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Health and Social Care Bill

moved Amendment No. 10: 10: Schedule 1, page 111, line 43, at end insert— ““( ) The Commission must appoint an advisory committee (““the Service User Panel””) made up of people who are or have recently been users of relevant services, including their families and carers, for the purpose of giving advice or information to it about matters connected with its functions. ( ) The Commission must have regard to advice and information given to it by the Service User Panel. ( ) The arrangements must include the establishment and maintenance of such a panel.”” The noble Baroness said: I shall speak also to Amendment No. 11, to which I have my name, on behalf of my noble friend Lady Campbell, who sends her apologies for absence because of a prior commitment. Amendment No. 10 is supported by the National Consumer Council, the Picker Institute and Which?. It aims to put users at the heart of the regulatory process by bringing them into the commission’s governance structures to influence the development of plans, programmes, methodologies and approaches at a formative stage through insider engagement. It is intended to bring patients, users and carers into the formative processes of the commission’s workings. Current consultation with service users is usually over specific projects or established work patterns when plans or decisions are already well formed, and involves users in inspections or reviews the methodology and approach which have previously been formed elsewhere. In other words, users are usually involved relatively late in the day and can seem almost tokenistic. The amendment would require the commission to set up a panel to oversee the work of the regulator, reaching out to and feeding back from a wide range of user and public views and experiences. It would focus on helping the regulator to carry out its functions, including setting themes and priorities for review, and shaping regulatory processes. The panel should not be dominated by professionals from charities or lobby groups but must ensure strong representation of service users themselves, particularly those who are vulnerable or seldom heard. What would the amendment achieve? The model for the service user panel is partly informed by the success of Ofcom's consumer panel. A service user panel would be a critical friend to the board and executive. It could comment on the extent to which the interests of service users, families and carers are properly built into the commission's work streams, and influence board planning and strategic direction. It could ensure that methodology development for inspection and review is appropriate to the patient and the user population of the service to be scrutinised, and enable external organisations such as local involvement networks cost effectively to feed their views into the commission. The Government have said that service users’ interests should have a high-level voice in the commission's board and executive, and the advisory committee required by Schedule 1, paragraph 6, is welcome but does not go far enough as it does not ensure the users' voices, rather than those of pressure groups, are heard. This advisory committee seems to be a general committee of all relevant stakeholders with the optional inclusion of service users. The nature, membership, objectives and functions of this committee need to be defined, otherwise the user voice will be only one among many. All the research and experience suggests that when patients’ voices are made to compete with other interest groups, they become effectively disempowered. The Government suggested that the proposed advisory committee could, through the way it works, help to make the user voice effective; for example, by enabling sub-committees or establishing meetings between the board and that part of the committee representing other interests. However, that is not stated in the Bill and, therefore, there are no guarantees that the commission would establish a sub-committee of service users per se. There are precedents. The Mental Health Act Commission has already developed an empowered service user reference panel. The National Institute for Health and Clinical Excellence, NICE, has established a citizens’ council which can cross-examine witnesses and make recommendations which NICE must consider and respond to. The Children’s Plan from the recently formed Department for Children, Schools and Families sets out proposals for parent councils to ensure that their voices are heard within the school. The Communications Act 2003 required Ofcom to establish a consumer panel, to which I referred earlier. The Act specified 13 separate subject areas on which the panel should be able to advise Ofcom, including, "““any other matter appearing to the Panel to be necessary for securing effective protection for persons who are consumers””." The Ofcom consumer panel has had significant influence. It is able to request involvement in, and explanation of, Ofcom work plans at the conceptual stage, and to begin providing critical feedback. It is skilled at identifying the consumer impact of Ofcom initiatives and at advising the regulator on how to make them explicit in work. The proposals in both these amendments fit the policy agenda for engaging users in the design and delivery of public services, including a requirement for regulators to engage with service users and the public at large. I was delighted to welcome the amendment to this amendment—Amendment No. 11—from my noble friend Lady Campbell of Surbiton. Her suggestion neatly ensures that service users are indeed at the heart of the commission. Amendment No. 11 would ensure an effective link between the proposed service user panel and the commission by requiring the Secretary of State to appoint a member of the commission who is a service user to chair the panel. This mirrors the arrangements made for the Equality and Human Rights Commission’s disability committee, which, as stipulated in the Equality Act, must be chaired by a member of its board. That would give service users more direct influence on the commission and thus enhance people’s confidence in CQC's ability to put patients and carers’ at the heart of quality assurance. It harnesses the talents of the very people that CQC seeks to help and can improve health and social care outcomes as a result. There is always a danger of the panel merely becoming a talking shop or a body to be consulted after decisions have been taken. In drafting this amendment, my noble friend Lady Campbell has drawn on her experience of chairing the Social Care Institute for Excellence for five years, where its partner panel is chaired by a trustee, and her experience on the Equality and Human Rights Commission, where she serves as both a commissioner and chair of the disability committee. It is the central seat at the table that ensures the users inform the workings of the commission and see its contribution reflected in its work programme and reports. It protects against any temptation for professionals and practitioners to default back to former ways of working where consultation may be token. The amendment seeks to ensure that service user involvement is enhanced by a strong conduit between the panel and the ““top table””, bringing the ideas and knowledge directly into the heart of decision-making and forward planning. I beg to move.