Previous Section Back to Table of Contents Lords Hansard Home Page

The other obvious option—delaying the abolition of patients’ forums for a period of months—though superficially attractive, is less desirable because it would swallow up a disproportionate amount of the PPI budget and therefore leave local authorities with a great deal less money than they otherwise would have had to set up and finance the new arrangements. Nevertheless, depending on the Minister’s reply, that option may have to be revisited between now and Third Reading. I beg to move.

Baroness Neuberger: My Lords, the noble Earl, Lord Howe, has, as ever, said most of what needs to be said. But perhaps I can emphasise again to noble Lords around the House just how many letters those of us who have been involved in this Bill have all had about all the issues to do with LINks and, most of all, about the pace of change and the abolition of patients’ forums before the new system is up and running. I have had literally hundreds of letters. We have also had support from the Local Government Association. It sent me a note today supporting our concerns, saying that local authorities need adequate time to implement these measures. It is also worth saying that David Pink—who will be well known to many people around this House as chief executive of the Long-term Conditions Alliance—has argued that, although the delay should not be too long, because there has already been enough uncertainty,

He is advocating something between three and six months. One of the reasons for six months to be in the amendment is that that is the view of people who

15 Oct 2007 : Column 589

are not necessarily pleading their own corner but are trying to work with the new system. He adds that he is making the statement,

that are members of the Long-terms Conditions Alliance, and says that,

For that reason, I very much hope that the Minister will support the amendment and recognise that some time for a transition arrangement is needed.

Baroness Andrews: My Lords, there is no doubt that this is a critical amendment on a critical issue. In Committee, I tried to explain how anxious we were to maintain momentum and focus on the way in which transition would occur. I will return to some of those arguments this evening.

The amendment would ensure that there would be no gap in activity in the transition between the end of patient and public involvement forums and the establishment of LINks. Let me be quite clear that it was never our intention to leave a gap between patients’ forums and LINks such that there would be potential for a gap in the local accountability of services. We all know the history of these arrangements over the years.

We have been clear with all key stakeholders, including local authorities, in the Getting Ready for LINks guidance, that the timetable and momentum are important, because preparations have begun in so many different ways. We value enormously what the noble Earl, Lord Howe, described as the collective, corporate memory that the patients’ forums have built up in their work over the years, as well as their experience and commitment. We did not want any local authority to feel that it or any LINk was in danger of losing that. Part of the reason for keeping the focus on a deadline was to ensure that people were concentrating on the task in hand, so that we could have as energetic a transfer as possible.

We have tried in that process genuinely to make it possible for local authorities to have as much help and incentive as possible to move to a position in which they could commission and procure the host, identify and map the potential scope of the LINKs networks and identify the sort of tasks that would be needed in the transitional arrangements. When you do not have an organisation to look at and you are setting one up, it is awfully difficult to be quite clear about what you are doing. However, we have published the Getting Ready for LINks guidance and we have run countless events. Department of Health officials have been incredibly assiduous in making themselves available and in putting out—in easy-read format not least—the information and guidance. We have put out a lot of communication material and we have made it clear that it is the local authority’s responsibility to ensure that, as of 1 April 2008, the activities assigned to a LINk should be able to be carried out.

A huge amount of activity is under way, as noble Lords will know if they have followed the progress of the early adopter projects. The nine projects have worked across the country, offering invaluable insight

15 Oct 2007 : Column 590

and experience, everywhere from Dorset to Durham to Kensington and Chelsea. They are looking at different ways of tackling the challenging idea of how to involve people who have never been involved before and how to amplify their voice in relation to health and social care.

The interim report of the nine early adopter projects was published in July 2007. We have run regional events for local authorities and stakeholders from other sectors and we have published two guidance documents Getting Ready for LINks:Planning your Local Involvement Network and Getting Ready for LINks:Contracting a host organisation for your Local Involvement Network. In addition, we have given £10,000 to each local authority to help them get started with the procurement process. We have done our best to make sure that we have done the things that we could do from the centre.

I know from what noble Lords have said that there is still public concern that, despite the best efforts of a given local authority, should that local authority experience difficulties in the procurement of a host, for example, or should there be any other impediment to the LINk being in place on 1 April 2008, the activities assigned to LINks may not be able to be carried out. The noble Earl openly talked about the difficulties of delay. He mentioned the fact that delay would mean less money; it might bring more time but it would certainly bring less money because we cannot afford to fund parallel systems. The other thing about delay, which was alluded to by the Local Government Association, is the element of frustration that a long delay might cause. We do not want to see that either. We want to make sure that this works. We do not want the leading local authorities to be held up because there are other local authorities that are slower, more laggard, less involved and less energetic. We must balance that.

Acknowledging that concern, and bearing in mind the need not to undo the good work already being undertaken, not wanting to slow progress or wanting any transitional arrangements to be over-complicated, I think that the noble Earl has come up with something very appealing. Therefore, I undertake to take this amendment away and consider it further. It is a thoughtful and careful amendment. What attracts me is that it is focused around the duty that we are already placing on local authorities to make arrangements to ensure that the activities of a LINk can be carried on. It is about preparation, and it supports the development of the arrangements that we are moving into rather than retaining the old regime. It supports the direction of travel, and it is consistent with what local authorities are already putting in place. I ask the noble Earl to give me a little more time to explore this in detail, and I hope that the amendment will be withdrawn.

