Local Government and Public Involvement in Health Bill

Public Bill Committee, 6 March 2007.

Clause 153

John Pugh (Liberal Democrat, Southport)

I beg to move amendment No. 226, in clause 153, page 109, line 28, after ‘of, insert ‘access to’.

Christopher Chope (Conservative, Christchurch)

With this it will be convenient to discuss amendment No. 227, in clause 153, page 109, line 34, at end insert—

‘(d) notifying relevant transport bodies of any problems or improvements in access to care services.’.

John Pugh (Liberal Democrat, Southport)

As we enter the last rounds, we come to two quite significant amendments that would introduce issues of access and patient journey times to the matters to be considered by local authorities.

There are major omissions from clause 153 as it stands. A big issue for patients is not so much the delivery of services but the reconfigurations that are going on throughout the land, which the Government say will continue. Medical changes might also dictate that the reconfigurations continue. Financial pressures and the payment by results system will also ensure a degree of change. The general policy is to move care from the secondary care sector to the primary care sector and to centralise around centres of excellence. All of those factors bound together will produce a rearrangement of the health landscape in any one area. That has specific consequences for patients, because it affects their journey paths to services.

The journey to health care is often the very core or essence of people’s anxieties. People do not doubt that they will receive quality services once they get there, but they sometimes wonder how easy it will be to get there or, in the case of emergency services, whether they will get there in time. It is particularly an issue for the elderly, the socially excluded and people with children. The matter is at the core of debates about community hospitals, of which there have been many in this place, and of debates about urban and suburban reconfigurations, but it is often ignored by the health establishment. Sometimes, public transport authorities and highways authorities seem to live in a parallel universe to health authorities, given the limited amount of consultation and interaction between them.

In my area, health services were reconfigured and services were moved from one hospital to another as a result of an extensive medical report, the Shields report. In it, Professor Shields said that such changes would create problems in accessing services, but that those were not problems for the health service—in other words, the problems could be deposited elsewhere. However, the changes have created problems for patients, and if there is to be a genuine and useful patient consultative body, it must take those problems on board.

I understand that we are not going to have a stand part debate on the clause, so I wish to make a few general comments. At the heart of the proposals is the fact that, as far as I can see, no lever of power is taken out of the hands of the quangos and given to the community. We are going to have a long and extensive debate about the shape of the consultative body, but the fact of the matter is that the lever of power will remain almost exclusively in the hands of the quangos. I am sure that the Minister will understand what I am trying to say if I compare the almost platonic model on which health service governance is based, whereby governance is left to the experts and is not given or handed to the people, with the local authority governance model presented in the Bill. The Department for Communities and Local Government allows the public, through electoral and other arrangements, to have an involvement in emergency services, transport, social care and so on, but when it comes to health services, the approach is altogether different.

I accept that the Bill attempts to put a certain amount of power in the hands of the public in so far as they will be consulted a little bit more. The Government are inching in the right direction; but they are only inching—they are moving very slowly. With the amendment I am trying to persuade them to go a little further. They can take a step by accepting the amendment, which asks them to take on board a serious concern for patients—the transport arrangements for getting to health services.

Phil Woolas (Labour, Oldham East and Saddleworth)

I thank the hon. Gentleman for moving the amendment in such a constructive way. He seeks to amend clause 153, which requires local authorities to make contractual arrangements to ensure that local involvement network functions can be carried out in the relevant areas. Establishment of host organisations is relevant to that. It might also assist if I remind the Committee that the clause will oblige local authorities to facilitate LINKs organisations.

The clause refers to all local authorities, but clause 159 limits the applicability of the clause to those with social services responsibilities, and only English authorities are relevant. In plain English, therefore, we are not concerned with districts. The LINK function definition which the hon. Gentleman seeks to amend is

“promoting, and supporting, the involvement of people in the commissioning, provision and scrutiny of”

health and social care services. The hon. Member for North-East Bedfordshire observed that that should include monitoring as well, and I have undertaken to consider that, because the Government see the sensein it.

A second, and important, part of the function as defined involves

“obtaining the views of people about their needs for, and their experiences of”

health and social care services. An additional element involves making those views known to

“persons responsible for commissioning, providing, managing or scrutinising local care services”

and making of reports and recommendations to such people about how provision of health and social care services could be improved. As has been mentioned, a regulation-making power is needed to allow the Secretary of State to amend, add to or delete such activities. However, my hon. Friend the Member for Bedford will have something to say about that later in the debate, and we shall be able to consider it then.

The Government believe that it is vital to promote user involvement in health and social care, because it is only through seeking out the views and experiences of those who use the services that we shall be able to improve them. In fact, it is not the only way, but it is a necessary way—if not a sufficient one. It is also a way to make services more user focused, which is what the hon. Member for Southport desires—to look at things not from the point of view of the provider, but from the point of view of the patient or would-be patient. In summary, the clause requires that councils with social services responsibilities make contractual arrangements—we shall debate later with whom, and how—to ensure that there are means by which a local involvement network activity can be carried out in the council’s area.

