Local Government and Public Involvement in Health Bill

moved Amendment No. 238KBA: 238KBA: Clause 222, page 154, line 29, leave out from beginning to ““specified”” and insert ““, establishing and supporting Local Involvement Networks to perform the functions”” The noble Earl said: I shall speak also to Amendments Nos. 238KBB, 238KCA and 238LF.The Minister may be glad to have reached Part 14 of the Bill, if only because the end of her marathon stint in Committee is in sight. I would also not be surprised if she were to view the change of subject matter as a welcome shift of focus. From these Benches, we look forward to a constructive debate on patient and public involvement, although these matters arouse considerable concerns and difficulties in the minds of many of us. I am sure that she will, in her customarily helpful way, do her best to try to reassure us, but I suspect that in some cases that will not be easy or straightforward. I start with a group of amendments designed to pose a simple question. The Minister will know from our debate at Second Reading that, in the eyes of many of us, the over-riding defect of this part of the Bill is that it appears to have been put together by a cryptologist. From reading it, it is impossible to decipher what on Earth it all means. The Minister clearly knows what it means and we may think we know as a result of all the background material and Explanatory Notes. As a starting point, it is worth asking this very simple question: should not part of the aim of all legislation, including this Bill, be to be comprehensible in its own right? We understand that, arising from the Bill, there will be new bodies called local involvement networks or LINks. It is understood that the function of LINks will be analogous to that of patient forums, except that the LINks will extend to social care. Certain members of LINks will be authorised to perform certain functions. While the exact form and membership of LINks will be up to local determination and, therefore, are not to be laid down in the Bill, we can safely say that LINks will, at least, have members. But when we read the Bill, what do we find? We find that we are led around in a kind of dance, the aim of which is to go to fantastic lengths to avoid making any sort of descriptive reference to local involvement networks, to avoid any mention of their functions or powers and to omit all reference whatever to the fact that they are supposed to have members. Instead, in Clause 222 we have ““arrangements””, along with ““activities””. We do not have members of LINks; we have people. LINks are not even given any powers. The powers of LINks are only visible, as it were, in the mirror because they take the form of other people having duties in relation to LINks. Indeed, LINks are not bodies at all. The only clue as to what a LINk is comes in Clause 223(2), where we are told: "““In this section, a reference to a ‘local involvement network’ is to a person””." That reference to a person is the nearest we ever get to a definition of a LINk in the Bill. But who on Earth refers to a network as a person? A ““person”” is not a word that makes any sense in this context at all; it may make sense to a lawyer, but who in the ordinary world can understand it? I do not think that any of this language is helpful. I ask the Minister why we have this rigmarole. Why can we not have, as the amendments propose, a definition of a LINk, however loose, on the face of the Bill, together with clear statements about its functions? There is a serious point here about accountability. Many of us will have seen the press report last week telling us that the Government intend to reduce the number of central targets for the health service and to make local bodies responsible for setting their own targets. That is fine, but what follows is more local accountability, and patient and public involvement in the planning and delivery of healthcare is a terribly important part of what we mean by local accountability. What are the mechanisms for delivering it? As far as I can make out, it is not even going to be a contract. The arrangements referred to in Clause 222 are arrangements not with a LINk but with somebody else—namely, a host organisation. If the mechanisms for delivering patient and public involvement do not include having independent statutory bodies with defined functions, and if LINks themselves are not subject to a contract, how can we truly say that we are setting up a system that delivers robust local accountability? I believe that it is very difficult. In her letter of 9 July, the Minister confirmed that we cannot prejudge what LINks will look like. As with a creature from Lewis Carroll, we may know a LINk when we see it, but we cannot, for the moment, define one. Whatever LINks seem to be, we see from the Bill that they will not have functions. If we cannot define a LINk and it does not have functions, the obvious questions arise. How will it be able to enforce its rights in law and, from the opposite perspective, how will people be able to enforce a complaint against a LINk about what it is or is not doing, and on what legal basis? I do not know whether the Minister can give us any satisfactory answers to all that. The point is not just that the Bill is vague but that it does not appear to deliver a sound basis for what most of us think patient and public involvement should truly be. I beg to move.