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This is about taking a joined-up approach. We should expect LINks to feed in their knowledge and experiences to CQC, so that it can act on the basis of the widest range of user views. We should expect some independent oversight of how well user involvement is working on the ground under the new arrangements so that problems can be picked up quickly and improvements made. At the moment, as has been clearly outlined, the relationship is undefined. I believe that we will do users of health and social care no favours by leaving it in this way.

Baroness Tonge: I add my support to the amendments. I was once upon a time on a community health council, when I was a young mother with little children, and I worked extraordinarily hard. It is never too late even in this debate to pay tribute to those people who worked on the community health councils; they worked hard and made a tremendous contribution to the health service. As a health service manager later on, I remember being driven mad by our local community health council, which was a very good thing indeed. It would not get off our backs if it was dissatisfied with something that was going on in the area. I was very sad to see the demise of the community health councils, although I was not in any sort of health brief at the time. Likewise the patient forums, which had barely got going; they were only just grouped and knew what they were doing.

We have heard today that there are no LINks yet because no host bodies have been found—that makes LINks sound a bit like tapeworms or liver flukes. What a dreadful phrase! Contrast that with what we were discussing earlier; the advertisement for and appointment of a shadow director of the Care Quality Commission, which rather pushes the users of the health service down the ladder a little bit and says that they are not nearly as important as some of us think they are. We should support the amendments, and I hope that the Government will take them on board and look at this carefully. It is an ideal and logical way

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of connecting the Care Quality Commission, if it ever comes into existence over my dead body—I am sure it will come into existence—and engaging with the users of the services.

Baroness Thornton: I hope that nothing will be over the dead body of the noble Baroness.

This group of amendments seeks to ensure that LINks are in the Bill. Amendment No. 17 requires the Care Quality Commission to have regard to comments or views expressed by local involvement networks that it considers are relevant. Amendment No. 16 is very similar and singles out LINks as a particular body whose views the commission must take account of when performing its functions. Amendment No. 26 simply defines a local involvement network for the purposes of Amendment No. 16.

I agree wholeheartedly that the involvement of those who use care services, carers and the general public must be central to the work of the new commission. Clause 2 already includes a requirement to have regard to the views expressed by and on behalf of members of the public in relation to activities where the commission has functions. My noble friend the Minister has already given commitments to address the issue of patient care, carer and user involvement as we move forward with the Bill. As discussed on Report in the Commons—someone mentioned this earlier—Clause 2 was specifically amended to refer to “on behalf of”, to ensure that the commission listens to representative groups, which include, but are not limited to, LINks.

Amendment No. 21A places a duty on the new commission to summarise the comments and views expressed by LINks and to report on the quality of LINks arrangements in each locality. Under Clause 79, the commission is already required to make an annual report, which must cover the way in which the commission has exercised its functions during the year. I reassure my noble friends Lady Wilkins and Lord Harris that it will include reporting on how it has engaged with the public. It seems highly likely that, as part of its engagement work over the year, the commission will have worked with LINks as a very important stakeholder, and that will duly be captured. As previous debates have indicated, we are committed to ensuring that the Bill reflects more strongly the aspirations for the involvement of patients, service users, families and carers.

5.30 pm

As to whether the commission should have a role in monitoring the effectiveness of LINks, I put it to the Committee that that is not an appropriate function for the commission. I say that because LINks have their own accountability. They are required to be transparent and must make public certain decisions that they make. They report annually direct to the Secretary of State and must provide details concerning their activities as set out in the Local Government and Public Involvement in Health Act 2007 as well as the extent to which local views were taken on board by commissioners and providers.

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LINks must also report on the amount of money received to fund their activities and how it was spent. We must be careful not to confuse or dilute LINks’ own particular accountability.

The commission’s functions are assuring the safety and quality of services, safeguarding the rights of patients subject to the Mental Health Act, commissioner assurance, the performance assessment of providers and minimising the burden of regulation. The proposal that the commission should consider the effectiveness of LINks therefore does not seem to fit with that remit. Indeed, placing the role with the commission would appear to cut across the arrangements to review their effectiveness.

