Local Government and Public Involvement in Health Bill

My Lords, I want to focus on the fourth key element of the Bill, Part 14, and to welcome the Government’s proposed new local government networks. Public involvement in the provision of health and social services transforms the experience of patients and service users if it is well organised and well supported. It has to be said that the PPI forums were not well organised and well supported. The proposal for a well established organisation, probably in the voluntary sector, to host the network and to provide strong leadership, support and governance structures, is to be welcomed. I will make two general points and then focus on my concern about the application of the LINks to mental health. Sadly, this reform is regarded by many as yet another example of the Government’s obsession with changes to services in the NHS. The fact is that endless change has done much to destroy morale in the NHS and to undermine the quality of service. I, for one, am hoping that our new Prime Minister may herald a new era of stability. As other noble Lords have noted, patient and public involvement forums were established at the end of 2003. Only six months later, in June 2004, the Government announced that the oversight body—the Commission for Patient and Public Involvement in Health—would be abolished. Since 2003, a variety of proposals has affected patient and public involvement, complicated by a lack of clear policy direction. During this period, my experience at the head of a mental health trust has been that PPI forums have limped along, but with the energy of a boat holed below the waterline. Service users have been very reluctant to become involved. After such a record, it is incredibly important that these reforms are a success and that the LINks remain in place for years to come, modified, I hope, over time but not torn up to join so many other organisations on the scrap heap. My second general point is that the Department of Health at times—I do not say always—fails to achieve joined-up government within the department, let alone across to other government departments. It is not clear that the Government have considered this reform in the context of the emergence of foundation trusts across the country. The proposed LINks will be responsible for ensuring that the public are involved in the provision of local health as well as social services, commissioning and scrutiny of those services. At the same time, foundation trusts are establishing boards of governors, supported by thousands of independent members, including service users, carers and other members of the public. It is difficult to see the differences between the concept of the LINk and these boards of governors and members. A key role of foundation trust boards of governors is to ensure that health services respond to the needs of the community and of patients in particular—precisely the role of the proposed LINks. I emphasise again my support for public involvement in the provision of services. The new LINks will surely be a constructive and helpful way forward for local authority services and commissioning where there is no effective public involvement framework, as well as for any NHS trust that has not become a foundation trust when the new LINks are established. My concern is that the potential for duplication of the public involvement role across foundation trusts will be confusing and unhelpful in the context of recent developments increasingly to integrate the mental health services. Secondary mental health trusts work more closely with primary care than ever before and this trend is increasing fast with the prospect of practice-based commissioning. Social work in mental health is now fully integrated within mental health trusts. Social workers are seconded to the trust and managed alongside doctors, nurses and OTs in community mental health teams and on the wards. A consultant will be responsible for a patient on a ward and is involved in the care of the patient through the community mental health team when that patient goes home. Does it make sense for the board of governors of the trust to be concerned about his care one week and the LINk to take over that responsibility when he goes home the following week, or, worse still, for both bodies to be falling over each other doing the same job in the same place for the same people? As the chair of a mental health trust, I can assure the House that the service users and carers on the board of governors will expect to be involved inthe community care provision of the trust as well as the ward or hospital-based provision. They will not take kindly to the idea that this is the responsibility of a LINk—a separate organisation contracted by the local authority to carry out these responsibilities. Can the Minister assure the House that he will give due consideration to whether the very similar work of LINks and FT boards of governors can be implemented without duplication? He may want to argue that a bit of duplication will not do any harm. He will need to take account of all the existing oversight bodies—the number 56 has already been mentioned. I will give just a few examples. In mental health, in-patient units already have regular visits, announced and unannounced, from Mental Health Act commissioners and the Healthcare Commission, although it is hoped that with the merging of these two bodies—and I welcome that merger—these visits will be co-ordinated. They also have visits from solicitors and others regarding tribunal hearings, and from dozens of other people, including advocates and so on. We should add to that the visits that they will no doubt have from foundation trust governors. We are not yet a foundation trust, so I talk about this in the future, but of course many other trusts are already foundation trusts. Will visits from yet another oversight body be in the best interests of patients? I hope that the Minister will give the House the benefit of his views on this point. Indeed, I ask him to consider whether guidance may be appropriate to make it clear that the LINks should focus on local authority services and commissioning, and perhaps on health services only in those trusts that are not foundation trusts when LINks become operational. The Health Select Committee assumes that the LINks will not be interested in the commissioning side of the work, but surely when LINks understand the enormously important role of commissioning in defining the future shape of health services in this country they will want to play a key role in involving patients and carers in that work, as well as, of course, in the delivery of local authority services. Finally, I understand that early adopter projects will trial the LINks. I understand that these projects are being evaluated. Will the Minister provide the House with the results of the evaluation of these early adopter projects? Can he inform the House when these results will be available? Also, will he assure the House that the Bill will not be set in stone before the results of the evaluation can be taken fully into account and that the guidance for the delivery of the LINks will be drawn up only after the results of the evaluation are known? In summary, I welcome the broader remit of LINks when compared with PPI forums. The LINks would do well to learn from the experience of boards of governors, the model that is now well established in NHS foundation trusts. I hope that the Minister will take my comments as evidence of my commitment to the success of the new arrangements. I look forward to hearing what he will say.