House of Commons
|Session 2006 - 07|
Publications on the internet
General Committee Debates
Local Government and Public Involvement in Health Bill
Local Government and Public Involvement in Health Bill
The Committee consisted of the following Members:
Alan Sandall, Committee Clerk
attended the Committee
Public Bill Committee
Tuesday 6 March 2007
[Mr. Christopher Chope in the Chair]
Health services and social services: local involvement networks
Dr. John Pugh (Southport) (LD): I beg to move amendment No. 226, in clause 153, page 109, line 28, after of, insert access to.
The Chairman: With this it will be convenient to discuss amendment No. 227, in clause 153, page 109, line 34, at end insert
(d) notifying relevant transport bodies of any problems or improvements in access to care services..
Dr. Pugh: As we enter the last rounds, we come to two quite significant amendments that would introduce issues of access and patient journey times to the matters to be considered by local authorities.
There are major omissions from clause 153 as it stands. A big issue for patients is not so much the delivery of services but the reconfigurations that are going on throughout the land, which the Government say will continue. Medical changes might also dictate that the reconfigurations continue. Financial pressures and the payment by results system will also ensure a degree of change. The general policy is to move care from the secondary care sector to the primary care sector and to centralise around centres of excellence. All of those factors bound together will produce a rearrangement of the health landscape in any one area. That has specific consequences for patients, because it affects their journey paths to services.
The journey to health care is often the very core or essence of peoples anxieties. People do not doubt that they will receive quality services once they get there, but they sometimes wonder how easy it will be to get there or, in the case of emergency services, whether they will get there in time. It is particularly an issue for the elderly, the socially excluded and people with children. The matter is at the core of debates about community hospitals, of which there have been many in this place, and of debates about urban and suburban reconfigurations, but it is often ignored by the health establishment. Sometimes, public transport authorities and highways authorities seem to live in a parallel universe to health authorities, given the limited amount of consultation and interaction between them.
In my area, health services were reconfigured and services were moved from one hospital to another as a result of an extensive medical report, the Shields report.
I understand that we are not going to have a stand part debate on the clause, so I wish to make a few general comments. At the heart of the proposals is the fact that, as far as I can see, no lever of power is taken out of the hands of the quangos and given to the community. We are going to have a long and extensive debate about the shape of the consultative body, but the fact of the matter is that the lever of power will remain almost exclusively in the hands of the quangos. I am sure that the Minister will understand what I am trying to say if I compare the almost platonic model on which health service governance is based, whereby governance is left to the experts and is not given or handed to the people, with the local authority governance model presented in the Bill. The Department for Communities and Local Government allows the public, through electoral and other arrangements, to have an involvement in emergency services, transport, social care and so on, but when it comes to health services, the approach is altogether different.
I accept that the Bill attempts to put a certain amount of power in the hands of the public in so far as they will be consulted a little bit more. The Government are inching in the right direction; but they are only inchingthey are moving very slowly. With the amendment I am trying to persuade them to go a little further. They can take a step by accepting the amendment, which asks them to take on board a serious concern for patientsthe transport arrangements for getting to health services.
The Minister for Local Government (Mr. Phil Woolas): I thank the hon. Gentleman for moving the amendment in such a constructive way. He seeks to amend clause 153, which requires local authorities to make contractual arrangements to ensure that local involvement network functions can be carried out in the relevant areas. Establishment of host organisations is relevant to that. It might also assist if I remind the Committee that the clause will oblige local authorities to facilitate LINKs organisations.
The clause refers to all local authorities, but clause 159 limits the applicability of the clause to those with social services responsibilities, and only English authorities are relevant. In plain English, therefore, we are not concerned with districts. The LINK function definition which the hon. Gentleman seeks to amend is
promoting, and supporting, the involvement of people in the commissioning, provision and scrutiny of
health and social care services. The hon. Member for North-East Bedfordshire observed that that should include monitoring as well, and I have undertaken to consider that, because the Government see the sensein it.
A second, and important, part of the function as defined involves
obtaining the views of people about their needs for, and their experiences of
health and social care services. An additional element involves making those views known to
persons responsible for commissioning, providing, managing or scrutinising local care services
and making of reports and recommendations to such people about how provision of health and social care services could be improved. As has been mentioned, a regulation-making power is needed to allow the Secretary of State to amend, add to or delete such activities. However, my hon. Friend the Member for Bedford will have something to say about that later in the debate, and we shall be able to consider it then.
The Government believe that it is vital to promote user involvement in health and social care, because it is only through seeking out the views and experiences of those who use the services that we shall be able to improve them. In fact, it is not the only way, but it is a necessary wayif not a sufficient one. It is also a way to make services more user focused, which is what the hon. Member for Southport desiresto look at things not from the point of view of the provider, but from the point of view of the patient or would-be patient. In summary, the clause requires that councils with social services responsibilities make contractual arrangementswe shall debate later with whom, and howto ensure that there are means by which a local involvement network activity can be carried out in the councils area.
We are debating amendment No. 227, which thehon. Gentleman addressed directly, and amendment No. 226, which would broaden the range of responsibilities. The hon. Gentleman mentioned the Highways Agency, I believe, or was it highways authorities?
Mr. Woolas: I am sure that all hon. Members would echo his views in that respect. It is important that such public sector agencies work together and in partnership. However, although I do not disagree with the purpose of the amendments, I do not believe that they are necessary.
Amendment No. 227 would add the activity of
notifying relevant transport bodies of any problems or improvements in access to care services.
That is unnecessary because the clause provides that the key organisations that will receive reports and recommendations from LINKs are the commissioners, providers, managers and scrutineers of care services. LINKs will certainly collect information that is important for other organisations too, and there is nothing in the Bill to prevent them from passing that information on. LINKs, in the first instance, couldI would argue that they shouldreport any access problems to the commissioner of those services so that it can take account of those matters in its commissioning decisions and when it influences other local partners through mechanisms such as local strategic partnerships. LINKs will also be able to refer matters of concern, such as accessibility, to the relevant overview and scrutiny committee. Therefore, I agree with the intention of the hon. Member for Southport, but argue that it is already covered.
