local services. Why do we not say that that is what LINks are there to do? Equally, why do we not say, in terms, that it is not enough for the contract with the host to specify that the activities mentioned are carried on; the contract needs to have as its aim that those activities should be undertaken effectively.

There is a very sterile and neutral feel about the wording in this part of the clause. Surprisingly, there is not even any mention of one of the main aims of patient and public involvement, which is to try to promote the interests of those people in the community whose voice is less often heard, or who, for one reason or another, are the victims of health inequalities. A good LINk will tackle social exclusion head-on and try to remedy it.

Perhaps I can illustrate that idea briefly. The Minister will be well aware that life expectancy varies depending on the area of the country where one lives, Manchester being the worst area for both men and women. If those with the shortest life expectancy do not have

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equal influence on services, the potential of those services to deal with these issues will be lost. A good example might be stop-smoking services, which need to be offered at the times of day and in the locations when those of working age in manual groups, which have higher rates of smoking, may access them easily. If they are involved in the design of services, those kinds of issues could be raised. Similarly, smoking in pregnancy is more than four times higher in social class 5 than in social class 1. The involvement of women from deprived areas in designing antenatal services could improve the success of those services. We know that the rate of perinatal mortality is twice as high among mothers living in the most deprived areas. It is essential for these groups to be involved in services so that they are designed effectively. There are any number of other examples, not least—it is fresh in my mind—the need to involve black and ethnic-minority patients in the design of psychiatric services.

6 pm

I hope the Minister will accept that that is a real issue. If LINks are able to make reports and recommendations to those with the appropriate power to change things in the health service or social care, then there should not be an artificial restriction on to whom they can report. The wording does not make it entirely clear and I would be grateful if the Minister could confirm that the persons responsible for commissioning, providing, managing or scrutinising local care services could include, for example, the Healthcare Commission and CSCI.

What are we to understand by the definition of “care services” in Clause 222(5)? We see here that,

That might seem perfectly all right until we remember that not everything that a patients’ forum is currently able to report on relates to health services as commonly understood. For example, concerns may be expressed about car-parking charges, waiting areas for hospital visitors or transport arrangements. These are matters that contribute to the patient experience in the broad sense but they are not directly to do with care. Can the Minister confirm that such matters will not be excluded from the purview of LINks? I beg to move.

Baroness Neuberger: I support the noble Earl, Lord Howe, in everything he has said. I will also add a few words to what he said about Amendments Nos. 238KD and 238KE.

The clause states that it is to enable “people” to monitor the local health activities. Instead, we have inserted,

If we are moving to LINks, and it seems fairly clear that—with all the queries that we have—we are, then it is right that we should say so and say what we mean about membership of those LINks. I am enormously grateful to the involvement network, which is a network of hosts, for the information it has submitted. It suggested that we must move to a system where LINks are sufficiently flexible,

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About forums, it said that they,

and other participants,

It added that,

and they,

That is exactly what we want LINks to be. The involvement network has suggested that we need to create “classes of membership” for LINks, and that might mean having a variety of memberships for groups and for individuals and at many different levels. Whatever it is, we need people to be members of that entity. The incredibly loose network that the Minister described before the Statement seems to be too loose to be bearable.

However the model works, there must be some sense in which LINks have members. Anna Coote, a former colleague at the King’s Fund who was on the group that looked at the new structure and who is now at the Healthcare Commission, suggested in her evidence to the Health Select Committee that the original idea was a “true network”—something very loose indeed—but that it was shifting somewhat. The Health Select Committee argued that the Department of Health was reluctant to talk about membership of a LINk, but we argue that if LINks are to do anything and gather views properly they will need members and some clarity of what kind of entity they are. It is essential, however loose they are or how many classes of membership there may be, that they know who their members are and who they can charge with taking on various functions, duties, activities or whatever it is they will be called.

Lord Rea: In lending my support to these amendments, I will speak briefly to Amendment No. 238KL.

Before that, I should explain to my noble friend why I have added my name to a number of the amendments being debated today. My noble friend will remember that I was critical of the Government’s decision to abolish community health councils in 2002, feeling that they should be strengthened and reformed instead. Their successor, the patients’ forums—I prefer to say fora—are now to be abolished in turn instead of being strengthened, perhaps with their structure and functions revised in light of experience and developments in the National Health Service and other social institutions.

Just over a week ago, my noble friend Lord Layard wrote an article in the Guardian entitled, “No change for change’s sake”. I will quote a small part:

Exactly. However, the Government have gone so far down the road to establish LINks, instead of patient participation fora, that our job today is to probe the

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Government’s arrangements for setting them up and ensuring that they work smoothly rather than seeking to attack the whole concept. In fact, the concept of LINks is admirable in many ways, particularly in that it covers the area of local authorities, rather than individual trusts. It also includes primary care and—better than anything—social services in its remit. It is potentially an extremely valuable reorganisation, although its remit could have been included in those of existing bodies. The Government have said that, by leaving some of the wording of the Bill non-specific, they will allow for flexibility in operation, but we feel that inserting certain words will make it easier for those setting up and working in LINks to carry out their tasks and to know what those tasks are.

The main purpose of the amendments, as noble Lords have said, is exploratory. It is appropriate for me, as a government Back-Bencher, to join the cross-party group that has tabled these amendments given that many Labour Party members and supporters—not least on the Health Select Committee of another place—are very concerned and have misgivings about the Bill.

I want to talk a bit about Amendment No. 238KL. Its purpose is to expand how LINks are to obtain the views of the population in their areas. Clause 222, at page 154, line 36, talks about local authorities,

That is extremely non-specific. That means that they can just go into the street and ask the views of a selection of passers-by. The amendment inserts, instead of “obtaining”,

this information, thus delineating more clearly how the LINk is to work. This is one of a series of amendments to clarify the structure and function of LINks.

