Just over a month ago the Government yet again snubbed the Mayor of London over his proposals for a pilot sobriety scheme, whereby the courts could impose on offenders, whose offences were alcohol-related, a requirement that they be compulsorily tested for alcohol daily for a three months period with a positive test meaning arrest and appearance again in court.
But now – either because they have finally listened to the overwhelming force of arguments coming from all corners of the House of Lords or because they want to provide a helpful headline to the Mayor prior to the Mayoral elections in seven weeks time – the Government has performed an 180° u-turn. They have now tabled an amendment to the Legal Aid, Sentencing and Punishment of Offenders Bill that will enable the courts to impose sobriety orders as part of a suspended or community sentence.
Offenders would have to wear ankle tags that continuously monitor alcohol levels, for up to four months. The orders would allow alcohol levels to be monitored either by these tags which test sobriety every half hour, or by requiring offenders to attend a police station daily – or at other regular intervals – to be breathalysed.
Of course, the other advantage from the Government’s point of view is that it saves a lengthy debate on a Bill that is already taking much more time to progress through its various stages in the House than expected. And what is more it avoids the certainty of another defeat for the Government to add to the nine they have already had on the Bill so far in the Lords.
It is really a case of Healey’s Law: when in a hole, stop digging.
Along with peers from all parts of the House of Lords, I have been pursuing concerns about the loophole that the Government was creating in the Protection of Freedoms Bill that would have meant that those volunteering to work with children did not have to be subject to Criminal Records Bureau checks or checked against the lists of those barred from working with children provided their activities were subject to “day to day supervision”.
These issues were debated again in the House of Lords late yesterday afternoon. In the end, the issues boiled down to whether an organisation with volunteers working with children could have an “enhanced” Criminal Records Bureau check on such volunteers and whether that check would include information as to whether that individual had been barred from working with children.
The legislation as originally envisaged would not automatically have given organisations the right to have enhanced CRB checks on volunteers. In essence, the Government have now conceded that right.
They resisted, however, the suggestion that the check should reveal whether or not an individual had previously been barred from working with children – even those 20% of those barred do not have a criminal conviction that would show up on a CRB check.
In the end, the Minister offered a compromise: the “enhanced” check would not disclose whether an individual had been barred but the information that had led to a decision to bar an individual would be made available to the police and they would have discretion as to whether to pass it on as part of the enhanced checking process.
Essentially this ought then to mean that any relevant information could be obtained by an organisation about a volunteer, but it seems a very convoluted way round of doing it. It would surely be much simpler to say whether that individual had or had not been barred. It also places the onus and the discretion on the police to pass on the information – so any failure to do so will no doubt lead to criticism of the police service concerned.
An exchange in the House of Lords this afternoon demonstrated that following the election of Police and Crime Commissioners public police accountability is to be done on the cheap.
Baroness Ruth Henig asked how much money was to be made available for Police and Crime Panels (these are the new bodies set up under the Police Reform and Social Responsibility Act to hold Police and Crime Commissioners to account and which will in effect be the only public forum in which policing decisions can be questioned). The answer was £53,300 per panel.
When I pointed out that this would be insufficient to employ more than one or two people to support busy local councillors fulfil their scrutiny role, I was told that perhaps I didn’t understand how local authorities work. This produced loud guffaws – not recorded in Hansard – as colleagues around the House seemed to think that my twenty-six years of experience in elected local and regional government might be rather more extensive than that of the Minister.
The full exchanges were as follows:
To ask Her Majesty’s Government how much money they will make available to each police and crime panel to cover start-up and first-year running costs.
In the House of Lords this afternoon, the Labour Leader, Baroness Jan Royall, asked a Private Notice Question of the Department of Health Minister, Earl Howe, about whether the Government would now publish their risk register on the Health and Social Care Bill given that the ruling of the Information Commissioner has now been upheld by the Information Tribunal.
The Government made it clear that they are waiting to see the detailed reasons from the Information Tribunal so that they could decide whether to appeal further. So the implication is that they will not comply with the ruling before the Bill completes its passage through the House of Lords next Monday.
