Local Government and Public Involvement in Health Bill

moved Amendment No. 242C: 242C: Clause 232, page 162, line 37, leave out ““significant”” The noble Earl said: I will also speak Amendment No. 242D. The amendment poses what I consider to be an extremely difficult set of questions. I would like, first, to direct to the Minister’s attention to the regulations made under Section 7 of the Health and Social Care Act 2001. These refer to when an NHS body is thinking about a substantial development of local health services or a substantial variation in the provision of a service, and provides that it must in those circumstances consult the overview and scrutiny committee of a local authority. Specifically, it says that: "““Where a local NHS body has under consideration any proposal for a substantial development of the health service in the area off a local authority, or for a substantial variation in the provision of such service, it shall consult the overview and scrutiny committee of that authority””." Let us take an example. There is, let us imagine, a proposal to develop renal services in a local authority area. Even if the proposal is not substantial or significant, under new Section 1B(a) of the Bill, planning to address it will still require consultation with patients. If it leads to proposals that are significant—that is, having a substantial impact on delivery of services—it will require consultation under new Section 1B(b). If it starts to involve a substantial development or substantial variation, it will require public consultation with the overview and scrutiny committee under Section 7 of the Health and Social Care Act. The first question is: at what point during the consideration of this proposal on renal services does Section 7 kick in? The answer has to be: as soon as it is understood that the proposal is for a substantial development or variation in the provision of a service. But what does that mean? In the context of Section 7 of the Health and Social Care Act, case law has helped to define what is meant by ““substantial”” variation and development. On the one hand, there is case law, and on the other, with the passing of this Bill, there will be statute law. As a result, we potentially have two different definitions to wrestle with: ““substantial”” as understood in the light of existing case law; and ““significant”” contained in Clause 232. We could, therefore, have a situation where it is considered that a change proposal or an operational decision is not going to have substantial impact on the delivery of services, but where nevertheless two apparently competing definitions come into play. One may dictate, under new Section 1B(b) and (c) that consultation with patients is not required and the other may dictate that consultation with the overview and scrutiny committee is required. At the very least, the situation is fiendishly complicated. It will lead to all sorts of confusion in the NHS and among LINks members—confusion which is likely only to be settled by a court of law. I really would like the Minister to explain how she envisages all that working. Setting that confusion to one side for the moment, what is wrong with the insertion of ““significant””? In brief, it is that it will constrain dialogue between the health service and local communities in an unhelpful way. We surely want a grown-up relationship between both parties. We want mutual understanding and the kind of embedded public involvement recommended in the report of the Bristol inquiry. The insertion of ““significant”” is detrimental to that. On Amendment No. 242D, there may be an argument for excluding operational decisions that are not significant. However, I have to ask the Minister where the evidence is that this has been a problem in the four or five years since the Health and Social Care Act came into force. I am not aware that it has been a problem; on the contrary, it seems likely that a better understanding of the operational difficulties of the NHS would make public expectations more realistic. In the absence of such evidence, it would seem foolish to dispense with the only means that the NHS and the public have to sit down together and solve the problems of the NHS in a grown-up way. Constraining that dialogue stifles the sort of relationship that I have just referred to and is counterproductive. I beg to move.