Clause 20

Health and Social Care Bill – in a Public Bill Committee at 9:30 am on 17th January 2008.

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Consultation in relation to guidance under s. 19

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

I beg to move amendment No. 76, in clause 20, page 10, line 19, at end insert—

‘(c) consult and have regard to the advice of the service user panel.’.

Photo of Derek Conway Derek Conway Conservative, Old Bexley and Sidcup

With this it will be convenient to take new clause 2—Duty to establish and maintain service user panel—

‘It shall be the duty of the Commission to establish and maintain an advisory panel to be known as “the service user panel”.

(5) The service user panel shall be comprised of such members as appear to the Commission to represent the views and interests of patients, service users and the public.

(6) The service user panel shall have such functions as determined by the Commission.

(7) The functions of the service user panel as determined under subsection (2) must include contributing to and advising the Commission upon:

(a) the annual plans of the Commission for inspections, reviews and special reviews, and inquiries,

(b) guidance on compliance with registration requirements,

(c) indicators to measure the compliance of registered organisations with the registration requirements,

(d) methodologies for performance measurement, and

(e) methodologies for inspection.

(8) The Commission may request the service user panel to help it to ascertain, from time to time, the opinions and level of satisfaction of patients, service users and the public with regard to the activities to which the Commission’s functions relate.

(9) The service user panel may establish and maintain such arrangements for consultation with patients and members of the public as agreed with the Commission as relevant and appropriate to the carrying out of the functions conferred on it by the Commission.’.

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

New clause 2 seeks to establish a service user panel, and amendment No. 76 is consequent on that, making sure that the CQC consults such a panel in formulating guidance under clause 19. Naturally, that builds on the discussions that the Committee has already had on service user involvement under clause 2 and amendments Nos. 2 and 134. The Committee can refer back to the points that were made in column 146 and following, rather than me restating them into the record. I hope that that is a helpful reference. I highlight again that, in response to the consultation preceding this Bill, the Department stated that

“many responses supported the greater input from patients and users of services proposed in the consultation document... The Care Quality Commission will be a user focused organisation”— and I emphasise—

“recognising that it can only do this effectively by involving them.”

Which? notes in its submission:

“It is a startling omission that the new body charged with overseeing the quality of health and social care will not have a duty to take patients’ views into account in the course of their work.”

Again, I would encourage the Minister to heed the Conservative party’s commitment to Healthwatch, a national consumer voice for patients and service users.

The service user panel can provide a high-level mechanism by which the commission can receive advice from service users. Plans, processes and methodologies that are relevant to the quality of care, the experience of service users and the successful engagement of service users generally can be developed in co-operation with an expert group on such matters. Patients and service users will be reassured that there is a voice for their interests at a high level. Moreover, the panel can seek wider views as required, which will further build confidence in the regulator.

Ofcom has a consumer panel that plays a similar role, and it convenes a regular consumer forum of interested parties such as consumer and disability organisations. The Office of the Health Professions Adjudicator, under clauses 101 and 102, and the Council for Healthcare Regulatory Excellence, under clause 108(4), are both given duties to consult the public, including bodies that seem to them to represent the views of patients; there is  no such duty for the commission. The service user panel can at least act as a proxy for such wider consultation.

The Minister made clear in an earlier debate that the Department expects the CQC to establish, under schedule 1, paragraph 6, a panel similar to that proposed in the amendment. That will give the commission the duty to establish at least one advisory panel. No doubt, that commitment will be used to call the CQC and the Minister to account when the CQC begins operating.

The Minister noted that he was still reflecting on the issue, and he undertook to come back to the Committee with clearer thinking on the subject. We hope that he will include Local Involvement Networks in the Bill—I am sure that the Committee remembers that discussion—and consultation with patients and service users.

Does the Minister agree that the voice of patients and service users is key to generating effective guidance on compliance with requirements? Does he agree that the new clause and amendment No. 76 would give him the precise vehicle that he seeks, and that he will therefore be minded to accept them?