Earl Howe: My Lords, the Minister’s reply opens up a ray of hope, and it is very welcome for that reason. I thank her for agreeing to consider the amendment. I hope that we can arrive at a satisfactory agreement between now and Third Reading. Because of her reply, I shall not move the next group of amendments.



15 Oct 2007 : Column 591

The general level of help and support to local authorities from the Department of Health is decidedly welcome, and I noted everything that the noble Baroness said on that. How much specific guidance are the Government giving to local authorities to enable them to undertake procurement? That is particularly important if we are not to see the new arrangements implemented with varying degrees of success and effectiveness. We all hope to see consistency of outcome in the formation of LINks, and the way to achieve that is to have consistency of procurement. The Government’s support for local authorities in the procurement exercise and the way in which they set about it is critical.

I will briefly flag up an issue that was referred to earlier by the noble Baroness, Lady Neuberger. Some health-related services, such as ambulance trusts and cancer networks, straddle more than one local authority area. How will the Government ensure that from the outset of those arrangements monitoring of those services by informed patients and their representatives will be undertaken? I am not convinced that the draft guidance takes full account of that dimension, and it would be helpful if between now and Third Reading the Minister would write to me on that.

Baroness Andrews: My Lords, I know that we are not supposed to bring visual aids to the Chamber.

Noble Lords: Order!

Baroness Andrews: My Lords, I have a document on host procurement entitled, Getting Ready for LINks and I will make sure that the noble Earl has a copy. I will write to the noble Earl on his second point about how we cope with services that run across areas and how we monitor them. The guidance should reflect that, if it does not do so already.

Earl Howe: My Lords, I am very grateful to the noble Baroness. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 233 [Abolition of function of Patients' Forums]:

[Amendment No. 210ZF not moved.]

Clause 234 [Abolition of Patients' Forums]:

[Amendment No. 210ZG not moved.]

Clause 235 [Abolition of Commission for Patient and Public Involvement in Health]:

[Amendment No. 210ZH not moved.]

Clause 236 [Duty to consult users of health services]:

Baroness Morgan of Drefelin moved Amendment No. 210A:

The noble Baroness said: My Lords, I hope the House will forgive me if I take a few moments to speak to the amendments in this group. The government amendments in this group are connected; for simplicity, I shall not deal with them strictly in numerical order, but rather in a way that best explains what we are aiming to achieve with them.



15 Oct 2007 : Column 592

Amendment No. 211 relates to the suggested reinstatement of “involve” in the duty on NHS bodies to consult patients and the public. In Committee, I committed to giving the issue further consideration over the Recess, following opposition amendments. As noble Lords are aware, the issue of what constitutes and differentiates consultation and involvement under Section 242 of the National Health Service Act is a complex one that has been subject to recent judicial review decisions. In last year’s case of North East Derbyshire, Mr Justice Collins was unable to find any differences of meaning between references to “involve” and “consult”. This judgment initially led the Government to exclude “involve” from the duty on NHS bodies to make arrangements to consult the users of health services.

However, noble Lords may know that, over the summer, the Court of Appeal in its judgment on Fudge held that in that case “involvement” could be seen as something less than “consultation”. That is certainly not the Government’s intention. The amendment therefore restores the reference to “involvement” and results in NHS bodies being subject to a duty to make arrangements to involve the users of health services. It is our intention that, depending on the circumstances, “involvement” can include actions such as passing on information, consultation and active participation in the planning and provision of services, and the wording of the amendment reflects that.

Amendments Nos. 218 and 219 make consequential amendments to Clause 236 arising from Amendment No. 211.

Amendments Nos. 212 to 217 deal with the removal of the word “significance” in Clause 236 and the lowering of the threshold for making arrangements for involvement, which in Committee I also agreed to take away and consider. We discussed this at some leisure in Committee, and we considered it to be important. As stated in Committee, Section 242 of the National Health Service Act 2006 is a wide-ranging duty, which currently provides no sense of scale to enable NHS bodies to apply the duty meaningfully. In inserting a threshold, the intention was to ensure that arrangements for consultation by English NHS bodies in England under Section 242 applied where a decision or proposal would have a substantial impact on the range of services and the manner of their delivery.

However, I understand the concerns, which noble Lords raised effectively in Committee. That is why we are proposing to amend the Bill by changing the threshold from proposals and decisions having a “substantial impact” to proposals and decisions having an “impact” and we have removed all references to “significant” in Clause 236. This means that the duty on English NHS bodies to make arrangements for involvement will apply where proposals or decisions have an impact on the range of services and the manner of their delivery.

I now turn to some important new elements to the involvement and consultation regime provided for in Section 242 of the National Health Service Act 2006. I am particularly grateful to the noble Earl, Lord Howe, for identifying two key areas by which we can

15 Oct 2007 : Column 593

strengthen the involvement duties. I am also grateful to the noble Baroness, Lady Neuberger, for her contribution to our discussions on this issue. I believe that these two areas strengthen the way by which patients and the public can have direct influence over their health services.

