Clause 178 - Healthwatch England

Health and Social Care (Re-Committed) Bill – in a Public Bill Committee at 2:00 pm on 14th July 2011.

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Photo of Paul Burstow Paul Burstow The Minister of State, Department of Health 2:00 pm, 14th July 2011

I beg to move amendment 199, in clause 178, page 157, line 36, at end insert

‘; and the Commission must inform the committee in writing of its response or proposed response to the advice.’.

We tabled the amendment in response to concerns raised about strengthening the status and influence of HealthWatch England. The views of patients and other service users should be, as I said earlier, central to the role of the Care Quality Commission in regulating health and social care services, and informing the action that the CQC takes in circumstances where services do not meet essential levels of safety and quality. The Bill establishes HealthWatch England as a committee of the CQC, and with that purpose in mind, we want to go further in clarifying its role. The CQC’s new HealthWatch England committee will place the views and experiences of patients and other service users at the heart of the regulator. It will provide a direct channel for the concerns of patients and other service users to the regulator, and HealthWatch England’s committee will therefore provide the CQC with advice and information that it needs to take action where the views of patients and other service users highlight substandard service provision.

New section 45A of the Health and Social Care Act 2008, as inserted by clause 178, sets out the functions to be exercised by HealthWatch England operating as a committee of the CQC. They include giving information and advice to a range of persons, including the CQC, on the views of patients, other service users, the public and local healthwatches. Most of those persons are required, by new section 45A(5), to provide HealthWatch England with a written response to such advice. Currently, however, the CQC is not. The amendment creates that duty for the CQC.

Let me deal directly with the criticism that I am sure will be made: that the amendment is identical to one moved by the Opposition, in particular the hon. Member for Islington South and Finsbury, who made some of these points in the Committee before. I freely acknowledge that that is the case. What we have here is an excellent example of what our decision to pause, listen and reflect was all about, and how it enables us to improve the Bill—a tendency that, I have to say, I never saw Labour exhibit during my time in opposition and that party’s in government.

The Government’s original thinking was that it would have been unusual and unnecessary to require the CQC to make formal written responses to one of its own statutory committees; moreover, we wanted to avoid creating the perception that there was a highly formal relationship between the CQC and HealthWatch England. We believe a clear distinction between the two bodies is needed, and we want and expect communications to be formal but also collaborative, with a continual two-way flow of information between them. Those views have not changed: we still need a collegial approach, as well as one that is formalised by such reporting requirements. However, we have listened, heeded and reflected upon the points that have been made, both in this Committee and since. As the NHS Future Forum put it in its remarks on HealthWatch England,

“Although it is technically part of CQC, it needs to be allowed the independence to discharge its functions freely.”

The Government unreservedly agree with that view and we believe the arrangements set out in the Bill will achieve that. Nevertheless, we heard the point about changing the basis on which it should operate. That is why we have tabled the amendment.

Photo of Emily Thornberry Emily Thornberry Shadow Minister (Health) 2:15 pm, 14th July 2011

In view of the exchange immediately before we moved on to this clause, will the Minister graciously accept that some of the amendments tabled by the Opposition were not wrecking amendments?

Photo of Paul Burstow Paul Burstow The Minister of State, Department of Health

I am sure that some of them had a good-spirited aspect to them and were about probing the Bill; but some were undoubtedly and clearly intended, in the hon. Lady’s own words, to wreck the Bill. She made no secret of that. We have seen from the large numbers of votes against clauses that delay is part of what is taking place in the Committee.

I urge the Committee to support the amendment, which reflects the views of the NHS Future Forum.

Photo of Roger Gale Roger Gale Parliamentary Assembly of the Council of Europe (Substitute Member)

Order. I have looked through the amendments and it is apparent that, by the time we get to the end of this free-standing one and the next group, we shall, in effect, have debated the clause. I therefore say to the Committee that we shall not have a clause stand part debate. Hon. Members from all parties may wish to take cognisance of that when contributing to debate on the amendments.

Photo of Liz Kendall Liz Kendall Shadow Minister (Health)

It is a pleasure to serve under your chairmanship, Mr Gale. You are firm but fair, and I am grateful to you for explaining some of the labyrinthine traditions of Bill Committees.

