Health and Social Care (Re-Committed) Bill – in a Public Bill Committee at 3:00 pm on 14 July 2011.
I beg to move amendment 205, in clause 179, page 160, line 5, at end insert—
‘( ) In Part 1 of Schedule 19 to the Equality Act 2010 (bodies subject to public sector equality duty), after the entry for the Health Service Commissioner for England insert—
“A Local Healthwatch organisation.””
The amendment ensures that HealthWatch England, like other bodies in the NHS, is subject to the public duties in regard to the Equality Act 2010.
I want to make some constructive comments about how the Government’s plans for local healthwatches could be bold, ambitious and really put patients at the heart of local health services and local social care services.
I have two overall points to make relating to a lack of independence and of funding. Even though I am a Front-Bench spokesperson, I hope that it is permissible for me to talk about what has happened in my own area and about my discussions with Leicestershire LINks, which represents patients throughout Leicester and Leicestershire and is based in Beaumont Leys in my constituency. I received an e-mail yesterday from Geoffrey Smith OBE, who is the chair of Leicestershire LINks, a member of two local involvement networks, a patient adviser in an NHS acute trust, a member and a chair of a patient and public involvement forum and who has experience as a company director and chief officer in a local authority. I set out his background to show that he is a very experienced man working in health and local government. He makes an important point in his e-mail:
“By creating HealthWatch the Bill offers an opportunity to avoid past mistakes in the involvement of patients and the public in health and social care. I regret that unless the Bill is amended HealthWatch will fail to meet the vision of an informed consumer champion for health and social care set out for it in the White Paper.”
He also said:
“Local HealthWatch will not be seen by patients and the public and particularly by users of social care services as independent. A body that is commissioned, funded and performance managed by a Local Authority is perceived to be subject to influence, direct or indirect, by the officers and Members of the Council and so unable to make unbiased reports and interventions.”
His view as a local LINks person is absolutely backed up by the National Association of LINks Members which, in written evidence to the Committee on 2 July, said:
“If Healthwatch is made accountable to the local authority the public will have no confidence that it will stand up for them when things go wrong.”
Similarly, National Voices said in its paper for the NHS Future Forum listening exercise that local healthwatch should be
“genuinely independent of both NHS and local authority interference.”
It is obvious that those who are funded through local councils will be less likely to want to criticise the social care or other services that are provided more generally. The recent terrible events at Winterbourne View demonstrate why it is so important that users and carers have a strong and independent voice. The National Association of LINks Members, says:
“The simple practical solution is for Healthwatch to be funded by Healthwatch England.”
There would be a separate funding stream, so that it would not be made through the local authority—[Interruption.] The Minister, the hon. Member for Sutton and Cheam, from a sedentary position says, “Extraordinary”. I thought they were supposed to listen. I am trying to be constructive. The National Association of LINks Members does not believe that the Government’s proposals for LINks will give them a strong or sufficiently independent voice. That is not extraordinary. It is a fact.
A moment or two ago, the Minister said that the Opposition had changed their stance after leaving government. Just in relation to the point we raised about nursing home registration, it is ironic that the Minister of State, the right hon. Member for Chelmsford, back in 2004 when he was the Opposition spokesman, was extremely critical of the regulatory regime which he described as “overprescriptive, expensive and bureaucratic”. He said that it was very damaging to the home care sector.
It is interesting that you level that criticism at us when you yourself have changed your position in calling for—
Order. The hon. Gentleman really must use the third person. This has nothing to do with the Chair.
My hon. Friend has made the point that the previous Government were often criticised for over-regulation. We need to take a long, hard look at the issues around regulation.
The hon. Lady is making some good points. However, there is concern in many communities, certainly in my area in Suffolk, that LINks are not accountable for the money that they are given to investigate and represent patients. Often the agenda of one or two individuals can skew the whole agenda of what a LINk is trying to do. The issue of accountability for the several hundred thousand pounds it receives is not properly addressed, and it would be better addressed if it had a closer link with the local authority.
The hon. Gentleman makes a very good point. Whether it is under LINks, the old CHCs or whatever patient and public involvement mechanism is available, there is always a danger that the organisation is not genuinely representative of the local community but has been captured by one or two individuals. I accept what the hon. Gentleman says about the fact that being part of a local council might give such an organisation greater democratic accountability, but anybody who has run an organisation that is solely reliant on funds from a local council, such as a local charity, will know that it can sometimes make people worry about speaking out. Sometimes they do; sometimes they do not; some charities do not care. They will go out there and champion their cause wherever they get their funding. Others are nervous.
I am reporting the views of the National Association of LINks Members and the LINk in my own patch, as it is my job to do so. However, not only am I doing that, but I am reporting the view of National Voices, which is the Government-run body, and the Minister should listen to it.
