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Local Government and Public Involvement in Health Bill

moved Amendment No. 207A: 207A: Clause 227, page 161, line 13, leave out ““a local authority”” and insert ““— (a) a local authority; (b) a National Health Service Trust; (c) an NHS Foundation Trust; (d) a Primary Care Trust; or (e) a Strategic Health Authority.”” The noble Earl said: My Lords, in moving Amendment No. 207A, I shall speak also to Amendments Nos. 208A, 209ZA, 210ZC and 210ZD. We have come to a group of amendments, most of which in their different ways, relate to the same problem. I use the word ““problem”” as the most neutral term I can readily think of for what many of us regard as a most serious and regrettable weakness in this part of the Bill; namely, the absence of even the slightest hint of a statutory identity for LINks. There is a complete lack of any descriptive reference to what a LINk might look like and practically no definition of a LINk, apart from it having to be a person, which is simply a piece of legal jargon and gets us almost nowhere. We know why this is. The Government say that they do not want to be prescriptive about the form that LINks should take because this issue should be up to local determination and local circumstances. That approach is all very well, but the result of it is that the law does not confer on a LINk any sort of functions or powers. If a LINk has no statutory functions or powers, it can never, by definition, act contrary to its functions or powers, and hence can never be accountable in any proper sense for what it does. Nor can it call anyone else to account because it has no right in law to do so. The only rights and duties that feature in this part of the Bill are conferred on other people, such that the identity of a LINk is defined only as a reflection of what other people are duty-bound to do in relation to a LINk. It is an extraordinarily contorted and unsatisfactory way to go about things. My view is that the Government should not have lived with this arrangement; they should have gone back to the drawing board and started again. Nevertheless, taking the Bill as we have it, there are several issues which I believe we need to deal with if these arrangements are to stand any chance of working. The first of these issues is addressed in Amendments Nos. 209ZA and 210ZD. As the Bill stands, there are no provisions for LINks to have any form of governance arrangements; it is left completely open as to how a LINk would be able to make decisions or authorise people to act on its behalf. This is a major issue because without some form of governance you cannot have accountability. If there are no people authorised to act on its behalf, a LINk cannot be accountable for the proper use of public money; it cannot be judged on its effectiveness or lack of effectiveness; nor, indeed, can it operate in any meaningful sense. For example, it cannot take decisions about what it should be doing. We debated in Committee the risk of bias within a LINk arising from single issue groups. We also flagged up the risk of a conflict of interest between a LINk and its host, if that host were a provider of services. Neither of those risks can be adequately addressed unless a LINk has some sort of system of governance. The Government say that they do not want to be prescriptive but this, but the process contemplated in the department’s advice document on LINks is not realistic. Each LINk is urged to, "““work to develop governance arrangements that are easy to understand and implement, not bureaucratic and exclusive””." Three questions arise from that. How long will this process take? How different will each model be? How will we be able to judge the quality of the many governance models if there is nothing laid down against which to measure them? The purpose of these amendments is therefore to make sure that LINks have the means to be effective and accountable. The key issues around governance are really three: how decisions are to be made; how activities are to be undertaken; and, who is to do these things? Without those minimum requirements we would be left with a situation where someone who has joined a LINk, but who never attended any meetings or received any training or signed any code of conduct, could demand a meeting with a chief executive of an NHS trust in the name of a LINk and raise whatever issue he or she thought appropriate without any accountability to the LINk or, indeed, to the community. That is only one example, but I suggest to the House that for us as legislators it is an unacceptable situation. Therefore, we need to have some sort of minimum provision about governance in the Bill. The second issue arising from the fact that LINks have no statutory identity is that in the final analysis they have no voice. What is to happen if a LINk decides to enter and view a set of premises and the door is shut in its face for no good reason? What happens if a LINk asks for information and that information is withheld when it should not be? What is the LINk then to do? And who can it turn to? At the moment, this kind of situation, which I am told happens frequently with patients’ forums, is referred to the Commission for Patient and Public Involvement in Health, which does its best to adjudicate on the dispute and to sort it out. Under the Bill there will be no equivalent body able to bang heads together. The LINk will be on its own. To be sure, it can try to shame the services provider into action by going to the local press or to the overview and scrutiny committee of the local authority; but with private providers, in particular, that approach will almost certainly not work. Informal pressure is not the same as having a quick and simple means of arbitration that is binding on both sides. Amendment No. 210ZC proposes a mechanism to achieve this. I have in mind the appointment of a LINks' monitor, whose job it would be to arbitrate in disputes, but who would also be charged with gaining an overview from a national perspective about how well or badly patient and public involvement was working, and to be a reference point to government in this area of policy making. There is a precedent for this in the field of immigration; but the model is a simple and straightforward one. The next issue is one I have referred to briefly already; that is the scope for conflicts of interest. As the Bill is worded, the body acting as a host for a LINk can be any body at all apart from a local authority. In Committee I raised my concerns about that—if a host were also a provider of local services, a LINk in carrying out its monitoring activities would be monitoring its host. Furthermore, the host would be responsible for writing the reports of a LINk. A critical report on the host as a services provider would place both parties in an invidious position and could seriously prejudice their working relationship in the future. In Amendment No. 207A I propose that it is as inappropriate for an NHS body to be a host as it is for a local authority. There is simply no need for us to allow for the possibility of this situation arising; and there is an easy way of avoiding it. Finally in this group I turn to government Amendments Nos. 208 and 209, which under the rules of Report I hope the Minister will allow me to comment on. These amendments are extremely welcome. I am very grateful to the Minister for having taken away the arguments put forward in Committee about the need for the Bill to allow explicitly for collaboration between LINks. However, I need to ask the Minister whether she is satisfied that the amendments in her name deliver everything that is necessary. The problem is that it is not clear what LINks would be able to collaborate on, given that their activities are explicitly only local in nature. The point of having a LINks umbrella body would be to take a national or regional view of health and social care services. That is particularly pertinent at the moment in the light of the review of the NHS by the noble Lord, Lord Darzi, which may come up with some far-reaching proposals that cannot be considered properly by LINks acting individually. Will the Minister assure me that her amendments would enable LINks, while collaborating, to consider the report of the noble Lord, Lord Darzi, in its regional or national context? I beg to move.