Health and Social Care Bill

My Lords, I hope I shall be allowed to put a contrary point of view to that of the noble Lord, Lord Warner, and those who have tabled Amendment 223. First, I apologise for not contributing in Committee on this area; I happened to be away during the debates on this, but I read the reports with much interest. This area of patient and public involvement is one that, as many noble Lords have said, we have struggled with for many years. I hark back to the CHCs with some nostalgia. They were a very mixed bag of organisations, but those that were good worked very effectively. I too pay tribute to the noble Lord, Lord Harris of Haringey, for the work that he did in supporting CHCs around London, which made my life an utter misery, as they were intended to do. I am very grateful for that. Unfortunately, the arrangements that were put in place after their abolition have not worked. I say to the noble Lord, Lord Whitty, who is very persuasive in his arguments, that we have been there, done that and it did not work. As the noble Baroness, Lady Pitkeathley, said, the Commission for Patient and Public Involvement in Health was a total disaster. It was an extremely expensive quango—it was bureaucratic, totally isolated from other health bodies, the Department of Health did not know what it was up to and I do not think it knew what it was up to itself. It fell out with all the local patient and public forums. It was a disaster. It did not have any symbiotic relationships with those who make the health and social care services work; it was not in any way linked in with local authorities, which is a huge difference from these arrangements; and it seemed to me then that you had to have a structure in which all the core patient and public involvement organisations locally were crucially interlinked with what makes things work. We now have HealthWatch England and yesterday some of us had the benefit of listening to the way in which East Sussex County Council is tackling the healthwatch development, with the council linking it into the health and well-being boards, which seems to me to be crucial. Their development needs very sophisticated support from a central body that will have the resources and the links to be able to do that. There is a very good reason for choosing CQC. With regard to quality, CQC is the eyes and ears of the Secretary of State. Healthwatch will be the local eyes and ears of the people on the way in which they receive healthcare and the way their healthcare should be designed. I think Winterbourne and Mid Staffordshire are very good examples: local initiatives, local patients and relatives could have taken their concerns to a local healthwatch and they could have had those local healthwatch concerns linked straight back into CQC through a committee. As the noble Baroness, Lady Cumberlege, has said, it is not a subcommittee; it is a formal committee. I very much like the amendments that link a local healthwatch, by elections, into this body and I am very supportive of the amendments of the noble Baroness, Lady Cumberlege. I think the Government structure is right but the way in which it works could benefit from some amendment. Finally, I am willing to give the government structure support because I think it is a way forward but a bit of me thinks that we should ditch all these arrangements and instead give patients rights. If patients had rights they would not need a bureaucratic structure to make things work. If we have to have these bureaucratic structures because we do not have what we need for patients in legislation, I think it is right that we should give this one a go. This has a much better chance than trying to recreate the commission, which is an independent quango. I think this will be a more economical and more effective way.