Local Government and Public Involvement in Health Bill

My Lords, I cannot resist congratulating my two noble friends on their splendid and humane maiden speeches. It is because of my interest and involvement in health that I am speaking in this debate. The noble Lord, Lord Hunt of Kings Heath, at one time was the secretary of a community health council, and I was a member of one. This is going back many years, but I clearly remember that it was the members who were representing the county council who were not the best attenders at CHC activities. As county council members they had many meetings, and health did not seem to be their highest priority. When the health reforms were taking place and CHCs were being replaced by health forums, the noble Earl, Lord Howe, and I, among others, were keen to build on CHCs and make them better instead of having to disband them and set up forums in their place, which we thought would not be as independent. The noble Lord, Lord Hunt, spoke very much in favour of health forums so, with the help of the Commission for Patient and Public Involvement in Health, patient and public involvement forums were set up. CHCs, which had existed for 28 years, were abolished in December 2003 to make way for the new system of patient and public involvement, which includes the establishment of the PPI forums and other committees. The CPPIH then established 572 forums; one for every NHS hospital trust, primary healthcare trust, ambulance trust and mental health trust. It recruited approximately 5,000 volunteer members of the public to serve on them. PPI forums monitor and review services provided by the National Health Service and report on matters of public concern and make recommendations for improvements. During the past months, I have attended two meetings for members of patient forums from all parts of the country, which were chaired by Patrick Hall, Member of Parliament for Bedford. He also is a past member of a community health council, and he and I serve on the Associate Parliamentary Health Group. In all my years in your Lordships’ House, I have never witnessed such a disgruntled group of people who feel utterly let down as those forum members. I thought that Patrick Hall did very well to keep such a ferocious gathering under control but at the same time enabling them to voice their frustrations. He gave me permission to mention that. I can understand the feelings of the health forum members, who have had to cope with the changes in the primary healthcare trusts during their first three years. Now to be disbanded seems a waste of everyone’s time and training and taxpayers’ money. They have specific legal powers to inspect services, request information from NHS trusts and refer matters of concern to other appropriate bodies, particularly local authority overview and scrutiny committees. In March, the House of Commons Health Select Committee produced a report on patient and public involvement. The committee expressed serious doubts about the Government’s proposals. It said that the evidence points to developing the existing system rather than starting again. That is what some of us said about CHCs. The Department of Health’s proposals are vague and woolly, as has already been stated today. The committee was concerned about social care providers acting as hosts because of the risk of conflict of interest. Who will be the hosts? Where will they be housed? Lines of accountability are confused. Will trial LINks offer a better picture of how LINks will operate, or will they all be different? The lack of clarity about the role and structure of LINks is likely to create confusion and inactivity. The committee was not convinced that abolishing the CPPIH would release significantly more funding to the front line. LINks will be asked to carry out more work than PPI forums, with no guarantee that the necessary resources will be available. The Department of Health has recently responded to the Select Committee’s concerns, so I expect that the Minister will respond to them in his winding-up speech. I see the value of the NHS and social services working more closely together, but the NHS alone has so much for patient representatives to concern themselves with, such as: hospital bedside entertainment services; telephones; hospital food and feeding; the need for volunteers; dignity and privacy; mental health facilities; maternity services; the needs of disabled patients; hospital hygiene—the fear of catching a hospital infection is very much in patients’ minds when they have to go into hospital—haematology services; patient safety; out-of-hours cover and disabled equipment in the community. The list is very long and it goes on. What about prison health and aftercare? Is that something that LINks should get involved with? It is now part of the NHS. If the facilities provided by social services are added to the NHS, might not the LINks fall between the two? It concerns me that LINks members are not going to be able to inspect premises directly, as the noble Earl, Lord Howe, said. I will now relate something that happened a few years ago. Out of the blue, I received a letter from a lady in Leeds who was in a care home. She wrote that on paper there were trained staff, but very often there were not. She was in a room with an alcoholic. She had her letters censored, and when she wrote to me a friend had to smuggle the letters out. She was unhappy and wanted to change homes. I contacted someone who I knew on the area health authority who had contacts. Some time later, I received another letter from the lady. She had been moved to a home in Harrogate. The day she arrived was her birthday, and they gave her a cake. She wrote that the move was like leaving hell and arriving in heaven. After the ““Panorama”” programmes this year on care homes, surely there should be spot checks on the dignity and safety of residents. Without seeing what goes on first hand, how will LINks members be able to write realistic reports? For the Secretary of State to make regulations to require service providers to allow LINks to inspect and observe their premises and activities seems like a delaying tactic, and it is very bureaucratic. It seems wrong that patients at risk must rely on undercover members of the press to expose some of the bad things that can happen. The NHS is so important and so many people who have benefited from it are grateful, but many people worry that there is fragmentation and too much bureaucracy. They would like a clear, quick route to have complaints heard expeditiously. The public want a body that will support their requirements and aim towards excellence; but, above all, it should be independent and not dominated by management. Good communication and patient safety should be paramount if satisfaction is to be achieved. The Royal College of Nursing is particularly concerned about Part 14 and Clause 232, regarding the duty to consult users of health services. The college fears that the dilution of the language in this part of the Bill will lead to great confusion among professionals about when the duty to consult is or is not appropriate. The use of the words ““significant”” and ““substantial impact”” is meaningless to nurses and patients. How big is significant? How small is substantial? Who decides what is significant? As there is currently no clear definition of when consultation should be triggered, the RCN fears that judicial review may be required to achieve clarity for patients and nurses. My grandfather-in-law, the first Earl of Swinton, a very experienced politician and lawyer, who was in your Lordships' House when I came into it in 1970, told me that in legislation there should always be a clear definition. I end on a different topic, but one that I consider to be therapeutic and beneficial for the health and well-being of many people. I am a member of the All-Party Parliamentary Group for Gardening and Horticulture, and it has been suggested to me that there is a strong wish to extend the opening hours of garden centres on Sundays. I do not believe that it is possible to understate the benefits that garden centres, supporting this most popular and widespread of British pastimes, can offer. Sadly, the ability of tens of thousands of gardeners to shape their weekend gardening activities around their schedule is severely limited because all garden centres with more than280 square metres of covered selling space are limited to a mere six hours of continuous trading between10 am and 6 pm, as a result of the Sunday Trading Act 1994. In the peak of the planting season, they are denied any access to garden centres on Easter Sunday. This Bill presents a timely opportunity to move away from the current settlement of uniform Sunday trading hours imposed on large garden centres towards a model whereby decisions over opening times are devolved to local authorities. A far more fair and flexible settlement, which is relevant to local feeling regarding large garden centre trading, could be achieved by adding a resolution permitting large garden centres to open for longer hours than at present on Sundays and to allow opening on the peak demand of Easter Sunday, if, for example, the licensing committee rules in favour following a community consultation. This flexible approach is warranted because garden centres offer a much wider range of choice of service and public benefit than most other large retail leisure stores covered by the Sunday Trading Act restrictions, as they provide not only plants but facilities and free expert advice pertaining to garden design and may also very well showcase best practice techniques and exemplars that are free to public viewing. Thus an outing to a garden centre on a Sunday provides not only access to quality goods and services but offers a whole-person experience of time well spent, doing something enjoyable, healthy and creative. I put this suggestion forward for your Lordships’ consideration and look forward to the Minister’s reply, as I know that he is a very keen gardener.