We are debating amendment No. 227, which thehon. Gentleman addressed directly, and amendment No. 226, which would broaden the range of responsibilities. The hon. Gentleman mentioned the Highways Agency, I believe, or was it highways authorities?

John Pugh (Liberal Democrat, Southport)

Highways authorities.

Phil Woolas (Labour, Oldham East and Saddleworth)

I am sure that all hon. Members would echo his views in that respect. It is important that such public sector agencies work together and in partnership. However, although I do not disagree with the purpose of the amendments, I do not believe that they are necessary.

Amendment No. 227 would add the activity of

“notifying relevant transport bodies of any problems or improvements in access to care services.”

That is unnecessary because the clause provides that the key organisations that will receive reports and recommendations from LINKs are the commissioners, providers, managers and scrutineers of care services. LINKs will certainly collect information that is important for other organisations too, and there is nothing in the Bill to prevent them from passing that information on. LINKs, in the first instance, could—I would argue that they should—report any access problems to the commissioner of those services so that it can take account of those matters in its commissioning decisions and when it influences other local partners through mechanisms such as local strategic partnerships. LINKs will also be able to refer matters of concern, such as accessibility, to the relevant overview and scrutiny committee. Therefore, I agree with the intention of the hon. Member for Southport, but argue that it is already covered.

Amendment No. 226 similarly aims to extend the activities to explicitly include obtaining people’s views on their access to services. However, that is already captured in subsection (2)(b), which refers to

“obtaining the views of people, about their needs for, and their experiences of, local care services.”

A key part of obtaining people’s views on access to services will be the extent to which their needs have been met and how they have experienced the services they have received. My hon. Friend the Member for West Ham gave a very good example of the practical impact of that. In a survey of her community, it was pointed out that access to the local GP was not being used to the extent that the health service expected; instead, patients were travelling a further distance to use the hospital. When asked why that was the case, people pointed to the blindingly obvious fact that there was a bus route to the hospital and none to the GP. Access to services, as the hon. Member for Southport says, is the type of issue that Members of Parliament deal with, but it is more commonly dealt with by local councillors. The example of my hon. Friend the Member for West Ham graphically illustrated that point.

The point that the hon. Gentleman makes about access to services has been well heard. It is part of the rationale behind the framework that we have created to solve those problems. That is why I believe that the clause as it stands covers the desirable consequences that the hon. Gentleman seeks. I ask him, therefore, to consider withdrawing his amendment.

John Pugh (Liberal Democrat, Southport)

I thank the Minister for that clarification. I think that what he is saying is that the phrase “experiences of” in subsection (2)(b) includes experiences of getting to the services as well as going through the services. Therefore, I am prepared to consider withdrawing the amendment for the moment, but I will seek further clarification on the matter from other colleagues at a later stage. However, what I would emphasise is that the problems are often unsolved in particular areas, and it is not clear who owns the problems. I have sat in debates in which members from Hertfordshire, for example, have complained about the reconfiguration of their services. They have drawn attention to the fact that when the health service directs some patients to Watford, it is completely unaware of problems caused by football traffic, for example—although that problem might be reduced next season.

My point is that the problems are genuine and widespread, but when they do occur, it is not obvious whose job it is to resolve them. There can be a certain amount of buck passing in which the health authority puts the onus on the transport authority to produce a better bus service, for example, but the transport authority then says that it was not advised properly when the reconfiguration first went through. The holes in the Bill as it stands leave certain problems unaddressed. None the less, for the moment, I beg leave to withdraw the amendment.

Alistair Burt (Conservative, North East Bedfordshire)

I beg to move amendment No. 197, in clause 153, page 109, line 34, at end insert

‘and to patients and the public’.

The amendment relates to the powers of LINKs to publicise their work. There is concern that, if the Bill does not specifically mention that, there may be a supposition that all the LINKs do is to report to the commissioners because that is all that is mentioned. The Minister of State, Department of Health, the right hon. Member for Doncaster, Central (Ms Winterton), sent the Committee a helpful note on how she envisages LINKs with work. Indeed, in the draft policy statement, under the section entitled “Make reports and recommendations and receive a response within a specified timescale”, the right hon. Lady sets out what she intends to put in regulations. The draft states:

“The regulations will specify the LINks’ power to make reports and recommendations and will specify...who they can make them to—NHS and social care commissioners and providers in their geographical area”—

and nothing else.

The straightforward reason why the matter has not been mentioned might be that it is intended that the work of LINKs should be published and, if they want to bring something to the attention of commissioners and others, they should feel perfectly free to make that information available to the public. However, that is not in the Bill. If regulations are tight and specify not a permissive power regarding to whom the LINKs may make submissions, but a restrictive power so that they make reports and submissions only to certain bodies, patients’ ability to make clear to the public what is going on will be stifled.

The purpose of the amendment is to draw out from the Minister a clear statement either that there will be an expectation that LINKs and other bodies will report to the public; or that the Government will make that clear by putting it on the face of the Bill. Naturally the accountability of LINKs to the public needs to be tested, which is a good reason for publication, but the accountability of the bodies that they are looking into on behalf of patients should be clear to the public. I should be grateful if the Minister will explain what he thinks and say whether my concerns are unnecessary or whether it would be helpful to have such a provision in the Bill.

