Local Government and Public Involvement in Health Bill

Half an hour ago, the hon. Gentleman voted for an amendment to prevent ring-fencing, yet now he is trying to provide for a ring-fenced budget. My difficulty as Minister for Local Government, as, I suspect, for all my predecessors and successors, is that Members are happy to argue against ring-fencing in general but that we should have it in a particular case. At last year’s Local Government Association conference, the right hon. Member for Witney (Mr. Cameron) said that he would abolish all ring-fencing—I will believe that when I see it. The money is provided for the local authority. In the round, based on what we know, we believe that it is sufficient. The Government are not ring-fencing the money because we trust local authorities and believe that by not ring-fencing we will achieve better value for taxpayers’ money. I am in danger of repeating myself about conflicts of interest. Local authorities, like Governments, face the potential for conflict of interest across the piece. If we devolve more power to local councils, that increases the chances of a perception of conflict of interest. At the moment, the commission is, in effect, funded by the Government, yet its independence is not questioned. Indeed, that independence is one of the virtues that Opposition Members have cited in arguing for its retention. However, the same applies to what the hon. Member for Billericay said about local authorities. Any organisation that bids to be a host must demonstrate that it is best equipped to win the contract. That must include being able to declare its interests and manage any potential conflicts of interest. The host will be accountable to the LINK and required to follow its direction, irrespective of its own interests. The sort of organisations that we expect to become hosts deal with such issues all the time, as do local authorities. Many of the current providers of staff support to patients forums also provide health and social care services. We know that potential conflicts of interest do not mean that support is compromised in those cases. The quality of the performance is what counts. I accept as a debating point that there may be circumstances in which there appears to be a conflict of interest. However, in practice, one has to strike a sensible balance. There is a national body and centre of excellence to improve public and patient involvement. However, it will be open to LINKs, if they so choose—I imagine that they will—to create regional and, indeed, national bodies. Their virtue is that they will be bottom-up bodies that provide even greater independence to the national umbrella body. My hon. Friend the Member for Plymouth, Devonport (Alison Seabeck) was worried that people who live outside a local authority area cannot join a LINK. I know that she has taken up the cudgels on their behalf and met the relevant body. A LINK is established to consider all the services that are provided in its area. Those outside can join the neighbouring LINK. Provision will be supplemented by the many interested people in Plymouth who are not currently in the forum. We described the position as the Great Ormond Street problem, whereby services are provided outside the local authority area. Our proposals are an improvement on the current situation. My hon. Friends the Members for Pudsey (Mr. Truswell) and for Luton, North (Kelvin Hopkins) made important points, which were raised in Committee, about the word ““significant”” and the impact on public-private relations. A change in the service provider rather than in the service provided—for example, the contract to run a GP’s surgery changing from one provider to another—would not significantly change the service. Another example of that is dealing with overcapacity, whereby—taking account of peaks and troughs—five beds are removed from a 10-bed ward in which only five are ever used. My hon. Friend the Member for Luton, North is therefore right that the definition of ““significant”” is important. However, amendment is unnecessary. Significant changes include changes in: patients’ convenience; availability and quality of service; and geography, thereby affecting travel arrangements, and possible eligibility. Statutory guidance, which has the power of statute, will be issued after we have consulted on the changes.