My Lords, these amendments deal, in their several ways, with the role of Healthwatch both locally and nationally. I begin with Amendment 42, in the names of the noble Lords, Lord Hunt of Kings Heath and Lord Patel, and the noble Baroness, Lady Thornton. This amendment would require ICBs to make provision in their constitutions for a non-voting member to be appointed from local Healthwatch branches.
I lay great importance, as do other noble Lords, on Healthwatch’s work on patient advocacy. However, as I said in relation to other amendments on the membership of ICBs—I know this is turning into something of a mantra—we want to avoid the Bill’s provisions being too prescriptive. It is essential that we provide local leaders the flexibility to design the board in a way that best suits each area’s unique needs. Even a non-voting member risks making the boards less nimble, undermining their ability to make important decisions efficiently. As I am sure the Committee is already aware, the ICB can appoint more members, including a Healthwatch representative, if it wishes, and I am sure many of them will. What is key is that local boards should be able to decide for themselves to appoint individuals with the necessary expertise to address local needs, and we want to allow them as much scope as possible to do so by not prescribing who all those members should be.
That said, I recognise that the growing complexity of health and care demands that we listen to the voice of patients, carers and the public. We want to ensure that they are heard throughout the system. I contend that there is adequate provision in the Bill to ensure that patients and the public are appropriately consulted and involved in decisions made by the ICB. I draw noble Lords’ attention to new Section 14Z36, regarding the duty to promote the involvement of each patient, and new Section 14Z44, regarding public involvement and consultation by ICBs.
I listened carefully to the noble Lord, Lord Harris of Haringey, as I always do, about the particular need for adequate and appropriate funding of local Healthwatch. If I may, I shall take away the points he made on that issue and others and write to him about them. We would expect Healthwatch to be closely involved with ICBs in carrying out their engagement and involvement duties. On what do we base that expectation? Many systems already have some system-level arrangements in place with Healthwatch. Indeed, NHS England has published guidance, which would apply to ICBs, on working with people and communities that encourages working closely with Healthwatch. Therefore, given that ICBs will already be required to engage patients closely in their decision-making process, and that we expect Healthwatch will be closely involved in that, we consider it unnecessary to require in legislation a member drawn from Healthwatch.
Amendment 103 would alter ICBs’ duties in relation to public involvement to require them to make adequate arrangements for the receipt and consideration of any relevant Healthwatch reports. As I said, the existing ICBs’ duties in relation to patient involvement are already comprehensive, and the amendment could unintentionally limit ICBs’ ability to form relationships with Healthwatch and other organisations appropriate for their area. As was the case for CCGs, ICBs will be required to make arrangements to involve patients in the planning of commissioning arrangements in areas that may impact the manner in which services are delivered, or the range of services available. This will ensure that patients receive appropriate representation where decisions are being made that could affect them.
I previously mentioned that NHS England, in its guidance to ICBs, has encouraged close working with Healthwatch. This guidance comes with the acknowledgement that what an appropriate relationship with Healthwatch looks like will vary from system to system. For this reason, we are seeking to establish comprehensive duties and requirements in the legislation while leaving the specifics of local relationships with organisations such as Healthwatch for ICBs to determine for themselves.
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Amendment 118 would alter the consultation requirements placed on ICBs and their partner trusts in the development or revision of their forward plans to explicitly include Healthwatch as a facilitator for consultations with the people in the ICB’s area. Again, this amendment would create an unnecessary additional restriction on the ICB’s ability to carry out its functions in a way that best suits its area.
The provision in question sets out a requirement for ICBs and their partner trusts to consult the people for whom the ICB has responsibility when it seeks to develop or amend its forward plan. This is already a comprehensive requirement, which, in addition to ICBs’ general duties relating to patient involvement in decision-making, will ensure that people will have ample ability to have their say in how their ICBs plan and commission.
