---

Local Government and Public Involvement in Health Bill

moved Amendment No. 210ZE: 210ZE: After Clause 232, insert the following new Clause— ““Transitional arrangements (1) Each local authority must make transitional arrangements for the purpose of ensuring that there are means by which the activities specified in section 226(2) for the local authority’s area can be carried on during the transitional period. (2) A local authority must have regard to any guidance issued by the Secretary of State with regard to the transitional period. (3) For the purposes of this section something is done by a local involvement network during the transitional period if— (a) it is done by a person who in pursuance of the transitional arrangements made under subsection (1) above is to carry on activities specified in section 226(2); and (b) it is done by that person in the carrying on, under those transitional arrangements, of activities so specified. (4) For the purposes of this section, the transitional period is the period of six calendar months beginning with the commencement of this Part.”” The noble Earl said: My Lords, we come to an issue which has exercised me and, I venture to say, a number of us, perhaps more than any other; and that is the very real prospect of a complete hiatus in patient and public involvement activities once this Bill comes into force. Why do we fear that? First, there is the strong evidence of precedent, when community health councils were abolished four years ago. At that time a large number of dedicated volunteers were so discouraged that they simply gave up and went home; and a great deal of corporate memory and skill was dissipated in the process. I have been told that exactly the same thing is now happening again with patients’ forums members. Looking ahead, we can see that there is almost zero likelihood that when patients’ forums and the commission are abolished on 31 March there will be anything resembling patient and public involvement activity going on in any part of the country. It is perfectly true that the department has taken a number of steps to kick start the setting up of hosts by local authorities. However, only a handful of local authorities are treating this exercise with any urgency, and even if by 31 March a number of hosts will have been appointed, it is abundantly clear that LINks will not be up and running for a considerable time after that. The whole business of procuring hosts, followed by the scoping and setting-up process for LINks, is going to take many months. Whatever we think of these reforms, one thing is surely clear: we have to do all that we possibly can to avoid what would amount to a wholesale suspension of patient and public involvement next year. The NHS needs to be monitored and held accountable by informed patients and their representatives. That is particularly pertinent at a time when proposals for a major reorganisation of the NHS are emerging from two reports of the noble Lord, Lord Darzi. A local perspective on both these sets of recommendations is vital. There is a further issue. The Government have invested around £34 million of public money a year into the current system of patient and public involvement. The public and the taxpayer are entitled to see that investment protected as far as it possibly can be as we move across to the new arrangements. It is really not acceptable for the accumulated corporate memory and expertise that currently reside in patients’ forums to be squandered. The amendment would put in the Bill an obligation on local authorities to put transitional arrangements in place for a six-month period. It focuses on the activities set out in Clause 226(2) and requires that these activities should be carried on immediately the Act comes into force. Guidance from the department would spell out how best these transitional arrangements might be made. What that means is that, while patients’ forums would be abolished on 31 March as originally intended, the continuance of effective patient and public involvement activity would be safeguarded. The guidance would put a range of options forward and local authorities would then choose the most appropriate one depending on their circumstances. Options would include temporarily co-opting willing patients’ forum members on to overview and scrutiny committees, supporting them as a sub-committee of the overview and scrutiny committee or as a stand-alone committee undertaking the activities. If a local authority manages to procure a contract with a host and set up a LINk that is effective and able to undertake the activities within the six-month period, this could constitute the transition arrangements until the end of the official transition period, when they would simply continue as the LINk. It would be important, however, for evidence to be supplied to the Department of Health for publication showing that the activities were in fact being undertaken. If the amendment, or something like it, is accepted, it could go a long way towards making sure that there will be real continuity of activity and that the expertise of patients’ forum members, which is critical to the early success of LINks, is not lost to their local communities. The other obvious option—delaying the abolition of patients’ forums for a period of months—though superficially attractive, is less desirable because it would swallow up a disproportionate amount of the PPI budget and therefore leave local authorities with a great deal less money than they otherwise would have had to set up and finance the new arrangements. Nevertheless, depending on the Minister’s reply, that option may have to be revisited between now and Third Reading. I beg to move.