I am glad that the Minister acknowledged that Opposition Members were right. I want to make three points—

Photo of Liz Kendall Liz Kendall Shadow Minister (Health)

It is funny the Minister says that, because my first overall concern about the establishment of HealthWatch England is that the Government are being unambitious about putting patients and the public at the heart of the NHS and giving them a stronger and more powerful voice. As ever, Opposition Members are the real modernisers and reformers. We are the ones on the side of patients and the public. If we were in government, we would have had a far stronger and more independent HealthWatch England.

That reminds me that during the previous Committee scrutiny, the Minister of State, the right hon. Member for Chelmsford and discussed several times whether HealthWatch England was independent. I questioned him on whether it was right that HealthWatch England should be a sub-committee of the Care Quality Commission.

Photo of Liz Kendall Liz Kendall Shadow Minister (Health)

He says, from a sedentary position, that it is not a sub-committee. On 15 March, as recorded in fabulous Hansard, he says,

“I must tell the hon. Lady that I think it is a little unfair to refer to HealthWatch in a derogatory way as a sub-committee of the CQC.”––[Official Report, Health and Social Care Public Bill Committee, 15 March 2011; c. 696.]

However, on page 38 of the Government’s response to the Future Forum, paragraph 4.39 states:

“We will…introduce a new requirement for the Care Quality Commission to respond to advice from its HealthWatch England sub-committee.”

Photo of Simon Burns Simon Burns The Minister of State, Department of Health

The hon. Lady still does not get it. What we object to is the derogatory way in which she classifies it as a sub-committee. That is our argument with her.

Photo of Liz Kendall Liz Kendall Shadow Minister (Health)

The Minister sounds as though he could be a member of the Labour party, with his knowledge of sub-committees. I am criticising the lack of independence for HealthWatch England. That is my first point.

Secondly, the proof that HealthWatch England is not strong or powerful enough comes when we assess the stature, power and resources it will get, compared with other bodies that are being set up, such as the new  economic regulator, Monitor. The right hon. Gentleman confirmed to the re-committed Bill Committee that the cost of new Monitor, which is currently £20 million a year, will increase to between £50 million and £80 million a year, so Monitor will get each year an additional sum of between £30 million and £60 million. The impact assessment for the original Bill—nothing in the amendments would change the core functions of HealthWatch England—states that HealthWatch England will receive £3.5 million a year. HealthWatch England, the new, supposedly powerful voice will get three and a half million quid to do its job, whereas Monitor gets up to £60 million extra resources a year to do the job. As Bernstein and Woodward said, “Follow the money”. We have followed the money and we can see that the power—

Photo of Liz Kendall Liz Kendall Shadow Minister (Health)

It does not really matter in which order I refer to them.

Photo of Liz Kendall Liz Kendall Shadow Minister (Health)

Journalists worrying about their status—let’s not go there.

My third point is a question for the Minister and a practical and constructive suggestion of help for the Government. I may have got this wrong; if I have, I hope I will be forgiven. As I understand it, both HealthWatch England and local healthwatch will come into being by October 2012. The National Association of LINks Members submitted evidence to the Committee on 2 July saying:

“HealthWatch England is to be established at the same time as Local HealthWatch. This makes no sense. It is needed in October 2011 to pave the way, in collaboration with LINks, the NHS and local authorities for local Healthwatch which start in October 2012.”

Will the Minister consider bringing forward the timetable for HealthWatch England’s establishment, so it can be there to get things going? Will he also explain why the Government have had so little ambition about putting patients and the public at the heart of the NHS? Will he give serious consideration to giving HealthWatch England a stronger voice and greater independence, so it can do what it says on the tin?

Photo of Tom Blenkinsop Tom Blenkinsop Labour, Middlesbrough South and East Cleveland

Fundamentally, HealthWatch England is a good idea and welcome, because it will provide patients with a greater opportunity for engagement. The real issue is that to be truly effective HealthWatch England must be an entirely independent advisory body, but in its current conceptual form, it is not quite there yet. The Government have missed an opportunity to act upon their own listening exercise and the Future Forum recommendations.

Nothing is more evident of that than the fact that HealthWatch England will still sit entirely within the CQC. In the Government’s new architecture for the NHS, there will be three big players: the NHS commissioning board, run by Sir David Nicholson; the CQC, which will ensure that basic standards of care are met, run by Cynthia Bower; and Monitor, which will promote competition as a means of improving quality, as the Government claim, run by David Bennett—for now, apparently. However, there will be a fourth crucial  arm, which is a much stronger voice for patients and the public. I do not agree with the Government’s approach. I firmly believe that, if patients and the public are to have a far greater say, the body to achieve that should be more important than the other three bodies. HealthWatch England should be independent.