Lord Harris of Haringey: I refer to the letter that I received from my noble friend Lord Darzi, in which he states quite clearly that the Care Quality Commission will assess how local authority social services are using outcome-focused indicators. That,

My noble friend Lord Darzi is saying that that is something that the Care Quality Commission will be doing. Are we now being told that it is something that it will do in secret and will not be prepared to tell the public about?

Baroness Thornton: No; the point that I am making is that LINks have their own accountability and that accountability should not be through the commission. That is not to say that LINks will not be involved very closely with the commission, as I said in my earlier remarks and as my noble friend said in the letter that you received. Of course, LINks will form a significant part of the work of the commission in this respect.

Lord Harris of Haringey: There is a distinction between an accountability to the host—already defined by the noble Baroness, Lady Tonge—and then through to the local authority. It would be in the interests of the LINk, the host and the local authority to feel that they are delivering value for money in this area. There is a distinction between someone else having responsibility for saying that it is an effective entity and an effective process. Where will that responsibility lie?

Baroness Thornton: LINks are accounting to the Secretary of State, so I suggest that the accountability of LINks’ effectiveness lies in their accountability. That is not to say that they will not be working with the commission very closely indeed and the commission will be accountable for its own effectiveness in this regard in the relationships that it has with LINks and a whole range of other organisations. I do not think that we are talking about separate things, but we may need to continue this dialogue elsewhere.

Amendment No. 64 requires the Care Quality Commission to give notice of particular enforcement action that it has taken where the commission considers it appropriate to do so. Primary care trusts and local authorities commission care from service providers.

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Where the Care Quality Commission initiates enforcement action against a provider, it seems appropriate for the commission to advise commissioners so that they can make arrangements, if necessary, to commission alternative care. It is therefore not necessary for there to be express provision for early notification to LINks for two reasons. First, under Clause 85, there is already provision allowing for regulations to make provision for the publication of enforcement action. That is an important provision which will provide the public with information about successful action the commission has taken in relation to breaches of registration. The purpose of Clause 35 is to allow early notification where a particular body may need to take action as a result of the initiation of enforcement action. I do not believe that in the majority of circumstances where the commission initiates enforcement action against a provider there is a need for LINks to take any specific action, although in the commission of their duties it seems likely that they will be aware of, interested and indeed involved in any given situation.

Secondly, Clause 35 allows the commission to notify any other person whom it already considers to be appropriate, so if it considers it appropriate for LINks to be notified, there is a provision that allows it to do so. The amendment is therefore unnecessary. Given the assurance that the Bill already allows LINks as well as other representative bodies to be involved in the work of the commission, I hope that my noble friend will feel able to withdraw the amendment.

Baroness Cumberlege: Does the Minister find no merit at all in the argument of the noble Lord, Lord Harris, about seeing the whole picture? I am happy for LINks to operate differently in different areas. They should be tinged, and should think about their local area and how they want to relate to it. They might want to act differently in one area from another. I am very happy with that. Nevertheless, there needs to be the whole picture, because someone needs to gather all this information together so that we see what is happening nationally. I did not hear the Minister answer those points.

Baroness Thornton: I attempted to answer those points when I said that the commission will have to account for the whole picture of how they are doing their work. That will include LINks. As I said, we are reluctant to name LINks in the Bill because we do not want to preclude other organisations. I think someone mentioned that. LINks are not the only organisation that will have a role in this area.

Baroness Cumberlege: Does the Minister not agree that this is simply a drafting point and that we could introduce LINks but not make them exclusive in the sense that no one else can take part in commenting to the commission?

Baroness Thornton: This is not a drafting point. We do not particularly want LINks to be the only body that is named when there are Carers UK, the Long-term Conditions Alliance, diabetes groups and

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many other groups that have a say, need to be involved and will be involved in the work of the commission. That is basically why we have used a generic term rather than a specific one.

Lord Lipsey: The amendment in the name of the noble Earl, Lord Howe, does not say “only LINks”. It says,

That is in no way incompatible with the objective stated by the Minister.

