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Local Government and Public Involvement in Health Bill

My Lords, I welcome these amendments and thank the Minister most warmly for having agreed to them, and of course I accept fully the assurances that she has given. I wonder whether she will allow me to ask a couple of questions on the content of the clause as a whole. First, in new Section 242A, we debated on Report the phrase ““prescribed matters”” and the uncertainty about what that phrase might cover. I would appreciate an assurance that no less than is currently provided for in the Health and Social Care Act 2001 is to be covered by the prescribed matters. I sought at the last stage to alleviate this potential difficulty by asking for consultation on the regulations, but the Government did not agree to that, so it would be extremely helpful to have an undertaking that at least the basic 2001 Act involvement provision—that is, the planning of services, planning changes in services and decisions about the operation of services—will be applied to the prescription of the matters to which the duty is to apply and that the regulations will be used only on the first and any subsequent occasions to expand on this core principle rather than reduce those principles. Secondly, in new Section 242B we are being asked to accept some extremely sweeping provisions that permit strategic health authorities, which are effectively branch offices of the department, to override local involvement work by PCTs, even where that work has already begun. That introduces a risk that a strategic health authority could undertake involvement work across one of the very large areas they cover without the sensitivity that only local involvement work by PCTs can bring, and which can then be precluded under this clause. For example, a reduction in the number of GP practices may make economic sense across a whole area, but the precise configuration can be determined only through the involvement of patients, so that transport and access difficulties that apply locally can be factored in. If that is left to consultation under Section 7 of the Health and Social Care Act, and if it is a substantial variation, it may well be too late to consider creative options for co-location that the public might generate when they are given the opportunity to do so. When I probed the purpose of these provisions on Report, the Minister indicated that they had been included to avoid duplication. However, the powers, if read literally, are drafted in a much wider way. Therefore I wonder whether I could have the Minister’s confirmation that the provisions are intended only to avoid duplication of involvement with the same people on the same issues and will be used only for this purpose. Thirdly, I would appreciate her confirmation that the provisions and any regulations will not be used to prevent, inhibit or override local involvement by PCTs with patients or their representatives locally; and finally, that the exercise of any powers by strategic health authorities in respect of whatever range of directions in new Section 242B is to be put in place will be decided by strategic health authority boards in public session and reported in the same way. There needs to be transparency here. All this gives rise to the question: how will compliance by strategic health authorities with these provisions be monitored and reported on, and who will performance-manage strategic health authorities on their involvement duties? PCTs are monitored by the Healthcare Commission on their patient and public involvement, but can the Minister confirm that the commission also has a remit under the Health and Social Care (Community Health and Standards) Act 2003 to monitor strategic health authorities, and that this monitoring function of the commission will apply to the new provisions in this clause?