Local Government and Public Involvement in Health Bill

Amendment No. 242G seeks to make it explicit that the duty on PCTs to report on consultation should relate specifically to consultation with the public. I shall deal with that first. I can see that this amendment is a genuine attempt to clarify the position. However, it inadvertently narrows what the Bill provides. Our intention is that consultation should relate to consultation of the public but it also relates to other groups, including stakeholders and staff. I do not see the need to prescribe so explicitly that it should be public consultation and I therefore hope that the amendment will not be pressed. I shall offer some words of explanation about Amendments Nos. 242H and 242J. As Clause 233 (3) makes clear, we wish to provide PCTs with some explicit requirements about matters relating to the new duty to report on consultation. The noble Earl asked about direction-making powers. The direction-making power that is identified in the amendment enables the Secretary of State to set out what kind of commissioning decisions are appropriate for the report. That is a question of reporting rather than what constitutes a commissioning decision. In every year a PCT will make hundreds of commissioning decisions about local services. We clearly do not want to create a duty that places by default such a heavy burden of reporting that it prevents a PCT doing its job effectively. However, we want to ensure that key decisions about, for example, the prioritisation of resources across the whole population of a PCT area, or how services per se are configured in the area, certainly should be reported upon. We think that directions are the right vehicle for setting out these requirements, backed up by guidance. The guidance, which is part of the same package to which I referred in an earlier debate, is currently being prepared and itself will be a product of wide ranging involvement and consultation. I now turn to Amendment No. 242HA, which proposes to place a duty on strategic health authorities to report on their compliance with the Section 242 duty to consult and to report on what influence people’s views have had on decisions. Perhaps I should remind noble Lords that SHAs are not service providers or commissioners; they are the organisations that are responsible for the performance management of local NHS organisations and are not responsible themselves for services. Bearing that in mind, it will be the SHA that will be looking to see that PCTs and trusts have complied appropriately with the requirements of Section 242 rather than fulfilling it itself. We have put the duty to report firmly on the PCT specifically because it is the PCT that controls the vast majority of money in the NHS and which makes decisions about the use of resources and how that affects the way in which a specific population receives its health services. It is the relationship between the PCT and the population whom it serves that needs to be developed and supported. PCTs need to be more open and accountable to local people and the duty to report on consultations is a tangible way in which PCTs can demonstrate that what they are doing is in the best interests of local people. Strategic health authorities have a different role altogether. Although they are listed in the consultation requirements of Section 242—it was Section 11—it does not impact on them as they are not directly responsible for the planning or provision of services. I hope that my comments have been helpful and that the noble Earl will feel able to withdraw the amendment.