Amendment No. 226 similarly aims to extend the activities to explicitly include obtaining peoples views on their access to services. However, that is already captured in subsection (2)(b), which refers to
obtaining the views of people, about their needs for, and their experiences of, local care services.
A key part of obtaining peoples views on access to services will be the extent to which their needs have been met and how they have experienced the services they have received. My hon. Friend the Member for West Ham gave a very good example of the practical impact of that. In a survey of her community, it was pointed out that access to the local GP was not being used to the extent that the health service expected; instead, patients were travelling a further distance to use the hospital. When asked why that was the case, people pointed to the blindingly obvious fact that there was a bus route to the hospital and none to the GP. Access to services, as the hon. Member for Southport says, is the type of issue that Members of Parliament deal with, but it is more commonly dealt with by local councillors. The example of my hon. Friend the Member for West Ham graphically illustrated that point.
The point that the hon. Gentleman makes about access to services has been well heard. It is part of the rationale behind the framework that we have created to solve those problems. That is why I believe that the clause as it stands covers the desirable consequences that the hon. Gentleman seeks. I ask him, therefore, to consider withdrawing his amendment.
Dr. Pugh: I thank the Minister for that clarification. I think that what he is saying is that the phrase experiences of in subsection (2)(b) includes experiences of getting to the services as well as going through the services. Therefore, I am prepared to consider withdrawing the amendment for the moment, but I will seek further clarification on the matter from other colleagues at a later stage. However, what I would emphasise is that the problems are often unsolved in particular areas, and it is not clear who owns the problems. I have sat in debates in which members from Hertfordshire, for example, have complained about the reconfiguration of their services. They have drawn attention to the fact that when the health service directs some patients to Watford, it is completely unaware of problems caused by football traffic, for examplealthough that problem might be reduced next season.
My point is that the problems are genuine and widespread, but when they do occur, it is not obvious whose job it is to resolve them. There can be a certain amount of buck passing in which the health authority puts the onus on the transport authority to produce a better bus service, for example, but the transport authority then says that it was not advised properly when the reconfiguration first went through. The holes in the Bill as it stands leave certain problems unaddressed. None the less, for the moment, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Alistair Burt (North-East Bedfordshire) (Con): I beg to move amendment No. 197, in clause 153, page 109, line 34, at end insert
and to patients and the public.
The amendment relates to the powers of LINKs to publicise their work. There is concern that, if the Bill does not specifically mention that, there may be a supposition that all the LINKs do is to report to the
The regulations will specify the LINks power to make reports and recommendations and will specify...who they can make them toNHS and social care commissioners and providers in their geographical area
and nothing else.
The straightforward reason why the matter has not been mentioned might be that it is intended that the work of LINKs should be published and, if they want to bring something to the attention of commissioners and others, they should feel perfectly free to make that information available to the public. However, that is not in the Bill. If regulations are tight and specify not a permissive power regarding to whom the LINKs may make submissions, but a restrictive power so that they make reports and submissions only to certain bodies, patients ability to make clear to the public what is going on will be stifled.
The purpose of the amendment is to draw out from the Minister a clear statement either that there will be an expectation that LINKs and other bodies will report to the public; or that the Government will make that clear by putting it on the face of the Bill. Naturally the accountability of LINKs to the public needs to be tested, which is a good reason for publication, but the accountability of the bodies that they are looking into on behalf of patients should be clear to the public. I should be grateful if the Minister will explain what he thinks and say whether my concerns are unnecessary or whether it would be helpful to have such a provision in the Bill.
Patrick Hall (Bedford) (Lab): I rise to speak to amendment No. 182. If you will allow me, Mr. Chope, I too wish to make some wider remarks
Dr. Pugh: I endorse amendment No. 197. Sometimes patient groups are not properly representative of patients as a whole. By having them refer back to the wider patient groups, there would be a more representative function.
Mr. Philip Dunne (Ludlow) (Con): To add a rider to that, will the Minister clarify whether ambulance trusts would be included in the scope of local services? As ambulance services have been regionalised, there is in relation to access to acute hospitals concern about whether ambulance services are capable of being scrutinised by LINKs through this process.
Mr. Woolas: The answers to the questions are yes, yes and yes. Ambulance trusts are covered, as is clearly desirable. The hon. Member for Ludlow makes the point that they cover a wider area than the local authority. It is, of course, up to the contractor bodies to make arrangements across the area of the ambulance trust. That is one reason why we need to be flexible. Similarly, a primary care trust might extend beyond one of two local authorities. In some cases, local authorities are not coterminous with PCTs. The Government, through their consultation on the reconfiguration of PCTs, faced criticism in respect of that exercise and chopping and changing, but part of our objective was to ensure greater geographical coterminosity between PCTs and local authority areas. My colleagues at the Department of Health consulted in anticipation of the policy that we have now brought forward. That is joined-up Government, although it did not look like it at the time. Seriously though, there is 80 per cent. coterminosity in England now. The answer to the point that the hon. Gentleman made about ambulance trusts is yes.
The hon. Member for Southport makes the valid point that part of the objective for LINKs and health scrutiny is to involve not only patients, but those who may have been or still are patients. The hon. Gentlemans point is important. However, I shall resist the amendment and will give my reasoning for doing so in a moment.
