Health and Social Care Bill (Programme) (No. 4)

My hon. Friend hits right at the heart of the flaws in the arrangements proposed tonight, which I was going to move on to. I am sure that Who Cares has its ear to the ground, good local connections and strong representation, and I want to see that continue, as I am sure he does. The real question is whether those organisations can go beyond hard-hitting reports, and who then will be accountable for the action that might need to be taken to follow them up. Where are the enforcement powers that could ensure that any problems they identify on behalf of patients are properly dealt with? I will move on to that point in a moment. In a sense, that links to the point I wish to put to Ministers now. In the arrangements before us it seems that if a local healthwatch organisation is not up to standard, is not doing the job and is somehow failing patients in an area or falling short of what is expected, we will be offered a new provision, a new power introduced by the Government through an amendment in the other place, for HealthWatch England to write a letter to the local authority, telling it that it must do better. Thinking of the two local authority leaders in the area that I am privileged to represent—Steve Houghton, the leader of Barnsley metropolitan borough council, and Roger Stone, the leader of Rotherham metropolitan borough council—I could not use language in this House that is likely to reflect their reaction. If I think of them, as elected local government leaders, receiving a letter from a sub-committee of a national quango responsible for regulating things that their local authorities have little or no responsibility for, telling them that they are not doing their job properly, I can just imagine their reaction. Quite frankly, ““You're having a laugh.”” That is simply not a serious power of, or provision for, redress on behalf of patients when a local patients' representative organisation is failing to do the job properly. So, no enforcement powers and no intervention powers, only the power to write a letter to the local authority. In the end, that brings us to the point. At this stage, in the final hour, at the end of this extraordinary Bill's passage through Parliament, we can see very clearly the truths at the heart of it. There is provision for an independent national commissioning board, an independent market regulator and independent hospital foundation trusts, but there is no provision for an independent patients' organisation. In this Bill there are powers to ensure strong action to guarantee competition, strong action to guarantee financial efficiency and strong action to guarantee professional concerns, but there are no powers to guarantee any sort of action, let alone strong action, on behalf of patients. I listened very carefully to my hon. Friend the Member for Leicester West (Liz Kendall), who made a very good speech from our Front Bench. When she notes that the representative body, National Voices, says on behalf of patients and interests groups, ““You're setting us up to fail,”” and reads the letter from Malcolm Alexander, the chair of the National Association of LINks Members, who says, ““You're creating weak bodies that will not be independent,”” I think that we in this House should be worried. Such action is, to borrow a phrase, pennywise, pound foolish. The Government are cutting what to Ministers and civil servants might seem to be small corners, but there could be big consequences for patients. I see a link—a common characteristic—between this debate and our earlier debate on the risk register. The Government will live to regret at length poor judgments and decisions made in haste and under pressure now. The Secretary of State will face the question of whether to release the transition risk register. If he insists on remaining resolute in refusing to disclose, and if he insists on keeping it secret, patients will ask, ““What are they hiding from us?”” In the future, in the months ahead, long after the Bill has received Royal Assent and is on the statute book, patients will rightly ask when things go wrong, ““Did they know these risks were there, and why didn't they tell us?”” The same applies to HealthWatch. When things go wrong, patients will find that they do not have the recourse and the representation that they may need to act and intervene on their behalf, and they may well find that the arrangements that we are invited to pass tonight are too weak to help them. I say to the Health Secretary, who is now on his own on the Front Bench, that this is likely to reinforce that lack of confidence and lack of trust in the notion that the Government's huge upheaval in our NHS, and this huge piece of legislation before the House, really is in the best interests of the NHS and NHS patients.