The exchanges showed seven Labour Peers (Baroness Jan Royall, Lord Charlie Falconer, myself, Lord Dale Campbell-Savours, Lord Bob Hughes, Lord Bruce Grocott, and Lord Maurice Peston) pressing the Government to publish. There was silence from the Cross-benches, a supportive question from Tory Lord Deben (aka John Gummer) and a nice easy question from LibDem Lord Marks of Henley-on-Thames.
Here are the full exchanges:
Private Notice Question
To ask Her Majesty’s Government, in light of the decision of the information tribunal last week, whether they will publish the risk register associated with the Health and Social Care Bill before that Bill completes its Report stage in this House.
The tribunal agreed with our assertion that the strategic risk register should not be published but disagreed when it came to the transition risk register. Our difficulty is that the case that we made for both documents, which are of a similar structure and have similar content, was based on essentially the same arguments, which makes it extremely difficult to make a decision on whether or not to appeal the decision. I hope, as I say, that the tribunal will give its reasons for the judgment as soon as possible so that we can determine the right way forward.
My excellent webmaster, Jon Worth, has written a blog post about his experiences earlier today with security on the Eurostar from Brussels.
He describes the pointless inconveniences that were introduced to plug the holes in an already leaky system. The extra measures in place on his journey were presumably intended to plug the Lille loophole, described in the Telegraph today. Yet the “solution” provided hardly seems cost-efficient or particularly effective.
The Sunday Telegraph explains the problem as follows:
“The loophole centres on the Schengen agreement signed between a number of European countries, including France and Belgium, which allows people to cross borders without passport checks.
The UK is not in the agreement can therefore check the passports of passengers travelling here.
As a result there are two gates for Eurostar trains in Brussels, one for those going to Lille, which does not have passport checks, and one for the UK, which does.
It means an individual could buy two tickets and then pass through the Lille gate but stay on the train to London without having their passport examined.”
Jon Worth describes the extra checks which took place on his train (no doubt as a result of this morning’s article in the Sunday Telegraph):
“Then today when the train called at Lille for more passengers to alight and board, we were told on the public address system in the train that there would be additional checks in the train between Lille and Calais. These checks were carried out by a team of 7 French rail police carrying guns and batons, but just checking tickets (and not passports). I asked the policeman who checked my ticket why he was doing so. “Parce-que c’est comme ça” (because that’s the way it is) he replied. I pushed him further, saying that of course I had to have a valid ticket, because how otherwise could I have actually got on the train? “C’est contre la fraude” (it’s against fraud) was the best I got out of him before he moved off.”
So that wouldn’t have prevented anyone with evil intent slipping into the UK.
However, today there was an additional check at St Pancras:
“Then upon arrival in St Pancras, not announced to passengers on the train, all passports and all tickets were being checked by UK Borders at the exit. Which – quite frankly – seems to render other checks superfluous. Why bother having a UK Border check in Brussels, and French police check in the train, if you’re then going to check in London too?”
Excellent – apart from the extra costs of the unnecessary and ineffective security checks beforehand.
But what about the impact on passengers? As Jon Worth points out:
“due to the small terminal exit and a few hundred people streaming off a train, the checks are not swift in London.”
This means at peak time there will either be terrible delays or – as happened with other border controls – the extra checks will be lifted.
The problem is potentially serious and it is amazing that the Home Office seems so relaxed about it.
LibDem discipline in the House of Lords is pretty monolithic – at least as far as the divisions on the Health and Social Care Bill are concerned.
I reported earlier in the week that in Tuesday’s five votes on amendments to the Health and Social Care Bill LibDem peers had voted en masse against every single one.
Today they were at it again.
The first vote was on a Labour proposal which would have removed the arrangements enabling NHS Foundation Trusts to earn up to 49% of their income from private patients. This was defeated by a majority of 58 with 53 LibDems voting against the amendment.
The second vote was on making HealthWatch England a genuinely independent body. This was voted down by a majority of 24 with 44 LibDems voting against the amendment.