It is clearly desirable to achieve what the hon. Member for North-East Bedfordshire is talking about. We expect that LINKs will publish such information in a way that makes it available to its public. Clause 158 sets out the process for the annual report, which it is desirable to include in the Bill. It is quite common, as hon. Members will know, for us to receive hefty envelopes containing annual reports that Parliament has required various bodies to produce. We want to provide those bodies with flexibility, so we do not wish to go further and specify the information and the process of providing it, but we do expect them to provide the relevant information and we intend that that would be covered in the notices and guidance that we issue.
Alistair Burt: No one would want an already bulky document at the annual general meeting to include all the individual reports that LINKs may have wanted to produce on their work during the year. The draft note from the Minister, which we have seen, does not include reference to publication. If the Minister took back to his colleagues the suggestion that the draft guidance should make explicit the need to make those reports public, that might do the job.
By talking about heavy, burdensome documents, the hon. Gentleman has pre-empted the second paragraph in my speaking notes, so I shall not bore the Committee any more than I have done. I ask him to consider my remarks and to withdraw the amendment.
Alistair Burt: To have wrung a concession from the Government at seven minutes to 11 makes this an early champagne moment. We will bank that, as Anne Robinson would say, and move on to the next amendment. I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Alistair Burt: I beg to move amendment No. 198, in clause 153, page 109, line 35, leave out subsection (3).
The Chairman: With this it will be convenient to take amendment No. 182, in clause 153, page 109, line 36, leave out or omitting any of.
The Secretary of State may by regulations amend this section for the purpose of adding to, varying or omitting any of the activities for the time being specified in subsection (2).
That is a wide power that would effectively render neutral the discussions that we have just had about what LINKs should do, because, no matter what the Bill says, if the Secretary of State decided in futureperhaps after complaints from health authorities or othersthat the powers given to LINKs are too extreme, then instead of returning to the House to agree primary legislation to change the Bill, the Secretary of State may, by order, simply remove those powers.
It is not just we who are concerned about this provision. I should like to quote two other bodies. In relation to subsection (3), the London Network of Patients Forums said in its briefing:
This is far too wide. It gives the present or any future Government of any political complexion the power to abolish all involvement of people in commissioning, providing or scrutiny of local care services...without further recourse to Parliament. It was probably drawn by an overzealous draftsmen
I hear hon. Members say, Surely not.
but it reminds one of the original proposal to abolish the Community Health Councils...without replacing them. It was parliamentary pressure that caused the Patients Forums to be created as a replacement of the CHCs.
The London network is plainly concerned, but the Commission for Patient and Public Involvement in Health is, too. I draw the Ministers attention to its briefing, which specifically raises concern about this clause:
Clause 153(3) gives the Secretary of State power to make regulations to add to, omit or vary any of the activities above for the time being, whereas the legislation establishing Patients Forums...gave the Secretary of State no power or limit to vary the functions of PPI forums.
The Bill does not give the Secretary of State power to make regulations on any other important matters, such as membership or governance rules and would therefore have no ability to intervene in the future, without amending the primary legislation, even if significant problems or concerns rose on such matters.
Why is the power in the Bill? What is the reason for the concerns of the CPPIH and of members of patients forums? I should be grateful if the Minister explained why this wide-ranging power is in the Bill?
Patrick Hall: As you can see, Mr. Chope, I am following the Committees orchestral score a little more carefully now, although I was in danger of being distracted by yet another reference to a champagne moment by the hon. Member for North-East Bedfordshire. They keep clocking up. I hope that careful note has been taken of that so that we are rewarded at the end.
I was asking you, Mr. Chope, if I might range a little wider, as you have kindly allowed others to do, as I would like to acknowledge the good and hard work of
It is remarkable that there are threads and strong issues held in common right across the piece. I was struck by the energy and commitment of the people. They are volunteers and they contribute a great deal of time and effort. They are also very well informed and their views are worth listening to. That is the purpose of having an all-party groupto hear what people outside this House have to say. Indeed, that is also the basis of our job as Members of Parliament. Those people wish to serve the community for the common good and have sought to do so through the mechanism of patients forums. Whatever happens, we must take great care not to lose the commitment, energy and qualities of people who are understandably a little concerned about what will happen. There is a role, and there will continue to be a strong and growing role, for patient involvement in health, whatever mechanism is designed to deliver it.
We should approach this matter from the viewpoint of the ground upon which we stand and build from where we are. There is a lot of perplexity among patients forums members about their abolitionit is indeed abolition that we are talking about. Although no one at the Bedfordshire forum meeting said that they loved what is happening, I was none the less encouraged to find that the forum had prepared a paper, a copy of which I will pass on to Ministers, especially those in the Department of Health, expressing the view that although the page is a little blankthe canvas is sketchy and almost emptythat provides an opportunity to help to shape what will happen. I thought that that was an optimistic and positive view.
I hope that my hon. Friends fully understand patients forum members disappointment, particularly with the decision to abolish the forums, and that Ministers will welcome their positive suggestions and others about the road to take. My approach to part 11 will be to seek through a number of probing amendments to encourage debate and thought and to encourage the Government to help us to colour in the many gaps on the canvas, because it is difficult to identify the architecture.
Last Thursday during our afternoon sitting, the hon. Member for Hazel Grove sought to gain the sympathy of the Committee by admitting that he had been too busy to have his lunch. I said nothing at the time, but at lunch that day, I was given for the first time a copy of a long-awaited draft model contract between local councils and host organisations, together with a restricted set of papers dealing with how LINKs will function. The bundle made reference to promised guidance on governance and engagement activities that will be published only when the Bill receives Royal Assent. That rich larder of information served as my lunch. I did not eat it, but I
Although some time has elapsed since Thursday, I must confess that I have not read those documents from cover to cover, although I have had the opportunity to examine them more. Looking at them, I have no doubt that the Government have strong ambitions for LINKs, that hosts will play a strong role and that there will have to be a lot more consultation before the architecture is built more clearly. There is a lot more to be done. It is important to consider the documents in the context of the amendments. Nearly all the amendments moved were prepared and tabled before we knew of the documents. None the less, our debate will be important.