Photo of Ben Bradshaw Ben Bradshaw Minister of State (Regional Affairs) (South West), The Minister of State, Department of Health

As I have indicated in previous sittings, I am still reflecting on the question of public and patient involvement. In respect of the Opposition’s affection for the new national body Healthwatch, there is nothing to stop LINks forming a national network if they wish, but we are trying to move away from the top-down approach from Whitehall to a more bottom-up approach. We would certainly welcome that development. It is very much up to LINks, as autonomous bodies, to decide if that is what they would like to do.

As I have indicated, part 1 requires the commission to have regard for the people who use the services in everything that it does. As the hon. Gentleman acknowledges, the Bill already requires the commission to establish an advisory committee under schedule 1, and it also provides for the commission to establish further committees or sub-committees, such as one that comprises solely service users. They might have specific functions or a more general function, allowing the commission to decide how best to seek input from different representative groups.

The problem with the new clause is that it proposes that the commission should determine the functions of the panel, while specifying a number of functions that must be included. Again, there is a debate to be had between flexibility and inflexibility. The new clause seems to be giving the commission the flexibility to decide how it uses the panel, but we believe that the commission can use a group to look at specific matters. It is important that a representative group should have the freedom to express its views in relation to any of the commission’s functions, rather than being restricted to functions specified in the clause, and any other matters that the commission determines. That is reflected in schedule 1.

Clause 43 requires the commission to publish a document on the frequency of reviews, and clause 75 requires it to publish its programme of special reviews and investigations. As with all the commission’s functions, it must have regard to the views of the public when preparing those documents. On the basis of those reassurances, I invite the hon. Gentleman to withdraw the amendment.

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

I am grateful to the Minister for restating that he continues to reflect on these matters. It would therefore be premature to press the amendment at this stage. I think that we can with some confidence look forward to something being produced on Report, given what he said. However, I caution the Minister against being a little too ready to be contemptuous of the concept of Healthwatch. It may well be instructive that he wants to give that rather more thought when he is reflecting on these matters. He will recall that the establishment and coming together of LINks was something that was won in another place on another Bill, on which my noble Friend Earl Howe led. Therefore, the Minister needs to be a bit careful about assuming that he has found the magic recipe for the bottom-up approach, rather than the Whitehall, top-down approach. Healthwatch is intended to be part of an organic, bottom-up approach. Having offered those cautions, but in the positive context in which the Minister is reflecting on these matters, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

I beg to move amendment No. 23, in clause 20, page 10, line 25, at end insert—

‘(c) lay the draft guidance before Parliament.’.

The amendment simply calls for the Secretary of State to lay before Parliament the draft guidance on compliance with requirements. Therefore, this is simply a matter of the Minister letting us know whether he thinks that Parliament should not have the right to debate such guidance.

Photo of Ben Bradshaw Ben Bradshaw Minister of State (Regional Affairs) (South West), The Minister of State, Department of Health

As with a similar amendment proposed to clause 18, I appreciate the Opposition’s concern with parliamentary scrutiny of these issues. Again, however, I am not wholly convinced that this proposal would represent the best use of parliamentary time. Standards for better health, against which the Healthcare Commission judges NHS bodies, are not currently laid before Parliament; nor are the national minimum standards that both the Healthcare Commission and the Commission for Social Care Inspection use to determine whether those health and adult social care providers that they register are fit to remain registered.

The clause includes specific provision requiring the new commission to consult on the guidance, or on any substantial revisions to it. The hon. Member for Worthing, West (Peter Bottomley) commented on Second Reading that there is a point at which one has to trust on such matters and the Secretary of State should be relied on to carry out an open and genuine consultation. I argue that we should be equally satisfied that we can rely on the commission to consult such people as are appropriate when developing guidance under the clause. The guidance will then be published. It will be a public document available for anyone with an interest to read. That is a reasonable arrangement. For that reason, I invite the hon. Member for Eddisbury to withdraw the amendment.

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

In the light of those comments, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 20 ordered to stand part of the Bill.