Local Government and Public Involvement in Health Bill

My noble friend is quite wrong because sometimes I do not know what I am going to say. I am departing from my note here and I hope that my officials do not fall out of the Box in horror. I shall try to follow it as much as is appropriate. These are important amendments, but I think that reluctantly the noble Earl and I shall have to disagree about them. He is wrestling powerfully with the notion of a wraithlike creature here, but I know that as we go through the amendments, things will become clearer. I can see the thinking behind the noble Earl’s amendment in the context of governance and conflicts of interest, but the problem lies in the notion of imposing a structure on the LINk. No matter how tempting it is to lay down a set of critical elements of what should be in place, we remain sure that it is not appropriate in the context of what we are trying to create. It should not be for the Government or Parliament to take the responsibilities away in this area, or for any body other than a LINk to determine its governance arrangements. The noble Earl said that everyone would have to have some form of constitutional or elected office. There may be models which are co-operatives or where there is a slightly more fluid arrangement. The problem is that once we start prescribing governance models, we will get into the sort of detail from which it would be difficult to move. It would resemble the problems we had with the patients’ forums when their functions were set out in the detail of the legislation. Every LINk will need to address different factors depending on geography, demography and local healthcare arrangements. Given that, I am afraid that regulations could hinder these processes rather than help them. I know that this response will be disappointing to the noble Earl, so I should make it clear that I accept that the LINks will need support and guidance to enable them to come to decisions about issues such as governance and conflicts of interest. It is certainly our intention to make those resources available and to help them all we can. The nature of the negotiations that will go into settling the contract to agree the governance arrangements for LINks will have to ensure that no one single organisation can dominate. That will be part of the challenge of management, and it will be a challenge because the membership of the LINks will be wide-ranging. On the other hand, there is a strength in that. LINks will be able to accommodate special interests more readily than a patients’ forum, which had a much more limited membership. Further, it is true of any statutory institution that it has to be able to manage potential conflicts of interest by ensuring that interests are recorded in accordance with standards in public life as made clear in the Nolan principles. We will provide examples of best practice to support the LINks in that context. I know that my noble friend anticipated my response, and it is true that Amendment No. 238Q is not required. The local authority has no power to influence the activities of a host or a LINk other than through the terms of the contract. We will set out in guidance what is an appropriate role for the local authority and host, but the guidance will certainly not dictate governance arrangements, terms of reference, ways of working, priorities or programmes. The notion of independence will be very substantial and not at all wraithlike. It will be clear that the local authority cannot influence the arrangements, and the host organisation will be accountable to the local authority in terms of performance management as its contract manager for the support costs. The LINk will be accountable to the public to demonstrate the effective spend of its budget, for example. On Amendment No. 238S, I note with interest the desire of the noble Baroness, Lady Neuberger, to put into the statute that: "““A local involvement network shall have the power to direct the actions of H in pursuance of the arrangements under section 222(1)””." The first point to make clear is that the arrangements are of a contractual nature and will be made between the local authority and the host. Our expectation is that there will be dual accountability. It is interesting to consider the medical analogy here. The host can reject a parasite, and there is something of a duality here. On the one hand the host will be accountable to the local authority in terms of the delivery of the contract arrangements, while on the other hand it will be accountable to the LINk for delivering support. We are setting out our expectations in this respect in the model contract and supporting guidance. The noble Baroness has raised some interesting issues and I should like to think further about them. I am not saying that I will come back and subscribe to the scenario, but over the summer we will have an opportunity to consider some of the tensions and possibilities. With that, I hope she will not move her amendment.