I will also fall for the assumption made by the hon. Member for Hazel Grove that the words on the face of a Bill mean what they saythat the English used means what I understand English in common-sense terms to mean. That is why I am pressing amendment No. 182. I shall assume, as subsection (2) says, that the purpose of LINKs is to promote and support
the involvement of people in the commissioning, provision and scrutiny of local care services,
the views of people about their needs for, and their experiences of, local care services
and to make such views known in
reports and recommendations...to persons responsible for commissioning, providing, managing or scrutinising local care services.
That seems absolutely fine. I do not know how else one could describe in a nutshell what a public involvement organisation should do, whatever one calls it. That is fine, but as has been mentioned, subsection (3) risks undermining that function entirely. The Conservatives wish to delete the subsection altogether, but I think that that would be too restrictive. It is sensible to be able to vary or perhaps add to the measures. Indeed, when they are established, LINKs might wish anyway for a mechanism to do so without going through all kinds of complicated, time-consuming bureaucratic procedures.
However, to allow the Secretary of State to omit any of the activities in subsection (2), even if they must consult on that omission, seems inappropriate. It goes too far. It could send a negative or destabilising signal at a time when people need to be reassured that there will be a firm foundation for patient and public involvement in health. My amendment seeks to reduce that uncertainty. I look forward to the Ministers response.
Dr. Pugh: As I understand the amendments, they are very different. Amendment No. 198 would ensure that the powers defined in the Bill could not be varied by the Secretary of State, while amendment No. 182 would just ensure that they could not be varied to omit any of the LINKs existing functions or roles. The ministerial position, in contrast to the amendments, appears to be to reserve the right in subsection (3) for unfettered varying.
I am in favour of the Secretary of States having some power to add to and to refine LINKs powers. I do not anticipate that he would give LINKs extreme power, as the Conservative spokesman suggestedI
Robert Neill (Bromley and Chislehurst) (Con): I support my hon. Friend the Member for North-East Bedfordshire. I referred in our discussions last week to some of the concerns raised by my patients forum, and this is one of them. There was concern that part of the unspoken, hidden rationale was the feeling that successful patients forums had rubbed people the wrong way.
If patients forums or the proposed LINKs are to do their jobs properly, it will sometimes be necessary for them to deliver messages that are uncomfortableuncomfortable for health service managers, for the Department and maybe for local authorities. They must be able to do so in the full confidence that, if their messages are uncomfortableif they sometimes say things that are harsh but necessarythere will not be a tendency, as sometimes happens, to say, Lets get rid of this rather awkward, turbulent priest and be done with it.
There is a suspicion at the moment that that is partly what has happened to the current patients forums. If they are to be successful in the guise of LINKs, they must have guarantees of independence. There is a concern about independence of funding, to which we can return later, and about how they will have the independence to inspect rigorously without being obstructed. There is also a concern that their functions should not be chopped and changed in a way that could at the very least emasculate their effectiveness.
I am sure that that is not in the minds of the Ministers here today, but who knows how such things will proceed? There are always pressures, and although I appreciate that the ability to remove the turbulent priest by statutory instrument is an improvement on Henry IIs method, the principle is just as unpleasant and inconvenient. If people are to have confidence in the volunteers whom we want to involve, surely they are entitled to know that the goalposts will not be changed as punishment for being effective and delivering harsh but necessary messages.
Mr. Woolas: I am not sure that I like the Henry II example. I am searching the cellar for some champagne.
I shall explain what the Government are trying to do in clause 153. The experience of the patients forums, as the Government acknowledge, was that their role and functions were too tightly prescribed in primary legislation. Changes in health that occurred more quickly than some might have expected meant that the forums were unable to adapt to fit the changing circumstances and their working environment as well as they and we would have liked. Therefore, it is important to retain the power to amend the specified activities. That is not unusual when establishing bodies. It will enable Parliament to adjust the role of LINKs on proposals from the Secretary of State when they are necessary to reflect changes in
I reassure the Committee that both Houses of Parliament will make the decision on future proposals, which will be subject to the affirmative procedure. Our intention is for LINKs to remain up to date, which is why we wanted subsection (3). As I said, it is not unusual that Parliament and the Secretary of State should retain such powers.
The Committee has a problem with the word omitting. The intention of having that word in subsection (3) is to account for possible changes in local circumstances, or for functions that are carried out at the moment but which might not be necessary in the future. I was told, when I entered Parliament, that it was still illegal not to practise archery on a Sunday. I have always believed that post-legislative scrutiny should get rid of laws as well as build them up. That was the entirely honourable intention behind the word omitting. My hon. Friend the Member for Bedford and Opposition Members have identified circumstances in which the power may cause disquiet among the people that we are trying to encourage, but mention of Henry II is going too far.
Robert Neill: I am sure that the Minister has the genesis of a Henry V in him. Perhaps he will come a little further with his reassurances.
Mr. Woolas: My general rule on kings is that if they were Lancastrians, they were probably good guys.
I agree with hon. Members in that there is a problem with the word omitting. However, we need the power to vary the specified activities subject to the parliamentary procedures to which I referred.
There is a slight difficulty in the wording of amendment No. 182. Should we accept it, the clause would not read properly because of the commaa tiny, technical point, but striving for perfection is a good thing. The Government agree with the intention of amendment No. 182 as regards the word omitting. However, we believe that amendment No. 198 goes too far because, if accepted, the Secretary of State and Parliament would not be allowed to bring the measures up to date when circumstances require. There is also the issue of how LINKs will develop. They may be required for support functions such as training that are not prescribed but which may become necessary. I would like, with the patience of the Committee, to find a way of getting rid of the word omitting while making the Bill read well.
