Local Government and Public Involvement in Health Bill

This has been a thorough debate on some complex issues. I much admire the noble Earl’s struggle with language. Sometimes we seem to exist in a virtual universe when we consider the language of parliamentary draftsmen. That is not unique to this Bill, but it is, perhaps, perplexing here. The noble Earl also did the House a service by emphasising how important it was for the LINks networks to be as wide as possible. The examples he gave, not least regarding the relationships of black and ethnic minorities with mental health services, were absolutely right. All I would say is that that is precisely why we have not listed organisations in the Bill or defined the scope and extent of a LINk, simply because we have made it clear in everything that we have written and sent out that the test of a LINk will be how far it reaches into the community. I say to the noble Baroness, Lady Howarth, that I certainly did not mean to denigrate people who manage change and who have had successfully to manage a great deal of change in recent years. I understand why she pushed me on clarity and I will do my best to conceptualise this and to answer some of the question that arise. Amendment No. 238KC seeks to insert ““effectively”” in relation to the means by which LINks arrangements can be delivered. What we mean by ““effective”” is, essentially, that LINks will be organisations with sufficient scope, as I have said, to bring in the widest and most effective range of influences for different purposes. Those influences may be very specific to an interest group made up, for example, of people clustered around the independent living agenda. The influences may be broad in relation to changes proposed whereby this alliance, this network, will have a collective view of the impact it will have or some of the changes that it wants to see. Some of those changes may run across interests and conditions but will affect a particular age group, such as the elderly or the young. So there will be, I am afraid, infinite variety. It is that sort of inference. The test of effectiveness is that there will be governance arrangements which are clear about the relative role of the host. The LINk will take decisions on priorities and activities and the host will provide the necessary support for them to carry it out. In all the documentation we have put out, that distinction and the need to be clear about that is vital. There will be clear and responsible partnerships with stakeholders, such as overview and scrutiny committees. Local partnerships will establish the role in relation to commissioning, at what point the LINk organisation and in what form—a group, a small sub-committee—would have a role in looking at the commissioning of particular services, maybe specialist services. Those sorts of things can be determined as the structure evolves. There are clear accountabilities in the system. Local authorities have a duty to make arrangements to establish a LINk. The host will be accountable for the delivery of the contract and provide appropriate support, advice and infrastructure. The LINk is accountable to the community. It will reflect the range of organisations and interest groups which have an interest in the whole range of services and working with them to obtain the voices, it will determine priorities for work programmes in accordance with the issues which matter to local people. We sought at the outset to establish a means of informing ourselves and local authorities on what will work best, and that was the point of the earlier doctor schemes. They are not pilots; they are earlier doctor schemes, attempting to show how different models of activity may work, how people can be engaged in different ways, how LINks can be governed, and, in short how they can be as effective as possible. We have just completed nine regional events at which we asked all stakeholders interested in LINks for their views on how the arrangements should be set up. The responses indicate that people were really keen for options to be set out in guidance on how best to deliver LINks’ functions and structures, how best to engage, how to reach the seldom-heard groups, how to make model policies on areas such as codes of conduct. No one has asked for that to be put in legislation. They have asked for help and guidance on how to formulate it. It seems to me that that is the responsibility of Government. We have consulted many voluntary and community organisations and there is a huge range of experience among them for obtaining responses and voices. The model contract specification was drawn up with their input to make sure that it set out the key features, which may well have been things that LINks are not as well as things that LINks should be. On contracting, local authorities are very accustomed to contracting local service providers and performance-managing those contracts. We explored the great variety of innovative arrangements at an early stage of this Bill. Local authorities are increasingly confident about new types of arrangements. By giving them a clear duty to make the arrangements necessary to establish the support LINks, we have chosen the right organisation to fulfil the role. I return to the notion of effectiveness. No, I will not return to the notion of effectiveness; I shall go on with the logic of what I was saying. I turn to Amendments Nos. 238KG, KE and KG. They seek to articulate the notion of members of LINks. My noble friend asked how one obtains the views of people and I would say to him that there is a huge range of options. I take the point he is making. I am not sure that I agree with him but I listened hard to what he said. The point is that there is an enormous range of experience on how to obtain voices, not just through existing organisations, which are often membership-based and therefore have responsibility to reflect their members’ views, but also through the new range of technologies which make it very easy indeed—not least e-gov with its direct relationship with local government—for people to text or e-mail what they feel about things. So we have ways of doing this which we did not