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Local Government and Public Involvement in Health Bill

My Lords, I hope that I will not lose my voice, at least for a moment so that I can help the House with further clarification along the lines requested by the noble Earl, Lord Howe, and the noble Baroness, Lady Neuberger. It may be helpful to set out a little background in order to assist noble Lords in understanding the new duty on SHAs provided for in the government amendment introduced on Report. The only services SHAs are themselves responsible for are nationally commissioned, specialised services. In commissioning those services, as I have said, SHAs are subject to the existing Section 242 duty to involve. What we are providing for additionally in new Section 242A is a duty on SHAs to make arrangements to involve patients and the public in, for example, the development of strategic frameworks within which services across a whole area are delivered. We have placed a duty on the Secretary of State to make regulations setting out the circumstances under which this duty would apply. As I said on Report, it is expected that these regulations will be developed with the key stakeholders I listed at that stage. The policy intention is that the duty will apply where an SHA is developing the future configuration and method of service delivery across the area for which it is responsible. We will be building up those regulations through a process of involvement to avoid the irony alluded to by the noble Earl on Report, but I would expect them to be comparable with the provisions already contained in Section 242—here I hope to reassure the noble Earl—the planning and provision of services, the development and consideration of proposals for changes in the way services are provided, and decisions to be made affecting the operation of services, but in the context of the whole area rather than one discrete PCT area. Other areas may emerge as the health service evolves, and there may be other circumstances that require SHAs to involve people in other aspects of the development of strategic frameworks. I can therefore reassure the noble Earl that we are talking about expanding, not reducing, the provisions in Section 242. On strategic health authority directions to PCTs, let us be very clear that it will generally be for PCTs to involve patients and the public, as set out in Section 242. Only in very particular circumstances might an SHA want to take over that responsibility. For me, the phrase ““take over that responsibility”” is key, because we are talking not about that responsibility disappearing but about it being taken over by the SHA. Yes, we did say on Report—and I am happy to reiterate now—that we are aiming to avoid duplication. We are not about preventing local consultation or about preventing the PCT consulting; we are making provision for a strategic health authority to take over a PCT’s responsibility. The situation might arise in which all PCTs in an area involve people in local arrangements within a strategic framework. Strategic health authorities would then be able to co-ordinate a single involvement exercise, rather than there being several very similar PCT arrangements with a similar timeline. Let me therefore reassure noble Lords that we intend to achieve a co-ordinated involvement process that avoids unnecessary duplication. There is absolutely no intention to limit involvement in any way. I absolutely agree that there can be no involvement and consultation without transparency. We do expect that SHA boards will receive reports and will be involved in decisions about consultation. That is exactly the role that one would hope boards would have. We therefore expect people to continue to be involved and that our proposals here expand, not reduce, opportunities for involvement. Given the assurance that I have been able to give the noble Earl and the noble Baroness, I hope that they will feel able to support the amendment. On Question, amendment agreed to.