The third vote was on Government amendments removing statutory status and governance requirements from local HealthWatch organisations. The Government pushed through their amendments with a majority of 77 with 40 LibDems supporting the Government line.
The fourth vote was on a Labour amendment which would have required clinical commissioning groups to get approval from local Health and Wellbeing Boards to their commissioning plan (i.e. to introduce some democratic accountability). This was defeated by a majority of 87 with 34 LibDems voting against the amendment.
In none of the four divisions did a single LibDem peer defy their Party whip and vote the other way.
Late this afternoon the Government finally got their way in the House of Lords and pushed through a group of fifty amendments that transform their proposals on how local HealthWatch organisations (the structures being created under the Health and Social Care Bill to represent the interests of patients in local communities) should operate. The amendments, produced without consultation and with little warning, remove the statutory status of local HealthWatch organisations, remove the schedule to the Bill that would have specified their governance and how they should be structured, and pave the way for the privatisation and fragmentation of the functions of local HealthWatch.
The amendments were approved by 168 to 91 – a Government majority of 77 (40 LibDems voted for the Government amendments with none against).
For the really, really, keen here is what I said in opposing the amendments:
“My Lords, this is a complicated group of amendments. There are, I think, 50 government amendments in this group that completely change the direction of this part of the Bill. Of course, we do not have the benefit of a Committee consideration of these changes, which is unfortunate, given the nature of the changes that are envisaged.
In fact, what we are being confronted with is an almost extraordinary volte-face by the Government about how local healthwatch organisations are going to operate and proceed. As it stood, before these amendments, the Bill provided local healthwatch with a very clear structure and very clear governance. It defined membership and it defined their role. As such, the arrangements were better than LINks, better than PPI forums and, in one or two respects, better than community health councils. It was a very clear statement. There remained the problem that local healthwatches were going to be the creatures of local government without the benefit of ring-fenced money and with the potential issues around conflicts of interest concerning social care. I am reminded that on 15 October 2007, the noble Earl, Lord Howe, clearly took the view that it was inappropriate for a local authority to be host to a LINk. Presumably, the same arguments that influenced his thinking then apply on this occasion.
We have been offered guidance on conflicts but, again, it is not clear how this will work, which is something that we could have pursued perhaps in detail in Committee. The amendment refers to having regard to the guidance on conflicts, which I suspect will not necessarily be strong enough for the sorts of conflicts of interest that potentially could arise. We also have the enormous concession, to which I referred earlier, of Amendment 226ZG, which enables HealthWatch England to write a letter if it feels that something has gone wrong.
That is where we were but now the Government, without explanation or consultation, have decided that local healthwatches will no longer be statutory bodies. We are told that that is all in the name of the need for flexibility. The noble Baroness has mentioned repeatedly the briefing which took place yesterday evening, to which, incidentally, I was not invited. Even had I been, I would not have been able to attend because the meeting clashed with the regular meeting of Labour Peers, which one would think that the Government would wish to avoid. At that meeting various papers were tabled which referred to the importance of flexibility but we are not clear as to what that flexibility will deliver.
In moving the amendment the noble Baroness talked about the Government’s proposals in the Bill as creating a series of “unaccountable quangos”. I recall previous briefings which I attended with Ministers and the Bill team when it was explained that there would be guidance about how the membership of local healthwatch was going to be derived and to demonstrate that these were going to be accountable bodies and not unaccountable quangos. Somewhere along the line, in the past few weeks, there has been this amazing change of attitude, which does not seem to follow the benefit of any real explanation or consultation with those who might take an interest in it.
That underpins the amendments spoken to by the noble Baronesses, Lady Cumberlege and Lady Jolly. The noble Baroness, Lady Cumberlege, highlighted the difficulty that would arise between members and staff. The noble Baroness, Lady Jolly, talked about the importance of lay leadership. In terms of the changes, the Government are going to make it more difficult for there to be lay leadership and the role of members versus staff will be blurred still further. Indeed, the staff will be the dominant influence.
