Sandra
Gidley: I wish to add only a few brief points, as I agree
with much of what the hon. Member for Eddisbury said. It is a great
disappointment that LINks in many areas of the country have been slow
to get off the ground. The public are not relating to them yet, their
powers seem to have been eroded, and they are poorly funded. The
Government’s drive over the past few years seems to have
decreased the importance of some of these independent groups. Some of
the community health councils were not very good, but those that were
good were excellent. It has always been a mystery to me why we did not
build on the strengths and beef up that structure rather than trying to
create something new and then, just when that was starting to work,
create the LINks concept. Nevertheless, that is what we have at
the moment. Although the Minister said that the Government were going to
consult, I cannot see LINks specifically mentioned in the
Bill.
Mr.
Mike O'Brien: The hon. Lady is quite right. What we
referred to was
“bodies or other
persons representing
patients”. The
amendment was tabled in the other place as a result of concerns raised
in relation to LINks. We do not know what the set-up will be in 10
years’ time, but we want to ensure that patients’
representatives will be
consulted.
Sandra
Gidley: The Minister is referring to clause
3(3)(a), which is where LINks would fit into the Bill. I am slightly
disappointed because it should be a given that LINks are included.
However, there are ways in which patients, bodies and “other
persons representing patients” can be consulted without going to
LINks themselves. Perhaps the Minister is admitting that the LINks
experiment has not been an overwhelming
success.
Mr.
Mike O'Brien: LINks are successful. They are clearly
independent of the NHS. They are funded through local authorities and
attached to local authority areas. However, it is our intention to
ensure that the representatives of patients are fully and properly
consulted during the whole course of the 10-year review. We have
already consulted local organisations representing patients as part of
the review that resulted in the introduction of the constitution. My
noble Friend Lord Darzi put on the record in the other place the fact
that we would consult LINks in any review of the constitution, just as
we did during the initial consultation. It is our intention to work
with LINks both on 10-yearly reviews and on any more minor revisions.
The amendment is therefore unnecessary. We listened to the debates in
the other place and to concerns raised by LINks and others that we
needed to refer specifically to patients bodies in the consultation.
The amendment was then tabled requiring the Secretary of State to
consult “bodies
or other persons representing patients”
during each 10-yearly
review of the consultation, and, as the hon. Lady said, that provision
is in clause
3(3)(a). Hon.
Members will be aware that it is not necessary for legislation to list
in detail every organisation and every body that needs to be consulted.
It was agreed in the other place that the phrase,
“bodies or other
persons representing
patients” strikes
the right balance. It ensures that patients and their representative
organisations are specifically consulted while respecting concerns
about listing large numbers of organisations. Although we refer to
LINks, there are other organisations that represent all sorts of groups
in the NHS. LINks address both health and social care issues. It was
for that reason that they replaced CPPIH and patient forums, both to
link public concerns and to ensure that social care and health can be
dealt with together and considered in the round. Therefore, we want to
ensure that local organisations are fully consulted during the course
of a 10-year review and any other
revisions. Patrick
Hall (Bedford) (Lab): For the record and for the sake of
clarity, while there are many private, voluntary and charitable patient
groups in this country, it is important to make it clear that LINks are
intended to be a public as well as a patients’
voice.
Mr.
O'Brien: My hon. Friend is right. I entirely accept that.
LINks are a primary source of much of the patient and public reaction
to Government initiatives on health and were important to the
consultations that we have recently
undertaken. 5.45
pm
Mr.
Stephen O'Brien: I am pleased that through that exchange
we have ensured that there is complete absence of any uncertainty about
the Government’s intention to include local involvement
networks—their own creation—in clause 3(3)(a). The fact
that has been put in generically perhaps reflects the fact that
successive bodies have represented patients under the
Government’s watch and that the Government did not want to bind
their commitment to LINks necessarily being the last
word. I
met representatives from LINks during the interval between
today’s Committee sittings. One of the things that we discussed
is how they could transit to the health watch that we have proposed for
a number of years, ensuring that that independent and powerful patient
voice can have real influence in how services are delivered and how we
consult on the constitution
.
