Committee stage in the Lords
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The Parliamentary Under-Secretary of State, Department for Communities and Local Government (Baroness Andrews)Labour- Quote
- My Lords, I beg to move that the House do now again resolve itself into Committee on this Bill. Moved accordingly, and, on Question, Motion agreed to. House in Committee accordingly. [The DEPUTY CHAIRMAN OF COMMITTEES (Lord Allenby of Megiddo) in the Chair.] Clause 222 [Health services and social services: local involvement networks]:
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Earl HoweConservative- Quote
- moved Amendment No. 238KBA:
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Baroness NeubergerCrossbench- Quote
- I support very strongly the words of the noble Earl, Lord Howe. Since I think that we agree on everything, I just want to add a little more weight to what he has said. Perhaps it is good for the Minister to hear that, across the Cross Benches, the Conservative Benches, the Lib Dem Benches and some of the Labour Benches, we are united in some of our concerns about this part of the Bill. When we first saw the Bill, many of us were deeply concerned because we could not find any clarity in it; we could not work out what it really meant. However, as the weeks have passed, we have learnt more about, for instance, what the early adopters of the LINk model were doing. I was truly shocked that they were given a set of objectives that asked them to focus on particular aspects—this is from evidence that was given by Meredith Vivian to the Health Select Committee—without a clear list of duties. So much of it, in everything that we could find, was process driven. It was all about, “how we can make sure we reach as many people as possible and are as engaged as possible with voluntary community sectors, how we can make sure that what we do is well-known in terms of communication and visibility”. But what the objectives are remains, to most of us, singularly unclear. It is not just me saying that. The Health Select Committee, in its report, said: “The ‘early adopter’ projects appear less an objective trial than a discussion with stakeholders, and a key point—what can be expected from Hosts—is not being addressed”. It went on to recommend full trials of LINks to assess the practical requirements for running them. Indeed, it listed evidence from Elizabeth Manero of Health Link, suggesting that a model for LINks would be the best practices of the patient forums, where a core group will perhaps run the LINk, “make decisions about the LINks activities, can sit in on trusts’ boards and meetings, and undertake surveys or visits. They produce reports and challenge trusts if they are unhappy with the response”. She added: “They would also do everything they could to connect with local groups and find out a wider public view”. Her worry about LINks, as presently imagined, was that, “the proposal is to have a very, very large, ‘perhaps thousands of people’, involved in the Health Service”. She continued that she was worried that this focused on a process rather than on refining an outcome.
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Lord Low of DalstonCrossbench- Quote
- I, too, support this group of amendments, particularly Amendment No. 238LF. I received an e-mail about the Bill at the weekend, which pointed out that as things stand, since local involvement networks have no independent legal personality, their members could be personally liable for their actions, even though they are discharging statutory functions. This contrasts sharply with the present position whereby patients’ forums are legal entities. Amendment No. 238LF changes the definition of a LINk in Clause 223(2) from a person carrying on the activities specified in Clause 222(2) to, “a body set up in pursuance of the arrangements specified in”, Clause 222(1). The amendment, therefore, would change LINks from groups of persons coalescing around a particular function or set of functions to a corporate legal entity. I submit that this is a much more satisfactory situation for the members of these local involvement networks and I believe, therefore, that this constitutes an ungainsayable argument for inserting Amendment No. 238LF into the Bill.
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- 16:30
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Baroness Howe of IdlicoteCrossbench- Quote
- I, too, would like to support the making of a LINk, if we are to have LINks in the way that has been suggested by the noble Earl, Lord Howe, and re-emphasised by my noble friend Lord Low. What really concerns us is that we have no real conception of what the future holds. The noble Baroness, Lady Neuberger, has spelt it out extremely well. I have to admit that I have another worry. It seems extraordinary that this Bill has been going on for so long now in the background without coming to Parliament. The Commission for Patient and Public Involvement in Health has been extended about nine times since it began. That is a fairly extraordinary figure. We have heard from some of the earlier doctors that very good work has been going on with more or less the same members as exist in the forum. I find it really rather upsetting that, even if the time has come to say goodbye finally to the Commission for Patient and Public Involvement in Health, nobody has thanked it for the work that it has done. Considering it was set up and abolished almost at once, it was a pretty disturbing commission to have been in charge of and to have been on the staff of. I would like the Minister to take this opportunity to say something rather more positive than we have heard so far. There are obviously reasons for moving in this direction, particularly on the social care side, as I understand it, which cannot so easily be joined with the health side. I believe that the health side is rather bossy and dominant. It will take some persuading that we will have a sufficiently strong social care side for them to be on a par and in partnership; many other Bills put through by the Government rightly aimed to achieve partnerships at all social levels. I just wanted to say that, by way of a background to my concerns. I did not take part at Second Reading because of other commitments later in the day but I was there for most of the time and I have followed, as far as I can, what has been going on since.
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Baroness Masham of IltonCrossbench- Quote
- The House of Commons Select Committee on Health called LINks woolly. What Members of this House have said today bears out what they felt. Members of health forums have been treated very badly. These are volunteers. They need support, not putting down. Will members of LINks be treated any better? We need good public involvement in health. I hope that the Minister will comment on that.