Dr. Pugh: The Minister is clearly trying to tidy up and give assurances and all of the things that it is desirable for a Minister to do on such occasions, but he is suggesting that the Secretary of State will not usethe powers without the affirmative resolution of the House. If that is the case, why is there a problem with putting that in the Bill?
Mr. Woolas: I am reliably informed that that is in the Billwhen I find it, I will let the hon. Gentleman know where. The hon. Gentleman made a fair point, but provision is made for the matter to be subject to the affirmative resolution.
Alistair Burt: Is the Minister suggesting that he will, in due course, introduce a new clause that will remove the word omit?
Mr. Woolas: Yes, I shall do that. It will also remove the comma, so that it reads properly. I should also like to take this opportunity to ask the hon. Member for Southport to consider clause 170, which relates to the point that he made.
I hope that the hon. Member for North-East Bedfordshire will consider asking leave to withdraw the amendment.
I am also relieved about the comma, the least said about which in future, the better. My hon. Friend the Minister was going to deal with the comma and the omission. On reading clause 153(2) it is difficult to imagine how patient and public involvement in health and social care could be carried out by omitting any of the requirements. Powers on variation and flexibility are included in the measure. In view of my hon. Friends intelligent, generous comments, I shall not press my amendment.
Alistair Burt: I endorse what the hon. Gentleman said. It is a good moment for Bedfordshire all round, in respect of the clause and the Bedfordshire amendments. However, I should be grateful, knowing what the English language is like, if the Minister made it clear that there is no way in future that the term variation would be deemed to include omission. If he did so, that would deal with the point. In theory, vary could mean anything. I forget whether Committee debate can be used in the courts to indicate what was in Ministers minds at the time that legislation was passed or changed. I am clear what the Ministers intention is, but it might be helpful if he said it.
Patrick Hall: There is always doubt, with the English language or any other language. I have checked the Concise Oxford English Dictionary, which defines vary as to change, make different, diversify and also to suffer change.
Alistair Burt: I am grateful to the hon. Gentleman. However, I would still find it helpful if the Minister made clear what we know his intention is.
Mr. Woolas: Vary in law carries a different meaning and definition to omit. Vary implies changing from one thing to another, not simply stopping doing things. I will undertake to make that clear.
Alistair Burt: I am grateful. That tidies things up and deals with the main point of our amendment, which was to cover the point raised by the hon. Member for Bedford. With the Ministers assurance, I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
(4A) The Secretary of State shall make payments to each local authority that are in the opinion of the Secretary of State sufficient to cover the costs incurred by that local authority in making contractual arrangements specified under subsection (1).
(4B) Nothing in this section shall prevent a local authority making contractual arrangements under subsection (1) so as to ensure that the activities specified in subsection (2) are carried on to a greater extent than would be the case if the arrangements were to cost no more than the payments made available under subsection (4A).
(4C) The Secretary of State must send to the Comptroller and Auditor General within sixty days after the end of the financial year a statement showing the payments made to each local authority under subsection (4A) and the costs incurred by each local authority in making contractual arrangements under subsection (1).
(4D) The Comptroller and Auditor General must examine, certify and report on the statement provided by the Secretary of State under subsection (4C) and must lay copies of the statement and of his report before Parliament..
The amendment has a number of aims. It provides, first, that the Secretary of State should make available to local authorities sufficient funds to deliver effective local LINKs; secondly, that councils are welcome to be generous and to add to that sum if they wish; thirdly, that information about the funding made available to each local authority should be open to scrutiny by the public, councillors and Members of Parliament; and, fourthly, that local authorities should use the funding that is made available by the Secretary of State to support LINKs and hosts, not for other purposes. The amendment is designed to meet concerns raised by forum members and by others.
Ministers have said, and it should be repeated, that patient and public involvement in health and social care will involve a vast number of people and organisationsnot only the patients forum members. Concerns have been raised across the piece that, as is often the case, funding will be insufficient. Whatever the state of the economy or of the settlements for local government, local councillorsI have been onealways say that funding is insufficient. Unless things are nailed down there is a temptation to use funds for other purposes, and the fear is that the funding for LINKs will not be ring-fenced and could be used for other purposes. I accept that there might be more that is wrong with the amendment than merely a comma. It probably would not succeed in achieving ring-fencing, but its purpose is to generate a debate and probe the issues.
A lot of the talk about costs is speculative, and I would appreciate some guidance from Ministers on the funds that might be made available. If that is too much to do now, perhaps the Minister could write to me later.
Whatever happens, LINKs will not come cheap, and there will be high expectations of the new system. They will cost money, and people will want to see that money being used cost effectively. Whatever the amount is, it will all be needed for LINKs, and it will not be acceptable for it to be frittered away in other directions. The amendment is intended to avoid that.
Tom Brake (Carshalton and Wallington) (LD): Does the hon. Gentleman agree with ring-fencing in principle? Is it the appropriate way for local government finances to be managed? I admit that it is an unlikely scenario, but I encourage him to consider a situation in which LINKs had worked so effectivelywith embedding of processes in parts of the health servicethat they were no longer required. The hon. Gentlemans amendment would mean that there would have to be a certain amount of spending on them nevertheless. Will he consider that?
Patrick Hall: We may have a clue as to whether it is needed after a few decades of studying how the new system has worked. However, I find it difficult to imagine that there will cease to be a need for patient and public involvement in health and social careI really do not see that need disappearing. Given the pace of change in the welfare systemtechnological, scientific, medical and in other waysI envisage an increase in the need, rather than a decrease.
The principle of ring-fencing ensures that taxpayers money, which comes from the Government for these purposes, is delivered through local councils to host organisations. There is a specific purpose for the money and, in principle, I do not see any harm in ensuring that the money is delivered for that purpose. Ring-fencing is the sort of mechanism that has occasionally been used before to ensure that a job is done. The purpose of the amendment is to ensure that we have the opportunity to debate that matter and to hear what the Government are thinking.