This is not a matter on which there has been consultation. I have received a note from the National Association of LINks Members, which states:
“Ministers say that they are ‘not convinced’ that LHW needs to be a stand-alone, statutory body corporate. It is not ministers who will be relying on LHW to get them a fair shake but the old, sick, vulnerable, frightened and marginalised and these, along with the rest of the patients and the public, are the ones who need to be ‘convinced’ that we have a model that will work”.
It says that it is not convinced. It points out that local healthwatch should,
“have a standard ‘platform’ of presence everywhere in England, not merely through logos, straplines and brands”—
which the Government’s amendments will make happen—
“but through a locally elected membership, a single ‘address’ and identifiable staff that it has appointed”.
It says that only:
“Statutory, body corporate status would deliver this”.
“Government says it does not want a top-down model but it is making top-down decisions, and these fly in the face of all the evidence of the past three and a half years of LINks, all the advice of all the LINks’ members of the government’s own HealthWatch Advisory Board, of the National Association of LINks Members, all the advice of many, many LINks all over England. ‘Being heard’ has simply vanished from the national scene. The government pontificates on what it does not practise. It legislates but it does not listen”.
It suggests, although I could not possibly automatically agree, that:
“What the Government actually fears is 152 statutory LHWs, with genuine independence, with real clout and public buy-in, a separate identity, and powerful and committed membership”.
If that is the concern, where do we go from here? I am taken with the sage advice your Lordships received from the noble Earl, Lord Howe, when we debated the creation of LINks, the slightly ill-fated proposal by the previous Labour Government. The noble Earl, in his typically courteous but forceful way, said then—given these government amendments, you can simply substitute HealthWatch for LINks:
“We have come to a group of amendments most of which in their different ways relate to the same problem. I use the word ‘problem’ as the most neutral term I can readily think of for what many of us regard as a most serious and regrettable weakness in this part of the Bill; namely, the absence of even the slightest hint of a statutory identity for LINks. There is a complete lack of any descriptive reference to what a LINk might look like and practically no definition of a LINk”.
That was the noble Earl, Lord Howe, talking about the creation of LINks. Yet today he has brought forward amendments—admittedly he has delegated this to the noble Baroness, Lady Northover, who is acting as his mouthpiece on this occasion—that will do precisely what he complained that the previous Government did.
Of course he said much more than that. I will not burden the House by repeating all the remarks he made in October 2007, but if we substitute HealthWatch for LINks every time it appears, we will get the flavour. He went on to say:
“As the Bill stands there are no provisions for LINks to have any form of governance arrangements; it is left completely open as to how a LINk would be able to make decisions or authorise people to act on its behalf. This is a major issue because without some form of governance you cannot have accountability. If there are no people authorised to act on its behalf, a LINk cannot be accountable”.—[Official Report, 15/10/07; col. 567.]
He later said:
“The key issues around governance are really three: how decisions are to be made; how activities are to be undertaken; and, who is to do these things? Without those minimum requirements we would be left with a situation where someone who has joined a LINk, but who never attended any meetings or received any training or signed any code of conduct”,—[Official Report, 15/10/07; col. 568.]
could proceed in particular ways. So the lack of statutory identity was something that the noble Earl, Lord Howe, told this House was absolutely critical when we debated the creation of LINks. And he was absolutely right. I remember agreeing with him at the time and feeling that my Government had got it wrong. But this is the point. The Government have now brought forward amendments which undo all his fine words at that time and all his attempts to put this right, and that is because statutory status at the local level was what was going to give HealthWatch a cutting edge, an authority in terms of its relationships with other bodies.
The noble Earl also had a few words to say about the underlying argument that this should be delegated down. He said then, and we could say it to him now, that we were told that the Government did not want to be “prescriptive” and that it would be up to each LINk to set itself up in the way it wanted.