HealthWatch England will lack independence because it will sit within the CQC, which creates two problems. It will have to work closely with the CQC, as it will with the other bodies, including the NHS commissioning board, so that it can ensure that information is passed up through the CQC to allow it to conduct inspections and investigations. However, what if HealthWatch England thought that the CQC had failed to do its job or work as effectively as it should?

The other problem is resources. By the end of 2012, the CQC has to register 30,000 new providers, including 9,000 providers of primary medical services, which have never before been registered, and 12,500 new providers of social care. In addition to those providers, the CQC also has to inspect and register individual sites, which, as the hon. Member for Stourbridge mentioned, is a huge task. The Ministers know about those concerns, which are being looked into, but the CQC’s resources are, like those of other arm’s-length bodies, being reduced, despite its huge tasks, and there is a real concern that HealthWatch England might not receive sufficient resources. My colleagues and I will be grateful if the Minister guarantees a ring-fenced budget.

How can HealthWatch act as the Minister envisages when it is situated within the CQC? How can it function independently when it will effectively be line managed by the CQC and, simultaneously, its chair will be line managed by the Secretary of State? The chair of HealthWatch England might have been appointed by the Appointments Commission, as mentioned in the original Committee by my hon. Friend the Member for Leicester West, but that is no longer possible because the Government have abolished the Appointments Commission, too. I cannot see how HealthWatch can behave freely, independently or robustly enough to hold its line manger, the CQC, to account. Is not the real danger that HealthWatch will be created with all the negative aspects of a quango, but without any of the benefits of being an independent body?

The Government had not acted to fulfil their promises to the Future Forum until Monday, when, fortunately, a few new amendments were tabled. Having looked at the their promises to the Future Forum, we expected the Government to introduce an explicit requirement that local healthwatch memberships be representative of different users, including carers. Fortunately that has now been done. The Government also agreed to introduce a new duty on health and well-being boards to involve users and the public, but, until Monday, that had not been done. My colleagues and I are predisposed, both politically and on an everyday level, to optimism, so I endeavour to be as positive as humanly possible about the Government’s amendments. Amendment 200—

Photo of Tom Blenkinsop Tom Blenkinsop Labour, Middlesbrough South and East Cleveland

Sorry, Mr Gale. We welcome amendment 199 as a positive amendment, because it places a statutory duty on the CQC to inform HealthWatch of its response or proposed response to HealthWatch’s  advice. The amendment also fully delivers on the Government’s promise, on page 38 of their response to the NHS Future Forum report, to

“introduce a new requirement for the Care Quality Commission to respond to advice from its HealthWatch England subcommittee”.

I would go so far as to say that I wish the Opposition had written the amendment—that is how upbeat I am. I have good reason to be upbeat, because when reading the Hansard of the original Bill Committee, I came across our debate on Opposition amendment 348, which bears an amazing resemblance to Government amendment 199, even after the expensive listening exercise.

I assume that the Minister’s attitude is as positive as mine, so I shall read out his response to amendment 348 to check whether he still agrees with what he said then:

“Opposition amendment 348 would require the CQC to respond in writing to advice and information that it receives from HealthWatch England committee. I sympathise with the point the Opposition are trying to make on behalf the Patients Association, with the intention of ensuring that HealthWatch England is able to have its own distinct identity within the CQC. However, the amendment could work against the building of effective working relationships between HealthWatch England and the CQC. Staff working for the committee and the wider commission should be having an open and ongoing dialogue about their work. Formalising that as the amendment proposes would give the impression that communication between the committee, with its independent role, and the CQC should be conducted by means of correspondence rather than open and ongoing dialogue. For that reason, we do not support that approach to prescribing the nature of that relationship.”––[Official Report, Health and Social Care Bill Public Bill Committee, 10 March 2011; c. 610.]

After an excruciatingly expensive listening exercise, the Government have finally been able to recognise that the measure makes good sense.

Given that the number of quangos in the NHS is set to explode as a result of the Bill, is it not entirely possible that HealthWatch could be swamped by the sheer number of bodies that it needs to check on and deal with? What guaranteed, recognised time would HealthWatch have to raise its concerns? Does the Minister feel that HealthWatch’s impact will need to be increased or diminished, when the board will have to listen to an ever-increasing number of clinical networks? Will he comment on whether HealthWatch’s day-to-day influence will not be marginalised?

