Health and Social Care Bill

My Lords, my two amendments have also been grouped with this one. In our debate on 13 December, I explained why I felt so strongly that the evidence from patients gained by the work of local healthwatch and HealthWatch England should inform local commissioning. I have since had two very helpful meetings with my noble friends Lord Howe and Lady Northover about local healthwatch and its role. I think that we are moving in the right direction, although there seem to be some outstanding concerns. Among my serious concerns, and the reason why I brought this amendment back, is that I feel we are not making commissioning robust enough. The process must be founded on evidence. Local healthwatch offers independent local evidence gathered through the unique statutory function of enter and view. This is evidence straight from the experience of patients lying in wards or sitting in mental health units, as well as those who can fill in surveys. Surveys are useful but do not necessarily reflect the views of the most vulnerable, people who may not be able to fill them in due to frailty, language difficulties or other reasons. The amendment also relates to the experience from HealthWatch England. If the local healthwatch has not done work on a particular provider but those in other areas have, that intelligence will be available to a CCG commissioner who is considering giving the contract to a new provider. It has been pointed out to me that Clause 182(6) already requires CCGs to have regard to those reports and recommendations, and that is very valuable. However, this means only that if local healthwatch produces relevant reports and recommendations, the CCG will have to have regard to them. It could be that those reports and recommendations arrive at the wrong point in the commissioning cycle or do not arrive at all. Then the CCG will not have an opportunity to have due regard to them. They will be commissioning from providers without evidence from patients of their actual experience, which can come only from local healthwatch, with its responsibilities to enter and view. The amendment was laid to ensure that that could not happen. It was redrafted in response to my noble friend Lady Northover's characterisation in Committee that if local healthwatch had an obligation to feed in such evidence, it would be too burdensome for a small organisation composed of volunteers. I am now suggesting that the responsibility should be with the CCG to take evidence from local healthwatch. It would be helpful if my noble friend could give assurances that CCGs will be guided to seek out from their local healthwatch evidence of the patient experience to inform their commissioning to the standard set out in new Clause 14Q. We know that local healthwatch will have a seat on health and well-being boards, and that will ensure that the knowledge that local healthwatch has will influence commissioning. Again, I welcome the membership of a lay member. This will have an input into the strategic role of those boards, but how can it give them a say in commissioning when the health and well-being board does not actually commission health services? The board's function is to explore opportunities to integrate services, and this is not the same as deciding whether the outcome of a good patient experience with provider A is better than with provider B. These decisions rest with the CCG under Clauses 140 to 145. In our debate on 15 December, my noble friend Lord Mawhinney queried whether this amendment was yet another, "““barrier to the commissioning process””.—[Official Report, 15/12/11; col. 1505.]" My view is that only a provider with something to hide would see this as a barrier. In market terms, this is market research carried out by experienced, impartial, accountable members of the public at no cost to the provider. No provider worth its salt would quibble with such a resource for its quality assurance, and no commissioner trying to commission for the outcome of a better patient experience should ignore this evidence. The best route from patient reality to commissioning theory is through local healthwatch and the Bill should provide for this. A report has recently been published on the Forward Look seminars that were held by the public inquiry into Mid Staffordshire NHS Foundation Trust, as has already been mentioned by the noble Lord, Lord Hunt. The inquiry concluded that CCGs need, "““systematic processes for capturing patient experiences””," as well as, "““more robust early warning systems of poor quality care based on qualitative feedback””." My amendment would help to address this. I hope my noble friends will seriously consider the value of this approach and, if they cannot accept the amendment as it stands, seek to achieve it through a government amendment and bring it back at Third Reading. The amendment is also grouped with Amendment 111, which carries forward the logic of connecting the key evidence-gathering function of local healthwatch, including its enter and view reports, with commissioning by CCGs, as set out in Amendment 95. Just as the health and well-being board, with its strategic function rooted in the community to which it is democratically accountable, should be consulted about the commissioning plan for local people, so should local healthwatch. After all, it is the repository of views and experiences garnered from health services. Both perspectives are indispensable to making commissioning work well. I hope my noble friend will look kindly on this simple amendment, too.