In June 2007, he quoted a telling Greek legend. Indeed, he may remember using this example:
“I think it was Proteus who was able to assume any shape or form that he liked. The reason why he did this was in order to avoid foretelling the future. For us debating this part of the Bill, it is almost impossible to foretell the future because neither the governance arrangements of LINks, nor their structures, nor their powers, nor even the precise scope of their activities, are set out here. In a real sense, as with Proteus, we do not know who or what we are dealing with”.
With these amendments before us today, the Government are substituting something else when we would have known what we were dealing with and where there were precise governance arrangements. But they are taking all that away and moving towards something that the noble Earl also, presciently, described in that debate, saying:
“As I understand it—the Minister may correct me—because LINks are not defined they are not classifiable as statutory bodies. We may know a LINk when we see it—although I am not completely sure about that—by virtue of the things that it does … The Bill refers to activities being ‘carried on’”.
I look at these amendments and, my goodness, Amendment 236C in the name of the noble Earl talks about,
“activities carried on for the benefits of the community in England”.
Incidentally, how a local organisation is supposed to act in the benefits of “the community in England” seems to be a very odd use of words. However, phrases such as “activities carried on” were precisely what he said then was the wrong way of going on.
The noble Earl went on to say in that June 2007 debate:
“In fact, in one way or another, there is quite a lot of carrying on in this part of the Bill. There may be a joke there somewhere but I shall refrain from trying to find it. But that nebulous form of drafting is as far as we get. It will be incumbent on us in Committee”—
we do not have the benefit of being in Committee today—to sort out this unsatisfactory regime. He continued:
“The main problem with the Bill is that because LINks”—
and you could say the same about HealthWatch now—
“have no identity or definition, they can be seen neither as bodies whose independence is guaranteed, nor as bodies which have the power to hold local health and social care commissions to account”.—[Official Report, 20/6/07; cols. 252-3.]
Those were the wise words of the noble Earl, Lord Howe, then, but he is the same noble Earl who is bringing forward amendments that create the same precisely the structure that he said was totally inappropriate then.
Let us look at what the Government are doing and I will be brief. Amendment 231B removes the statutory status. Amendment 231C removes all structure, form and governance from the Bill. Amendment 234A talks about “one set of arrangements”. It implies not just a single arrangement in any local authority area, but a set of arrangements, so it would not necessarily be one contractual arrangement: it would be a set of contractual arrangements. The word “arrangement” is in the plural.
Amendment 235C is the great catchall that tells us it is all going to be all right and that all these bodies are going to be the same in that there will be a licence to use a trademark. I am enormously reassured by that. Amendment 235D provides for subcontractors for the different functions. So what we are envisaging is that a local authority will divide up the functions of HealthWatch organisations and contract each of them to a separate organisation. Does that really make sense? Is that the strong patient voice that we were promised at local level?
In Amendments 238ZM and 238ZN there are specific references to contractors. This is essentially moving from a position where there will be a clear number of local statutory bodies delivering patient representation on behalf of their communities, with members from those communities running those organisations, because that is what the governance arrangements were before. This is essentially privatising that process, albeit by so-called social enterprises. This is privatising consumer representation.
How can contractors be representative? Yes, there is an amendment that says that these contractors will be broadly representative of the local community, but how can an enterprise itself be representative of the local community? I find this concept difficult to understand. Because we are not in Committee, we do not have the opportunity to have it explained to us fully and a chance to probe the Government.
The amendments that we talked about a few minutes ago envisaged that local healthwatch would be able to have local representation on the board of HealthWatch England. How will we have representatives from local healthwatch organisations—the arrangements that will be subcontracted for different functions to social enterprises—how will representatives be produced at the national level for HealthWatch England? Is this going to be board members of a social enterprise, charged with the effective running of that enterprise not the representation of the community? Will it be the staff? That comes back to the point about lay leadership that the noble Baroness, Lady Jolly, raised earlier.