Lord Harris of Haringey: There has been a fundamental misunderstanding of this group of amendments in that the responses that we have just heard from the Minister and the correspondence that I have had from my noble friend Lord Darzi all seem to suggest that it is proposed that the only channel of expression of user interest and user voice will be through LINks. However, the amendment suggests that there is statutory recognition of that voice—that channel—along with all the other channels that merit being specifically referred to in the Bill because the bodies that are being set up by Parliament for this purpose will receive public money for this purpose. For that reason, they should be separately and explicitly mentioned.

In case the Minister is not minded to reply to that point, I shall also comment on her saying why it was not appropriate for the Care Quality Commission to report on the effectiveness of LINk arrangements. She said in effect that she acknowledged the distinction that I was drawing between accountability to a body that has a vested interest in running things and making them effective and that external scrutiny would be by the Department of Health. Yet we are told—she made this clear in her response—that the Care Quality Commission will have a responsibility to look at how engaged the public and service users in each area are in service planning and in the impact on public involvement and user feedback on local services. We are told that the Care Quality Commission will do that, so are we now being told that the effectiveness of those arrangements will be scrutinised by the Care Quality Commission and entirely separately by some army of civil servants in the Department of Health? The implication of what she is saying is that this will be duplicated. The Care Quality Commission will do work on how effective these arrangements are in local areas, but it must not publish it because that would not quite fit in with everything else that it does. It will do it and keep it secret. Separately, the Department of Health will monitor the commission’s effectiveness and presumably tell someone whether it thinks it is effective.

Baroness Thornton: My noble friend is being slightly unfair. I did not say that anything would be secret: I said that everything would be transparent. We clearly need to have further discussion about this because Members of the Committee feel strongly about it. I said at the beginning of my remarks that we would be looking at the wider review of involvement to which my noble friend Lord Darzi referred. We probably need to include a discussion about LINks in that debate.



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Baroness Howarth of Breckland: Before the Minister finally sits down, I would just like to say why I have been so quiet this afternoon. I would like to have supported the noble Earl, Lord Howe, because he and I have battled this out and tried to get some sense into LINks during the passage of the original Bill. I am speaking now because there is time for thought between now and Report, when I may be more vocal in this area. I do not know what LINks are or will be—I do not even know what grammar to use to describe them. That has been my difficulty. Therefore, if I support the noble Earl, which I would like to do, I do not know whom I am supporting in having this power in relation to the users. I might prefer all the other groupings, if I understood them. I might have preferred Parliament to have created a different kind of representative body.

One reason for the demise of the community health councils was that they were rather troublesome. They raised issues that should have been raised, but sometimes not in the quietest way. My worry about LINks is that they are so amorphous that their voice will be muted, particularly in relating directly to the local authority. Some organisations owe their funding to the local authority. I declare an interest as someone with a sister who feels she cannot speak out about what is happening in the voluntary sector because she is dependent on funding from her local authority, which is a typical scenario that happens with people who are dependent on funding. LINks will be dependent on funding from the local authority. At the moment, we have no picture of how that will be managed or monitored—points made clearly in previous debates. I also find it difficult to know whether it is appropriate to monitor user involvement.

While I am on my feet, I should say that there are also some real issues about user involvement and the privacy of those using the institutions, homes and hospitals. I was appalled to hear the noble Lord’s description. I hope and pray that he reported directly to his local commissioners, because no visitor should see that kind of condition and not report what has been seen. He should also expect a response. I relate that directly back to LINks. LINks should have on them people such as the noble Lord who can report directly back. Then there is a voice that is not muted by the local authority. The report can go directly to the Secretary of State, although I still do not know exactly how that accountability will work, and the commission will somehow be able to get that information together. The Commission for Social Care Inspection excelled in many areas, but particularly where there was no information about the number of homes and their conditions. We now have a complete register. It would be valuable if the new commission could link into the local bodies to gather that information.

There is an awful lot to do here until we are absolutely clear about how this pattern and matrix will work. That is crucial if ordinary folks’ voices are to be heard appropriately and privacy maintained.