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Baroness Howarth of BrecklandCrossbench- Quote
- I want to ask one or two questions. I apologise for not being able to take part on Second Reading. I, too, am bemused about this but could not have put the position more eruditely than did the noble Earl, Lord Howe; it is always a joy to listen to him but this afternoon was a particular joy. My questions are about how ordinary people who will become part of LINks—or at least those whom the Government hope will become part of LINks—will understand what they are engaging in. I say that having talked to some ordinary folk who regretted the loss of their community health councils, but continued stalwartly to join patient forums—I declare an interest as a rather distant member of the St Thomas’s forum—and would like to continue to work in these areas. They do not understand two things, the first of which is about governance. How do these strange bodies, which are so ill defined, fit into the total governance structure of the health service? Do they have any power? Are they just sounding boards? What is their value? How will they be appreciated and understood? How will you get that message to ordinary people to maintain their interest? Secondly, because of all this, I do not really understand what the objective is for the new groups. That may be my lack because I was not able to engage in Second Reading or listen to all of it, although I read a certain amount. I understood the community health councils; the Government may not have liked what some of those groups did in terms of challenging issues in the health service. I have begun to understand—just about—what the patient forums were doing. I cannot understand what LINks are going to do. I am afraid that, even after listening very carefully to the noble Earl, Lord Howe, who usually illuminates me, I still do not understand—probably because he does not know either—what the organisations, bodies or people will do. I would be grateful for clarification from the Minister. A great deal depends on this in relation to local involvement, particularly, as my noble friend Lady Howe said, if we are to try to engage people in understanding LINks in relation to social care, with which I have a strong connection. It would be a great help if local communities could understand LINks. If they cannot understand the structures, they will never understand the services.
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- The Parliamentary Under-Secretary of State, Department for Communities and Local Government (Baroness Andrews)Labour
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- I am tempted to welcome this new cast to Part 14 of the Bill. We have had a splendid time so far but we have an even better time in prospect. I am challenged by the “enigma code” version of the Bill proposed by the noble Earl. I am happy to do what I can to decrypt the Bill. I hope to inspire noble Lords to have confidence in where we are and why we are there. We give additional information in the hope of clarifying and supporting people’s understanding. Given what has been said, it might be useful if I give a bit of background about why we have come up with this formulation. The amendments explore our changes and why we made them, the relation between the host and the LINk and the form and function of what is planned. Those issues go to the heart of what we are trying to do. I understand what noble Lords are saying about the absence of a statement of objectives at the front of the Bill. We have that debate over and over again in the House; we had it recently on mental health.
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- Earl HoweConservative
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- The noble Baroness has made a brave attempt to respond to the points made in this extremely interesting debate, but I am afraid that I remain pretty unconvinced that we have anything comprehensible here. In these amendments, I was trying to pin down a sense of what legal identity, if any, LINks would have. I am puzzled by that because while the Bill tells us that a local involvement network is a person, we are told that it cannot be a statutory body. It seems an odd contradiction to state in the Bill that a LINk is a person while we are told that it has no legal identity. Can the Minister clarify that, before we go further?
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- 16:45
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- Baroness AndrewsLabour
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- As I understand it, the contractual legal arrangement is that exemplified in the contract held between the local authority and the host. The LINks themselves are networks, rather like local strategic partnerships; they are arrangements of local people taking part and coming together for different purposes, without having a formal or fixed legal structure.
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- Earl HoweConservative
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- All this is very strange. I should have thought that that would indicate that a LINk could not therefore be a person. No doubt we will have time to resolve these matters.
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Lord Wedderburn of CharltonLabour- Quote
- A trade union is not in law a person but by statute has the capacity to make contracts.
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- 17:00
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- Earl HoweConservative
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- I thank the noble Lord for that very interesting and illuminating observation. I will have to see how relevant it is to the Bill; I am not quick enough to know whether it is. The vagueness in the wording of this part of the Bill is in danger of letting down the Government. Let us look at the word “activities”. It struck me on reading this that there may be nothing to prevent more than one LINk in a local authority area. It would be possible, for example, for a host to support several bodies calling themselves LINks in a particular area, rather than just one. I do not think that is what the Government have in mind. It would be extremely undesirable and confusing to have more than one LINk in a local authority area. The Bill appears to allow for it. Do the Government want to rule out that possibility? If so, why does the Bill not do so?
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- Baroness AndrewsLabour
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- That is an interesting point. I am fairly certain that, by definition, we do not want to see more than one LINk because the area should be coterminous with the local area. We certainly will look at any element of drafting that we need to. On the legal point, like all voluntary organisations it is possible for a LINk to form itself into a company limited by guarantee, and even in due course to set itself up as a charity. Therefore it can have a legal status, rather than just being a completely amorphous collection of people. That goes some way in identifying the legal profile.
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- Earl HoweConservative
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- I am grateful to the noble Baroness, and, indeed, I picked up from her remarks that a LINk can have a legal identity in that sense. What I was trying to get closer to is whether it has a statutory identity. I confess I was puzzled by some of the other things the noble Baroness said. She said that if we try to include functions in the Bill, the language of functions would mean that whatever we included in the Bill would be mandatory. I am not sure that that is a show-stopper. If we believe that these bodies should have functions then why should we not say so? We need to reflect carefully on that. The point about accountability and powers is a key part of all this. If an organisation has no powers conferred on it in statute, and not even any direct contractual obligations, it is very difficult to see how it can be part of a chain of accountability for local public services. It will amount to being no more than a talking shop. That is what some of us suspect LINks may turn into. A suspicious mind before this debate might have believed that that is what the Government were hoping to set up by means of the Bill, but I take the noble Baroness’s word that it is not. The Minister has indicated that the department has been in receipt of representations about the shortcomings of patients’ forums. I do not doubt that, but I am tempted to reflect on the question of whose legislation it was that set up the forums in the first place. I think that we all know the answer to that. It is time to move on after nearly 45 minutes, and I beg leave to withdraw the amendment. Amendment, by leave, withdrawn. [Amendment No. 238KBB not moved.]
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Baroness Morgan of DrefelinLabour- Quote
- I beg to move that the House do now resume. Moved accordingly, and, on Question, Motion agreed to. House resumed.
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