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Lastly, I return briefly to the issue of private providers. How will the Government ensure that private providers of health or care services are obliged to respond to requests for information and visits from those charged by the local authority with implementing the transitional arrangements? If the duty of a private provider to respond to such requests is enshrined in the service contract, it may in many instances be specific to patients’ forums rather than to individuals carrying on activities in the transitional period. How will the Government make sure that private providers are under an equal duty to respond even after forums are abolished? In the Minister’s letter to me, for which I thank her, she indicated that in relation to the activities of LINks the matter would be subject to directions given to PCTs. Will the same apply to the transitional arrangements? If so, who will monitor the extent to which PCTs and independent contractors abide by the content of such directions?

Baroness Neuberger: My Lords, I agree absolutely with everything that the noble Earl has said. As noble Lords can hear, I am losing my voice, so I will not say much. I thank the Minister for the letter that she wrote to the noble Earl and me, in which she made it very clear that accompanying the regulators on visits would be an expectation. It is very important that that will be in the guidance and I am truly delighted by that.

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On the point raised by the noble Earl about independent and private providers, there is a further complication, which was drawn to my attention only today. Increasingly, there will be some private provision of support functions to the PCTs. Some of that may include part of public and patient involvement. I wonder how, and not only in the transitional arrangements, the Government think that in the guidance and the regulations it can be made very clear—whoever is involved, be they private, voluntary or public sector, whether they are involved in providing support to patient and public involvement or whether they are the organisations that need to allow access—that somehow everybody will be treated equally. That is what we are really getting at; we want to know that this will be a level playing field.

Baroness Andrews: My Lords, I will take those questions in order; I will have a better chance of answering the last one if I start with the first one. I say to the noble Baroness that this Bill has proved deeply unhealthy. At some point everybody on the Front Bench has lost their voice. We will be well out of it at the end of this.

The noble Lord makes important points on the transitional arrangements. He has identified some of the ways in which this could be done, in relation to the website, the monitoring of services and so on. We have tried in this area, as well as in others, to achieve the right balance in giving people power, in enabling them, in giving them money and now in giving them scope, by way of transition, to go and do things that they think are right and proper and will make a difference. They can draw on their experience.

The amendment that we debated earlier about the governance mechanism will substantiate the sort of changes that we want to see. That will make it absolutely clear that this is not tokenism but that these are real changes. The activities are being undertaken, including investigating and monitoring reports, which can be logged up—and certainly one would be looking at the relative levels of activity in inspections, visits and so on. In those arrangements for governance, we identified decision-making arrangements, using money wisely and making sure that a membership is in place, for example. They are tough and will be explicit. The department will keep a very close eye on this over the next few months.

On the timescale of the regulations, the noble Earl rightly said that we do not have time to consult, given where we are. That is why I stressed that we would be working with stakeholders to make sure that we have the common-sense approach that we need. We will bring forward the regulations as soon as we can. We will be looking to have them in place in the New Year. I take the point that time is very important.

On the question of “may” and “shall”, we intend to introduce regulations on all the matters to which the noble Earl referred. I will write to him on that point because there may be other points of detail that would be useful to pick up. I will certainly have to write on some of the questions raised about private providers. I am advised that directions will apply during the transitional period in relation to the

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independent sector. The Department of Health will make sure that there is compliance with those arrangements. Those are important questions and I am not really equipped to give more of an answer, but I can certainly make sure that we write.

On Question, amendment agreed to.

Clause 226 [Sections 220 to 225: interpretation and supplementary]:

Baroness Andrews moved Amendments Nos. 62 and 63:

On Question, amendments agreed to.

Clause 230 [Duty to involve users of health services]:

Baroness Morgan of Drefelin moved Amendment No. 64:

“(a) guidance given by the Secretary of State as to when, or how often, involvement under arrangements under subsection (1B) is to be carried out;(b) guidance given by the Secretary of State as to the form to be taken by such involvement in any case specified by the guidance.”

The noble Baroness said: My Lords, Amendments Nos. 64 and 65 follow on from our debate on Report when concerns were expressed that, with our amendments to Section 242 of the 2006 Act, we might be paving the way for too narrow a concept of involvement. I undertook to look one last time at the form of words being used, and my noble friend has now tabled these amendments to take account of those concerns. Although they are a relatively minor change in language, the amendments offer more clarity that involvement can take various forms in different circumstances. I should like to put on the record that there was never any attempt by us to provide for a narrow definition of involvement or prescribe a particular, unique form of involvement. The two amendments are necessary to reassure noble Lords of our intentions and to avoid any doubt on the matter. I hope that noble Lords will recognise the spirit of this clarification and feel able to support the amendments. I beg to move.

Earl Howe: My Lords, I welcome these amendments and thank the Minister most warmly for having agreed to them, and of course I accept fully the assurances that she has given. I wonder whether she will allow me to ask a couple of questions on the content of the clause as a whole.

