Local Government and Public Involvement in Health Bill

I will certainly bear that sensible advice in mind. As we have already heard from a number of contributors, the Bill contains many good things, not least the facility to allow credible cases for unitary council status to go forward. None the less, I hope that we will not lose sight of—or fail to debate in as much detail as is required, certainly in Committee—the public involvement part of the Bill. I wish to address that subject today, as the hon. Member for Billericay (Mr. Baron) has just done. Out of 14 parts and 176 clauses, only one part—part 11—covers patient and public involvement in health and social care. Although I express a personal view, I also speak as chair of the all-party group on patient and public involvement in health. In 2000, a national health service plan proposed to abolish community health councils. In late 2003, patients forums were set up, together with the Commission for Patient and Public Involvement in Health. Now, both the forums and the commission are to go, to be replaced at local level by LINKs and at national level by, it would seem, nothing. The all-party group has sought to identify the views of patients forum members on the best way forward. We met a large number of representatives on 30 October in the House and we will meet a smaller number on 30 January. The principal concerns expressed by patients forum members that we have dealt with are as follows. First, there is uncertainty about the direction of travel and where we are going. Secondly, there are fears that LINKs will not be independent and will be subservient to the political process in local councils. Thirdly, there is the feared abolition of the inspection rights currently enjoyed by forums. Fourthly, there is the apparent lack of a national voice. Fifthly, there is the failure of Government, as perceived by the people we met, to recognise that forums already actively pursue networks, links and local contacts with a variety of voluntary and other organisations in their areas. All those are fair points to raise and need to be addressed in the House, both today and, perhaps especially, in Committee and later. Personally, as I indicated in an intervention on the hon. Member for Billericay, I do not think that coming under the umbrella of local government necessarily undermines independence. I support local government and I think that it is capable of doing the job properly, but we need to be aware of those concerns and ensure that they are properly addressed. As I said earlier, both for budgetary and overall administrative reasons, community health councils came under local health authorities, although perhaps they were called strategic health authorities at that time. There have been so many changes, I cannot quite remember. However, community health councils were not accused of being the creatures of the Department of Health or local health authorities and so it does not necessarily follow that LINKs would suffer from that same accusation. However, we need to think through the administrative arrangements, the resourcing and the governance issues with regard to LINKs in order to understand how independence is to be secured and how accountability is to be made clear. My right hon. and hon. Friends on the Front Bench will understand that the Government’s intention to consult on these and a number of other related matters risks giving rise to a period of greater uncertainty and speculation on some crucial questions. That is inevitable, although hopefully it will not last too long. Having more uncertainty and speculation on some of these matters is not satisfactory. I am not upset at the thought of there being one LINK for every local government social services area in the country. I understand that that would mean 152 LINKs, instead of well over 400 patients forums. However, it is essential that they be rooted in the local authority area and that they be local. I am not certain that that would be guaranteed, because, in carrying out its duty to establish a LINK, a local council will have to tender for an outside body to do that on its behalf. I do not think that it is likely that there will be 152 outside bodies, waiting to be tendered to operate in those council areas and to set up a LINK. If a regional or a national organisation does that in some places, which is likely, we will need to ensure that local sensitivities and the shape of local areas are sufficiently respected and understood. With regard to the power to inspect health and social care facilities, I think that the concerns expressed by forum members are largely met. Earlier in the debate, there was some probing of the meaning of the words used, but in clause 156, there is a commitment that LINKs will have such powers, and that answers many of those concerns. Okay, so the wording is"““to enter and view, and observe””," but in general terms, people will understand that to mean inspection, although it is a legitimate issue for further debate in Committee. That is not necessarily the same inspection that would be made by an expert group that was statutorily empowered to take a particular route, but in general terms, many of the forums’ concerns are answered in clause 156.