5.45 pm

Earl Howe: I thank all Members of the Committee who took part in this debate, particularly those who spoke in support of the amendments. I had thought

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that I might be pushing at a slightly open door with these amendments, but no such luck. I question how robust the Minister's defence really is. As has been pointed out, I have always been under the impression that including the words “in particular” in an amendment was a way of specifying someone or something without implying that that was an exclusive arrangement, so I am slightly surprised that the Minister should have interpreted the amendment in the way that she did.

I fully take the point made by the noble Baroness, Lady Howarth. We do not know what LINks will look like—I made that point earlier—but they are creatures of the Government's own making. It is odd, to say the least, that the Minister will not countenance the idea of giving them a special place at the table because, as the noble Lord, Lord Harris, rightly said, LINks are established by Parliament and funded by public money. Because of that alone, they have a particular claim to be involved and listened to, not exclusively, as the noble Lord emphasised, but certainly automatically.

Whether the Minister's reply is a reflection of a lack of confidence in the department about how effective LINks will be or of the desire of the Government to dumb down LINks I do not know, but I hope that we can continue these discussions after Committee and before Report. I look forward to those discussions, and, in anticipation of that, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 17 not moved.]

Baroness Thornton: As a new innovation, I beg to move that the Committee do now adjourn until 5.57 pm.

Moved accordingly, and, on Question, Motion agreed to.

[The Sitting was suspended from 5.47 to 5.57 pm.]

Baroness Stern moved Amendment No. 18:

“( ) the extent to which complaints about the provision of health and social care by members of the public, in particular users of health and social care services, are adequately dealt with by the bodies which it regulates,”

The noble Baroness said: All the amendments that I shall propose come from the Joint Committee on Human Rights. As you know, the Joint Committee scrutinises all Bills for human rights implications. We recently decided to try to ensure implementation of our recommendations by producing draft amendments that we hope the Government will consider seriously and ideally accept. I express my warm gratitude to the Minister for arranging a meeting where we could discuss the amendments proposed by the Joint Committee.

The Bill engages human rights to a considerable degree. I will say more about that when I speak to a later grouping. Here, I shall represent only the Joint Committee and its amendments and keep my own views about matters such as amalgamating inspectorates to a later stage of the proceedings. I will speak briefly

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to Amendment No. 18, which is one of our two amendments about complaints. The other is Amendment No. 63, which has not been grouped with it.

6 pm

The Joint Committee on Human Rights has proposed the amendment as a result of the findings of its report into older people in healthcare. The people whom the committee was concerned about were vulnerable and powerless. In that inquiry, we heard a lot of evidence that strongly echoes the remarks made earlier this afternoon by the noble Lord, Lord Campbell-Savours, when he described his search for a care home.

Being able to complain without fear of victimisation is an essential element of the protection of rights of all vulnerable people, whether they are prisoners, detained mental patients, people in hospital or people receiving social care. It is not just about being able to complain; it is also important to get a satisfactory and speedy response. The amendment would require the Care Quality Commission, in exercising its functions, to consider the extent to which the complaints of those who use the services are dealt with adequately by the providers of health and social care who are being regulated.

Amendment No. 63, our second on complaints, would require the Secretary of State to enable the Care Quality Commission to hear individual complaints where the service users were not satisfied that their direct provider had handled a complaint effectively.

As I indicated, the amendments in this group are intended to deal with problems that we identified in our study into older people in healthcare. These were that the system was inaccessible; did not meet all the complaints that residents may wish to raise, particularly where human rights were at issue; and could not deal with complaints raised by self-funders, who could complain only directly to their provider—which was difficult when they were resident in a care home—or through a contractual claim in the civil courts. The Government responded to our report, making it clear that, in their view, these amendments were not necessary because, in cases where care is commissioned by the NHS or local authorities, there will be a statutory complaints process with a further avenue of complaint to the relevant ombudsman, who is either the health ombudsman or the Local Government Ombudsman. Those whose care is privately funded will not be covered by these procedures, but the Government are considering what options should be available to them.


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