Dr. Pugh: We support the thrust of the amendment if not its actual fine detail. I think that it will be well received by treasurers of local authorities who are used to local authorities being given extra responsibilities and then being told by the Secretary of State that the cheque is in the post. Sometimes they have difficulty
Tom Levitt (High Peak) (Lab): Mr. Chope, I hope that you will give me licence to raise one or two points that might more properly be discussed on clause stand part. I will refer to the amendment, but I understand that it is not your intention to allow a clause stand part debate.
I would be grateful if the Minister confirmed for me that when the amendment refers to local authorities, that means local authorities with social services departments. In two-tier areas such as my own, that would be the county council rather than the district council.
The Minister pointed out that approximately 80 per cent. of PCTs are now coterminous with local authorities. In my constituency, our PCT is one of the 20 per cent. that are not. In Tameside and Glossop PCT, Glossop comes under Derbyshire LINK, and the rest of the PCT area comes under Tameside metropolitan borough councils LINK. In those situations, the local authorities and the LINKs must be obliged to talk to each other if they are discussing services and constituents who live in their area. That leads me to ask another question: if someone lives in Glossop, and therefore comes under Derbyshire county council and Derbyshire LINK, but uses a service in Tameside, which is within the same PCT but outside their LINK area, would they take their problem to the Derbyshire LINK, which covers where they live, or to the Tameside LINK, which covers the area where the facility is provided? In other words, are the inspections on behalf of the residents or of the facilities?
My final point relating to that and the amendment is that the administrative costs in those LINKs that are dealing with more than one PCT area will presumably be significantly higher than those in which there is a one-to-one relationship. Will the Minister give an assurance that where LINKs have to deal with more health bodies than would be the case in a coterminous situation, the additional funding will be supplied?
Mr. Dunne: I share the concerns raised by the hon. Member for High Peak, particularly in relation to LINKs covering a relatively narrow geographical area. The issue that comes to my mind is of services that go beyond the scope of the general PCT. I refer here to specialist services. In my area, for example, the mental health service has been taken out of Shropshire County PCT and now comes under the South Staffordshire Healthcare Trust, which has responsibility not only for mental health services within South Staffordshire but also across the Prison Service. I understand that the trust looks after mental health services in more than50 prisons, including on the Isle of Wight. Has the Minister considered how a trust that develops activities way beyond its historic area will interact with LINKs?
Finally, I wish to ask the Minister from where will the funding come? As it is to come as a result of the Bill, I assume that it will come from his Department. Was the £26 million of PPI forum funding to which the hon. Member for Bedford referred a Department of Health budget? Can all local authorities be secure in the knowledge that the funding will be provided to them through their relationship with their own Department rather than from the Department of Health?
Robert Neill: I want to reinforce my hon. Friends point about prison medical services. I practised as a barrister in the criminal courts for 25 years and I sometimes had a great deal to do with the recipients of prison medical services, so that strikes a important chord. There is real concern among legal professionals, the judiciary and the probation service about the variable quality of medical services in prisons, how they are provided and their accessibility. There is a difficulty with transparency and patient voice in prison medical services. I do not expect the Minister to have an answer now, but I flag up the matter because it is of real concern, particularly given the linkage and the large number of people in prison who suffer from mental health problems.
There is concern about the difficulty in finding means by which we can keep up consistent pressure to improve the quality of services, especially when, for example, prisoners on remand may be moved from one institution to another and therefore come under the care of more than one trust as the provider. There is a complete lack of transparency and accountability in those circumstances. People in prison, by its nature, often do not have the constituency base to argue for them that there is in the general community.
Tom Brake: Last week, I visited a prison and saw its medical services. Does the hon. Gentleman agree that the cost implications for LINKs set up in an area with prisons are significant? The process of consulting prisoners will clearly be more challenging than consulting the public generally.
Robert Neill: Indeedthe hon. Gentleman is absolutely right. LINKs may not be the solution for prison medical services, but we must have something that will safeguard the interests of prisoners, either on remand or convicted, who are also patients. Inadequate treatment of a number of problems, particularly mental health, is sometimes a significant trigger in reoffending, as we all know. It is important that the matter is taken away and looked at and, perhaps before the Bill is discussed on Report, we can receive more assurance about how overview and scrutiny of medical services in prisons will be dealt with.
Mr. Woolas: I thank hon. Members for their comments because they really show the value of Bill scrutiny. Many of the points that have been made and the questions that they throw up provide reasons why
Members of Parliament make representations on behalf of their constituents to service providers that are sometimes at the other end of the country or overseas. They sometimes make representations on behalf of people whose last known address was in their constituency, but are now overseas or serving at Her Majestys pleasure, if I could put it that way. The arrangements are important and I am grateful to members of the Committee for raising them.
I confirm to my hon. Friend the Member for High Peak that we are talking about social services authorities. Two-tier district authorities that do not provide social services would not be covered. In consideration of his point about what we do in areas that are not coterminous, I was casting around for the most difficult example in the country; I then realised that it was Glossop in Derbyshire and in the same thought, realised that my hon. Friend the Member for High Peak was on the Committee.
Those Committee Members who know that part of the world will know that there is a natural community in the north-west of Derbyshire that pulls towards the Greater Manchester area in terms of travel-to-work arrangements, but that the rest of the constituency of Derbyshire pulls towards the rural and beautiful county of Derbyshire. Indeed, my hon. Friends mental health trust is shared with other local authority areas in the Greater Manchester area, including my own. Therefore, he raises a very good point.
The hon. Member for Carshalton and Wallington has raised the point about prison medical services. In those circumstances, other things being equal, the costs would be higher. That is why we believe that the mechanism of grant distribution should not be as tightly ring-fenced as my hon. Friend the Member for Bedfords amendment would have it.