Patrick Hall (Labour, Bedford)

I rise to speak to amendment No. 182. If you will allow me, Mr. Chope, I too wish to make some wider remarks—

Christopher Chope (Conservative, Christchurch)

Order. Amendment No. 182 is not being discussed. We are discussing amendmentNo. 197.

Patrick Hall (Labour, Bedford)

Sorry, I was looking at last week’s selection list.

John Pugh (Liberal Democrat, Southport)

I endorse amendment No. 197. Sometimes patient groups are not properly representative of patients as a whole. By having them refer back to the wider patient groups, there would be a more representative function.

Philip Dunne (Conservative, Ludlow)

To add a rider to that, will the Minister clarify whether ambulance trusts would be included in the scope of local services? As ambulance services have been regionalised, there is in relation to access to acute hospitals concern about whether ambulance services are capable of being scrutinised by LINKs through this process.

Phil Woolas (Labour, Oldham East and Saddleworth)

The answers to the questions are yes, yes and yes. Ambulance trusts are covered, as is clearly desirable. The hon. Member for Ludlow makes the point that they cover a wider area than the local authority. It is, of course, up to the contractor bodies to make arrangements across the area of the ambulance trust. That is one reason why we need to be flexible. Similarly, a primary care trust might extend beyond one of two local authorities. In some cases, local authorities are not coterminous with PCTs. The Government, through their consultation on the reconfiguration of PCTs, faced criticism in respect of that exercise and chopping and changing, but part of our objective was to ensure greater geographical coterminosity between PCTs and local authority areas. My colleagues at the Department of Health consulted in anticipation of the policy that we have now brought forward. That is joined-up Government, although it did not look like it at the time. Seriously though, there is 80 per cent. coterminosity in England now. The answer to the point that the hon. Gentleman made about ambulance trusts is yes.

The hon. Member for Southport makes the valid point that part of the objective for LINKs and health scrutiny is to involve not only patients, but those who may have been or still are patients. The hon. Gentleman’s point is important. However, I shall resist the amendment and will give my reasoning for doing so in a moment.

It is clearly desirable to achieve what the hon. Member for North-East Bedfordshire is talking about. We expect that LINKs will publish such information in a way that makes it available to its public. Clause 158 sets out the process for the annual report, which it is desirable to include in the Bill. It is quite common, as hon. Members will know, for us to receive hefty envelopes containing annual reports that Parliament has required various bodies to produce. We want to provide those bodies with flexibility, so we do not wish to go further and specify the information and the process of providing it, but we do expect them to provide the relevant information and we intend that that would be covered in the notices and guidance that we issue.

Alistair Burt (Conservative, North East Bedfordshire)

No one would want an already bulky document at the annual general meeting to include all the individual reports that LINKs may have wanted to produce on their work during the year. The draft note from the Minister, which we have seen, does not include reference to publication. If the Minister took back to his colleagues the suggestion that the draft guidance should make explicit the need to make those reports public, that might do the job.

Phil Woolas (Labour, Oldham East and Saddleworth)

That sounds sensible and desirable. I give that undertaking to the Committee.

By talking about heavy, burdensome documents, the hon. Gentleman has pre-empted the second paragraph in my speaking notes, so I shall not bore the Committee any more than I have done. I ask him to consider my remarks and to withdraw the amendment.

Alistair Burt (Conservative, North East Bedfordshire)

To have wrung a concession from the Government at seven minutes to 11 makes this an early champagne moment. We will bank that, as Anne Robinson would say, and move on to the next amendment. I beg to ask leave to withdraw the amendment.

Alistair Burt (Conservative, North East Bedfordshire)

I beg to move amendment No. 198, in clause 153, page 109, line 35, leave out subsection (3).

Christopher Chope (Conservative, Christchurch)

With this it will be convenient to take amendment No. 182, in clause 153, page 109, line 36, leave out ‘or omitting any of’.

Alistair Burt (Conservative, North East Bedfordshire)

The amendment would removeclause 153(3), which states:

“The Secretary of State may by regulations amend this section for the purpose of adding to, varying or omitting any of the activities for the time being specified in subsection (2).”

That is a wide power that would effectively render neutral the discussions that we have just had about what LINKs should do, because, no matter what the Bill says, if the Secretary of State decided in future—perhaps after complaints from health authorities or others—that the powers given to LINKs are too extreme, then instead of returning to the House to agree primary legislation to change the Bill, the Secretary of State may, by order, simply remove those powers.

It is not just we who are concerned about this provision. I should like to quote two other bodies. In relation to subsection (3), the London Network of Patients’ Forums said in its briefing:

“This is far too wide. It gives the present or any future Government of any political complexion the power to abolish all involvement of people in commissioning, providing or scrutiny of local care services...without further recourse to Parliament. It was probably drawn by an overzealous draftsmen”—

I hear hon. Members say, “Surely not.”—

“but it reminds one of the original proposal to abolish the Community Health Councils...without replacing them. It was parliamentary pressure that caused the Patients’ Forums to be created as a replacement of the CHCs.”

