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Local Government and Public Involvement in Health Bill

My Lords, the debate opened with the noble Earl being very sceptical about the form that the LINk would take. We had extensive debate in Committee on that. I will return to that argument as I go through the amendments because I have something to say. I will also pick up some of the other points made in the Chamber. The group of amendments includes some government amendments, so I will take things in grouped order. Amendment No. 207A would clarify that an NHS body cannot take on the role of host for a local involvement network. I understand why the noble Earl is returning to this point at Report, because it is important to deal with potential conflicts of interest. In this clause we explicitly exclude NHS bodies from being LINks, but not from being hosts. It is formulated in that way because it follows the principle that we have so firmly addressed in the vision that we have for LINks because it is ultimately for a local authority to decide who ought to be a host. We have made the premise and purpose of a LINk clear in the Bill and in guidance. A LINk will be a body able to independently scrutinise health and social care services. Given that purpose, I entirely agree with the noble Earl that it is clearly undesirable, not least on the grounds that there might be a potential conflict of interest, that an NHS body should take on the role of host. We have made it clear throughout the whole debate on Part 14 that it is deliberately permissive. The issue of who and what can be a host is a good example. We have said from the beginning that we want LINks to reflect the local ecology of health and, for the first time, local care services. It is an extremely important and radical development. A LINk will reach out into communities beyond the normal networks in a way that will be different from the excellent work of the patients’ forum. It is a different organisation and we congratulate members of the patients’ forum on all the work they have done. We are indebted to them and I am confident that they will be working very closely to pursue the same objectives with the LINks. They are very dedicated people. We have placed a duty on local authorities to make arrangements and those arrangements are to procure the services of a host. Local authorities are extremely knowledgeable, none more so than about what makes up their local communities—what concerns they have, what services are provided locally and what services are best suited to the needs of local people. The Bill is deliberately permissive about who can be a host. Only the local authority itself, as the noble Earl said, can explicitly not be chosen. I also accept that NHS bodies would not be appropriate hosts. It is not our call. We believe that local authorities are best placed to make that choice—not Parliament, the Department of Health or the Department of Communities and Local Government. I do not fear that there will be a dearth of people coming forward. As soon as the commissioning process is under way—it has already started in many local authorities and it is going well—many different authorities and organisations will want to come forward to be hosts. Many will come from the voluntary sector, which is particularly well placed. It is well used to the role of advocacy. Some will come from the forum support organisations. For those reasons, the balance that we have tried to strike between making sure that the host is a responsible body, and not proscribing, other than excluding the local authority, who it should be. I hope that the noble Earl will take that point. I am very pleased that both the noble Earl and the noble Baroness, Lady Neuberger, have welcomed what we have been able to do with government Amendments Nos. 208 and 209. I will come to the point about whether we have satisfied every criterion in a moment. The probing amendment put by the noble Baroness in Committee was useful because it clarified whether LINks would be able to collaborate with other LINks either regionally or nationally. In particular, she sought assurance that there would be the potential for LINks to form a national association and that will obviously provide an important focal point for LINks. She also sought to clarify the budgetary arrangements for possible LINks collaboration. At the time, I recognised that further thinking was needed around collaborative arrangements. It was not clear enough, not least because we had always envisaged that some LINks would be bound to want to forge relationships with others. They would want to share ideas. There is a huge wealth of experience, not least that generated by the patients’ forums. They would want to share information and good practice. We wanted to be sure that there were no barriers to that happening. The Bill is written in such a way as to allow local authorities, hosts and LINks organisations to create their own models of working, because we believe that local communities know best how to form their own partnerships. But the flexible nature of the arrangements under the Bill would in any case allow for arrangements to be made which enable groups of LINks to be able to join together to form a national association. What could happen was never in doubt. The noble Baroness raised an important point when she said that the Bill should make explicit a LINk’s ability to use host funding to collaborate with other LINks. On reflection, while we do not want to impose partnerships on LINks, we have agreed with her. Amendment. No. 208 therefore sets out the arrangements made to ensure a LINk’s activities can be carried out, "““may (in particular) make provision as respects co-operation between a local involvement network and any English network or English networks””." Amendment No. 209 ensures that such networks can carry out the same activities as a LINk can individually. Those specific provisions therefore ensure that the contractual arrangements made by a local authority with the host can include arrangements for a LINk to co-operate on a local, regional or national basis as a means of undertaking its core activities. We have also included a specific reference to the host organisations supporting LINks in, "““joint working where