Local Government and Public Involvement in Health Bill

My Lords, I, too, congratulate the noble Baroness, Lady Campbell of Surbiton, on a very courageous speech, and I look forward very much to the speech of the noble Lord, Lord Mawson, of Bromley-by-Bow, whose centre is a national inspiration which is led by an inspired leader. Like many parliamentarians I started my public life in local government. At the age of 22, I stood for election to the Chailey rural district council. The previous election had been fought the year before I was born. In my part of Sussex, democracy was somewhat suspect. My first election was splendid: four candidates for two seats and I topped the poll. I topped the poll because my father, the local family doctor, was hugely respected and loved. Knocking on the door of one elderly tenant, I was told that she and her sister might vote for me, although I was very young, because I had ““the doctor's eyes””. If democracy was suspect, party politics certainly were. I quickly became a local government addict and served on the county, district and parish councils all at the same time. It was rewarding, not financially because our only claim on the public purse was for travel, but we took pride in our communities and knew them inside out. We shaped them. We bought land, built houses and allocated them. We were responsible for huge tracts of public land such as Ashdown Forest. We regenerated run-down areas and the port of Newhaven, and we did so much more. We had the freedom to do such a lot, and without a doubt we improved the lives of our electorate. So I very much welcome any measures in this Bill that give more autonomy to local people and reject those that do not. In 1982 I was appointed to chair the Brighton health authority by the then Secretary of State, my noble friend Lord Fowler. He is now my friend but at the time I had not even met him. It was he who introduced me, or rather seduced me, into the management of the National Health Service. Rather than draw on very outdated knowledge of local government, I reserve my comments for Part 14—the section on patient and public involvement in health. Regarding the NHS, the Government have had an insatiable and unhealthy appetite for destruction—a sort of Maoist tendency for constant revolution. The noble Lord, Lord Hunt of Kings Heath, will remember our splendid battles in this Chamber to retain the much loved community health councils. But they had to go and be replaced by health forums. The Government argued that CHCs were variable and ineffective. That is a fallacious argument when primary care trusts are variable, hospitals are variable, schools are variable and human nature is variable. But the Government decided that CHCs had to go. The resilience of the British people has to be admired. Despite being roundly snubbed some CHC members did not give up and volunteered to join the new forums. Altogether around 5,000 volunteer forum members were recruited. But these dedicated men and women, who are prepared to do so much for their local communities, just four years later are to be snubbed yet again, and sacked. We do not know whether the new system of links introduced in the Bill will work, but I am very encouraged by the noble Baroness, Lady Campbell of Surbiton, who was an architect of this new idea. However, I am sure that if we are to avoid constant revolution, and if another cohort of willing volunteers are not to be swept away yet again, we, the legislators, must be brave enough to allow for flexibility and not be tempted to impose rigid structures. Only then will these new links be able to keep pace with the changes in our institutions, which in turn should reflect the changes in society. I welcome the philosophy which underlies the establishment of links—the return to closer community involvement, the responsiveness required at local level, the devolved budget and the one-stop shop which serves a whole community. In fact there is a very strong resemblance to community health councils, which had and did all these things. The tragedy is that instead of exercising a little humility and working with CHCs to modify and resource them appropriately, the Government swept them away and replaced them with another untried, ill considered plan—health forums; this at the same time the Government were establishing foundation trusts, each with their own governors and members—all volunteers tasked with representing their communities’ views. The master plan is to make every hospital, every mental health trust, every primary care trust, every community, every combined acute-and-community, every ambulance and learning disability trust, into a foundation trust—a total of 425 in all. Each and every one of them is to have its own legion of volunteer members, as many as they can recruit, to feed in the community’s views. For instance,St Thomas’, a first wave foundation trust, has proudly recruited 6,000 members from its patients and local boroughs. It is to be congratulated on that, but it has taken a great deal of time and financial cost. In addition, local authorities will have their own citizens’ panels or similar organisations that need to recruit volunteers for public involvement. If your Lordships have not already been recruited, you soon will be. We will need all hands to the pump. No one will be spared. Every person in this country will be needed to feed the great machine of patient and public involvement. The cry has gone up that patients and public must be involved at every step of the way, regardless of whether those seeking our views are prepared to give time to listen, to take them seriously, or to act on our suggestions. We know that too often decisions have been taken long before our views have even been sought. I believe in the wisdom of the crowd and in getting the views of people. I believe in listening to the public. I can think of countless examples where that has happened and far better and more appropriate services have resulted. Quite simple requests from those who use public services, when acceded to, can radically change the patient experience; but if patient and public involvement is to make sense and if the new proposals are really going to influence the delivery of services, they must be carefully thought through. One of the strengths of the new system is its integration with local government. They will hold the contracts for the hosts for the LINks. However, what is not clear is where the accountability lies. The Health Select Committee expressed concern that if a LINk is failing, since the host has no power to change the LINk and the local authority would only be able to hold the host to account, who would take the necessary action, and how? If LINks are to be taken seriously, they need to be involved very early on in the planning and commissioning of services, long before ideas have crystallised. If that happens and they are seen as an essential part of the team, I can see them being a catalyst to get the right people into the same room. When a PCT and a council are beginning to think about their commissioning plans for the following year, they should ensure that the LINk members are there to feed in their local knowledge and experience. They are there to knock heads together and to ensure joint commissioning between health and local government. I want to see them encouraging new and better practices, to extend the good things and to stop the bad things from happening. I want to see them not only exercising intellectual leadership in contracting, but being practical in resolving real issues. For instance, more than 12 years ago this House was concerned about mixed-sex wards. I remember it well; I was in the firing line. That is a real issue which troubles the public and which flies in the face of dignity and respect when people are at their most vulnerable. I am told that nurses do not like single-sex wards. Nurses will tell you that an all-women ward is miserable, but put a man in there and women behave differently. I do not know whether that is true, but the public tell us that they want single-sex wards. That has been government policy for the past 10 years, but we still have mixed-sex wards. Perhaps the Minister could tell me how LINks would resolve such an issue. The Health Select Committee had a number of reservations about the Bill. The RCN and the Commission for Patient and Public Involvement in Health have also expressed disquiet on a range of issues, as has Health Link, which carried out a remarkable survey on patient and public involvement. Their concerns centre around, among other things, conflicts of interest, the restrictions on visiting, maintaining independence, clear and coherent governance, sufficient resources, clarity on the words ““significant”” and ““substantial”” in the Bill, the absence of a national body to relate to other national bodies, such as Monitor, and so on. All those aspects will no doubt be teased out and tested during the passage of the Bill. In conclusion, although I think that there is merit in these proposals, they need what this House is so good at: a bit of amendment, a bit of refining and careful thought so that we are not faced with another period of disillusionment as thousands of committed and willing volunteers are rejected and dismissed as being unwanted, unimportant and unloved. They have wisdom, knowledge and experience which can greatly enhance the quality and type of public services if they are given the opportunity, freed from endless upheavals, and are simply allowed to get on with the job.