Essentially, for the average patient to be satisfied in the environment that the Bill creates, the Government must be clear about where HealthWatch’s advice will sit. Where will I, as a patient, take my case locally? What opportunities will I, as a patient, have for input? What will the general structure be? Will there be different structures at local level, or similar structures? Will those local structures be constitutionally different or similar? The proposals have obvious implications for transient populations and could lead to inequalities of opportunity for those who wish to seek redress in different localities. Furthermore, varying structures lead to varying levels of remuneration.

How will I as a patient know where to go? What is the budget for local, regional and national advertising to spread knowledge of HealthWatch and how will patients be consistently consulted?

Photo of Karl Turner Karl Turner Labour, Kingston upon Hull East 2:30 pm, 14th July 2011

For the benefit of the Minister, I also have speaking notes. However, I can assure you, Mr Gale, that I, unlike the Minister, prepared the notes that I am speaking from. Opposition Members have seen time and again that Ministers do not seem to have a clue about what they are saying. They seem to make it up as they go along, looking occasionally to the civil servants for support.

This is not a particularly controversial part of the Bill—

Photo of Simon Burns Simon Burns The Minister of State, Department of Health

Which is why he is going to talk about it.

Photo of Karl Turner Karl Turner Labour, Kingston upon Hull East

Did the Minister want to intervene? No.

This part of the Bill is not especially controversial, but it is important. I am particularly concerned about the independence of HealthWatch and the lack of a voice for children and young people in the Government’s proposals. I welcome the fact that the Government have listened to the Opposition, but there are issues outstanding that we ought to consider.

Although it is to be an arm of the Care Quality Commission, HealthWatch will need to be equipped with the freedom it needs to perform its functions effectively. In that, I am in agreement with the Future Forum. I am concerned about the degree of freedom afforded to HealthWatch England by the Bill. The Patients Association has highlighted that concern in its written evidence, stating that

“HealthWatch England’s position within the CQC compromises its independence – this conflict needs to be resolved.”

The Minister needs to act to defuse that potential conflict. What can he say to the Committee to allay those concerns? It is vital, as the Future Forum and Patients Association have highlighted, that HealthWatch’s independence is guaranteed. I welcome, as everybody would, greater accountability and public participation in the national health service, but if the Minister fails to address these concerns and if HealthWatch England is kept on the CQC’s leash, it will lack the necessary bite to discharge its functions effectively.

A voice for children and young people is vital. The NHS Future Forum was clear in its prescription for representation of children and young people, but the Bill makes no reference to that group in relation to either HealthWatch England or local healthwatch. The Royal College of Paediatrics and Child Health has rightly argued that the reforms have been lacking in providing the structures and frameworks for young people and children to be properly represented. That group must be given a voice. They are too often ignored or disregarded by this Government. How will their views be represented on HealthWatch England and local healthwatch?

In the Government’s response to the Future Forum, they committed to amending the Bill to add a requirement that HealthWatch membership be representative of different users. The Government have tabled several welcome amendments, as I have already said, but there is still too little mention of children and young people in the Bill and the Government’s changes. Will the Minister respond to my concerns and those of the Royal College of Paediatrics and Child Health and the National Children’s Bureau? What are the Government doing to ensure that children and young people will be properly represented on HealthWatch?

I said that this part of the legislation is uncontroversial because the Government’s plan is to privatise the NHS—I see hon. Members on the Government Benches looking extremely confused, but that is my submission—so this section is relatively uncontroversial given the rest of the Bill. The Minister has a habit of brushing any criticisms aside, but the issues need to be addressed.

Photo of Fiona O'Donnell Fiona O'Donnell Labour, East Lothian

I begin with two apologies, Mr Gale. First, I apologise for my absence. I wanted to take part in the debate on the closure of coastguard stations. Secondly, I will also be referring to notes that I prepared myself, but I will have to hold them close by, because I left my glasses in the room after a previous sitting of the Committee. I returned last night to try to find them, but they were not here. However, I am now a member of the all-party group on Kashmir, and I had my photo taken and made a short speech. [ Laughter. ] This job is offering me so many new opportunities.

I suppose that, given the hasty arrangements of this partnership, we should have expected shotgun legislation, and, with reference to clause 178, its legitimacy is not improved. Government Members have accused us of scaremongering, but, as my hon. Friend the Member for Kingston upon Hull East said, concerns are not just coming from Opposition Members; they are also coming from patients and patient organisations. The Government need to listen. However, I welcome the fact that the Government are so enthusiastic about equality duties that they are now part of HealthWatch England’s duty.

