Local Government and Public Involvement in Health Bill

My Lords, this is an extremely complex and comprehensive Bill which no one could regard as offering light bedtime reading. Like other Members of the House, I shall concentrate solely on Part 14. Many years ago, under another Government, there was a body called the Health Education Council. That Government replaced it with the Health Education Authority and, in turn, replaced with the Health Policy Unit, which vanished without trace. In a debate in this House at the time, I coined a new acronym: RONS—a rose by any other name would smell as sweet. In Part 14 there is something of a powerful aura of the RONS syndrome. Like many other speakers in this debate, having spent my lifetime working in the National Health Service, I deeply regretted the disappearance of the community health councils and their replacement by forums. Of course, in the past few weeks, I recognise that grammar schools are no longer very popular with any of the political parties, but as a former grammar school boy of more than 70 years ago, I was taught to say ““fora””, but I know that that pass was sold a long time ago. In a debate about a month ago, when we were examining certain features of the National Health Service, I pointed out, as the noble Lord, Lord Hunt, knows well, that the report of the NHS Confederation had identified no fewer than 56 bodies and organisations that had the right to assess and comment on the behaviour and performance of NHS authorities. As implied by the noble Baroness, Lady Cumberlege, I suggested that the management of the NHS had become swamped by an intolerable quangocracy. It may be paradoxical, therefore, that I believe that the Commission for Patient and Public Involvement in Health is a quango that is well worth preserving. When the community health councils died and the commission was created, many of us were very concerned, but the commission and the forums now have a considerable record of achievement in the five years since they were created. Many key impacts have been introduced and achieved, despite their impending abolition, by the dedication and hard work of volunteer forum members who, as others have suggested, are becoming very disenchanted. In particular, a series of national campaigns supported by the Commission for Patient and Public Involvement in Health have brought issues of wide concern to public attention and, subsequently, have been taken up by the Department of Health and the Healthcare Commission. I need only draw the attention of the House to the outstanding report, produced by the commission, entitled Care Watch, an extremely valuable document, particularly at a time when another recent report has shown the great concern that we must all feel about the abuse of elderly people either in their own homes or in care homes throughout the country. It is of great importance. I firmly believe that it is vital to preserve a public mechanism whereby patients and public voices can be heard on health and social care, identified, as others have said, by the Wanless report and many others. Sharon Grant, the chairman of the Commission for Patient and Public Involvement in Health, has recently said publicly that the Bill represents a very significant step backwards in securing a proper voice for patients and citizens in the NHS. Having studied it carefully, I cannot but share that view. Like the right reverend Prelate the Bishop of Peterborough, I would much prefer to see evolution rather than revolution. The Bill abolishes the forums and recommends that the LINks—local involvement networks—under local authorities must be created by local authorities contracting with third parties to host each LINk. Which third parties will do that task? The Bill sets out the activities for LINks, their powers and rights, including placing limitations on the duty of service providers to allow them access to premises where services are provided. Unlike forums supported by CPPIH, LINks will have no formal national body to support them, and the Bill narrows the duties of NHS bodies to consult users by specifying that the relevant changes and decisions must be significant. The meaning of ““significant”” is defined only as being the manner in which services are delivered and the range of services being provided. In another place, significant concerns were raised on all sides about the abolition of forums, the lack of guidance and direction on how LINks will function, and the lack of any right for a LINk to do spot-check inspections. Concerns were also raised about the reduction in NHS bodies’ duties to consult. Having studied the Bill, I regard the terms of the LINks as set out in the Bill—their responsibilities, location and governance—as vague, imprecise and poorly defined. The history of structures being abolished in the NHS and the creation of new and untested institutions does not really breed public confidence. I strongly feel that patients’ forums should be developed, be more representative and be reduced in number by substantial mergers, with a revision of their roles so as to cover a wider range of activities, including social care. The Government have publicly gone on the record as saying that, in the near future, they propose to merge the Council for Social Care Inspection and the Healthcare Commission. That is another merger which is pending. Should they not see what effect that merger has before they go ahead in abolishing the CPPIH which has shown itself to have had a significant role in the past few years? The proposed network model would lack the means to hold the NHS to account and could result in established pressure groups having significantly more influence that those that are not organised. The sheer lack of clarity about the role of LINks and their structure will mean that they will have difficulty in deciding in what they are going to do and how to do it. As a result, they will lose the interest of the volunteers who, after this, they will have difficulty recruiting in any event. They will be expected to do significantly more than forums, without the same budget. Hence there is a serious risk that LINks are being set up to fail. The Health Committee in another place said that, in its opinion, the existing legislation on consultations should be made to work rather than the law being amended, as the Government propose. The noble Baroness, Lady Andrews, whose inability to speak on this we much regret, has been splendidly supported by her articulate locum tenens today with, I am sure, the admirable support of their minder, the noble Lord, Lord Hunt, on the Front Bench. But I believe that their views have been guided on this legislation and, I fear, misguided on this part of the Bill by their masters—perhaps their mistresses—in another place. This clause deserves serious consideration. To modify the present structure would be an infinitely better solution in the interests of the NHS and of the public at large.