Mr.
Mike O'Brien: Did I hear the hon. Gentleman right? He
wants to reorganise patient groups again, having complained previously
about their being
organised.
Mr.
O'Brien: No, the Minister did not hear right. I was very
careful to say “transit”, because we have made it clear
that the last thing that we would do is to unpick LINks. However, we
would enhance and reinforce both their role and what they
do. I
was pleased to hear the hon. Member for Bedford make a contribution. I
am happy to put on the record the fact that he fought an at times
lonely but noble fight on CHCs a decade ago. He has made a valid point
about the public role, as well as the role for the individual
patient. In
light of our exchanges, I need not press the amendment to a vote. We
need to make sure that there is not only involvement but a real attempt
to understand how important the independence of the voice concerned is,
in order to engender the trust and confidence that enables patients to
feel that they are being well represented in the right way. LINks also
have the broader role of identifying the pattern of experience and
behaviour, and of spotting if anything goes wrong. All of us have the
tragic and worrying experience of the Mid Staffordshire trust in mind
as we consider such matters. I beg to ask leave to withdraw the
amendment. Amendment,
by leave,
withdrawn.
Mr.
Stephen O'Brien: I beg to move amendment 13, in
clause 3, page 3, line 24, after
‘NHS’, insert ‘or social
care’. We
can be a bit briefer on this amendment, which questions the definition
of “carers” in the Bill, something of particular interest
to all of us in light of Carers Week having taken place last week.
Currently the Bill defines “carers”
as “persons
who, as relatives or friends, care for other persons to whom NHS
services are being provided”.
A somewhat strange
contradiction seems to exist in that definition of
“carers” being put forward by the
Government. The
Committee should note that carers were only put in the Bill in the
other place. That was very welcome, and I am glad that the Government
were prepared to show acceptance. However, we need to be sure that the
amendment that was made in the Lords is seen through in both spirit and
letter. Amendment 13 would change the Bill to refer
to “persons
who, as relatives or friends, care for other persons to whom NHS or
social care services are being
provided”. The
important addition is the words “or social
care”. Section
5(4)(b) of the Health and Social Care Act 2008 already has a statutory
definition of “carers”. In that Act, which the hon.
Member for Romsey and I spent many hours debating in a room just along
the corridor, the definition
is “people
who care for service users as relatives or
friends.” What
seems strange is that that is not the definition used in the Bill,
provoking the question why it is not being used. Is something intended
by changing the definition, or are we in danger of spreading
confusion?
I hope that
the Government are not worrying about the numbers—whether that
is 5 million or 6 million carers. I think that there are 5 million in
England and 6 million in the UK as a whole, but that is often
thought to be an underestimate, as is the number of 175,000 child
carers. I do not believe that the Government seek to use the definition
to change anything to do with the numbers, but it is important to
recognise that there was a fairly settled position in the Health and
Social Care Act which seemed to be accepted by all the carer
organisations. It
is fitting to raise that point, particularly when we have just had
carers week. Like so many stakeholders, carers are yearning for the
publication of the Government’s social care Green Paper. That
has been promised by spring this year, so technically no later than 25
June. As we know, carers bridge the gaps in a system which have
remained unaddressed for too long.
I hope that
the Government take the point seriously, and in the spirit in which it
is intended. The amendment seeks to ensure that we have a clear
definition and an explanation as to why, if the Minister wishes to
pursue the matter, he has not adopted the same definition as that
proposed by the Government a year ago.
Mr.
Mike O'Brien: I certainly agree with the hon. Gentleman
that carers are an important group in our society. We have the highest
regard for them and for the work that they do. We are not changing our
definitions in relation to the Health and Social Care Act.
Amendment 13
would expand the definition of “carers” to include those
who care for persons to whom social care, as well as NHS services, are
provided. We propose a duty on the Secretary to State to consult
carers, in their capacity as carers for those who receive NHS services.