First, in new Section 242A, we debated on Report the phrase “prescribed matters” and the uncertainty about what that phrase might cover. I would appreciate an assurance that no less than is currently provided for in the Health and Social Care Act 2001 is to be covered by the prescribed matters. I sought at the last stage to alleviate this potential difficulty by asking for consultation on the regulations, but the

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Government did not agree to that, so it would be extremely helpful to have an undertaking that at least the basic 2001 Act involvement provision—that is, the planning of services, planning changes in services and decisions about the operation of services—will be applied to the prescription of the matters to which the duty is to apply and that the regulations will be used only on the first and any subsequent occasions to expand on this core principle rather than reduce those principles.

Secondly, in new Section 242B we are being asked to accept some extremely sweeping provisions that permit strategic health authorities, which are effectively branch offices of the department, to override local involvement work by PCTs, even where that work has already begun. That introduces a risk that a strategic health authority could undertake involvement work across one of the very large areas they cover without the sensitivity that only local involvement work by PCTs can bring, and which can then be precluded under this clause. For example, a reduction in the number of GP practices may make economic sense across a whole area, but the precise configuration can be determined only through the involvement of patients, so that transport and access difficulties that apply locally can be factored in. If that is left to consultation under Section 7 of the Health and Social Care Act, and if it is a substantial variation, it may well be too late to consider creative options for co-location that the public might generate when they are given the opportunity to do so. When I probed the purpose of these provisions on Report, the Minister indicated that they had been included to avoid duplication. However, the powers, if read literally, are drafted in a much wider way. Therefore I wonder whether I could have the Minister’s confirmation that the provisions are intended only to avoid duplication of involvement with the same people on the same issues and will be used only for this purpose.

Thirdly, I would appreciate her confirmation that the provisions and any regulations will not be used to prevent, inhibit or override local involvement by PCTs with patients or their representatives locally; and finally, that the exercise of any powers by strategic health authorities in respect of whatever range of directions in new Section 242B is to be put in place will be decided by strategic health authority boards in public session and reported in the same way. There needs to be transparency here.

All this gives rise to the question: how will compliance by strategic health authorities with these provisions be monitored and reported on, and who will performance-manage strategic health authorities on their involvement duties? PCTs are monitored by the Healthcare Commission on their patient and public involvement, but can the Minister confirm that the commission also has a remit under the Health and Social Care (Community Health and Standards) Act 2003 to monitor strategic health authorities, and that this monitoring function of the commission will apply to the new provisions in this clause?

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7.45 pm

Baroness Neuberger: My Lords, I simply want to support the noble Earl, Lord Howe, in what he has said about the monitoring arrangements. We are grateful for these amendments, but as they stand the intention is not absolutely clear, so some guidance from the Minister on what the Government mean would be enormously helpful. As we come to the end of this part of the Bill, I want to say how helpful it has been to have the sorts of conversations we have had with the noble Baronesses, Lady Andrews and Lady Morgan. It has been a great pleasure to work on this part because I think that we have come a long way. We would still like a little more clarity, but we have made good progress—even if one by one we have been losing our voices.

Baroness Morgan of Drefelin: My Lords, I hope that I will not lose my voice, at least for a moment so that I can help the House with further clarification along the lines requested by the noble Earl, Lord Howe, and the noble Baroness, Lady Neuberger. It may be helpful to set out a little background in order to assist noble Lords in understanding the new duty on SHAs provided for in the government amendment introduced on Report. The only services SHAs are themselves responsible for are nationally commissioned, specialised services. In commissioning those services, as I have said, SHAs are subject to the existing Section 242 duty to involve. What we are providing for additionally in new Section 242A is a duty on SHAs to make arrangements to involve patients and the public in, for example, the development of strategic frameworks within which services across a whole area are delivered. We have placed a duty on the Secretary of State to make regulations setting out the circumstances under which this duty would apply. As I said on Report, it is expected that these regulations will be developed with the key stakeholders I listed at that stage.

The policy intention is that the duty will apply where an SHA is developing the future configuration and method of service delivery across the area for which it is responsible. We will be building up those regulations through a process of involvement to avoid the irony alluded to by the noble Earl on Report, but I would expect them to be comparable with the provisions already contained in Section 242—here I hope to reassure the noble Earl—the planning and provision of services, the development and consideration of proposals for changes in the way services are provided, and decisions to be made affecting the operation of services, but in the context of the whole area rather than one discrete PCT area. Other areas may emerge as the health service evolves, and there may be other circumstances that require SHAs to involve people in other aspects of the development of strategic frameworks. I can therefore reassure the noble Earl that we are talking about expanding, not reducing, the provisions in Section 242.

On strategic health authority directions to PCTs, let us be very clear that it will generally be for PCTs to involve patients and the public, as set out in Section 242. Only in very particular circumstances might an SHA want to take over that responsibility. For me, the phrase “take over that responsibility” is key, because

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we are talking not about that responsibility disappearing but about it being taken over by the SHA. Yes, we did say on Report—and I am happy to reiterate now—that we are aiming to avoid duplication. We are not about preventing local consultation or about preventing the PCT consulting; we are making provision for a strategic health authority to take over a PCT’s responsibility. The situation might arise in which all PCTs in an area involve people in local arrangements within a strategic framework. Strategic health authorities would then be able to co-ordinate a single involvement exercise, rather than there being several very similar PCT arrangements with a similar timeline. Let me therefore reassure noble Lords that we intend to achieve a co-ordinated involvement process that avoids unnecessary duplication. There is absolutely no intention to limit involvement in any way.

