Local Government and Public Involvement in Health Bill

moved Amendment No. 238KC: 238KC: Clause 222, page 154, line 30, after ““on”” insert ““effectively”” The noble Earl said: I shall speak also to Amendments Nos. 238KDA, 238KF, 238KH, 238L and 238LE. One thing that makes people like me suspicious about what is to emerge from the Bill is the phraseology of Clause 222(2). To put it at its simplest, the activities that are described in the subsection are all about process; they are not about outcomes. That pertinent point was raised earlier by the noble Baroness, Lady Neuberger. It is as if all that matters is that someone observes the carrying on of health and social care commissioning and provision and obtains people’s views. What is the point of that activity? The point is to improve the quality of local services. Why do we not say that that is what LINks are there to do? Equally, why do we not say, in terms, that it is not enough for the contract with the host to specify that the activities mentioned are carried on; the contract needs to have as its aim that those activities should be undertaken effectively. There is a very sterile and neutral feel about the wording in this part of the clause. Surprisingly, there is not even any mention of one of the main aims of patient and public involvement, which is to try to promote the interests of those people in the community whose voice is less often heard, or who, for one reason or another, are the victims of health inequalities. A good LINk will tackle social exclusion head-on and try to remedy it. Perhaps I can illustrate that idea briefly. The Minister will be well aware that life expectancy varies depending on the area of the country where one lives, Manchester being the worst area for both men and women. If those with the shortest life expectancy do not have equal influence on services, the potential of those services to deal with these issues will be lost. A good example might be stop-smoking services, which need to be offered at the times of day and in the locations when those of working age in manual groups, which have higher rates of smoking, may access them easily. If they are involved in the design of services, those kinds of issues could be raised. Similarly, smoking in pregnancy is more than four times higher in social class 5 than in social class 1. The involvement of women from deprived areas in designing antenatal services could improve the success of those services. We know that the rate of perinatal mortality is twice as high among mothers living in the most deprived areas. It is essential for these groups to be involved in services so that they are designed effectively. There are any number of other examples, not least—it is fresh in my mind—the need to involve black and ethnic-minority patients in the design of psychiatric services. I hope the Minister will accept that that is a real issue. If LINks are able to make reports and recommendations to those with the appropriate power to change things in the health service or social care, then there should not be an artificial restriction on to whom they can report. The wording does not make it entirely clear and I would be grateful if the Minister could confirm that the persons responsible for commissioning, providing, managing or scrutinising local care services could include, for example, the Healthcare Commission and CSCI. What are we to understand by the definition of ““care services”” in Clause 222(5)? We see here that, "““‘care services’ means—""(a) services provided as part of the health service in England””." That might seem perfectly all right until we remember that not everything that a patients’ forum is currently able to report on relates to health services as commonly understood. For example, concerns may be expressed about car-parking charges, waiting areas for hospital visitors or transport arrangements. These are matters that contribute to the patient experience in the broad sense but they are not directly to do with care. Can the Minister confirm that such matters will not be excluded from the purview of LINks? I beg to move.