necessary between LINks locally, regionally or nationally””," which is a very important capacity for enabling them to inspire and support. That is in the model contract specification, which was published in the summer, for local authorities to use when procuring host organisations for LINks. That makes the position absolutely clear. The noble Earl, Lord Howe, and the noble Baroness raised whether we are satisfied that, by doing this in this way, local organisations which are joined regionally, locally or in a national organisation can address the big issues raised by the Darzi report, or even by Dentistry Today and patients’ forums. The answer is that there is absolutely no reason why they should not. There is no problem. They are not restricted to commenting on local activities if they choose to work collaboratively. It would be very unlikely that they would not want to be part of a national dialogue or address a national agenda. It would be invaluable if they did. Amendment No. 208A seeks to amend our Amendment No. 208, the goal being to make it clear that any co-operative network of LINks which is established can have as broad a remit as possible with respect to the services in different areas. Perhaps I may reply to the question raised by the noble Baroness, Lady Masham, on hospital-acquired infection and addressing it locally, as have some patients’ forums in their specific work with institutions. With LINks coming forward and representing people on the receiving end of care services, acquired infections will be an important challenge for people to engage with. I appreciate the sentiment behind Amendment No. 208A, but, having made it explicit that LINks are able to establish such networks, it is important to let them get on with the job and determine their own priorities and agenda. On Amendments Nos. 209ZA and 210ZD, the noble Earl powerfully set out a sustained and sceptical description of LINks, judged by the absence of prescription. In Committee, we went to some lengths to explain why we have made such a radical departure from the forms of governance that we normally expect organisations and policies to have. Our intention has been to enable people whose voices are not normally heard to come forward and make their concerns and contributions felt in what we admit are new and radical ways. I appreciate that the intention behind the amendments is to address concerns that, without proper governance arrangements, LINks will be hampered in carrying out their activities—certainly, that is not what we intend—and will not be properly accountable to their local communities. The noble Earl referred to the models we put forward in different forms of guidance. He raised very important questions about how decisions will be made if you do not have governance, how they will achieve what they want to achieve and who will do what. We have been clear from the outset that part of the role of the host is to ensure that a LINk has proper governance arrangements in place. We are not advocating complete anarchy in any sense. I do not think that the dire predictions of the noble Earl would be fulfilled, not least because our publication, Getting ready for LINks, Contracting a host organisation for your Local Involvement Network, makes it very clear that the host will be working closely with the LINk precisely to establish terms of reference for those arrangements. Given the principle of trying to hand this over to the local community and say, ““You tell us your concerns and devise a means of governance which fits your particular ways of working in partnerships””, we wanted to retain the flexibility. But the most cheerful news is that when you look at the early adopter projects—I hope that it does not get transcribed this time in Hansard as ““earlier doctors””, bearing in mind the contractual arguments at the moment—many different models are emerging, but they all have specified, or anticipate, some form of governance arrangement. They vary enormously in the way in which they will do things and the models will vary. Ultimately, they will have governance arrangements. It is extremely unlikely that this would not happen. We intend to publish further guidance about possible governance mechanisms in due course, which will enable effective governance. I am impressed by the passion with which the noble Earl has spoken, by the consistency with which he has drawn attention to the problem and the seriousness of his diagnosis, although I do not entirely agree with him. I appreciate that there are residual concerns about whether these responsibilities are discharged effectively. I welcome the breadth of the amendment. Therefore, I propose to take the principle of the amendment away to consider further before Third Reading. Finally, Amendment No. 210ZC provides for an arbitrator. I take the noble Earl’s point that there are many instances where access to information, or access to premises, disputes arise. It is desirable that it should be settled as quickly and smoothly as possible. We have set out in guidance that the host should have a clear responsibility to support LINks in resolving disputes. On those grounds, I do not see how an additional arbitrating body can help in this respect. It would add to bureaucracy and obscure the clear responsibility we have set out for the host to ensure that there are means and ways for disputes to be effectively resolved. Once again, as with the governance arrangements, I do not think that a centrally prescribed arbitrator, who would also limit the host’s ability to respond flexibly, is appropriate. Even if a dispute cannot be immediately remedied by the host’s arbitration, it is clear that there are number of ways for the LINk to ensure that its voice is heard, including by complaint to an appropriate local body—whether a PCT, a local authority, a regulatory body, the press or the local MP. Acknowledging and exploiting those publicly available and transparent mechanisms are more effective than establishing another arbitrating body whose powers and functions would be obscure. It might get in the way of the host. With that rather long explanation and response, I hope that the noble Earl feels he can withdraw his amendment. I hope he accepts my assurance that we will take away the amendment on governance.