The London network is plainly concerned, but the Commission for Patient and Public Involvement in Health is, too. I draw the Minister’s attention to its briefing, which specifically raises concern about this clause:

“Clause 153(3) gives the Secretary of State power to make regulations to add to, omit or vary any of the activities above for the time being, whereas the legislation establishing Patients Forums...gave the Secretary of State no power or limit to vary the functions of PPI forums.”

It continues:

“The Bill does not give the Secretary of State power to make regulations on any other important matters, such as membership or governance rules and would therefore have no ability to intervene in the future, without amending the primary legislation, even if significant problems or concerns rose on such matters.”

Why is the power in the Bill? What is the reason for the concerns of the CPPIH and of members of patients forums? I should be grateful if the Minister explained why this wide-ranging power is in the Bill?

Patrick Hall (Labour, Bedford)

As you can see, Mr. Chope, I am following the Committee’s orchestral score a little more carefully now, although I was in danger of being distracted by yet another reference to a champagne moment by the hon. Member for North-East Bedfordshire. They keep clocking up. I hope that careful note has been taken of that so that we are rewarded at the end.

I was asking you, Mr. Chope, if I might range a little wider, as you have kindly allowed others to do, as I would like to acknowledge the good and hard work of patients forums’ members up and down the land. I have met a number of patients forums’ members through the all-party parliamentary group on patient and public involvement in health, assisted by the Commission for Patient and Public Involvement in Health. We recently held two sessions, one in Parliament in October and another just outside this building last January, to enable patients forums’ members to have their say and to express their hopes and fears about LINKs. The week before last, I also had a meeting with members of the Bedfordshire patients forum.

It is remarkable that there are threads and strong issues held in common right across the piece. I was struck by the energy and commitment of the people. They are volunteers and they contribute a great deal of time and effort. They are also very well informed and their views are worth listening to. That is the purpose of having an all-party group—to hear what people outside this House have to say. Indeed, that is also the basis of our job as Members of Parliament. Those people wish to serve the community for the common good and have sought to do so through the mechanism of patients forums. Whatever happens, we must take great care not to lose the commitment, energy and qualities of people who are understandably a little concerned about what will happen. There is a role, and there will continue to be a strong and growing role, for patient involvement in health, whatever mechanism is designed to deliver it.

We should approach this matter from the viewpoint of the ground upon which we stand and build from where we are. There is a lot of perplexity among patients forums’ members about their abolition—it is indeed abolition that we are talking about. Although no one at the Bedfordshire forum meeting said that they loved what is happening, I was none the less encouraged to find that the forum had prepared a paper, a copy of which I will pass on to Ministers, especially those in the Department of Health, expressing the view that although the page is a little blank—the canvas is sketchy and almost empty—that provides an opportunity to help to shape what will happen. I thought that that was an optimistic and positive view.

I hope that my hon. Friends fully understand patients forum members’ disappointment, particularly with the decision to abolish the forums, and that Ministers will welcome their positive suggestions and others’ about the road to take. My approach to part 11 will be to seek through a number of probing amendments to encourage debate and thought and to encourage the Government to help us to colour in the many gaps on the canvas, because it is difficult to identify the architecture.

Last Thursday during our afternoon sitting, the hon. Member for Hazel Grove sought to gain the sympathy of the Committee by admitting that he had been too busy to have his lunch. I said nothing at the time, but at lunch that day, I was given for the first time a copy of a long-awaited draft model contract between local councils and host organisations, together with a restricted set of papers dealing with how LINKs will function. The bundle made reference to promised guidance on governance and “engagement activities” that will be published only when the Bill receives Royal Assent. That rich larder of information served as my lunch. I did not eat it, but I did not have time to eat anything else. I am sure that I will now have some well earned sympathy, and perhaps another notch up on the champagne later.

Although some time has elapsed since Thursday, I must confess that I have not read those documents from cover to cover, although I have had the opportunity to examine them more. Looking at them, I have no doubt that the Government have strong ambitions for LINKs, that hosts will play a strong role and that there will have to be a lot more consultation before the architecture is built more clearly. There is a lot more to be done. It is important to consider the documents in the context of the amendments. Nearly all the amendments moved were prepared and tabled before we knew of the documents. None the less, our debate will be important.

I will also fall for the assumption made by the hon. Member for Hazel Grove that the words on the face of a Bill mean what they say—that the English used means what I understand English in common-sense terms to mean. That is why I am pressing amendment No. 182. I shall assume, as subsection (2) says, that the purpose of LINKs is to promote and support

“the involvement of people in the commissioning, provision and scrutiny of local care services”,

to obtain

“the views of people about their needs for, and their experiences of, local care services”

and to make such views known in

“reports and recommendations...to persons responsible for commissioning, providing, managing or scrutinising local care services”.

