Local Government and Public Involvement in Health Bill

My Lords, I count it a privilege to offer the congratulations of the House to the noble Baroness, Lady Campbell, on what I am sure all your Lordships will agree was a most impressive and powerful maiden speech. It was notable for its alliance of institutional analysis with a passionate concern for the spirit which should inform those institutions, a spirit which has informed the whole of what the noble Baroness has devoted her entire adult life to advancing. I am in a good position to know this as the noble Baroness and I go back quite a long way—nearly 25 years, in fact. The causes with which we have been identified have marched, to a fair extent, in step with one another. We began our association in the dying days of the GLC. There are not many people around who are prepared to admit to that these days. The noble Baroness and I fought a kind of last-ditch stand in support of the disability resource team, where we both worked. That was quite successful, although the same, alas, could not be said for every part of the GLC. We have both since been intimately involved, as the noble Baroness has said, in the campaign for anti-discrimination legislation and inclusive education for disabled people. We came together again somewhat later as DRC commissioners, promoting and monitoring the implementation of the anti-discrimination legislation for which we had both fought. The noble Baroness has also led in fields with which I have been less concerned. She mentioned direct payments and the new Commission for Equality and Human Rights. I would add the work she is currently leading on independent living for disabled people. Your Lordships should be in no doubt that we now have in our midst a big hitter, a mover and shaker of formidable talents, but one who is also subtle and persuasive. The record of her achievements attests to that. I am sure it will already have become obvious to your Lordships that we can look forward to benefiting greatly from the noble Baroness’s counsel and inspiration. Like the noble Baroness, I shall talk about Part 14 of the Bill, which concerns patient and public involvement in health. Although it takes up half the title, it is buried away somewhat obscurely in a Bill that is principally concerned with local government. Like the noble Baroness, I can see the attraction of the proposed local involvement networks in bringing together health and social care, but I have many more reservations about the process by which we got here and the amount of detail that still needs to be filled in before we can have confidence that we have a mechanism that is truly fit for purpose. I am reassured that noble Lords who have spoken have picked up some of the same imperfections. In truth, if we track back, the gestation of the networks presents a saga of false starts, U-turns and changes of mind that are not an object lesson in how to run a railroad. I will not try your Lordships’ patience with the gory details; suffice it to say that for much of the time it appears that the Government have simply been making it up as they went along. For instance, they wish to replace the four-year-old Commission for Patient and Public Involvement in Health and patients’ forums. Apparently, however, they have wanted to do so almost from the moment they set them up. At the same time as they were setting up these bodies, the Government were simultaneously planning to dismantle them. That is hardly a shining example of joined-up government. Indeed, I believe that the commission has already been abolished and given a further lease of life on no fewer than six occasions. Those who have been in your Lordships’ House longer than I have can therefore be forgiven if they have a sense of déjà vu. As for what is missing and still needs to be filled in, the Health Select Committee in another place described the proposed changes as ““vague and woolly””. So they are. The Bill is silent on the membership, structure and accountability of LINks or the infrastructure to underpin them. Indeed, the Minister sought to make a virtue of the lack of infrastructure, but I venture to think that your Lordships will find that less than convincing. Where the Bill is clearer, such as about plans to impose significant limitations on the rights of entry, the Government’s motives are opaque. Nevertheless, there seems to be a widespread consensus that improvements in patient and public involvement in health are possible. I welcome the Government’s obvious desire to secure such improvements and hope that the Bill can be made to serve as a vehicle for achieving that. However, there remain many doubts. The Government are seeking improvements by abolishing the one national supporting body for public involvement in health—the commission—just before setting up 150 new bodies—the LINks—which will all need resourcing over the recruitment and training of volunteers, and so on. They recognise that the LINks will want or need to set up their own national body to support them in due course. Is the Minister confident that a hiatus between the current regime and the next is really the best way forward, being, as it is, devoid of any transition arrangements or arrangements for training and the transfer of skills? I am afraid that the department’s assurances to the Select Committee that it was in discussion with the National Centre for Involvement, together with its reliance on publishing departmental guidance to LINks once the Bill is passed, give the impression of a measure brought forward before it is ripe. In any case, the National Centre for Involvement is not really the body to perform this role. It is rather an academic body, with only a fraction of the commission’s budget; it was set up to give policy advice to the NHS rather than provide hands-on support to local consultative forums. I share the enthusiasm of the noble Baroness, Lady Campbell, for a new culture of inclusion and look forward to seeing her taking a lead in its creation. She is right that LINks need to be open to the widest range of voices, yet the Bill is silent on the right to be consulted, which the forums have had. That is why I hope the Minister will be able to provide concrete detail on the department’s future plans and put such detail in the Bill. There is much expertise in this House which could be tapped to improve the Bill. However, if all the substance of the new system will emerge only in subsequent regulations and guidance, Parliament will not, despite the name of the Bill, have a proper involvement in shaping patient and public involvement in health.