This is an opportunity to create a strong voice for patients, but if it is to live up to its objective it must have clarity in its purpose and operation. I am afraid that, as far as patients are concerned, that clarity is not there at this stage. Goodness knows the Bill in its entirety has created enough confusion. Patients need to know where to go when they have a complaint or when they want to influence the shape of services. If they are to meet these objectives it must be clear how HealthWatch England and local healthwatch organisations will be accessible, user friendly, inclusive, properly resourced, independent and autonomous.

First, on accessibility, the Department of Health has already said that there will not be a budget for advertising to tell patients how all this fits together and where they can go to make their voices heard. I hope that the Minister will reassure us as to how patients and carers will become aware of HealthWatch’s duties and how they will be able to contact it.

Regarding the user friendly and inclusive aspect, my hon. Friend has already mentioned how important it is that the voices of children and young people are heard. I hope that the Minister will tell us how that will be realised by the clause. Also, what advocacy will be provided for people with learning disabilities, those possibly unable to speak for themselves, so that their views and input can be heard and valued?

In terms of independence and autonomy, it is important that HealthWatch is seen not just as part of the Care Quality Commission, but as an independent body with a clear and distinct role. Looking at local organisations and funding by local authorities, how can we be confident of their autonomy and independence from the people who fund them when those people also commission and deliver services that the local healthwatch organisations  may have responsibility for feeding back on? The Government must respond to these legitimate concerns and clarify the relationships. When an NHS or social care service crosses local authority boundaries, where will local healthwatch organisations feed in those views? How will the weight be divvied up—I hope that that is not just a Scottish expression—between the two?

In terms of funding, at a time when local authorities are under such pressure, how can we be sure that the necessary money will be available to give bodies the independence and resources they need? I seek reassurance on those points and look forward to hearing the Minister’s response, because this is an opportunity to ensure that patients genuinely have a say, but the Government must be much clearer about what they want to achieve with the clause. They must tell us how they will provide the support and training so that this is not just about tokenism. When views from HealthWatch on how it feels about the service are put to the various bodies—the Secretary of State, Monitor—that individual or body must not simply have a duty to record receipt. Their response and the action that follows complaints must also be in the public domain.

Photo of Nicky Morgan Nicky Morgan Conservative, Loughborough

It is a pleasure to speak under your chairmanship, Mr Gale. I will speak briefly because I was not going to speak on these clauses. However, as the Minister knows, the issue of patient and particularly public involvement has always been very close to my heart and I have mentioned my thoughts in this area to him many times. The comments from the hon. Members for Middlesbrough South and East Cleveland and for Kingston upon Hull East prompted some thoughts, so there are some things that I want to put to the Committee.

The hon. Member for Middlesbrough South and East Cleveland talked about three main bodies in the NHS: the commissioning board, the CQC and Monitor. He also talked about the importance of patient and public involvement, and I agree with him. The tragedy of this Committee is that we have spent so long talking about bodies that are irrelevant to patients and the public. When people go to their GP or hospital for treatment, they are not necessarily worrying about competition, patient caps, tariffs and everything else. What they want is good treatment.

The hon. Member for East Lothian is absolutely right. If someone is unhappy about treatment, they want somewhere to go and complain or express thoughts. If someone suffers from a long-term condition—hon. Members will know I have spoken about mental health issues a number of times—they want somewhere to go and put thoughts about treatment and care pathways, and be heard. That is why these clauses dealing with HealthWatch England, local healthwatch and the health and well-being boards are so important. It is a shame that, because of everything else we have discussed for so many sittings, we are only now getting to them.

Photo of Liz Kendall Liz Kendall Shadow Minister (Health) 2:45 pm, 14th July 2011

The reason we have got to these clauses only today is because the Government put knives in for the days when matters would be discussed. They set out which clauses would be discussed on which days. That is the reason we have reached them only today.

Photo of Nicky Morgan Nicky Morgan Conservative, Loughborough

The hon. Lady, like me, is a new Member, and we are all learning about parliamentary procedures together. One of the frustrations of the Bill has been all the discussion here and outside. I hesitate to use the word scaremongering, but it is true about the way it is to be worked out. We are forgetting the patient and public involvement. The hon. Lady may well be right about parliamentary procedure, but there is no doubt that hon. Members, particularly Opposition ones, have spent a lot of time talking. There is no reason why, if we had got through clauses earlier, we could not have rushed on to talk about these sooner.