That seems absolutely fine. I do not know how else one could describe in a nutshell what a public involvement organisation should do, whatever one calls it. That is fine, but as has been mentioned, subsection (3) risks undermining that function entirely. The Conservatives wish to delete the subsection altogether, but I think that that would be too restrictive. It is sensible to be able to vary or perhaps add to the measures. Indeed, when they are established, LINKs might wish anyway for a mechanism to do so without going through all kinds of complicated, time-consuming bureaucratic procedures.

However, to allow the Secretary of State to omit any of the activities in subsection (2), even if they must consult on that omission, seems inappropriate. It goes too far. It could send a negative or destabilising signal at a time when people need to be reassured that there will be a firm foundation for patient and public involvement in health. My amendment seeks to reduce that uncertainty. I look forward to the Minister’s response.

John Pugh (Liberal Democrat, Southport)

As I understand the amendments, they are very different. Amendment No. 198 would ensure that the powers defined in the Bill could not be varied by the Secretary of State, while amendment No. 182 would just ensure that they could not be varied to omit any of the LINKs’ existing functions or roles. The ministerial position, in contrast to the amendments, appears to be to reserve the right in subsection (3) for unfettered varying.

I am in favour of the Secretary of State’s having some power to add to and to refine LINKs’ powers. I do not anticipate that he would give LINKs extreme power, as the Conservative spokesman suggested—I think that, if the Government did that, we would be amazed—but there is clearly a drive in the Committee to understand what the variation might mean, given that no guidelines have been laid down on it. The most acceptable outcome, from the Liberal Democrats’ point of view, would be variation governed by certain guidelines and restrictions.

Bob Neill (Conservative, Bromley and Chislehurst)

I support my hon. Friend the Member for North-East Bedfordshire. I referred in our discussions last week to some of the concerns raised by my patients forum, and this is one of them. There was concern that part of the unspoken, hidden rationale was the feeling that successful patients forums had rubbed people the wrong way.

If patients forums or the proposed LINKs are to do their jobs properly, it will sometimes be necessary for them to deliver messages that are uncomfortable—uncomfortable for health service managers, for the Department and maybe for local authorities. They must be able to do so in the full confidence that, if their messages are uncomfortable—if they sometimes say things that are harsh but necessary—there will not be a tendency, as sometimes happens, to say, “Let’s get rid of this rather awkward, turbulent priest and be done with it.”

There is a suspicion at the moment that that is partly what has happened to the current patients forums. If they are to be successful in the guise of LINKs, they must have guarantees of independence. There is a concern about independence of funding, to which we can return later, and about how they will have the independence to inspect rigorously without being obstructed. There is also a concern that their functions should not be chopped and changed in a way that could at the very least emasculate their effectiveness.

I am sure that that is not in the minds of the Ministers here today, but who knows how such things will proceed? There are always pressures, and although I appreciate that the ability to remove the turbulent priest by statutory instrument is an improvement on Henry II’s method, the principle is just as unpleasant and inconvenient. If people are to have confidence in the volunteers whom we want to involve, surely they are entitled to know that the goalposts will not be changed as punishment for being effective and delivering harsh but necessary messages.

Phil Woolas (Labour, Oldham East and Saddleworth)

I am not sure that I like the Henry II example. I am searching the cellar for some champagne.

I shall explain what the Government are trying to do in clause 153. The experience of the patients forums, as the Government acknowledge, was that their role and functions were too tightly prescribed in primary legislation. Changes in health that occurred more quickly than some might have expected meant that the forums were unable to adapt to fit the changing circumstances and their working environment as well as they and we would have liked. Therefore, it is important to retain the power to amend the specified activities. That is not unusual when establishing bodies. It will enable Parliament to adjust the role of LINKs on proposals from the Secretary of State when they are necessary to reflect changes in health and social care. I agree with the hon. Member for Bromley and Chislehurst in that we have to pass legislation for a sustained and unforeseen period, not only for circumstances as they exist. It is perfectly possible that new functions and areas of health and social care will come about as a result of technological developments, or as a result of localised changes and the devolutionary powers that health and social care services have.

I reassure the Committee that both Houses of Parliament will make the decision on future proposals, which will be subject to the affirmative procedure. Our intention is for LINKs to remain up to date, which is why we wanted subsection (3). As I said, it is not unusual that Parliament and the Secretary of State should retain such powers.

The Committee has a problem with the word “omitting”. The intention of having that word in subsection (3) is to account for possible changes in local circumstances, or for functions that are carried out at the moment but which might not be necessary in the future. I was told, when I entered Parliament, that it was still illegal not to practise archery on a Sunday. I have always believed that post-legislative scrutiny should get rid of laws as well as build them up. That was the entirely honourable intention behind the word “omitting”. My hon. Friend the Member for Bedford and Opposition Members have identified circumstances in which the power may cause disquiet among the people that we are trying to encourage, but mention of Henry II is going too far.

Bob Neill (Conservative, Bromley and Chislehurst)

I am sure that the Minister has the genesis of a Henry V in him. Perhaps he will come a little further with his reassurances.

Phil Woolas (Labour, Oldham East and Saddleworth)

My general rule on kings is that if they were Lancastrians, they were probably good guys.

