Local Government and Public Involvement in Health Bill

I too have a massive speaking note, which I shall discard and try to address as quickly as possible the significant points that have been raised. I start with the case made by the noble Baroness, Lady Meacher. I know she thinks that LINks are unnecessary and will duplicate the work of foundation trust boards. They are not unnecessary, for all the reasons I have given in the course of the debate today. They will not overlap with the foundation trust boards, which are doing something very different. They are institution-based, while LINks are area-based and cover social care and healthcare. LINks will include organisations that might have an almost marginal attachment to health, and yet whose members will be affected by health provision. The bodies will do different things in different ways. Although I understand the noble Baroness’s anxiety, she should not worry about it in the way she is. I repeat what I said earlier: the business of conversions, co-option and co-operation will be the way forward. We are talking about new animals. I remember, when we were debating the passage of the National Health Service reorganisation Bill, we discussed in great detail who would constitute the boards and what they would do. Now here we are, worrying about whether they will overlap with an organisation that is fundamentally different. No doubt we will come back to some of this on Report, but I hope that in the mean time the noble Baroness and I can talk some more about it privately. The noble Earl, Lord Howe, asked why we need something separate; why we cannot just evolve a system. He also asked key questions about the transition. The reason we need something new in legislation is simply because LINks are different from PCTs. A patients’ forum was established for every trust, while LINks will cover an area. Forums are generally small organisations of seven or eight members, while there is much greater scope for LINks and a different governance arrangement. Forums have been established for NHS institutions, while LINks will look at both healthcare and social care. We have not spoken today about just how significant a change that is, and how maddening and frustrating it has been over the years that healthcare and social care have been separate, with all the disability that that has built into the system. LINks will support capacity in the local and voluntary sectors in different ways and will tap into the excellent work and experience that already exists. For all those reasons this is a fresh start. We want a transition that is as smooth and easy as possible. I take the noble Baroness’s point that people have made a commitment, and once you lose your purpose as a volunteer it is easy never to return. It is very difficult to recapture that enthusiasm, and local authorities must think about that as they move into contracting organisations, since those are the people who will deliver for them. When I spoke about a small gap, I was trying to be as honest and realistic with noble Lords as possible, maybe to take them into my confidence. We could not realistically expect to establish new bodies without some sort of changeover, and it was better to admit the possibility that not every LINk would be up and running in March next year rather than to be overconfident. We must be careful. We are trying to learn from experience. As for how small is a small gap, it is difficult to quantify. There were two reasons why we have had to move in this way. I will not go through the clause stand part but will move instead to the substance of the amendment. We have been in this situation since 2004. There has been a great deal of uncertainty and anxiety. We have not exactly rushed into this but there has been a build-up of anxiety, which we need to address and resolve. For the past two years, forum members have said to us, ““Whatever you decide, decide quickly because we need to move on””. That is an important point. We are creating a new system with a fresh start—a step change. What will we do to achieve a smooth transition? I will not go through all the detail but it includes everything that we set out in the letter to noble Lords. We knew that the timing would be contentious so we put activity in place early on to inform and mobilise people. Local authorities need to be thinking about hosts. Three-quarters of them already have someone in place whose responsibility it is to identify the host. We have put a raft of activities in place to inform stakeholders; we have been holding regional events over the past couple of months with key stakeholders and there is the work of the early adopter projects. Many local authorities are starting work to warm up the potential host market and will report back to us. Many are planning to run events as well as mapping local activity and bringing together local partners, but the crucial thing is to have the host in place. There is considerable interest from organisations that would like to do that and we will shortly be providing them with model contracts. Local authorities will be under a statutory duty to make contractual arrangements. We are soon to write to all local authorities attaching the model specification. After that, the documentation will make it clear that local authorities can carry out activity now to kick-start the arrangements. Activities include identifying lead personnel; identifying prospective host organisations; raising awareness among potential hosts; telling the media what LINks will do; trying to suss out who might be interested in being a host; putting in place a draft timetable and project plan; keeping track of the progress of the Bill; bringing stakeholders together; and mapping who will be involved. Local authorities will be encouraged to get together with neighbouring authorities to talk about jointly procuring a host organisation to support more than one LINk, for example. I have spoken about the regional rotas. There is a monthly newsletter. We are working with the Centre for Public Scrutiny, the Healthcare Commission, CSCI, the care services improvement partnerships, the NHS National Centre for Involvement, and so on. Procurement work starts in August. Some local authorities have already done this, giving them time to have in place contracts with hosts prior to the closure of forums. There is much to be done. There is also anxiety and uncertainty, and it is our job to build confidence and overcome that. It is a major change, which is why we are working across the field. On Amendment No. 252A, of course I understand why noble Lords are anxious about this issue, and I applaud them for it. We intend to commence the legislation in such a way as to support a straightforward move into LINks. If the amendment were accepted, however, all patient forums, as well as the Commission for Patient and Public Involvement in Health, would remain in place until every local authority had made contractual arrangements for LINk activities. If even one local authority was slow to establish a LINk for its area, every other area would have to run two systems in parallel. That would be very impractical; the same people would be involved and it would be very expensive to scrutinise the same services. It does not make sense. Over the next two or three months, the picture will become much clearer. When we come back on Report, there will be more clarity and visibility about the progress that has been made.