Local Government and Public Involvement in Health Bill

I very much agree with my hon. Friend. We probed the Government on that point in Committee, but as yet we have not had a satisfactory answer, although I hope the Minister will put that right today. In fact, I would suggest that the Government are so blind to the benefit of this approach that their own draft regulations subordinate the few inspection rights that LINKs members have to the work of the regulator—for example, by requiring LINKs to obtain the agreement of the regulator before making a visit and to co-ordinate their work. Amendments Nos. 131 and 132 might provide an opportunity to restrict the ability of the Secretary of State to impose limitations on the rights of LINKs to enter and view or inspect premises. However, there is still time for the Minister to make a commitment at the Dispatch Box not to fetter the right of LINKs to make spot checks on premises that they are entitled to enter. It is absolutely right to say that we have not had a satisfactory explanation of why the Government seem so concerned about the ability of LINKs to enter and inspect. I would welcome the Minister’s response to that point. I now turn to perhaps the most important part of the debate. Conservative amendments Nos. 80 and 81 would save patient forums from abolition. They reflect a number of concerns and observations that we have about the manner in which the Government are proceeding. There are too many questions about LINKs that the Government seem either unwilling or unable to answer. Issues such as the composition of LINKs, the potential conflict of interests and the right to inspect have not been properly addressed. For that reason, we believe that it is unwise to abolish what presently exists, and works increasingly well, and to replace it with a structure about which we have many doubts. First, let us not be fooled by the talk of building on forums or turning forums into LINKs. The truth is that forums are being abolished and LINKs are being created from scratch. When community health councils were abolished, many hard-working volunteers were lost to the system. Too little of that expertise made the transfer to patient forums. I fear that the same mistake will bedevil LINKs. Ministers have said that they hope that patient forum members will be included in LINKs. I have heard that many times from the Minister. But such inclusion cannot be guaranteed. It is in the gift of the host organisations. We do not want to lose the body of expertise that has been built up over the last four years. Secondly, I remain concerned that funding from the Department of Health might be prevented from reaching the front line of patient and public involvement. The money given to local councils will be targeted, but crucially, it will not be ring-fenced. The expert panel that developed or helped to develop the idea of LINKs did not propose that funding would be handled in that way. Money intended for health could end up being siphoned off by local government, which could be under financial pressure in relation to a whole range of issues. I challenge the Minister to explain, even at this late stage, how that can be guarded against. If the Government are serious about targeting the money, why should it not be ring-fenced? Thirdly, although the focus of LINKs is understandably local, the Government have shown a complete lack of leadership on the question of a national voice for patients. Ironically, after years of delay, the patient forums have finally persuaded the Commission for Patient and Public Involvement in Health to help them to develop a national organisation, but if patient forums are abolished, it looks as if that national organisation will be abandoned. LINKs would put nothing in its place. Finally, questions of accountability have not been answered. It is not clear what sanctions exist if the LINKs are not performing well. Patient forums are ultimately responsible to the commission, which is an independent body. I accept that we do not want to give too many organisations a lever of undue influence over the LINK or the host organisation, but clearly there must be accountability when it comes to the use of public money, and what is done in the name of local people. That accountability is sadly lacking. Patient forum volunteers up and down the country have worked hard, despite some of them being badly served by patchy administrative support and hesitant leadership from the commission. Given our reservations, I would like to test the opinion of the House on amendment No. 80. I should say a few words about amendments Nos. 82 to 85, which seek to challenge the inclusion of the word ““significant”” as a qualification on the duty to consult. Our fear is that that represents a mechanism by which consultation can be restricted, rather than enhanced. Ministers have said that a threshold is needed to prevent mischievous or vexatious interpretations of the duty and to avoid consultation fatigue on trivial changes. However, I am aware of no specific examples—none at all—of that being a problem under the current arrangements, which, as far as we are concerned, do not include such a qualification. Indeed, it is difficult not to be a little sceptical about this measure, because the definition of what is significant is often controversial; it is a very subjective term. Some of the examples given by the Minister in Committee, such as a reduction in the number of beds in a hospital or changes to a GP’s opening hours, might well be considered significant by patients, but not by the health service bureaucracy. The last thing we ought to be doing is setting the scene for legal wrangling, when the promise of the document ““A Stronger Local Voice”” was to clarify the duty to consult. In conclusion, the Government have failed to make the case for LINKs. Too many of our questions remain unanswered. There may be a need to improve patient and public involvement in health by enabling more people to get involved in more flexible ways and to join up health and social care. However, that could and should have been achieved by reforming patients forums and building on their expertise, rather than abolishing them and starting from scratch. Too much taxpayers’ money is being wasted, and perhaps more importantly, too much expertise risks being wasted. Instead, the Government seek to abolish the system that they put in place only four years ago. They are betraying the hard work and dedication of volunteers, who do not understand what they have done wrong or why they are being got rid of. If the system of patients forums has failed, it is only because Ministers have made mistakes. They should not be allowed to walk away from those mistakes without being called to account in the Division Lobbies of this House. We have sought to improve LINKs and make them workable, and I believe that the Government’s amendments would, to a certain extent, help to do that. However, key questions still have not been answered about the composition, membership and governance of LINKs, about their rights to enter and inspect premises and about the relationship between them and the host organisations. Crucially, I do not believe that LINKs represent continuity and retention of expertise within patient and public involvement in health. They represent careless reorganisation and uncertainty—something that the NHS has had far too much of in recent years. For that reason, Madam Deputy Speaker, and with your permission, my colleagues and I will call on the House to vote against the abolition of forums by supporting our amendment No. 80.