have before. The example given by the noble Lord, Lord Bruce-Lockhart, in relation to this was very interesting and I would like to think about what he said. This batch of amendments is generally about giving identity to LINKs; giving members individual or collective identity or responsibility. I come back to where I started on the previous amendment, to the need to allow for flexibility and self-design; the need people themselves to say that this is the sort of organisation they want and that it is what will work for them. Obviously there will be participants in LINks who want to take on a more active role than others, who want to form the steering committee, and they will be enabled to come forward. The host’s first task is to identify who in the local area is active, involved and committed and who among those committed organisations, as they come forward, might be willing to take on some of these responsibilities. It will be an open but negotiated process. We have not prescribed whether there should be a board or a steering committee but it is very unlikely that there would not be. In terms of membership, the noble Baroness, Lady Neuberger, asked why certain people could not be members. The involvement network has come up with some interesting ideas but it would be difficult to put classes of membership in the Bill. A company limited by guarantee or a charity could be members. There is nothing to stop it being a membership organisation but this should be for local people to decide. I know it is not easy. We are wrestling with a bit of a miasma but that is in the nature of what we are trying to achieve. The noble Baroness, Lady Masham, asked who the hosts are and what they do. Hosts are organisations made up of the same sort of people who supported the patients’ forums. They can be voluntary organisations or social enterprises. The acid test is: do they know the field? Will they be able to be inclusive, to know who is able to or wants to make a contribution? Are they organisations that understand health and care matters? They could be an organisation in the field or a care provider, or a voluntary organisation dealing with health. They could also be a citizens’ advice bureau. We will have to see what comes forward and what capacity they offer the local authority. This is the test the local authority will impose. Can they do what we want? Are they sufficiently familiar, confident, trustworthy, open and capable to host and provide the infrastructure for this new organisation? We have not said what organisations should come forward for that reason. What happens if they go bust? There will be a rigorous process in awarding a contract but if they go bust, it will have to be retendered. Let me say something about commissioning. PCTs and local authorities have a duty to seek the views of local people, especially in commissioning decisions. LINks will be an ideal resource for commissioners to enable easy access to people who are interested and knowledgeable about that process. I think we have a natural synergy there. I have dealt with the hosts; let me come back to the notion of people. We do not think it is right that people should be identified in the legislation as having specific power or responsibilities. The intention of the legislation is to define the LINk’s functions rather than how it should be managed or governed. As I have said, there will be different ways of doing that. Amendment No. 238KF seeks to require that the activity of a LINk to monitor and review the commissioning and provision of services is for the purpose of securing and maintaining improvements to those services. I think the purpose is a good one. I can see the argument but I want to take this away and think about it, because getting something in the Bill about securing and maintaining improvements could be helpful. I have to consider how it could be applied to all of LINks’ powers rather than just one so there will be some implications to be teased out. Amendment No. 238L seeks to ensure that the list of LINks’ activities given in Clause 222(2) includes that the LINks can make their reports and recommendations to the bodies responsible for services. As it is currently drafted, subsection (2)(d) states that LINks can make, "““reports and recommendations … to persons responsible for … services””." It is not necessary to amend that to read ““persons or bodies”” because, in the legal context, ““persons”” includes a body of persons and therefore applies to institutions that are responsible for services. The noble Earl asked whether LINks would be able to make reports—require responses, as it were—to the Healthcare Commission or CSCI. No; LINks will be able to make reports to regulators but they are not included in this list because they will not be under a duty to respond, as commissioners will be. There is a distinction. LINks reports are to be sent to local organisations that commission care services, not to national bodies, to emphasise the local LINk rather than the national commissioning body. I turn to Amendments Nos. 238KD and 238KH. I absolutely agree that it would be important for LINks to promote involvement opportunities to encompass the views of the entire population, as I said, including those who are hard to reach. The activities for a LINk listed under Clause 222(2) already include promoting people’s involvement and obtaining views. The most reassuring thing that I can say to noble Lords is that we will be setting out in guidance the importance of doing that and collecting best practice about how it is already done. I will have to write to noble Lords about Amendment No. 238LE; I do not have the answers to hand. Finally, the noble Earl, Lord Howe, asked whether LINks will be able to consider transport or access to services. Yes, LINks will be able to hear many views on matters relating to healthcare; it will not be confined to the delivery of health services per se. It will cover all the things that make a difference to the way in which people access and perceive their health services. I am sorry; I seem to have spoken for quite a long time. I hope that I have given some of the answers that noble Lords were looking for.