I absolutely agree that there can be no involvement and consultation without transparency. We do expect that SHA boards will receive reports and will be involved in decisions about consultation. That is exactly the role that one would hope boards would have. We therefore expect people to continue to be involved and that our proposals here expand, not reduce, opportunities for involvement. Given the assurance that I have been able to give the noble Earl and the noble Baroness, I hope that they will feel able to support the amendment.

On Question, amendment agreed to.

Baroness Morgan of Drefelin moved Amendment No. 65:

“(a) guidance given by the Secretary of State as to when, or how often, involvement under arrangements under the regulations is to be carried out;(b) guidance given by the Secretary of State as to the form to be taken by such involvement in any case specified by the guidance.”

On Question, amendment agreed to.

Lord Graham of Edmonton moved Amendment No. 66:

“Payments on loss of office(a) an elected mayor of the authority (within the meaning given by section 39);(b) an executive leader of the authority (within the meaning of Part II); or(c) a councillor of the authority appointed to the executive of the authority.

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The noble Lord said: My Lords, the whole House will have waited all day for this speech, because this is the last amendment. Goodbye, Freddy. I apologise to the House and to the Minister for having tabled this important amendment very late in the proceedings. I was prompted to do so after discussions with London Councils. The noble Baroness, Lady Hamwee, the noble Lord, Lord Jenkin, and I are, of course, joint presidents of that association.

One aspect in which the Bill is deficient is in the treatment of full-time local councillors who are not re-elected and who consequently suffer financially. The amendment seeks to rectify this situation by granting local authorities powers to award compensation payments to full-time local authority councillors who are not re-elected to the council. I served as a councillor many years ago when not a breath of payment was made. Progress has been made since. Councillors deserve treatment equal to that of other full-time politicians. MPs receive compensation payments if they are not re-elected to the House of Commons. As a result of powers to be granted under the Greater London Authority Bill, which is shortly to become an Act, the Mayor of London and London Assembly members will also receive compensation on ceasing to hold office. It is inequitable that although MPs, the Mayor of London and London Assembly members receive these payments, full-time local authority councillors are treated differently.

The amendment is not a case of councillors attempting to award themselves more money across the board. It would apply only to a limited number of local authority members in a limited number of situations. It would apply only to directly elected mayors, cabinet members and the leader of the council. It would apply only if they stood for re-election and were not voted back on to the council. It would not apply to other councillors and could be agreed only by the full council. It would be for local authorities to decide whether they wanted to institute these payments. They would not be obliged to do so. With these limitations, the amendment is reasonable and fair, and would allow each authority to decide for itself.

Last year, an independent report entitled The Remuneration of Councillors in London concluded that there is a clear need for the law to be changed in this regard. I beg to move.

Baroness Hamwee: My Lords, I declare an interest, to which the noble Lord referred, as a joint president of London Councils, although I have to say that it has not briefed me on this and I did not know where the amendment came from. I also declare an interest as the prospective recipient of a similar provision in the Greater London Authority Bill, as it probably just about still is. The noble Lord raises an important

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matter, although I am surprised that he managed to slip it in at Third Reading without anyone waving yellow or even red cards at him, but there we go. I shall comment on the clause as it is presented to your Lordships.

The issue of payments of different types to members of local authorities requires quite a lot of attention. Clearly it becomes even more of an issue as the roles change, but it is not such a recent matter that members have taken decisions that have affected their careers very substantially by choosing to go down the route of public service. I do not oppose the principle that those who have been employed full-time, or pretty much full-time, should receive some sort of severance payment when that office comes to an end. However, the noble Lord limits the provision in a number of ways. First, it is limited to members holding certain positions. We discussed at earlier stages of the Bill the difficulty of those who chair, for instance, an overview and scrutiny committee being perceived as less important than those in an executive position. I would not like to see a severance scheme that did not allow for full consideration of the range of involvement in local government, although I appreciate that the amendment would not set up such a scheme but would provide a framework to enable a scheme to be drawn up.

Secondly, I do not know whether, in the noble Lord’s mind, the failure to be re-elected includes failure because of deciding not to re-stand. As I understand it—I may have got this a bit wrong; I hope that your Lordships will forgive me if I have, but the principle applies—the scheme that applies to Members of Parliament was changed when it became clear that some MPs, who did not want to continue but who did not want to lose out on the severance payment, stood in a hopeless seat. That is not a good situation to have. The scheme that has been worked up and which is likely to apply following the enactment of the Greater London Authority Bill extends beyond those who have failed to be re-elected in the normal sense of the word. Perhaps I should have put this in the first category, but there are also members who are re-elected as councillors but who do not go into the cabinet—they do not have an executive position.

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