Although the duty to involve in the amended Section 242 applies to strategic health authorities, this section applies only in respect of services for which a strategic health authority is responsible. Strategic health authorities are responsible only for the national commissioning of a limited number of specialised services. However, there are times when, although they have no direct responsibility for the provision of services, strategic health authorities, as we all know, take the lead in formulating strategic frameworks for a whole area within which more localised services are then developed and implemented. It is in cases such as these, when strategic health authorities are developing these kinds of strategic frameworks, that we think it right that they involve patients and the public.

Therefore, Amendment No. 219ZA places a duty on the Secretary of State to make regulations imposing a duty on strategic health authorities to make arrangements to involve users of health services in certain matters. The amendment also provides that in complying with this duty, SHAs must have regard to statutory guidance. I am sure that noble Lords will agree that the level of detail needed to clarify what activities are needed and when they apply is more appropriately set out in guidance.

Amendment No. 219ZA also provides for the Secretary of State to make regulations which provide for SHAs to make directions to primary care trusts to ensure that there is no unnecessary duplication of involvement activity. If we were not to do that, I am sure that noble Lords could imagine that all sorts of duplication could come into play. The regulations provide for the directions to specify that a strategic health authority may take over responsibility for involvement activity, thus freeing the PCT from its existing obligation under Section 242. The regulations also enable directions to make provision about circumstances where involvement activity by a PCT might have already commenced prior to the making of directions.

The Government have listened carefully to the observations of the noble Earl, Lord Howe, in his meetings with my noble friend Lady Andrews on government Amendment 219ZA. However, I am content that our amendment provides for his objectives under Amendment No. 219ZAA and I hope that he will agree—although he may wish to discuss the matter further. The term “form” allows for the guidance to set out the fullest possible variety of methods or activities of involvement that might be necessary in any given circumstance and certainly does not limit SHAs to involvement in any lesser way than might be necessary or desirable.

Government Amendment No. 219ZA provides also that SHAs must have regard to when and how often the involvement duty is to be fulfilled; and the guidance can also make clear when certain circumstances apply

15 Oct 2007 : Column 594

that the duty should be fulfilled. I resist Amendment No. 219ZAA of the noble Earl, Lord Howe, and I would be interested to hear how much he wishes to push it.

I understand the point of Amendment No. 219ZAB but I am going to resist it for very good reasons. We are keen for the involvement and consultation requirements to come into force as soon as possible. I am sure that all noble Lords will agree that patients and the public should be involved and consulted at every level of the NHS, and the requirement on SHAs that the government amendment imposes is a particularly important one. We do not want now to hold that duty up by requiring a lengthy consultation process on the regulations. That is not because we do not want stakeholders to inform the detail of the regulations. Indeed, we are committed to developing regulations with the NHS and organisations representing the interests and concerns of patients. We have been assisted greatly by officers of HealthLink in working through the detail of these amendments and I know that it is committed to helping the development of regulations and statutory guidance.

We are committed to two crucial issues: first, that the guidance and the regulations are developed in partnership with stakeholders and, secondly, that the duty is put in place as soon as possible. With those comments I commend the amendments to the House and I hope that the noble Earl will consider not moving his amendments. I beg to move.

Earl Howe: My Lords, I thank the Minister for this extremely welcome group of amendments and for her detailed comments. She will know that these are issues to which we on these Benches have attached great importance and I am grateful to her for taking away the concerns we expressed in Committee and for treating them positively. The reinsertion of “involve” is very positive, as is the removal of words which would have inserted a threshold for the involvement of service users. It is equally good news that the Government have agreed to place involvement responsibilities on to strategic health authorities.

I wish to ask the Minister a number of questions. First, in new Section 242A(1), there is reference to “prescribed matters”. Can she clarify what those matters are to be? I would have expected to see here explicit provisions directly analogous to those in new Section 242 of the 2006 Act, as amended, for the planning and provision of services, the development and consideration of proposals for changes in the way that those services are provided, and for decisions to be made by the body affecting their operation. Those are the issues on which health service users should be involved by strategic health authorities, but it is unclear why we cannot say this directly in the Bill.

Secondly, regarding my Amendment No. 219ZAA, I listened carefully to the Minister, but, with all due respect, I do not think that the wording of new Section 242A(4) is all that it should or could be. This is not meant to sound ungrateful, because my gratitude for the amendments as a whole is unbounded, but the phrase,



15 Oct 2007 : Column 595

could be improved. It sounds as if there is only one possible form of involvement, whereas involvement can take several forms. The word “form” is puzzling in itself, because “ways” is used in new subsection (1). While I never wish to tilt at windmills, the last thing that we would wish to do is confuse the court if these provisions were subject to a legal challenge. If “ways” is used in one part of the section and “form” in another part, the obvious question is whether they are intended to mean different things. If the same meaning is intended in each case, why use two different words where one would be better?

7.30 pm

Next Section Back to Table of Contents Lords Hansard Home Page