Last night, I got an e-mail from an existing LINk member, with whom I have never previously communicated, saying:
“I’m much involved with my local LINk, which it can be argued, has already been ‘taken over’ by its Host in advance of the Privatisation of the Public’s voice when HealthWatch comes about. Lay ‘Volunteers’ have been demoted from being Members to Participants”—
there is the lay leadership of the noble Baroness, Lady Jolly—
“and our Management Committee has been redesignated as an ‘Advisory Group’”—
again, lay leadership—
“with few if any powers over anything. Expulsions have been initiated against those who don’t toe the new autocratic line—and the local authority just turns a blind eye despite appeals to the Council Leader, CEO and Portfolio holder. What hopes for a voice for the public/patient when Local Healthwatch is in place?”.
I believe that the Minister received a letter from another member of a local LINk who talks about his dedicated service. He lists at some length all the different bodies that he has sat on representing the public, then says that,
“My most precious resource—the time I have given—has, at a stroke, been set to nought”.
There is no local lay leadership in these arrangements. That is why these amendments are so sad.
We have to ask why the Government are doing this. Is it because some unit in the Cabinet Office has suddenly discovered this bit of the Health and Social Care Bill and said, “Oh, they have missed something out about the opportunity to introduce competition so let us put it in this bit of the Bill”? Or perhaps it is because Government Ministers have suddenly realised that the Bill is rather unpopular. There are some difficulties with it, the public’s perceptions of it are increasingly negative, so having proper patient representation would now be extremely dangerous.”
The Government successfully fended off an attempt to ensure that HealthWatch England (the national body that is being set up to represent the interests of patients) is a genuinely independent body in the House of Lords this afternoon.
Under the proposals in the Health and Social Care Bill HealthWatch England is constituted as a committee of the much-criticised NHS regulator, the Care Quality Commission. The amendment, which I had seconded would have made it a genuinely independent body and given it responsibility for supporting and funding local HealthWatch organisations.
In the end the amendment was narrowly defeated by 165 votes to 189 – a Government majority of 24 (44 Liberal Democrats voted against the amendment, none voted for it).
For those with time to kill, my speech was as follows:
“My Lords, I think this is the part of the Bill which I assume the Minister had hoped would give him a quiet time. Indeed, he has passed on the responsibility for answering this amendment to his noble friend Lady Northover. Originally, one had to respect the Government’s intention with regard to HealthWatch because I am sure the intention was to create effective patient representation at national and local level. That intention has been challenged in the discussions that we have subsequently had and in some of the changes that have occurred over the past few months. However, it is worth going back for a moment to first principles. What constitutes effective patient representation? The first significant element of that has to be independence. The organisation representing patients’ interests has to be independent of the providers of health services, those who commission them and those who regulate them because the act of representation can potentially challenge any or all three of those interests.
Secondly, effective representation at national level must be representative. There must be real representativeness within that structure. It must be derived from local groups and local individuals and have that authority which is derived from being a representative structure. With the best will in the world, you cannot be an organisation which can speak with proper authority on behalf of patients or, indeed, any consumers if you are simply appointed from on high by a Secretary of State. In my time, I have worked for organisations that have been structured like that and I have to say that although they can do good work, they cannot be properly representative. They cannot properly have the authority that comes from being derived from the grass roots. The third element which is critical is that the work and the comments that these bodies produce have to be derived from sound local information, which necessitates being able to pick up information from local networks around the country. That has to be safeguarded in whatever proposals are put forward.
The Government originally promised us that HealthWatch England would be the independent patients’ champion. However, as the noble Lord, Lord Patel, has just pointed out, being a subcommittee of the Care Quality Commission does not demonstrate independence. It demonstrates a subsidiary role in relation to the Care Quality Commission. I am sure that the people currently at the Care Quality Commission are motivated to try to create an arm’s-length structure. We do not know, of course, whether that desire for independence would survive the first occasion when HealthWatch England challenged the decisions made by the Care Quality Commission, or how often it would survive after repeated such challenges. However, independence is also about the perception and the appearance of being independent. How can you appear to be independent if you are a subcommittee of one of the organisations that you may have to criticise from time to time?