The amendments and the debates around this clause strike at the very principles that underpin local government funding. Promising the end of ring-fenced funding is an easy way to get a round of applause at the Local Government Association conference, as the right hon. Member for Witney (Mr. Cameron) discovered last July. It is a different thing altogether when one looks at some of the many functions that local government provides, especially under a regime of devolution and partnership working. In practice, one applies pragmatics to the deliberations. Local councils, as has already been said, will always present a gross bill for their new functions. In my experience, they have never presented a net bill of the savings as well as the new costs. I do not expect them to do so, but I always hope that they will. We therefore have to be wary in our implementation of the new burdens policya policy to which the Government are committed and for which, as has already been established, we do deliver the money.
We shall deliver the money for the LINKs function, but one has to be has to be realistic in preparing new burdens grants and ensure that that they are meeting net costs and not paying an invoice that has arrived from 150-plus local authorities around the country. I am not suggesting that treasurers would over-egg the puddingthey do not need me to suggest that. They put together the most ingenious, innovative reasons why every one is unique. Sometimes they are rightsometimes there are real needs, as described by my hon. Friend the Member for High Peak. It would therefore not be sensible to make legislation that precisely prescribed a mechanism that would result in, in effect, a blank cheque. On the other hand, it is entirely desirable that the functions are properly financed, both in their establishment and in their operation. Let me explain how we propose to do that.
There are four parts to amendment No.180. The first proposes that a requirement be put on the Secretary of State to ensure sufficient funds are available to cover a local authoritys costs in its work to put in place contractual arrangements that enable the establishment of LINKs. The intention, as the Committee knows, is that the Secretary of State will make a grant to each local authority to enable it to fund its activities to procure a host organisationthose are the establishment costsand subsequently to fund the activities of the LINK itself. We propose that the grant should be made under section 31 of the Local Government Act 2003. The grant will be explicitly targeted to provide funding for the purpose of making arrangements to establish a LINK. In relation to this part of the Bill, it is Department of Health money that I am spending on the champagne.
In making the grant, the Secretary of State will assess what levels of funding will be necessary for each local authority to cover its costs and ensure that there are sufficient funds to enable arrangements to be made to fulfil the activities set out in the Bill. The grant will go to the council in recognition of the fact that the council has a statutory duty to fulfil those activities, but will not prescribe the money too tightly, as ring-fenced budgets in other areas do. That will give the local authority some flexibility in making arrangements.
In anticipation of the new arrangements, we are working with local councils and with the Local Government Association, which is once again carrying out an essential function on councils behalf, to determine the costs associated with administering and monitoring contracts between councils and host organisations, which will vary according to the nature of the area and the local authoritys infrastructure. Funding will be allocated to local authorities according to a mechanism that takes into account factors such as variations in size and arrangements with health care-providing organisations. We believe that to put all that on the face of the Bill would create a self-fulfilling prophecy of complications and bureaucracy. At the end of the day, it would not give the taxpayer the best value for money.
Alistair Burt: May I ask the Minister to note that an issue about formula funding in health care and local authority matters is arising in rural and semi-rural areas? There is a concern that formula funding does not properly take into account some of the problems of such areas, such as distance and isolation. I am keen for him to indicate that any formula should take into account such issues, because there is a debatable point about how they are currently handled, and I want that to be noted.
Mr. Woolas: The ears of my hon. Friend the Member for Wigan are twitching after that intervention. He represents Wigan and the metropolitan authorities and he is conscious that if I answer in the affirmative, the metropolitan authorities will get a smaller slice of the cake, other things being equal. That is the problem faced by any Government in distributing fundsa point that I urge hon. Members to raise with proponents of the Sustainable Communities Bill, as that fact of basic arithmetic seems to have gone missing. My answer is yes: sparsity is a factor in the proposed distribution calculation.
Hon. Members will point out the apparent differences between the health funding formula and the social care funding formula. Under the social care funding formula, we take into account the number of people over 90 in an area, but I believe that in health funding the cut-off age is 85. That represents a sensible policy relating to prevention and health. As health and social care are brought closer together, funding formulas must be rational and transparent. We all desire that. What we do not want to do in recognising the different pressures on different areas is to create a complicated formula, because complicated formulas are the enemy of transparency and accountability. They are also the enemy of a happy state of mind for Ministers for Local Government.
Patrick Hall: The formula, complicated or otherwise, is to do with the amount granted to a local council to set up hosts and LINKs. My question is not only about whether that amount will be enough, but whether the money will be used for the purposes for which it is allocated.
Mr. Woolas: The answer is that yes it will. Special grants over and above the revenue support grant are often described as ring-fenced. When there is flexibility, the money is given in the expectation that a council will carry out a function. We do not prescribe and create a situation in which if x amount of money is given, it must be spent specifically on certain expenditures because there are different ways in which functions can be undertaken. For example, if one wants good use of buildings, one might enter into an arrangement with a health authority to rent one. Is the money involved to be accounted for by LINK, or should the accounting of it be proportionate to the fact that the building might be used by another part of the health and social care service, or by an independent tenant?
The formula and special grant, under the 2003 Act, does not prescribe exactly; it meets the purposes that my hon. Friend, on behalf of LINKs and the people hoping to be involved, quite rightly outlined. Can we guarantee that the money given to a council will be
The 2003 Act provides for a mature way in which to fund councils, whereby there is an expectation that functions are delivered without the unnecessary bureaucracy that the present and previous Governments have imposed in the past.
Tom Brake: May I bring the Minister back to the subject of complex formulae? He expressed a preference for simple formulae. Do I take it from that that the presence of a prison will not influence the amount of funding for a LINK?
