Health and Social Care Bill

My Lords, there is no intention that this should be a further hurdle, but if commissioners are going to commission services that are really relevant to local people then they need to take account of what the local healthwatch is saying. This is a huge resource that could improve services enormously and make contracts much more relevant than some of them have been in the past. I hope that that answers my noble friend. I shall take three quick examples to illustrate my point. The first is a patient in an older persons ward who leant forward confidentially to the CHC visitor, saying, ““They don’t feed them in here, you know. They just put the food at the end of the bed, then they take it away again. Please don’t tell them it was me who told you””. The second one is the mental health in-patient in a unit with an outside garden, who explained that he could not go out even though the summer was really hot. There were not enough staff to accompany the patients outside so he ““had to stay in all the time””—his words. What quality of life is that? The third is from another patient in an older persons ward who expressed concern about a patient whose hearing aid battery was flat: ““They could just have gone to the audiology department to get another battery, but they wouldn’t””. The staff just spoke more loudly to the profoundly deaf patient, increasing his distress and isolation. To some people these examples may seem quite trivial, but to the people concerned they are not—they are very important. I took those three examples because the first is over 10 years old, yet we know from the CQC’s recent dignity and nutrition inspection programme, and from the evidence from Mid Staffordshire, that patients are still not always adequately fed in hospital. That makes the point of the amendment perhaps more powerfully than anything else. What we are doing now is not working; it is not effective, and does not bring about the radical changes that are necessary. We have to do things differently, and the suggested new clause gives us the opportunity to do just that. I feel strongly about this issue and I hope that the Minister will give it serious consideration. Otherwise, I may have to bring it back at Report. My remaining amendments, Amendments 320ZA, 321C and 322A, are designed to ensure that local healthwatch organisations have the status, powers and functions necessary to be efficient and effective. Without these proposals, they will be another initiative to involve citizens without the necessary infrastructure, and will betray all those volunteers who put so much time and effort into trying to get the voice of users heard. We cannot afford for another attempt at this to fail. Otherwise, our credibility will evaporate. Amendment 320ZA concerns the pay and rations functions of local authorities which need to be delivered to local healthwatch, and takes up the concerns expressed by the noble Lord, Lord Low of Dalston. It reduces the role of the local authority to the minimum needed for the local healthwatch to come into being and to work efficiently. It provides pay and rations for local healthwatch and gives the local healthwatch the option to have a budget, if that is what it prefers. The current contracting arrangements are unduly complex and inconsistent with the status of local healthwatch as an independent body rather than a mere creature of the local authority. Clarity and simplicity are essential. Local healthwatch needs to be an enabler of local people and local groups, including those groups which support vulnerable and marginalised people, who should have a voice that is heard directly at the decision-making table by those reaching decisions on health and social care. This is an important job that needs to be got on with as soon as possible. Local healthwatch must of course have the rights, powers and functions necessary to work flexibly and to have some autonomy over its organisational destiny. It needs independence so that it can work with lay people on local programme boards, in partnership with local community groups through pooled budgets, or as commissioners of projects through support groups. Above all, it needs the confidence of vulnerable groups that will only speak openly through it. How local healthwatch then establishes its ways of working to meet its functions cost-effectively and efficiently is then for local determination. For an effective local healthwatch to get on with the job of patient involvement and monitoring services—its core function—as soon as possible, five ingredients are essential: a simple, clear structure requiring minimal input locally before starting work; a set of functions on which local healthwatch can be held to account; consistent standards to measure that accountability; a suite of powers to enable it to achieve those functions in a range of ways for maximum efficiency and effectiveness; and a transparent enabling role for local authorities, rather than a directive one. Many amendments in this group are designed to go some way towards this. Transition must be managed very carefully. Who steps into the body from the Local Involvement Network should depend on how well the existing LINk has met a set of transition criteria, which could be set in consultation with LINks and others, and which should be transparently and consistently applied by local authorities. I hope my noble friend will consider these amendments very carefully. I turn very quickly to my last two amendments. Amendment 321C enhances the structure of local healthwatch by giving it functions instead of activities controlled by the local authority. It is another attempt to make local healthwatch independent. Either local healthwatch is going to be independent or it is not. In the scheme that the Bill currently sets up, with the term ““activities””, the local healthwatch could be a creature of the local authority instead of an independent organisation hosted by it. My final amendment, Amendment 322A, seeks transparency and consistency in local authority decisions on local healthwatch. At the moment, a local authority may cut funding from a Local Involvement Network, and may do so in future for a local healthwatch, and then criticise the poor performance which has, in fact, been caused by inadequate funding. The Bill must safeguard local healthwatch from such undue interference and give confidence to local communities that we are creating something that will help prevent a repeat of Mid Staffordshire. Furthermore, in its role of scrutinising social care, local healthwatch scrutinises local authorities, who are also its funders, as commissioners of social care—a peculiar version of arm’s-length accountability. This introduces the potential for bias in local authority decisions about funding and setting up local healthwatch. In Clause 182, new Section 223A(6) recognises that independent advocacy services must involve neither the person complained about nor someone who has investigated the complaint. Therefore, I am seeking that a similar principle should apply to the role of local authorities, who are sometimes commissioners and even providers of social care themselves, as funders of local healthwatch. Greater transparency in decisions made about local healthwatch by a local authority is part of the solution, as it would make bias and undue influence much more difficult as a rationale. All the decisions would have to be explicit and aligned with the statutory functions of both organisations. This is not to reduce the autonomy of local authorities but merely to improve the transparency with which they exercise that autonomy. I hope the Minister will consider these amendments carefully.