The issue of money and resources available for the local healthwatch has been raised with me by my Leicestershire LINk. Geoffrey Smith wrote in his e-mail:
“The experience of Local Involvement Networks in securing adequate funding for their work from the grants made to local authorities by the Department of Health does not inspire confidence that there will be adequate funding for the greatly extended functions given to Local HealthWatch.”
As I am sure hon. Members know, local healthwatch will bring together LINks, patient advocacy and liaison services, and complaints services in one body.
Mr Smith continued:
“Without such funding there will be no consistent Local HealthWatch service, the public will be confused and the reputation of HealthWatch will be irreparably damaged.”
Is my hon. Friend concerned, as I am, about ring-fencing? If local healthwatch is to rely on the local authority for its funding, surely there is a major concern about those budgets being ring-fenced.
My hon. Friend makes the point that I was about to come on to. National Voices—the national organisation that gives a voice to patients and the public—said that the simple answer is to protect local healthwatch funding, which it says is being cut due to pressures on local authorities. Ring-fencing is the best way to enable an effective local champion. It is pretty simple; I do not know whether the Minister has discussed that matter with his right hon. Friend the Secretary of State for Communities and Local Government, but it is something he should look at, and we would support it.
Interesting evidence was provided to the Committee by the National Association of LINks Members, showing that local authorities have already cut funding to LINks, which is entirely understandable, because they have to keep funding for child protection and care for older people. The evidence showed that local authorities have cut funding to LINks by an average of 24%, so a quarter of their budgets have been cut. Some councils have cut funding for LINks by up to 76%. I say to Government Members, including my relatively close neighbour, the hon. Member for Loughborough, that if they want to back that patient and public voice, which I believe the hon. Lady wants to champion, LINks should be independent and they should not have their budgets cut by a quarter. Those are the concerns we have on this area of the Bill.
Thank you, Mr Gale, for giving me another opportunity to speak in this part of our debate. I would also like to thank my hon. Friend the Member for Leicester West for her contribution, in which the intervention by my hon. Friend the Member for Kingston upon Hull East was particularly interesting.
There is a question about the funding of local healthwatch organisations, and my concerns go beyond ring-fencing and the need to protect budgets. In responding to the previous clause, the Minister seemed to adopt a passive rather than proactive approach to the duties that would be expected of local healthwatch organisations. I absolutely want them to be able to respond, develop and emerge to reflect local need, but I think we also need an assurance about the quality of services and access to them over different local authority areas. My concern is that when budgets are tight, advertising and training, for example, are the first things that are cut, even though they are essential to the quality of services that healthwatch organisations will deliver locally. Will the Minister give us assurances about how we will know that those organisations will genuinely reflect local views? How will that be measured? How will the local community be able to intervene if it thinks that its local healthwatch organisation does not reflect its views and is not acting in its best interests?
On independence from local authorities, the submission by the National Association of LINks Members says:
“Healthwatch can’t be both the champion of the public and the poodle of the local authority.”
We need reassurance that there will not be a conflict in that area, because we can imagine several scenarios in which that could become an issue. There are lessons to be learned from Southern Cross, and my experience locally has been that the local authority, struggling to find places for people with special needs and learning disabilities, is accessing services that I would certainly not be happy for my mother, or my son or daughter to use. If it is not good enough for my family, it is not good enough for anyone’s.
I was not satisfied with the Minister’s response about the provision of advocacy services. It is important that such services are provided at a local level, because they will be far more effective as a result of the local knowledge that has built up. I hope that the Minister will at least provide some guidance to local healthwatch organisations to encourage them to use local mental health advocacy services and carers’ organisations, so that we can be sure that there is a known standard in health care organisations. I am sure that we have met people in our surgeries and on our visits who complain about the service that is provided, but when we approach the local authority, we are told, “Well, they have told us that everything is fine.” It is often difficult for older or vulnerable people to speak up and complain about the service when someone from the same organisation will be delivering very intimate care to them the next day.
Will the Minister give us some information about which groups will have a duty to provide information to local healthwatch organisations? I am struggling to keep count of all the organisations and quangos that are being created by the Bill, but there are concerns that clinical commissioning groups may not have to provide information. Can the Minister give me any assurances about that?
I note what the hon. Lady has said about quangos, but are we not in danger of having unaccountable bodies in the LINk organisations that are accountable only to themselves on a local level? They may purport to represent the interests of patients—in many cases, they may well do that—but in some cases they may be pursuing the agendas of a very few people in an area, which are not necessarily for the general benefit. Having a link with the local authority helps to provide better joined-up thinking, greater accountability and a better voice for patients because of the larger agenda that the local authorities are engaged in for health.
I cannot provide the hon. Gentleman with that reassurance, but I am seeking it from the Minister. It is the Minister who has to answer these questions. That is why I asked whether local healthwatch organisations would deliver true accountability and reflect the views of local communities. The hon. Gentleman’s intervention would be better made to the Minister.
