Local Government and Public Involvement in Health Bill

My Lords, as a regular wearer of purple, I hesitate to speak after the remarks of the noble Baroness, Lady Hamwee. However, I am grateful to her for reminding me of our time together in Mortlake, where we developed a model of partnership between church and local government whose fruits are still evident within that community. The histories of the structure of local government and the church in this country have long been intertwined, and not just by nomenclature. The boundaries of parishes in both church and local government are still coterminous in many rural areas. All of us grapple with the connotation of the word ““local””. What is ““local”” in our modern society? Tempting though it is to draw parallels between the changes in local government proposed in this Bill and the changes going on in the church, I will leave comment on that part of the Bill to others. I, too, want to concentrate on Part 14. I do so because of not just my experience of being a patient and a member of the public, but my contact with the work of the patient and public involvement forums and the work of our local primary care trust and the foundation hospital trust in Peterborough. Indeed, this is an area in which I should probably declare a conjugal interest, as my wife has almost made a second career of involvement with the NHS as, successively, a member of a medical ethics committee, a non-executive director of an area health authority in East Sussex, then of North Peterborough PCT, and now a non-executive member of the board of the new Peterborough Primary Care Trust. In 2004, as North and South Peterborough PCTs in partnership, that was the first PCT to develop a full partnership agreement and pooled budget with the local authority’s adult social care service. It recently negotiated a memorandum of understanding with its children’s services. That is a model of partnership before LINks existed and certainly before the Bill was published. It suggests that we do not necessarily need a radical change of structure in order to achieve the outcomes of the Bill. Everyone must recognise the importance of the accountability of those who provide public service. That was reflected in the Department of Health’s document A Stronger Local Voice, to which noble Lords have referred. The Health Select Committee’s report suggests that there is some ambiguity about the nature of the accountability. It asked whether it is that of a service provider that responds to what people want, the mutual accountability of a partnership or the democratic process of public scrutiny. Speaking as a representative patient, I want the processes of accountability to foster, if not absolutely guarantee, better provision for the health of the whole community—my neighbour’s health as well as mine. I also want them to influence the policy decisions that inevitably affect the provision of healthcare. We hear a lot about patient choice, but administrators and medical staff increasingly face difficult choices in the allocation of precious resources. They do so in the context of a society that wants the latest developments in healthcare to be universally available without always being prepared to spend the extra finance required to bring that into effect. The inevitable result is that there are difficult choices to be addressed about policy and the allocation of finance. Public involvement in health must not only provide feedback, but also create greater understanding of and involvement with the hard choices faced by every doctor, PCT and hospital trust operating with a finite budget. It is against our understanding of accountability that the proposals of the Bill must be judged. I therefore find myself asking whether the provisions of the Bill will provide better feedback and the greater involvement of the public in the policies that inevitably affect patient choice. I agree with many of the comments made by the noble Lord, Lord Low, and the noble Baroness, Lady Cumberlege. Given the notorious attitudes of some of my predecessors in previous centuries, it is perhaps rash of me to advance the notion that evolution is better than revolution, but I think that it is true in this context. We are presented with the third system of patient and public involvement in fewer than 10 years. As noble Lords know, until the turn of the century, community health councils provided the mainstay of such involvement, but since 2001 we have seen their replacement with patient and public involvement forums supported by the Commission for Patient and Public Involvement in Health. We have also seen the extension of the remit of overview and scrutiny committees to include healthcare, and we now have the proposals in the Bill to replace that system with local involvement networks. I do not think that the Commission for Patient and Public Involvement in Health is alone in thinking that the objectives for increased scope for individuals to be involved in aspects of healthcare, "““could be achieved by amending the existing legislation surrounding PPI Forums rather than legislating for a completely different system””." The present arrangements have not had time to bed down before we are faced with a revolution and a new system. I would prefer to see evolution rather than revolution. In the consultation process, following the publication of A Stronger Local Voice my PCT expressed its concern in five areas. I hope that the Minister can give it and me reassurance about these matters. First, the forums have both statutory responsibilities and statutory powers supported by a national body. Will the duty on local authorities to establish local involvement networks be equally or more effective in granting these powers and fulfilling these responsibilities? Secondly, unless these powers are granted, will the local networks attract the quality of volunteers who, as the noble Baroness, Lady Cumberlege, reminded us, are able and willing to make a significant difference? The forums’ role and structure were clearly defined and attracted members whose experience and knowledge have grown since they joined. As my PCT said, it seems wasteful and counterproductive to start again with a new organisation, with loose and ill defined terms of reference and without the clout to attract and motivate volunteers. Thirdly, at present the fora set their own agendas, without political or commercial interference. Will the networks be equally independent and free of the risk of undue influence from groups of individuals with a particular agenda of their own? Fourthly, will not the reliance on funding from the local authority rather than independent sources put adequate financial support at risk from political or commercial pressure? Finally, in the light of the Minister’s opening remarks, I should value confirmation that the networks will have the key powers of access and response to inquiries to enable them to be as effective as the present arrangements are in monitoring services and processes within health and care organisations. I recognise that the basic principles of this Bill are unlikely to change, but I hope that we will be able to amend it in Committee. The Minister said in her introduction that the Bill is essentially pragmatic, but I fear that I am yet to be persuaded of the advisability or necessity of the wholesale changes to the existing provision proposed in Part 14. As patients, we need reassurance that the proposed system will provide a better service, with a stronger local voice, as the Government desire. I hope, therefore, that the concerns that my PCT has aired can be allayed in your Lordships’ ongoing consideration of the Bill.