Photo of Tom Blenkinsop Tom Blenkinsop Labour, Middlesbrough South and East Cleveland

I generally respect what the hon. Lady says: she often makes this point. Amendment 199 is effectively a replica of our previous amendment 348. A number of the amendments that we will discuss later came through only on Monday.

Photo of Nicky Morgan Nicky Morgan Conservative, Loughborough

I hear what the hon. Gentleman says. The Minister mentioned the listening exercise, which has happened. There are points that were discussed previously that have been re-emphasised outside this House, and then brought before the House in the amendments.

Photo of Fiona O'Donnell Fiona O'Donnell Labour, East Lothian

It is not only Members here who have complained about the lack of time. Every single organisation that gave evidence also said it had not had time to consider.

Photo of Roger Gale Roger Gale Parliamentary Assembly of the Council of Europe (Substitute Member)

Order. We have a limited amount of time. We either debate the Bill or the timetable motion. The timetable motion has already been debated, so let us get back to the clause under discussion.

Photo of Nicky Morgan Nicky Morgan Conservative, Loughborough

I hear what the hon. Lady says, but I will take the Chair’s ruling. There are three points I want to make. First, the hon. Member for East Lothian mentioned local healthwatch. My understanding is that local healthwatch will play just as critical a part as HealthWatch England in raising patients’ concerns. We should not forget that it will take quite a lot of the burden.

The CQC will have to respond formally in writing to advice it gets from HealthWatch England. Ministers will have heard earlier of concerns from all parties about the burden on the CQC and the way it exercises its powers. It is a good thing. I echo the hon. Member for Leicester West in saying that HealthWatch England must be independent of the CQC. I think the Minister has already said that, and I invite him to put that on record.

A more important point—not just in the Bill but across Government—is that for a lot of these bodies it is about having the right people and the right ears listening. We can talk about money and budgets. We as Members of Parliament do not get advertising budgets, but people know where to come and find us.

Photo of Nicky Morgan Nicky Morgan Conservative, Loughborough

Well, perhaps the hon. Lady has had more success with IPSA than I have had. If the right people are in position doing the right job and are the  right advocates, there is a lot that can be done in telling the public how to come and describe the treatment they have had. We should worry less about process and the way that Committees are constituted. We should get the right people in, because they have the right ears for hearing about cases of bad treatment, or listening to people with long-term conditions making it clear how care pathways can be improved.

Photo of Paul Burstow Paul Burstow The Minister of State, Department of Health

We have had a good and thorough debate, and while perhaps the tone has not suggested it, there is a good deal of consensus across the Committee about the importance of this particular clause and amendments. There is a shared purpose, it seems, about how we can strengthen patient involvement in the NHS.

However, I detect a slight contradiction in some of the arguments, in that again we seemed to be condemned when we do listen and condemned when we do not. I suppose the luxury of opposition is to be able to condemn both. It certainly seems to have been the substance of these particular points. In passing, I want to pick up on the comments by hon. Member for Kingston upon Hull East about involving young people. I very much agree with him and I want to say what we are doing on that.

The hon. Gentleman also makes some passing references to the hard work and diligent support that Ministers receive during Committee deliberations to ensure that we are properly briefed as the Committee progresses. I for one am very grateful for that. Having sat on the other side of the Committee for many years, I have seen the frenetic activity that exchanges across the Committee sometimes involve. But it is not a new feature of the Committee that has suddenly emerged since the election. It is something that has always happened, and is just a natural part of the process of—

Photo of Karl Turner Karl Turner Labour, Kingston upon Hull East

On a point of order, Mr Gale—

Photo of Karl Turner Karl Turner Labour, Kingston upon Hull East

My point is that the Minister made reference to one of my hon. Friends from a sedentary position. That was what I said at the outset of my speech, and I ought to be allowed to have that on the record.

Photo of Roger Gale Roger Gale Parliamentary Assembly of the Council of Europe (Substitute Member)

Mr Turner, you have to differentiate between a point of order and a point of debate. That is a point of debate.

Photo of Paul Burstow Paul Burstow The Minister of State, Department of Health

I have put my point on the record, and that was the purpose I was trying to achieve as well. I want to begin by reading from the Hansard report on 28 June when we were considering the evidence from various witnesses. I agree with a point made by Jeremy Taylor, who said:

“I am not sure that it matters where HealthWatch England sits.”––[Official Report, Health and Social Care (Re-Committed) Public Bill Committee, 28 June 2011; c. 67, Q142.]