This amendment seeks to do three key things. It would set up HealthWatch England as an independent statutory body and write that independence into statute, set out a clear relationship with local healthwatch organisations and safeguard their funding mechanism. I recall some very wise words said to your Lordships’ House in July 2007 when we were debating the creation of the Commission for Patient and Public Involvement in Health. It was stated that,
“one signal advantage of the commission is that the money that it distributes to forum support organisations cannot be used for purposes other than those for which forums were established. Under the arrangements in the Bill, however, there is no guarantee at all that money intended to support the activities listed … will actually reach the front line. It would be possible for a local authority to say that it was delivering the activities in the Bill when, in reality, those activities were so minimal that they were hardly worth the name of patient and public involvement. What steps could be taken, in those circumstances, to ensure that such involvement in health and social care is delivered properly?”.—[Official Report, 23/7/07; col. 615.]
The person speaking said that the answer was not delivered by the Bill brought forward at that time by the Labour Government. Who was the person who delivered those words? It was, of course, the noble Earl, Lord Howe—the current Minister. He made it quite clear that the arrangements which he is now seeking to replicate were not adequate and would not, and could not, work. Yet the proposals which were going to establish the independent patients’ champion are weakened precisely because he has not accepted the lessons of his own words.
The noble Earl, Lord Howe, went on to say that he was concerned that, as:
“LINks are going to assume different forms and guises in different localities, it is axiomatic that the level of activity that they undertake is going to vary”.—[Official Report, 23/7/07; col. 615.]
He asked how the amount of money in any given area was to be assessed. Therefore, I ask the noble Baroness—who will respond on behalf of the noble Earl, who gave us that wise advice in 2007—what will be the mechanism for determining how much money is allocated to each local authority for healthwatch in its area? Will this be a global sum that will go from the Department of Health to the Department for Communities and Local Government, and then be allocated to local authorities by the mysterious process by which the block grant from the DCLG is decided for each local authority area? Or will there be a separate formula that will go with that money and decide how much money is allocated to local healthwatch around the country? If it is the latter, will that information be published? Will it be possible for residents in a local area to know how much money has been allocated so that they can see whether it is being used? I suspect that unless we have the answers to those questions we will know that the reality is that this money will disappear in the wash and not be effective. The point about the amendment is that it provides a solution to that problem because the same money would be channelled through a body that would be dedicated to the provision of local healthwatch organisations and want to ensure that the money was spent properly and appropriately.
The Government’s arguments—we have had several discussions about this with Ministers, and I am grateful to the noble Earl and the noble Baroness for providing those opportunities—seem to be broken down into three areas. First, they argue that there is a natural synergy with the work of the Care Quality Commission. However, I have already pointed out that the CQC is one of those bodies that HealthWatch England may have to criticise. There is also a synergy with the work of the NHS Commissioning Board, Monitor, Public Health England and all sorts of other parts of the new NHS. Why is there specifically a synergy with the CQC?
The Government’s second argument was that there would be cost efficiencies and that this would be the most efficient way of doing this because there would be savings due to the collocation. However, as the noble Lord, Lord Patel, pointed out, you can achieve that in many ways. You can simply say that one of the things that HealthWatch England, as an independent statutory body, could be required to do through guidance, would be to look at how its back-office operations could be provided from a variety of organisations of appropriate stature and size, where the issue of conflict would not necessarily arise. That provision could then be made by way of a clear legal agreement. However, that is not being done, and I am not quite sure why the Government are saying that there are efficiencies and cost savings that could be made only by the precise structure that they propose. In terms of providing the funding to local healthwatch, our proposal has to be a more efficient provision that will deliver the resources without leakage and without local authorities deciding that perhaps there is a greater local priority than local healthwatch.
The noble Baroness, Lady Northover, spoke vehemently about the way in which the former Commission for Public and Patient Involvement in Health had operated, and how it had a wasteful and top-heavy way of distributing resources to local patients and for public involvement. That is not the only way to distribute resources. The only reason that the former commission distributed resources in that wasteful and inefficient way is because the Department of Health at that time—I regret, led by a Labour Minister—insisted that it was done in that rather ridiculous and cumbersome way. If Ministers want distribution done efficiently and simply, perhaps that can happen. If you appoint the right people to the initial board of HealthWatch England, I am sure that they would want to ensure that that is the case. It does not have to be done in the way I described.