Mr. Woolas: The most extreme example I can remember of an argument for change to a funding formula in social care involved a local authority, which said that because it had an above-average number of blocks of flats with an above-average number of stairs, it took social workers in the area longer to meet clients than elsewhere. The hon. Gentleman knowswe have debated this beforethat formulae cannot be too complicated. I said simple formulae, not very simple formulae; that is important. The judgment will be based on factors such as the size of an area, the nature of the population, demographics and so on. It will perhaps also be determined by factors such as the one he mentions.
For the hon. Member for Bromley and Chislehurst, I can confirm that prison medical services will be covered by LINKs. LINKs will make representations about and will cover prison medical services on behalf of the patient, which is to say the prisoner, not the prison. Therefore, what matters is how many prisoners a local authority area has, not whether they are imprisoned in their local authority. I am certainly not going to suggest that some local authority areas have more people in prison than others, but hon. Members will be aware of the delicate balance.
Alistair Burt: I do not want to hold up proceedings unduly and the Minister may not be able to answer this question just now. Yarls Wood, which is the largest asylum detention centre in Europe, is in my constituency. It has had some issues relating to medical and health care. What provision is being made to ensure that detained asylum seekers and their representatives have access to health LINKs? I do not expect the Minister to have the answer at his fingertips, but I would be very happy to receive a letter on that in due course.
Mr. Woolas: The hon. Gentleman is entirely accurate when he says that he cannot expect an answer to that question now. None the less, he makes a good point. Yarls Wood is in his constituency and for many years he has arguedvery conscientiously in my viewon
Tom Levitt: I just want to make a helpful passing comment to the Minister. The issues being raised by the hon. Member for North-East Bedfordshire are not any different to those in respect of patient advice and liaison services. When an individual has a complaint that they want make, they use the PALS procedure. It is already established that PALS will take a complaint from anyone who lives within the PALS area.
Mr. Woolas: My hon. Friend makes an important point, and it applies to many representative and advocacy bodies.
Robert Neill: I appreciate the spirit in which the Minister has approached the question of prisons, and I hear what he says about funding. My intervention also relates to access, which is a point my hon. Friend the Member for North-East Bedfordshire has raised as well. There is concern among the prison population in particular that prisoners can be transferred between a number of institutions and moved from the care of one trust that is providing for a number of prisons into the care of another. There is a long-standing concern about the handover of prison records to ensure continuity of treatment, medication and so on. Again, I appreciate that the Minister will not have the answer at his fingertips, but can we have some assurances in writing about how LINKs will work to ensure that there is scrutiny of the prison medical service, and about how prisoners and their families can get access? Their specialist advisers will need access as well because they may need the right medical reports to put before a court.
Mr. Woolas: The hon. Gentleman makes a good and fair point. He will know also of the circumstancesin which a prison can commission a number of health providers. Even when the prisoner and patient isunder their jurisdiction, they are not necessarily in the same hospital. Therefore, I will comply with his request.
In proposed subsection (4B), it seems that my hon. Friend the Member for Bedford is aiming to allow local authorities to spend more on making contractual arrangements than the allocation provided by the Health Secretary. There is nothing in the Bill to prevent councils from making additional funds available for LINK activities. I hope that my hon. Friend willagree that the amendment is not necessary in that respect.
I can see what is being proposed in subsection (4C). It is a means by which a local council can be identified if it has chosen to use some of the funds provided on expenditure that is not LINKs related. As I have said, I think that it is right that local councils be able to spend funds in a way that best enables them to make appropriate arrangements. That they have to make the arrangements is what the Bill is designed to ensure.
When the Secretary of State makes grants to fund LINKs to local authorities, the amount of the grant is in the public domain. As it is a special grant, unlike the revenue support grant, it is possible to identify how much has been allocated. That is not the case for other items. The most recent example that occurs to me is the concessionary bus fare scheme, in respect of which money was put through the revenue support grant formula. It is not possible to identify specifically how much is being given in such cases, but it is possible in the present case, which is the reason for having chosen the funding mechanism that has been adopted.
It follows that local authorities will have to account for their monies, and the monies that they make available to fund LINK activities will be covered by the annual audit. LINKs will be able to say how much money local authorities made available to fund their arrangements, and they will know how much the Secretary of State provided. I imagine that they will be professional and vigilant in holding any diversion to account.
The problem on subsection (4D)my hon. Friend the Member for Bedford acknowledged itis that the resulting process for arranging statements and national auditing might be too complicated. Money will be made available to local authorities, and they will be accountable. They will have to make decisions in line with the thrust of the Bill, which is designed to give greater local freedoms and flexibilities. The Government will ensure that grants are open and transparent, and LINKs will know how much money has been made available.
I believe that the Bill achieves approximately the right balance, and I hope that my hon. Friend the Member for Bedford and the Committee will agree.
Patrick Hall: I have listened carefully to the debate, and it has been helpful. My hon. Friend did not refer to the total sums that might be available, and I cannot quite understand that. There is a lot of speculation about whether that total will correspond to the amount spent on patients forums and on the commission, or be equivalent to community health council spending. Although the Minister might not be able to state the amount now, I hope that he will write to me to give a broad indication.
Mr. Woolas: I apologise that I did not answer that question. The answer is that the amount is not yet known, because we are entering discussions with local authorities to identify their needs. There is an obligation to provide sufficient funding, however. The budget for the Commission for Patient and Public Involvement in Health for 2006-07 is £28 million. If the Bill passes, that money would be taken into consideration.
Patrick Hall: I thank my hon. Friend for that. I think that many of peoples understandable fears will be answered when people consider what he said about section 31 of the Local Government Act 2003 and the special grant nature of the money. Local councillors will also know that there will be a great deal of interest in such matters as the time approaches, and I am sure that they will wish to ensure that the process is properly
Amendment, by leave, withdrawn.
Clause 153 ordered to stand part of the Bill.
|©Parliamentary copyright 2007||Prepared 7 March 2007|