As I said, and as we all appreciate, local needs will vary, so different approaches for this engagement will be appropriate in different areas. Again, we want to maximise ICBs’ ability to conduct engagement under the legislation in a way that best works for them. We would expect Healthwatch to be closely involved in this process for the reasons I gave earlier. The central point is that we want to empower ICBs to work out the relationships with Healthwatch and local people generally that are appropriate for their areas, rather than creating constrictive requirements from the centre.
Amendment 149 relates to the integrated care partnership, which each integrated care board and its partner local authorities will be required to establish. This partnership is intended to bring together representatives from across the system and is tasked with developing a strategy to address its health, social care and public health needs.
To effectively fulfil the statutory requirement to produce a strategy, each partnership will need to involve a wide range of organisations and representatives from across the system, and we would expect a representative of Healthwatch to be a member of an integrated care partnership. However, once again, it is right that local areas should be able to determine the model and membership that best represent their area. As the footprint of many integrated care partnerships will sit across many Healthwatch areas, it would not be prudent to specify that only one representative should sit on the board, rather than give local areas the flexibility for each partnership to make their own arrangements appropriate to their circumstances—they may want more than one, in other words.
Amendment 220 would establish Healthwatch England as a body corporate and allow Ministers to use secondary legislation to set out its functions, board and funding. It is important to seek the perspectives of health and
social care users. We value the voice of patients and use their views and experiences as a driving force for improvement. Healthwatch England is already well established as the independent champion for people who use health and social care services. It has a duty to understand the needs, experiences and concerns of service users and to speak out on their behalf.
Under existing arrangements, Healthwatch England already has the ability to exercise its four main functions: to provide leadership and support to local Healthwatch organisations; to issue recommendations and warnings to local authorities in England; to escalate concerns about health and social care services to the CQC; and to provide advice to the Secretary of State, NHS England and Monitor, and English local authorities. Healthwatch also has a duty to report annually to Parliament on how it has exercised its functions.
I listened with care, as I always do, to the noble Lord, Lord Patel. We believe that Healthwatch England is appropriately set up to carry out this important role effectively. As a statutory committee of the CQC, it has a separate chair and a committee of members who oversee strategy, provide scrutiny and oversight, and approve policies and procedures. The department provides funds annually to support Healthwatch England and local Healthwatch. In 2019-20 alone, over 350,000 people shared their views about health and social care services with Healthwatch England, and local Healthwatch helped over 960,000 people access advice and information. The Healthwatch network used this to make over 5,870 recommendations to improve services, based on people’s experiences of care.
I confess I was surprised to hear the noble Lord, Lord Patel, argue that Healthwatch England lacked public trust. I do not agree with him that it is not seen as being sufficiently independent. We have already heard from noble Lords about how well received the reports published by Healthwatch England have been and how authoritative they are seen to be. Healthwatch England is a genuine, and now proven, national voice for patients and I would suggest that it is valuable for the CQC, which has to opine on the outcomes experienced by patients, to have the voice of patients in its midst.
The Bill requires integrated care boards to make arrangements to involve patients in the planning of commissioning arrangements and we expect Healthwatch to be involved in this process. Further, Healthwatch will have a key role to play in integrated care partnerships. It is our expectation that a representative of Healthwatch would be a member of integrated care partnerships. In addition, new Section 116ZB, inserted by the Bill, requires ICPs to involve local Healthwatch organisations in the development of their strategies.
I hope I have given the noble Lord, Lord Hunt, and other noble Lords some reassurance that Healthwatch England is already established, is performing effectively under the CQC and has the ability to perform its duties, purpose and functions. It has had a positive impact on health and care services by ensuring that NHS leaders and other decision-makers hear the user’s voice and use feedback to improve care—that is what it is all about. This has been a good and wide-ranging debate. I hope I have reassured your Lordships about
the value we place on Healthwatch. However, we must balance this with the values of flexibility and local determination. For those reasons, I ask the noble Lord to withdraw the amendment.