I know that my hon. Friend did not have the benefit of being a member of the original Bill Committee, but at that stage, the point was made that it would have been good for the Government to evaluate LINks before abolishing them and introducing something else. Does my hon. Friend know whether in the interim period, as part of their listening exercise and pause, the Government have finally looked at the effectiveness of LINks and found out whether there are any lessons to be learned?
I confess that I am not aware of that. I wish that I had asked Professor Field whether the Future Forum took that into account, but hopefully the Minister will take the opportunity to answer where I have failed. Finally, reflecting on my earlier observation, I would like the Minister to tell us whether local healthwatch organisations will have any influence on the commissioning of services used by local authorities.
Before I address the points raised by Opposition Members, I want to correct a term of art related to the shadow bodies that are being established. I used the term “early implementers” when talking about local healthwatch when I should have used the phrase “pathfinders”, and in future I shall refer to local healthwatch as such. The pathfinders are an important part of ensuring that we draw lessons about good practice from LINks into the new system and that we build on good practice elsewhere when involving patients in the work of local healthwatch.
The hon. Member for East Lothian asked about raising the profile of local healthwatch. It is not all about advertising. As I have said, we have a development programme in place. Our advisory group, which is made up of stakeholders from LINks, local authorities, voluntary groups and community groups, is working through the way in which the profile of local healthwatch can be raised at local level. The communications working group is looking at developing a toolkit of materials to help patients understand how and where to access local healthwatch from October 2012. We hope to benefit from earlier implementation with the pathfinder programme.
I made a sedentary remark during the comments of the hon. Member for Leicester West, which is uncharacteristic for this Committee, and I apologise unreservedly for doing so. I reacted in that way because I was casting my mind back to the debates on the role of the Commission for Patient and Public Involvement in Health. I recall that many people involved in local patients forums at the time felt that the organisation they often called “Chippy” was overweening and overbearing in the exercise of its functions, not least in its distribution of resources, so I had a feeling of déjà vu. It is interesting that those organisations now feel the opposite.
My noble Friend Earl Howe and I are happy to continue engaging with the National Association of LINks Members on such issues, but I remind LINks members, some of whom were involved in previous iterations, of their concerns about being told what to do by national organisations. Learning may be necessary on all sides when it comes to such issues.
The hon. Member for Leicester West suggested that local healthwatch will be part of the local authority. It most certainly will not. Local healthwatch organisations will be separate bodies, and we are providing for their establishment as bodies corporate. They will have a variety of legal identities, including as social enterprises, so legal independence will be established.
It is important to reassure Opposition Members on that independence by rehearsing some of the issues. A local healthwatch organisation will set its priorities based on information and intelligence gathered on local health and social care. Although some requirements will be imposed on it, a local healthwatch organisation will, in general, choose independently how to deliver its work, which is further reinforced by its place on the local health and well-being board. The local healthwatch organisation has a separate status in shaping local health decision making.
Additionally, local healthwatch organisations have independence because they feed up to HealthWatch England. Local authorities cannot arbitrarily veto the plans of local healthwatch, they cannot stop it publishing advice, including advice to local authorities, and they cannot abolish it without the Secretary of State’s consent. Not only are there local safeguards, such organisations have clear independence.
Is it correct to say that the funding of local healthwatch is not ring-fenced? Local authorities, although they may not abolish local healthwatch organisations, could, to coin a phrase, simply strangle them at birth.
No. I will explain why the hon. Lady is second-guessing my remarks, but first I shall say something on funding.
We are making available £60 million to fund local healthwatches. It is for local authorities to make the funding available through local determination, and we are working with local authorities through our healthwatch advisory group and the pathfinders. We recognise the importance of making the funding available to local healthwatches in full, which is similar to what we are doing in other areas. We do not think it would be right to ring-fence local healthwatch money. The NHS Future Forum agreed with that view and said that it was not appropriate for central Government to ring-fence funds in that way.
We are aware of the concerns of the National Association of LINks Members and of its report this year on funding cuts to local involvement networks, which says that the cuts are causing difficulties to LINks as a result of the problems that local authorities face. We want to ensure that we raise the profile of HealthWatch and the importance of its role from 2012. The funding that local healthwatches receive will ensure that the voices of patients, service users and the public are not lost during the changes. That brings me to why I disagree with the assertion that the hon. Lady made.
Local authorities will have a duty to seek to secure local healthwatch arrangements that operate effectively. Local authorities will also have a duty to make those local healthwatch arrangements, which inevitably means providing the necessary funds to enable those activities to take place. The hon. Member for East Lothian said that a local healthwatch should be a champion, not a poodle. That is certainly the Government’s intention, which is why we have established checks and balances.
Interestingly, the hon. Lady then posed an important question, and asked what do we do when a wayward healthwatch is not representative of its population and does not properly take concerns into account? That is where there is a legitimate role for a democratically elected and accountable local authority to step in and make an appropriate challenge. It is one of the checks and balances that we are trying to construct with the Bill, which is why we have a pathfinder programme to ensure that we get it right as we implement the changes. With that, I propose that the clause stand part of the Bill.