Local Government and Public Involvement in Health Bill

moved Amendment No. 242ZA: 242ZA: Clause 232, page 162, line 35, after ““services”” insert ““and members of the public”” The noble Earl said: I shall speak also to Amendment No. 242A. I pointed out at Second Reading that, in one particular respect, Clause 232 did something which was highly regrettable. It is to that issue that I return. Section 11 of the Health and Social Care Act 2001, which became Section 242 of the NHS Act 2006, placed a duty on NHS bodies to ensure that service users are, "““involved in and consulted on””," the planning of the provision of health services and any proposed changes in those services. I paraphrase the duty slightly, but the words that I wish to emphasise here are ““involved in””. Clause 232 amends Section 11—if I may continue to call it that—and in so doing removes the words ““involved in””, keeping only the words ““consulted on””. There is an obvious irony in the fact that a Bill that contains ““involvement”” in its title should remove that very concept from a key part of the Bill. Why have the Government done this? According to the Minister’s letter of 9 July, it was because of the judicial review in the case of north-east Derbyshire, when the judge found it difficult to perceive any real difference between ““involve”” and ““consult””, so ““involve”” has been taken out. In her letter, the Minister said that she did not think that anything would be lost by doing that. I must respectfully beg to differ with her on that—and, equally respectfully, with the judge in the case of north-east Derbyshire. There really is a material difference between involvement and consultation; that difference can most easily be described in terms of the before and after duties. The before duty is about the NHS having a dialogue with patients and the public when proposals are first being formulated. ““Involvement”” is the word that describes how patients and the public develop ideas as equal partners with the NHS. Consultation—the after duty—is what happens when that initial planning stage is over. It is about giving people the opportunity to comment on plans that have already been formulated. I think that we all understand the difference between the two processes. To take an example, involvement in a review of a service for older people would include setting the review’s terms of reference and suggesting what extra services might be needed so they could be considered as the review rolled out. Consultation on such a review would mean commenting afterwards on a set of fully formed proposals. There is a potential source of confusion here because commenting afterwards is provided for already in Section 7 of the Health and Social Care Act 2001 and its accompanying regulations. This is the section now translated into the 2006 NHS Act, which obliges NHS bodies to consult the local overview and scrutiny committee on developments and variations in services. It is true that the Section 7 duty applies to substantial variations and developments in services, whereas Section 11 applies much more generally, but it is most confusing to have ““consult”” in both contexts. If it is intended to mean the same thing in both cases, it seems rather pointless—because, if people have been consulted about a substantial variation as it has developed, what on earth is the point of consulting them again after their views have been taken account of? If, on the other hand, it is intended that in Clause 232 ““consult”” should in practice mean ““involve””, surely that is the word that should be brought back into the drafting. Why has the change been made? I am certainly not clear about it—and, as I have said, it is a change that is likely to generate confusion in all quarters. The point of Amendment No. 242ZA is to widen the definition of those who should be consulted to those members of the public who may not be direct users of services but who nevertheless have an interest in them. This might, for example, include parents of children who are users or friends and carers of people with mental health problems. In fact, it could include anyone with an interest in improving care services, which is surely what we would expect to happen if, to take a typical case, primary care services were being reconfigured in a particular area. It is not just the users of those services who have an interest in what is decided but a much wider group of people, including those whom those services are not properly reaching. I beg to move.