On Friday, when Parliament was not sitting, the Government published 68 amendments to the Health and Social Care Bill changing the status of local HealthWatch organisations (the local bodies that are intended to protect patient interests in the new Tory/LibDem vision of the Health Service), as I predicted a few weeks ago.
The amendments are very complex and difficult to follow – they amend amendments to Part 14 of the Local Government and Public Involvement in Health Act 2007. And they are scheduled to be debated next week during the House of Lords Report Stage consideration of the NHS Bill.
That means that these amendments – slipped out without proper warning or explanation (a normal courtesy of writing to those Peers with an interest in a particular matter doesn’t yet seem to have happened in this case) – will not receive proper Parliamentary scrutiny. They have never been considered by the House of Commons (and, if passed in the Lords, will now only be taken there as part of the truncated Consideration of Lords Amendments procedures). In the House of Lords, they have not been subjected to detailed scrutiny at Committee Stage and will essentially have to be debated on a take it or leave it basis when they are eventually reached probably some time late on Thursday. That will be the only opportunity for any discussion on what these amendments mean.
So what are these amendments about?
The biggest change is to remove Clause 181 and Schedule 15 of the Bill. These established local HealthWatch organisations as statutory bodies with a defined local membership (appointed in accordance with regulations) that could employ staff, would meet in public etc.
Instead, local authorities will be expected to make “arrangements” with a body that “a person might reasonably consider … acts for the benefit of the community in England”. And these bodies will then be able to sub-contract the patient representation work further.
The role of the national body, HealthWatch England (which the Government still want to be a sub-committee of the heavily-criticised Care Quality Commission) to advise local HealthWatch organisations is also being diluted with their power to give “advice” being changed in another amendment to a weaker role of giving “general advice”.
Presumably as a sop to people like me who had complained that there was nothing to require local authorities to provide an adequate local HealthWatch organisation (or even to spend the money allocated for local HealthWatch for that purpose), there is an amendment that gives HealthWatch England the power to give a local authority “written notice of its opinion” that the services expected of a local HealthWatch organisation are not being provided properly. This gives HealthWatch England the power to write a letter, but that is all. There is not even a requirement for a recalcitrant local authority even to respond to the letter. I am sure they will be quaking at the prospect!
The Government acknowledges that there may also be a conflict of interest between a local HealthWatch organisation and the local authority that is responsible for setting it up and funding it (for example, if a local HealthWatch criticises the quality of the social care provision provided by a local authority). They are therefore putting forward an amendment saying that local authorities “must have regard to any … guidance on managing conflicts” that the Secretary of State may issue. Again, not much of a safeguard.
The amendments also seem to envisage that a local authority may get different contractors to provide the various functions of local HealthWatch organisations, so one contractor may “gather information” and “make recommendations”, another may be responsible for “monitoring” services with the power to “enter and view” them, a third might provide advocacy services and a fourth might be responsible for “influencing commissioning”. This is hardly a recipe for an effective structure.
And there is another strange amendment which suggests the possibility of imposing a requirement that in any area “Local HealthWatch contractors (taken together) are representative of people who live in the local authority’s area”. This acknowledges that there are likely to be several sub-contractors providing patient representation services in an area, but also opens up the possibility that the sub-contractor providing one service may not be representative provided the other subcontractors compensate for the first’s unrepresentativeness.
Without these amendments, there would at least have been some clarity as to what a local HealthWatch organisation might look like – even though they would be hampered, possibly shackled and potentially starved of funds by being subservient to the local council in their area whose social care provision they would be monitoring. However, with these amendments local HealthWatch organisations are likely to be fragmented and will lose the authority they would have had by being statutory bodies. What is more by deleting the schedule that would have specified membership arrangements and governance they will now be shadowy and unaccountable structures.
The net effect of these amendments will be to make it more likely than not that the new local HealthWatch organisations will be ineffective and that there will be no proper and coherent structure of patient representation at local level.
One can only speculate as to why these amendments have been brought forward in this way at this time.
One possibility is that some obscure unit in the Cabinet Office charged with dismantling the public sector suddenly realised that there was a bit of the Health and Social Care Bill that did not facilitate privatisation and instructed the Department of Health to change it.
Another is that Department of Health Ministers have realised that the changes they are making to the NHS are so unpopular and are likely to have such a damaging effect on patients that they simply cannot risk having an effective mechanism for patients’ interests to be represented.
I don’t know which is the real reason, but it is difficult to conceive of any other rational explanation.