Local Government and Public Involvement in Health Bill

I welcome some of the Minister’s amendments; it is clear that the Government have, to a certain extent at least, listened in Committee, particularly in respect of amendments Nos. 32 to 34. However, it should be said that the measures in part 13 of the Bill would bring about a radical change in the NHS. They would fundamentally alter the structure of public and patient involvement in health, notably by scrapping patient forums. Therefore, it is unfortunate that these measures have been included at the fag-end of a Bill dealing with local government—a Bill that does not even have the word ““patient”” in the title. Some might conclude that that shows the low priority that patient and public involvement has been given under this Government. Many would consider this yet another pointless reorganisation. Ministers abolished community health councils in the face of widespread opposition and replaced them with a myriad of costly, fragmentary bodies. Now, only four years after setting up patient forums, the Government are abolishing their own reforms at a cost of about £120 million to the taxpayer. Those figures have been audited. Hard-working volunteers up and down the country are appalled that yet another reorganisation is on the cards, believing it to represent a weakening of the patient’s voice and public scrutiny. We know that they have told the Government as much, but Ministers have still not published the submissions from forums to the document, ““A stronger local voice””. My remarks on the Bill, which reflect the amendments tabled, will focus on a number of key concerns. My first concern is with regard to the role of LINKs as defined in clause 1(7)(2). The Government have introduced several amendments in respect of points that we raised in Committee. As I said, I welcome those, but we believe that an opportunity has been missed to make the Bill even better. Government amendment No. 32 would add the words:"““enabling people to monitor, and review, the commissioning and provision of local care services””" to the list of local activities. Before that, according to the Government, LINKs would have been nothing more than a conduit for people expressing their views. As we argued in Committee, LINKs should be about much more than that, and I am pleased that the Government agree. It was always a role of patient forums to monitor services, and that should be allowed to continue. The amendment allows the public to have a proactive role in reviewing and, ultimately, improving the quality of services. That is to be welcomed. Without that function, the right to enter and view premises would be simply another means to gather views, and not a remit to inspect and critically assess health and social services. There is one further activity that needs to be included in the Bill, and that is what we hope to achieve with amendment No. 76. It would require LINKs to report back to local people as well as to other bodies, such as primary care trusts. The Government’s view is that LINKs are primarily a conduit for local people to express their views about the commissioning and provision of services. We believe that the flow of information needs to be two-way. That is especially important if Government amendment No. 32 is passed, as it is likely to be. LINKs will then have a proactive role in monitoring and finding out about services. The findings should be brought to the attention of local people. They need to hear back about how they are being represented, while the sharing of information generally facilitates patient choice and promotes accountability in the broadest sense. I therefore invite the Minister to accept our amendment. Government amendment No. 33 is a step in the right direction. It is another concession in response to the point that we raised in Committee, in that denies the Secretary of State the power to restrict the activities of LINKs. Our fear was that the definition of patient and public involvement included in the Bill could be rewritten entirely by the Secretary of State without having to return to the Floor of the House. It would certainly make a mockery of our careful consideration of the Bill if the House were to approve this part in its current form. My second concern is about the composition of LINKs, as covered by clause 173. This is one of the vaguest parts of the Bill, and has been the cause of confusion among patient volunteers about future arrangements. Government amendment No. 34 helps because it removes the possibility of a LINK, as the Minister has already highlighted, being a purely virtual arrangement—that is, one without individuals or organisations being directly involved. Clearly, that would be unacceptable. I know that the amendment has been tabled following probing by my hon. Friend the Member for North-East Bedfordshire (Alistair Burt) in Committee, and I welcome it. The Government amendment, however, still leaves too many questions unanswered, in particular about the rules for membership and the arrangements for governance of the LINK. The Government’s aspiration is clearly to get as many people as possible involved in health and social care by giving them the freedom to drop in and out of patient and user involvement. However, the larger the LINK becomes, the more infrequently some of its members are involved, and the more difficult and unwieldy it becomes for it to decide on programmes of work and undertake a proactive role in monitoring services. Therefore, we believe that there needs to be a core group of dedicated members who have training, expenses and support to give leadership, drive and focus to the work of the LINK. Current members of patient forums are good candidates for such a role, but that is not being delivered by the legislation. At the moment, the Bill leaves such matters to chance. There will be some vague arrangement, whereby the host organisation and the LINK will somehow put such arrangements into place. In short, Parliament will vote a large sum of money to set up LINKs without knowing what we are getting in return—and that takes me to my third concern. It is still not clear how much influence the host is meant to have over the LINK—for example, in determining the governance arrangements—which leaves the way open for a possible conflict of interest. Our amendment No. 77 would ensure that the host organisation was not a provider of local services to be monitored by the LINK; otherwise a clear conflict of interest might arise, because the host organisation would on the one hand be providing a service for the local authority, while on the other hand it would be part of an organisation whose responsibility it was to monitor the effectiveness of that service—my hon. Friend the Member for North-East Bedfordshire (Alistair Burt) made a related point earlier. That would be nonsense, and the conflict of interest problem needs to be addressed. If the Government object to our amendment, it is for the Minister to explain exactly how they intend to require prospective host organisations to demonstrate an ability to manage such a conflict of interest. In Government amendments Nos. 42 to 52, the Minister introduces the concept of non-networked activities carried out by the host organisation and requires the host to report on them annually. Exactly what are non-networked activities? It is not clear in the measure. Are they activities relating to the formation of a LINK, and if so, will the Minister confirm at the Dispatch Box that they are the only activities that host will be able to undertake independently of the LINK? If not, we shall be creating much uncertainty. My fourth point is extremely important, and it relates to the right of LINKs to enter and inspect premises. The opinion of current forum members is particularly vexed on that subject; indeed, the Government agreed to include a limited power—to view premises—only after the Minister of State, Department of Health, the right hon. Member for Doncaster, Central (Ms Winterton) was ambushed at a meeting of irate volunteers last autumn, at which I was present. Where patient forums have been successful—for example, in putting the spotlight on cleanliness or the quality of hospital food—the power to enter and inspect premises has often been key. However, the Bill contains only a watered down version of that power—to enter and view. Our amendment would replace the word ““view”” with the word ““inspect””, because there is a fundamental difference between the two. In our book, ““to view”” means that one is simply collecting information, whereas ““to inspect”” suggests something more—that services are being monitored against set guidelines. The reason given in Committee for the Government’s opposition to our proposal was:"““LINKs members are not inspectors or regulators as covered by the inspectorate regime.””––[Official Report, Local Government and Public Involvement in Health Public Bill Committee, 6 March 2007; c. 545.]" A fair comment, one might think—but the Government’s approach completely misses the point. I ask the Minister to address this point: there is such a thing as lay inspection, influenced by patients, which is what patient forum members around the country have been doing. They are a critical friend rather than a formal regulator; they build up relationships with members of staff and the management, and their visits are more frequent and spontaneous than those of the Healthcare Commission. That approach has worked well, so it is a shame that the Government are blind to the excellent work of patient forum members in that respect.