I agree with hon. Members in that there is a problem with the word “omitting”. However, we need the power to vary the specified activities subject to the parliamentary procedures to which I referred.

There is a slight difficulty in the wording of amendment No. 182. Should we accept it, the clause would not read properly because of the comma—a tiny, technical point, but striving for perfection is a good thing. The Government agree with the intention of amendment No. 182 as regards the word “omitting”. However, we believe that amendment No. 198 goes too far because, if accepted, the Secretary of State and Parliament would not be allowed to bring the measures up to date when circumstances require. There is also the issue of how LINKs will develop. They may be required for support functions such as training that are not prescribed but which may become necessary. I would like, with the patience of the Committee, to find a way of getting rid of the word “omitting” while making the Bill read well.

John Pugh (Liberal Democrat, Southport)

The Minister is clearly trying to tidy up and give assurances and all of the things that it is desirable for a Minister to do on such occasions, but he is suggesting that the Secretary of State will not usethe powers without the affirmative resolution of the House. If that is the case, why is there a problem with putting that in the Bill?

Phil Woolas (Labour, Oldham East and Saddleworth)

I am reliably informed that that is in the Bill—when I find it, I will let the hon. Gentleman know where. The hon. Gentleman made a fair point, but provision is made for the matter to be subject to the affirmative resolution.

Alistair Burt (Conservative, North East Bedfordshire)

Is the Minister suggesting that he will, in due course, introduce a new clause that will remove the word “omit”?

Phil Woolas (Labour, Oldham East and Saddleworth)

Yes, I shall do that. It will also remove the comma, so that it reads properly. I should also like to take this opportunity to ask the hon. Member for Southport to consider clause 170, which relates to the point that he made.

I hope that the hon. Member for North-East Bedfordshire will consider asking leave to withdraw the amendment.

Patrick Hall (Labour, Bedford)

Let me be the first to say it: yet another champagne moment—the second of the day!

Alistair Burt (Conservative, North East Bedfordshire)

Surely, it is a magnum moment.

Patrick Hall (Labour, Bedford)

I have not been counting as accurately as the hon. Gentleman.

I am also relieved about the comma, the least said about which in future, the better. My hon. Friend the Minister was going to deal with the comma and the omission. On reading clause 153(2) it is difficult to imagine how patient and public involvement in health and social care could be carried out by omitting any of the requirements. Powers on variation and flexibility are included in the measure. In view of my hon. Friend’s intelligent, generous comments, I shall not press my amendment.

Alistair Burt (Conservative, North East Bedfordshire)

I endorse what the hon. Gentleman said. It is a good moment for Bedfordshire all round, in respect of the clause and the Bedfordshire amendments. However, I should be grateful, knowing what the English language is like, if the Minister made it clear that there is no way in future that the term “variation” would be deemed to include omission. If he did so, that would deal with the point. In theory, “vary” could mean anything. I forget whether Committee debate can be used in the courts to indicate what was in Ministers’ minds at the time that legislation was passed or changed. I am clear what the Minister’s intention is, but it might be helpful if he said it.

Patrick Hall (Labour, Bedford)

There is always doubt, with the English language or any other language. I have checked the “Concise Oxford English Dictionary”, which defines “vary” as to change, make different, diversify and also to suffer change.

Alistair Burt (Conservative, North East Bedfordshire)

I am grateful to the hon. Gentleman. However, I would still find it helpful if the Minister made clear what we know his intention is.

Phil Woolas (Labour, Oldham East and Saddleworth)

“Vary” in law carries a different meaning and definition to “omit”. “Vary” implies changing from one thing to another, not simply stopping doing things. I will undertake to make that clear.

Alistair Burt (Conservative, North East Bedfordshire)

I am grateful. That tidies things up and deals with the main point of our amendment, which was to cover the point raised by the hon. Member for Bedford. With the Minister’s assurance, I beg to ask leave to withdraw the amendment.

Patrick Hall (Labour, Bedford)

I beg to move amendment No. 180, in clause 153, page 109, line 39, at end insert—

‘(4A) The Secretary of State shall make payments to each local authority that are in the opinion of the Secretary of State sufficient to cover the costs incurred by that local authority in making contractual arrangements specified under subsection (1).

(4B) Nothing in this section shall prevent a local authority making contractual arrangements under subsection (1) so as to ensure that the activities specified in subsection (2) are carried on to a greater extent than would be the case if the arrangements were to cost no more than the payments made available under subsection (4A).

(4C) The Secretary of State must send to the Comptroller and Auditor General within sixty days after the end of the financial year a statement showing the payments made to each local authority under subsection (4A) and the costs incurred by each local authority in making contractual arrangements under subsection (1).

(4D) The Comptroller and Auditor General must examine, certify and report on the statement provided by the Secretary of State under subsection (4C) and must lay copies of the statement and of his report before Parliament.’.