The third argument that I have heard Ministers make for locating this body within the CQC is that it will provide all sorts of informal support and guidance—that there will be a library, information resources and so on. However, the Government have told us how important the duty of collaboration is within the new NHS and how significant it will be. Why do you need to collocate and have HealthWatch England as a subordinate structure within the CQC when there is a duty to collaborate? Indeed, why cannot HealthWatch England collaborate with other national bodies as part of the NHS?
Within this group there are other amendments, including Amendment 224 and 225, which propose that the majority of members of HealthWatch England will not be from the CQC and will be appointed by local healthwatch. I have two concerns about those amendments. Why cannot all the members be derived from local healthwatch organisations? The bigger question comes in a later group of amendments, which is: if you have destroyed the statutory status of local healthwatch organisations, how can contractors, which will be delivering local healthwatch services at a local level, deliver representatives to a national structure? Will we thereby have representatives of different local social enterprises appointing people to sit on a national body? That is a strange representative structure.
Then there is Amendment 226ZG, which is the Government’s answer as to how they make sure that local healthwatch organisations are satisfactory. This gives HealthWatch England—this sub-committee of the Care Quality Commission—the power to write a letter. It is the power to write a letter to a local authority and say, “In our opinion, the local healthwatch organisations that you have organised in your area are insufficient”. My goodness, as a former local authority leader, I know that I would be quaking to receive a letter from a sub-committee of a national organisation that did not really regulate anything that I was particularly bothered about, telling me that I was not doing something absolutely right. There would be no enforcement powers and no means of intervention, but the power to write a letter. Brilliant. Excellent. It is just what we are looking for. It offers hardly any solution, although I appreciate the concession that the noble Baroness and the noble Earl have made in that amendment.
I conclude by saying that this is not a party-political issue. The previous Government got this wrong and, sadly, the present Government look as if they are about to get it wrong. This was an opportunity to get it right. Patients need effective representation, particularly in the context of the Bill. Even if you believe that the Bill will deliver to us a better health service—and I am obviously not one of those—patients need to be given confidence that their interests will be properly represented. At the moment, the arrangements proposed by the Government do not do that. That is why an independent HealthWatch England is so important.”
The report of the Parliamentary Joint Committee on the National Security Strategy (of which I am a member) has just been published.
Its key findings are that:
The Committee also expressed concern about the operation of the National Security Council concluding that it did not operate always at an appropriately “broad and strategic” level. For example, it became deeply involved in essentially operational issues during the operations in Libya. Moreover, it failed to consider the national security implications of the Eurozone crisis or the possibility of Scottish independence.
Yesterday there were five votes in the House of Lords on the competition sections of the Health and Social Care Bill. The amendments were all defeated by the Government and, despite all the LibDem huffing and puffing over the last few weeks, not a single LibDem Peer voted for any of them.
The first amendment which would have placed a duty on the Secretary of State in respect of standards of adult social care was defeated by 261 votes to 203 – with 66 LibDems voting with the Tories against the amendment.
The second amendment which would have protected the NHS from the worst effects of competition (and was originally moved by a LibDem peer) was defeated by 275 votes to 188 with 66 LibDems voting with the Tories.
The third amendment which would have retained Monitor’s role as the independent regulator of NHS Trusts was defeated by 255 votes to 183 with 65 LibDems voting with the Tories.
The fourth amendment which would have tried to limit “anti-collaborative” behaviour in the NHS was defeated by 221 votes to 171 with 58 LibDems voting with the Tories.
The fifth amendment which would have enabled NHS commissioners to determine the most effective way of delivering NHS services without necessarily putting them out to the market was defeated by 203 votes to 157 with 52 LibDems voting with the Tories.
In none of the divisions did a single LibDem vote with Labour to protect the NHS.