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Local Government and Public Involvement in Health Bill

My Lords, I thank the Minister for this extremely welcome group of amendments and for her detailed comments. She will know that these are issues to which we on these Benches have attached great importance and I am grateful to her for taking away the concerns we expressed in Committee and for treating them positively. The reinsertion of ““involve”” is very positive, as is the removal of words which would have inserted a threshold for the involvement of service users. It is equally good news that the Government have agreed to place involvement responsibilities onto strategic health authorities. I wish to ask the Minister a number of questions. First, in new Section 242A(1), there is reference to ““prescribed matters””. Can she clarify what those matters are to be? I would have expected to see here explicit provisions directly analogous to those in new Section 242 of the 2006 Act, as amended, for the planning and provision of services, the development and consideration of proposals for changes in the way that those services are provided, and for decisions to be made by the body affecting their operation. Those are the issues on which health service users should be involved by strategic health authorities, but it is unclear as to why we cannot say this directly in the Bill. Secondly, regarding my Amendment No. 219ZAA, I listened carefully to the Minister, but, with all due respect, I do not think that the wording of new Section 242A(4) is all that it should or could be. This is not meant to sound ungrateful, because my gratitude for the amendments as a whole is unbounded, but the phrase, "““as to the form to be taken by involvement””," could be improved. It sounds as if there is only one possible form of involvement, whereas involvement can take several forms. The word ““form”” is puzzling in itself, because ““ways”” is used in new subsection (1). While I never wish to tilt at windmills, the last thing that we would wish to do is confuse the court if these provisions were subject to a legal challenge. If ““ways”” is used in one part of the section and ““form”” in another part, the obvious question is whether they are intended to mean different things. If the same meaning is intended in each case, why use two different words where one would be better? There is also a lack of clarity about this provision. Surely the guidance needs to cover not the form to be taken by involvement but, rather, which forms of involvement are applicable to which sorts of circumstances. That is what matters here. In some cases, the requirement will be satisfied by the strategic health authority simply providing a LINk with certain information; in others, the LINk will need to be consulted by the strategic health authority on the set of proposals; and, in others, it will need to be fully involved from the outset as the proposals are put together. Those are only three examples but involvement could take other forms as well. My Amendment No. 219ZAA may not consist of the most elegant drafting but it seeks to encapsulate a requirement to flesh out what involvement means, or should mean, in different situations. Why, in new Section 242B(3)(b), do the Government require the power to direct primary care trusts on involvement and even to suspend involvement that has already been started? I ask that because we are constantly being told about devolution of power to the front line. Here, we have a power that allows Ministers to interfere directly in the relationship between a PCT and a local community, and I am nervous about that. Amendment No. 219ZAB concerns consultation on the regulations proposed in the government amendment. I believe in consultation as a rule anyway but, here, there is a special justification for it because of the vagueness of the phrase ““prescribed matters””. There is a strong case for consultation, too, in relation to new Section 242B. I have not tabled an amendment on that, although I should have done. In these provisions we have the possibility of strategic health authorities, which are effectively branches of the Department of Health, taking over or bringing to an end involvement undertaken by PCTs when it has already started and excluding the involvement of certain people whom another body will involve. Therefore, it is essential that there is public consultation on whatever regulations, guidance or directions are produced; otherwise, we are likely to face the prospect of further ambiguity. I listened to what the Minister had to say. I understand that she has not warmed to this amendment but I wonder whether she would consider the idea of an informal process of consultation with key stakeholders so that there is at least an inclusive approach as the regulations and guidance are put together. It would be somewhat ironic, as well as regrettable, if the Government provided for regulations and guidance on involving people without involving them in what the regulations and guidance will say. Therefore, in that loose sense, I hope that the Minister will look favourably on the notion of prior consultation and that she will also consider the other points of difficulty that I have tried to highlight.