The amendment has a number of aims. It provides, first, that the Secretary of State should make available to local authorities sufficient funds to deliver effective local LINKs; secondly, that councils are welcome to be generous and to add to that sum if they wish; thirdly, that information about the funding made available to each local authority should be open to scrutiny by the public, councillors and Members of Parliament; and, fourthly, that local authorities should use the funding that is made available by the Secretary of State to support LINKs and hosts, not for other purposes. The amendment is designed to meet concerns raised by forum members and by others.

Ministers have said, and it should be repeated, that patient and public involvement in health and social care will involve a vast number of people and organisations—not only the patients forum members. Concerns have been raised across the piece that, as is often the case, funding will be insufficient. Whatever the state of the economy or of the settlements for local government, local councillors—I have been one—always say that funding is insufficient. Unless things are nailed down there is a temptation to use funds for other purposes, and the fear is that the funding for LINKs will not be ring-fenced and could be used for other purposes. I accept that there might be more that is wrong with the amendment than merely a comma. It probably would not succeed in achieving ring-fencing, but its purpose is to generate a debate and probe the issues.

A lot of the talk about costs is speculative, and I would appreciate some guidance from Ministers on the funds that might be made available. If that is too much to do now, perhaps the Minister could write to me later. All sorts of figures are being bandied around. For example, it is being said that community health councils cost, in their last one or two years, an average of £150,000 each. People have said that each LINK, and each host that sets one up, will get that amount, but I do not think that that can be correct, because there were many more community health councils than the proposed 152 LINKs. The amount that is currently spent on patient forums is also being mentioned. I believe that that is £26 million, which equates to £170,000 per new LINK. If the central costs of the Commission for Public and Patient Involvement in Health are added to that—I am informed that they are £1.5 million—the average figure increases to £184,000 per LINK. The commission itself estimates that an average budget of £400,000 will be required for LINKs to carry out the vast range of tasks that have been set for them—tasks that we have just discussed. That would produce a national total of more than £60 million.

Whatever happens, LINKs will not come cheap, and there will be high expectations of the new system. They will cost money, and people will want to see that money being used cost effectively. Whatever the amount is, it will all be needed for LINKs, and it will not be acceptable for it to be frittered away in other directions. The amendment is intended to avoid that.

Tom Brake (Liberal Democrat, Carshalton and Wallington)

Does the hon. Gentleman agree with ring-fencing in principle? Is it the appropriate way for local government finances to be managed? I admit that it is an unlikely scenario, but I encourage him to consider a situation in which LINKs had worked so effectively—with embedding of processes in parts of the health service—that they were no longer required. The hon. Gentleman’s amendment would mean that there would have to be a certain amount of spending on them nevertheless. Will he consider that?

Patrick Hall (Labour, Bedford)

We may have a clue as to whether it is needed after a few decades of studying how the new system has worked. However, I find it difficult to imagine that there will cease to be a need for patient and public involvement in health and social care—I really do not see that need disappearing. Given the pace of change in the welfare system—technological, scientific, medical and in other ways—I envisage an increase in the need, rather than a decrease.

The principle of ring-fencing ensures that taxpayers’ money, which comes from the Government for these purposes, is delivered through local councils to host organisations. There is a specific purpose for the money and, in principle, I do not see any harm in ensuring that the money is delivered for that purpose. Ring-fencing is the sort of mechanism that has occasionally been used before to ensure that a job is done. The purpose of the amendment is to ensure that we have the opportunity to debate that matter and to hear what the Government are thinking.

John Pugh (Liberal Democrat, Southport)

We support the thrust of the amendment if not its actual fine detail. I think that it will be well received by treasurers of local authorities who are used to local authorities being given extra responsibilities and then being told by the Secretary of State that the cheque is in the post. Sometimes they have difficulty finding the cheque for the sum that they incurred when they took on the new responsibility. It seems to me that the hon. Member for Bedford is suggesting housekeeping measures that will have to be agreed to at some time anyway. It is really a question of how it is done and whether it is done by adding a schedule to the Bill, by making provision elsewhere in the Bill or by a Minister—or more probably a civil servant—on a Friday afternoon. I think that I prefer the hon. Gentleman’s solution to the problem.

Tom Levitt (Labour, High Peak)

Mr. Chope, I hope that you will give me licence to raise one or two points that might more properly be discussed on clause stand part. I will refer to the amendment, but I understand that it is not your intention to allow a clause stand part debate.

I would be grateful if the Minister confirmed for me that when the amendment refers to local authorities, that means local authorities with social services departments. In two-tier areas such as my own, that would be the county council rather than the district council.

The Minister pointed out that approximately 80 per cent. of PCTs are now coterminous with local authorities. In my constituency, our PCT is one of the 20 per cent. that are not. In Tameside and Glossop PCT, Glossop comes under Derbyshire LINK, and the rest of the PCT area comes under Tameside metropolitan borough council’s LINK. In those situations, the local authorities and the LINKs must be obliged to talk to each other if they are discussing services and constituents who live in their area. That leads me to ask another question: if someone lives in Glossop, and therefore comes under Derbyshire county council and Derbyshire LINK, but uses a service in Tameside, which is within the same PCT but outside their LINK area, would they take their problem to the Derbyshire LINK, which covers where they live, or to the Tameside LINK, which covers the area where the facility is provided? In other words, are the inspections on behalf of the residents or of the facilities?

