Local Government and Public Involvement in Health Bill

I support very strongly the words of the noble Earl, Lord Howe. Since I think that we agree on everything, I just want to add a little more weight to what he has said. Perhaps it is good for the Minister to hear that, across the Cross Benches, the Conservative Benches, the Lib Dem Benches and some of the Labour Benches, we are united in some of our concerns about this part of the Bill. When we first saw the Bill, many of us were deeply concerned because we could not find any clarity in it; we could not work out what it really meant. However, as the weeks have passed, we have learnt more about, for instance, what the early adopters of the LINk model were doing. I was truly shocked that they were given a set of objectives that asked them to focus on particular aspects—this is from evidence that was given by Meredith Vivian to the Health Select Committee—without a clear list of duties. So much of it, in everything that we could find, was process driven. It was all about, "““how we can make sure we reach as many people as possible and are as engaged as possible with voluntary community sectors, how we can make sure that what we do is well-known in terms of communication and visibility””." But what the objectives are remains, to most of us, singularly unclear. It is not just me saying that. The Health Select Committee, in its report, said: "““The ‘early adopter’ projects appear less an objective trial than a discussion with stakeholders, and a key point—what can be expected from Hosts—is not being addressed””." It went on to recommend full trials of LINks to assess the practical requirements for running them. Indeed, it listed evidence from Elizabeth Manero of Health Link, suggesting that a model for LINks would be the best practices of the patient forums, where a core group will perhaps run the LINk, "““make decisions about the LINks activities, can sit in on trusts’ boards and meetings, and undertake surveys or visits. They produce reports and challenge trusts if they are unhappy with the response””." She added: "““They would also do everything they could to connect with local groups and find out a wider public view””." Her worry about LINks, as presently imagined, was that, "““the proposal is to have a very, very large, ‘perhaps thousands of people’, involved in the Health Service””." She continued that she was worried that this focused on a process rather than on refining an outcome. I already had real concerns about all this, as did many members of forums who have contacted me separately and together in the past few weeks. But my concerns have been strengthened considerably during the past week. The Minister kindly sent all of us involved in the Second Reading debate the drafts of two guidance documents for the establishment of LINks. The first was the model contract specification and the second was a document that sets out, "““what we expect an effective LINk would look like, based on what we have learned so far from the work of the Early Adopter Project sites, as well as from other networks in the community””." I am grateful to the Minister for sending us this material, but the second document made me almost lose the will to live. It is, indeed, all about process—what it will be like—including a rather offensive list of what it will not be like. The document states: "““A LINk is not … a group of volunteers who are solely responsible for inspecting NHS and social care premises and services … a method of performance managing health and social care services … a method of dealing with individual complaints about local care services … a network that duplicates other networks and initiatives””," and so on. That list is, rather, a suggestion that forums have not lived up to expectations and that they are somewhat like these theoretical groups that LINks are not to be. The real clue lies in the statement that the detail of the powers of LINks will be provided in the future regulations that the Government intend to consult on in the autumn. There is no clarity, just the suggestion that, "““LINks have a role in … promoting and supporting the involvement of people in the commissioning, provision and scrutiny of local health and social care services … obtaining the views of people about their need for, and experiences of, local health and social care services … enabling people to monitor and review the commissioning and provision of care services … making their views known to the people responsible for commissioning, providing, managing and scrutinising those services””." We are then told: "““This will be achieved by establishing a flexible framework, which can be tailored in each area””," according to local circumstances. There follows a series of diagrams from early adopters—Kensington and Chelsea, and Durham. While I could understand Kensington and Chelsea’s simple membership diagram and begin to comprehend its more complicated model of how it would work with no central hub membership, the Durham model left me wholly baffled. In each case, the text tells us that the models are under development. I am not surprised. This way of thinking is absurd. The first decision must be about the objectives, powers and duties of LINks. What are they to do? What must they do? What can they do? Only then should this discussion of process even begin. This has seemed to me to show that the Department of Health is more concerned with process in this area than outcome and is more concerned with breaking down the present structure of patient forums than developing them and creating a smooth transition into LINks. It is not concerned about creating a huge cadre of disaffected volunteers, who will look at all this and ask, quite sensibly, what it really means. For those reasons and many others, I strongly support this group of amendments.