Local Government and Public Involvement in Health Bill

I will introduce a very different note. I should first declare an interest. I am the chairman of a mental health trust in east London and my organisation would fall within the remit of a local involvement network. Nevertheless, I hope that my brief remarks will be constructive and will support the Minister in her deliberations about Part 14. In declaring my interest in this matter, I make very clear my strong commitment to service-user involvement in service provision. In mental health we have been working long and hard to involve our service users in a meaningful and fulfilling way. Indeed when I became chairman of the trust, one of my first actions was to create a service-user sub-committee of the trust board at the very highest level of the organisation. In that committee the various representatives of our many service-user forums across the trust come together with board directors to discuss policy and any issues of concern to those service-user representatives. In questioning the inclusion of LINks in this legislation for health services, I emphasise that I am an advocate of user and public involvement. However, I believe that Part 14 requires some more work before it is set is stone. The creation of LINks to ensure public involvement in the monitoring of social care facilities—the social care homes and nursing homes to which the noble Baroness, Lady Masham, referred—where such visits are lacking, may prove a helpful way forward. My concerns in relation to this are limited to the health services, and in particular the mental health services. Clause 225 places on the service providers a duty to allow entry by local involvement networks to, "““view and observe the carrying-on of activities on premises owned or controlled by the services-provider””," as mentioned by the noble Earl, Lord Howe. If LINks are to be established and have a right of entry to view the staff and patients on wards, I would strongly support the Government’s provision that some restrictions will need to be placed upon that right. However, I have an apparently controversial view within this House that there should not be another body whose members will visit hospital wards at this time before further detailed work is done; I strongly emphasise that work. By it, as I will say later on in relation to other clauses, what I mean is that these LINks should be piloted and evaluated, and we should be absolutely sure that they are effective and efficient and work to the benefit of patients and service users before we find these things being brought into play. Why do I take this view? We know that there are already inordinate numbers of bodies charged with visits to hospitals and hospital wards for one reason or another. The number 56 has been referred to in relation to the total number of bodies that come into health services for inspections and monitoring. I just want to mention five. The Mental Health Act Commission undertakes announced and unannounced visits to wards to inspect the operation of the Mental Health Act 1983. It checks on care and treatment of detained patients. When the commission has merged with the Healthcare Commission, I understand that its ward visits and interviews with patients will continue. The Healthcare Commission visits hospital wards, as other noble Lords have mentioned. Again, those visits can be announced or unannounced. Mental Health Act managers regularly visit wards. They are members of the public rather than NHS professionals. Apart from undertaking appeals at the request of patients, those managers are concerned about the standard and quality of care of patients and the individual patient’s experience of that care. Mental health review tribunal members have a right to see patients on the ward. The new boards of governors of foundation trusts also need to have access to wards and other facilities that are managed by the trust. Those bodies, like LINks, represent patients, service users, carers and the public. That is the nub of what I feel so strongly about. I will say more about these boards in relation to other clauses. The noble Baroness, Lady Neuberger, suggested—helpfully, I think—that a LINk member might joint a Healthcare Commission visit. However, the boards of governors will want to join those visits. There really is a duplication here in relation to the health sector but not, I fully accept, in relation to social services. Both sets of people—service users, carers and the public—will go around assuming that they are the key body that represents users, carers and the public; they will monitor services, feed back to providers, want their views to be taken seriously and so on. How will all that work? Unlike care homes, hospital wards are overwhelmed by visits from inspectors and monitoring bodies and governors add the all-important voice of service users and carers. If LINks also visit wards, they will risk duplicating precisely what governing bodies will be doing. The wards really cannot cope with that sort of duplication. Leaving inspection on one side, wards are under the most incredible pressures these days—greater pressures than they have ever experienced—because the in-patient population is ever more challenging: more and more patients are managed within the community even when they have very severe psychotic symptoms. Only the most ill and high-risk people ever get into a hospital ward these days. The value added of every inspection—every monitoring visit—should be carefully assessed to ensure that the benefit to patients and service users really does outweigh the distraction of staff from the job in hand and disruption to those very disturbed patients. I hope that the Minister will agree to commission work to analyse the many demands on hospital wards and how best to avoid duplication by LINks and boards of governors of foundation trusts in particular before pressing ahead with Clause 225.