Local Government and Public Involvement in Health Bill

moved Amendment No. 238LC: 238LC: Clause 222, page 155, line 4, at end insert— ““(4A) The Secretary of State shall make payments to each local authority that are, in the opinion of the Secretary of State, sufficient to cover the costs incurred by that local authority in making contractual arrangements specified under subsection (1). (4B) Nothing in this section shall prevent a local authority making contractual arrangements under subsection (1) so as to ensure that the activities specified in subsection (2) are carried on to a greater extent than would be the case if the arrangements were to cost no more than the payments made available under subsection (4A).”” The noble Earl said: I shall speak also to Amendment No. 238N. It was perhaps inevitable that, at some stage in these proceedings, we should come to the vexed subject of money. Through this amendment, I want to raise a number of questions for the Minister about the resourcing of LINks. We understand that funding is to be made available to local authorities by the Department of Health to enable the host organisations to support LINks and their activities. If, as I imagine, that funding is not to be ring-fenced—though the Minister may correct me—the obvious question arises about whether the activities undertaken in a local authority area in the name of patient and public involvement will be adequate in any given case. If it is open to local authorities to apply money intended to support that involvement to other activities altogether, we have the prospect—or, at any rate, the possibility—of LINks being supported on a mere shoestring and, therefore, not being able to do their job properly. We will be debating the role of the Commission for Patient and Public Involvement in Health in later amendments, but one signal advantage of the commission is that the money that it distributes to forum support organisations cannot be used for purposes other than those for which forums were established. Under the arrangements in the Bill, however, there is no guarantee at all that money intended to support the activities listed in Clause 222 will actually reach the front line. It would be possible for a local authority to say that it was delivering the activities in the Bill when, in reality, those activities were so minimal that they were hardly worth the name of patient and public involvement. What steps could be taken, in those circumstances, to ensure that such involvement in health and social care is delivered properly? The answer is not clear from the Bill. Another aspect to this issue is that, if LINks are going to assume different forms and guises in different localities, it is axiomatic that the level of activity that they undertake is going to vary from area to area. That will not only be because the activities themselves naturally give rise to a different burden of work in different parts of the country; it will also reflect the size and composition of the LINks, which may be large and diverse in one area and thin and perhaps weak in another. The amount of money directed toward PPI in any given area has to be based on a reasonably objective and dispassionate assessment of what that area needs in order for the job of PPI to be done properly and effectively. This is not to advocate the conscious overfunding of LINks that may be a bit thin and weak. My point is that the budget for the host contract has to be arrived at on the basis of what is, and what might be, needed to deliver desired outcomes. How is that aim to be achieved? Again, the Bill is extremely vague and uninformative. What considerations will underpin the process whereby a local authority judges that funding of a host for a given year should, let us say, go up? If it reaches such a judgment, what factors will the Department of Health look to if it is to persuade the Treasury that additional funding should be provided? Whatever process is employed here needs to be transparent and fair, not least as between different parts of the country. I would be grateful if the Minister could shed some illumination on those issues. Also, what total amount of funding has been earmarked by the Department of Health for patient and public involvement in 2008-09 and any subsequent years? Is it less or more than the amount currently granted to the Commission for Patient and Public Involvement in Health, and how has the budgeted amount been arrived at? Does she believe that more funds will find their way to host organisations than currently goes to forum support organisations and, if she does, how much more money will there be? I hope that the Minister will be able to give us at least a measure of reassurance that there will indeed be a budget comparable in size to the present one and that the effect of all these changes is that we will see worthwhile amounts of money released to the front line, as adumbrated in her letter to noble Lords of 9 July. I beg to move.