Baroness Meacher: I support the concerns expressed by noble colleagues regarding these amendments. They have been well put and I very much hope that the Minister will take them seriously.

Baroness Masham of Ilton: I am in exactly the same position as the noble Lord, Lord Rea, on these amendments. Will the Minister give us examples of who may be the hosts for LINks and what happens if they suddenly move or go broke—especially if they are housed in a voluntary organisation?

Baroness Howarth of Breckland: I want to speak to these amendments to probe further a question which I remain unclear about, although I had hoped it to be clarified in the previous group of amendments. I was somewhat disappointed when the Minister gave us the impression that some of us, by probing these issues, might not be in favour of change. I think that change is often extremely positive but, to take change forward, we have to understand how we harness the energy of those involved in existing services and do not demoralise them. The management of change is around gathering people with you and taking you forward with their energy. If we are to take these changes forward, we have to conceptualise what this is about—and I am struggling to do that, particularly when I read in Clause 222 that the activities include,

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The commissioning of local care services is a highly complex process. What kind of organisation will we have? I continue to use that phrase, “What kind of organisation?”, because I do not know the terminology with which to describe the matrix it appears that the LINks will be. I agree with these amendments—we have to have some sort of form and structure, some sort of membership and some sort of understanding of the host. I agree with my noble friend who asked who the hosts will be. I do not understand that and have very little idea of what their governance relationship is with the local authority or the primary healthcare trust—or, indeed, how those two relate to the LINks in terms of governance.

I am sorry if this is losing some thread in our discussion and the nature of the documents that have been sent out. I have tried to follow it, but, as the noble Baroness will know, I spend a lot of my time in governance and trying to sort out some of the difficulties of change that the Government have created, which have not been too easy. I ask these probing questions simply because I am keen that we do not again create an animal that is unmanageable and something that we will have to unpick. This is a crucial change for the future.

Baroness Howe of Idlicote: As “host” has been mentioned, can the Minister say whether it is appropriate now or at a later stage to consider why we need hosts, how they will work, how much money they will have and whether they will be voluntary organisations that do not get involved in the work that was going on? Those will be very important points to explore later and I very much agree with what the noble Lord, Lord Rea, said, because he put some of our concerns very effectively.

6.15 pm

Lord Bruce-Lockhart: I add my support to this group of amendments, particularly Amendment No. 238KG, on,

their experiences. I wish to add to my noble friend Lord Howe’s search for clarity on the purpose of LINks.

Perhaps I may use an example from my local authority in Kent. Three years ago it wanted to support the patient forums by establishing an independent focal point to allow patients and residents to report their experiences of the NHS. We have, like many local authorities, a 200-seat, 24-hour-a-day call centre. We were simply suggesting that people could phone in, because one of the problems of patient forums is—and one of the problems of LINks will be—the large amount of anecdotal evidence. What they need is a professional organisation to take widespread opinion, to analyse that and produce hard evidence of patient experiences. This seemed a good idea. We called it Kent Health Watch, but at the time it was opposed by the NHS health authority. However, such an idea would be immensely valuable. Amendment No. 238KG and the clause bring that out. Will the Minister support the establishment of that kind of patient information base, which is very important both for information and choice?

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Baroness Andrews: This has been a thorough debate on some complex issues. I much admire the noble Earl’s struggle with language. Sometimes we seem to exist in a virtual universe when we consider the language of parliamentary draftsmen. That is not unique to this Bill, but it is, perhaps, perplexing here. The noble Earl also did the House a service by emphasising how important it was for the LINks networks to be as wide as possible. The examples he gave, not least regarding the relationships of black and ethnic minorities with mental health services, were absolutely right. All I would say is that that is precisely why we have not listed organisations in the Bill or defined the scope and extent of a LINk, simply because we have made it clear in everything that we have written and sent out that the test of a LINk will be how far it reaches into the community.

I say to the noble Baroness, Lady Howarth, that I certainly did not mean to denigrate people who manage change and who have had successfully to manage a great deal of change in recent years. I understand why she pushed me on clarity and I will do my best to conceptualise this and to answer some of the question that arise.

Amendment No. 238KC seeks to insert “effectively” in relation to the means by which LINks arrangements can be delivered. What we mean by “effective” is, essentially, that LINks will be organisations with sufficient scope, as I have said, to bring in the widest and most effective range of influences for different purposes. Those influences may be very specific to an interest group made up, for example, of people clustered around the independent living agenda. The influences may be broad in relation to changes proposed whereby this alliance, this network, will have a collective view of the impact it will have or some of the changes that it wants to see. Some of those changes may run across interests and conditions but will affect a particular age group, such as the elderly or the young. So there will be, I am afraid, infinite variety. It is that sort of inference.

The test of effectiveness is that there will be governance arrangements which are clear about the relative role of the host. The LINk will take decisions on priorities and activities and the host will provide the necessary support for them to carry it out. In all the documentation we have put out, that distinction and the need to be clear about that is vital. There will be clear and responsible partnerships with stakeholders, such as overview and scrutiny committees. Local partnerships will establish the role in relation to commissioning, at what point the LINk organisation and in what form—a group, a small sub-committee—would have a role in looking at the commissioning of particular services, maybe specialist services. Those sorts of things can be determined as the structure evolves.

There are clear accountabilities in the system. Local authorities have a duty to make arrangements to establish a LINk. The host will be accountable for the delivery of the contract and provide appropriate support, advice and infrastructure. The LINk is accountable to the community. It will reflect the range of organisations and interest groups which have an interest in the whole range of services and working with them to obtain the

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voices, it will determine priorities for work programmes in accordance with the issues which matter to local people.

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