That is quite an important point from the person who leads National Voices. He went on to say:

“What matters is whether it has clout, credibility, independence and sufficient resources.”––[Official Report, Health and Social Care (Re-Committed) Public Bill Committee, 28 June 2011; c. 67, Q142.]

I reject the notion that the Government lack ambition when it comes to involving patients. I find it curious that after 13 years of having the opportunity to do this—

Photo of Paul Burstow Paul Burstow The Minister of State, Department of Health

Of course, the hon. Lady was a special adviser at various stages of her career, and she was involved with a party that was in government for 13 years. While she may wish to disown those 13 years, they were an opportunity to do something—

Photo of Liz Kendall Liz Kendall Shadow Minister (Health)

I am incredibly proud of what the Labour Government did, and I would not disown any of it, but the Minister would accept that we were always determined to do more. More could be done to put patients at the heart of the NHS, and we have tried to be constructive in suggesting to the Minister that the Bill is not ambitious enough and will not achieve that.

Photo of Paul Burstow Paul Burstow The Minister of State, Department of Health

I will take from that that the hon. Lady accepts that it was unfinished business, and we know it was unfinished, not least because during those 13 years we saw the abolition of community health councils, which were replaced with patients forums, the establishment of a Commission for Patient and Public Involvement in Health—which I believe was largely loathed by local patient organisations—and the final iteration, or attempt, to get this right under Labour: the introduction of local involvement networks. When we talk about a shambles, that epithet might apply to the endeavours of the previous Administration in this area.

However, the hon. Lady makes some important points about the timing of the establishment of HealthWatch England. She discussed the concerns of a number of organisations, and I am aware of those concerns. We are determined to do as much as we can to bring forward the date at which HealthWatch England can be established, for the very reasons given by outside organisations, as they have an important part to play both during the transition and in ensuring that the new structures work. I hope that that reassures the hon. Lady about the work of HealthWatch England. She also asked about local healthwatch.

Photo of Paul Burstow Paul Burstow The Minister of State, Department of Health

In that case, for her information, there is also a programme of early implementers with regard to local healthwatch. She also asked about funding. HealthWatch England, as a committee of the CQC, will have £3.5 million to help with its start-up and estimated ongoing costs. As I said when we debated this in March, the CQC will provide infrastructure such as IT, and financial and other expertise. In effect, it will have access to the resources that the CQC has as well.

Photo of Fiona O'Donnell Fiona O'Donnell Labour, East Lothian

In that list, the Minister did not mention training. If we are serious about involving young people or those with learning disabilities in this process, is there a budget for training and supporting them?

Photo of Paul Burstow Paul Burstow The Minister of State, Department of Health

Training is an essential part of making sure that the committee does its job, but also training at a local level for local healthwatches. That is one of the things we are exploring through the early implementation of local healthwatches.

I was also asked whether the CQC had failed and whether a body that was part of the CQC could blow the whistle on it. Healthwatch England certainly can do that, because of the clear statutory independence that the Bill provides. If it considers that it is appropriate to advise the Secretary of State on relevant matters within its remit, then the Secretary of State, under the amendments and other changes we are making in the Bill, will have to have regard to advice on how he discharges his functions with regard to an organisation’s failure.

Healthwatch England can therefore formally advise the CQC, which would have to respond—this is one of the amendments that we will come to later—and Healthwatch England could publish that advice. It can raise an issue with the CQC, the CQC has to have regard to it, and their exchanges can be published as well.

The hon. Member for Middlesbrough South and East Cleveland made a number of points and a key question I want to address is who do people complain to. If someone has a complaint about a service that they received from a provider, they would write to the provider. I would imagine that, as a constituency MP, that is what the hon. Gentleman does now, so he would write to the NHS trust or the foundation trust that provided the service.

If the issue was about a service that was not well specified, the hon. Gentleman may well choose to write to the local commissioner, so he would write to the clinical commissioning group. If he continued to have concerns, he could raise them with the local healthwatch and seek its support. Ultimately, if he felt that the complaint had not been dealt with satisfactorily through the various stages that each organisation would have to set out, he could take it up with the health service ombudsman. There are therefore a number of stages that he or his constituents could use to proceed with a complaint.

The hon. Member for Kingston upon Hull East spoke about the importance of involving children and young people, and I know other hon. Members share that view. It is important to make sure that, as organisations are established nationally and locally, they hear and respond to the voices of young people. That is particularly the case in later amendments which deal with representativeness. The measures capture that concern, and we should make sure that in establishing those bodies they involve young people.