Where a carer cares only for someone who receives social care services,
the constitution would not be relevant. That is because the
constitution is for the NHS, not for social care. There would be a
responsibility to consult NHS services, but not in relation to a
non-existent constitution relating to social
care.
Sandra
Gidley: It would be helpful for the Minister to clarify
the definition of “NHS care”. Does he refer only to that
element of care in a nursing home, for example, that is funded by the
NHS? The difficulty with nursing homes is that there is not always a
clear division between health care and personal care. There are endless
debates with funding panels over that issue. It is difficult enough for
commissioners to provide absolute clarity on that, and a patient or
carer might have great difficulty in differentiating between health
care and social care. People often feel aggrieved when their loved one
has needs that are related to a health condition—in cases of
Alzheimer’s, for example—and those needs are deemed as
being related to personal care rather than to health care. Will the
Minister provide greater clarity about where that boundary will be
drawn? It is a difficult issue.
The
Chairman: Order. That is rather a long
intervention. I call Stephen O’Brien. I mean Mike
O’Brien.
Mr.
O'Brien: Thank you, Mr. O’Hara. Having
more than one O’Brien can get a bit confusing. Of course we
accept that health care and social care are interlinked. It remains a
Government priority for the NHS and social care systems to work
together on the constitution, and it highlights the importance of
joined-up services.
For example,
principle 5
reads: “The
NHS works across organisational boundaries and in partnership with
other organisations in the interest of patients, local communities and
the wider
population.” The
constitution also contains a pledge to make the transition as smooth as
possible when patients are referred between services such as the NHS
and social care or where services are jointly provided. It is
particularly relevant to transitions between health and social
services. Anyone who cares for someone in receipt of an NHS service is
captured by this and is therefore able to be
consulted. NHS
services must be paid for out of NHS funds. The obligation is on the
Government to consult the carers on the NHS constitution. It would
therefore be rather odd to seek to consult those merely receiving care
services about a constitution that does not directly apply to those
care services. Where there is a factor of NHS provision in the
patient’s component of care—some of it might be social
care and some might be NHS care—there is a requirement to
consult representative
organisations. The
concern that the hon. Member for Romsey expressed about the situation
is being addressed, because we are looking at who needs to be consulted
and what they need to be consulted on. They need to be consulted on the
NHS constitution, because it applies to them. If it does not apply to
them directly, there is no obligation to be consulted on the social
care itself. That will happen separately. Indeed, the Government will
in due course publish a major Green Paper on the reform of the care and
support systems. That is a different issue. It is interlinked, but is
not about the NHS
constitution. It
is appropriate to say that carers will be consulted when there is an
NHS factor in the care provided. I hope that that reassures the
Committee that the Government theme of partnership is clear. We want to
work closely with those providing social care, which is an important
component. We want to ensure that carers
are properly consulted, but that they are consulted on a particular
thing—the constitution. They will be consulted only on that. In
relation to other matters, such as social care, consultation will take
place in other ways. I hope that that reassures people that it will be
relevant to consult only those who care for people receiving NHS
care. Mr.
Stephen O'Brien: I have listened to the Minister and
recognise that he does not intend to do anything by sleight of hand. I
dare say we will come back to the issue when we deal with direct
payments in chapter 3, but the more that we look at packages of care
that straddle the NHS and social care, it becomes more important,
because it is difficult, as was mentioned, to disentangle care services
that are provided by the NHS and those that are an extension of care
packages. We
have about 30,000 people under continuing care, which is an NHS
provision that carries forward into the social care context, but that
is becoming more fungible as we look at the growth of direct payments,
individual budgets or personal health budgets. That is the direction
that I think hon. Members on both sides of the House wish to see
pursued. It is appropriate and relevant to individual patients and
those who need care, and it is something to which we will need to
return. In the meantime, I am prepared to postpone some of the
discussion until we get on to direct payments and I will take the
Minister’s assurance at face value. I beg to ask leave to
withdraw the
amendment. Amendment,
by leave, withdrawn.
Question
proposed, That the clause stand part of the
Bill.
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