I will give a couple of examples of good practice. The first is the work of the National Children’s Bureau, which runs a young inspectors programme, which is a good model of how local healthwatches could engage with young people and use their eyes, ears, views and imagination to improve services for them. That is one of the things that we want to explore through the early implementers programme.

It is worth putting one other example on record. We are in the process of redesigning child and adolescent mental health services in England to extend the idea of talking therapies to young people. That is something  new that the Government have committed themselves to implementing, and we are working with Young Minds, an expert charity in the field, which is bringing young people directly into the process of redesigning the services. That is a model of how services should be redesigned in future, ensuring that they are tailored to the experience and expertise that young patients can bring to services, and it is very much at the heart of how we want the NHS to be reformed.

Photo of Fiona O'Donnell Fiona O'Donnell Labour, East Lothian

The Minister is being very generous in accepting interventions. Given that local healthwatch organisations follow local authority boundaries and that public health duties will sit with local authorities, will local healthwatch organisations have any role in feeding into the development of public health campaigns and in ensuring that young people’s voices are also heard in those?

Photo of Paul Burstow Paul Burstow The Minister of State, Department of Health 3:00 pm, 14th July 2011

Yes, absolutely. That is an essential part of how the new architecture fits together. There are many good examples of local authorities doing just that sort of work, and as they take on their new public health responsibilities there will be ample opportunity for more of it.

Photo of Steve Brine Steve Brine Conservative, Winchester

Young Minds in Chandlers Ford in my constituency came to see me recently, fired up by the Minister’s plans. It said: “Thank goodness the Government are finally listening to people like us.” I just want to place on record the fact that Young Minds is an excellent organisation, which gives young people a real chance to get involved. Well done to the Minister.

Photo of Paul Burstow Paul Burstow The Minister of State, Department of Health

I am grateful to my hon. Friend. Young Minds has had some appropriate promotion. It does good work, and I am grateful to the hon. Member for Kingston upon Hull East for raising that important matter.

The hon. Member for East Lothian asked about advertising. There is nothing to prevent local healthwatches from advertising locally, and there is nothing to prevent the CQC, or indeed the Department, particularly during the transition, from using various online and other free media to promote HealthWatch England. The CQC has a budget, and it will be for it to make decisions about how to apportion that budget to undertake promotional activities in conjunction with local healthwatches.

The hon. Member for East Lothian asked about the powers that HealthWatch has, both locally and nationally. We will come on to amendments that deal with the duty to have regard to a number of organisations that will be recipients of that body’s advice.

Photo of Paul Burstow Paul Burstow The Minister of State, Department of Health

If the hon. Lady will forgive me, no. I am conscious of time, but if she wishes submit a written question I will be happy to answer in that way.

In conclusion, we are trying here to establish HealthWatch England on a firm foundation, grounded in but independent of the CQC, to ensure that the patient voice is at the heart of the delivery of services that properly meet their needs. The amendment is modest, and I hope that it will be agreed to.

Amendment 199 agreed to.

Photo of Paul Burstow Paul Burstow The Minister of State, Department of Health

I beg to move amendment 200, in clause 178, page 158, line 31, after ‘discharge’, insert ‘, and that the failure is significant’.

Photo of Roger Gale Roger Gale Parliamentary Assembly of the Council of Europe (Substitute Member)

With this it will be convenient to discuss Government amendments 201 to 203.

Photo of Paul Burstow Paul Burstow The Minister of State, Department of Health

The amendments are about what happens if HealthWatch England fails to perform its functions. They are part of a series of amendments, which we have considered and will continue to return to during the remainder of today’s sitting. They ensure that the Secretary of State has intervention powers in the event of significant failure, and that his overarching duties to promote a comprehensive health service can be given effect by that ability to intervene.

Amendment 200 agreed to.

Amendments made: 201, in clause 178, page 158, line 34, at end insert—

‘( ) In subsection (2A) of that section (inserted by section[Failure to discharge functions]), after “(1)” insert “or (1A)”.’.

Amendment 202, in clause 178, page 158, line 37, at end insert—

‘( ) In subsection (4) of that section (inserted by section[Failure to discharge functions]), after “(1)” insert “, (1A)”.’.

Amendment 203, in clause 178, page 158, line 37, at end insert—

‘( ) For the title to that section substitute “Failure by the Commission or Healthwatch England in discharge of functions”.’. —(Paul Burstow.)

Clause 178, as amended, ordered to stand part of the Bill.