My final point relating to that and the amendment is that the administrative costs in those LINKs that are dealing with more than one PCT area will presumably be significantly higher than those in which there is a one-to-one relationship. Will the Minister give an assurance that where LINKs have to deal with more health bodies than would be the case in a coterminous situation, the additional funding will be supplied?

Philip Dunne (Conservative, Ludlow)

I share the concerns raised by the hon. Member for High Peak, particularly in relation to LINKs covering a relatively narrow geographical area. The issue that comes to my mind is of services that go beyond the scope of the general PCT. I refer here to specialist services. In my area, for example, the mental health service has been taken out of Shropshire County PCT and now comes under the South Staffordshire Healthcare Trust, which has responsibility not only for mental health services within South Staffordshire but also across the Prison Service. I understand that the trust looks after mental health services in more than50 prisons, including on the Isle of Wight. Has the Minister considered how a trust that develops activities way beyond its historic area will interact with LINKs? In particular, has he given consideration to how LINKs can fund their activities if they wish to go across boundary?

Finally, I wish to ask the Minister from where will the funding come? As it is to come as a result of the Bill, I assume that it will come from his Department. Was the £26 million of PPI forum funding to which the hon. Member for Bedford referred a Department of Health budget? Can all local authorities be secure in the knowledge that the funding will be provided to them through their relationship with their own Department rather than from the Department of Health?

Bob Neill (Conservative, Bromley and Chislehurst)

I want to reinforce my hon. Friend’s point about prison medical services. I practised as a barrister in the criminal courts for 25 years and I sometimes had a great deal to do with the recipients of prison medical services, so that strikes a important chord. There is real concern among legal professionals, the judiciary and the probation service about the variable quality of medical services in prisons, how they are provided and their accessibility. There is a difficulty with transparency and patient voice in prison medical services. I do not expect the Minister to have an answer now, but I flag up the matter because it is of real concern, particularly given the linkage and the large number of people in prison who suffer from mental health problems.

There is concern about the difficulty in finding means by which we can keep up consistent pressure to improve the quality of services, especially when, for example, prisoners on remand may be moved from one institution to another and therefore come under the care of more than one trust as the provider. There is a complete lack of transparency and accountability in those circumstances. People in prison, by its nature, often do not have the constituency base to argue for them that there is in the general community.

Tom Brake (Liberal Democrat, Carshalton and Wallington)

Last week, I visited a prison and saw its medical services. Does the hon. Gentleman agree that the cost implications for LINKs set up in an area with prisons are significant? The process of consulting prisoners will clearly be more challenging than consulting the public generally.

Bob Neill (Conservative, Bromley and Chislehurst)

Indeed—the hon. Gentleman is absolutely right. LINKs may not be the solution for prison medical services, but we must have something that will safeguard the interests of prisoners, either on remand or convicted, who are also patients. Inadequate treatment of a number of problems, particularly mental health, is sometimes a significant trigger in reoffending, as we all know. It is important that the matter is taken away and looked at and, perhaps before the Bill is discussed on Report, we can receive more assurance about how overview and scrutiny of medical services in prisons will be dealt with.

Phil Woolas (Labour, Oldham East and Saddleworth)

I thank hon. Members for their comments because they really show the value of Bill scrutiny. Many of the points that have been made and the questions that they throw up provide reasons why the precise prescription in the amendment is not desirable. I think that my hon. Friend the Member for Bedford accepts that. The arguments that have been made are very pertinent to the consideration of the Sustainable Communities Bill. In essence, we have heard the experience of Members of Parliament in the real world and how we have to adapt to that to make mechanisms work.

Members of Parliament make representations on behalf of their constituents to service providers that are sometimes at the other end of the country or overseas. They sometimes make representations on behalf of people whose last known address was in their constituency, but are now overseas or serving “at Her Majesty’s pleasure”, if I could put it that way. The arrangements are important and I am grateful to members of the Committee for raising them.

I confirm to my hon. Friend the Member for High Peak that we are talking about social services authorities. Two-tier district authorities that do not provide social services would not be covered. In consideration of his point about what we do in areas that are not coterminous, I was casting around for the most difficult example in the country; I then realised that it was Glossop in Derbyshire and in the same thought, realised that my hon. Friend the Member for High Peak was on the Committee.

Those Committee Members who know that part of the world will know that there is a natural community in the north-west of Derbyshire that pulls towards the Greater Manchester area in terms of travel-to-work arrangements, but that the rest of the constituency of Derbyshire pulls towards the rural and beautiful county of Derbyshire. Indeed, my hon. Friend’s mental health trust is shared with other local authority areas in the Greater Manchester area, including my own. Therefore, he raises a very good point.

The hon. Member for Carshalton and Wallington has raised the point about prison medical services. In those circumstances, other things being equal, the costs would be higher. That is why we believe that the mechanism of grant distribution should not be as tightly ring-fenced as my hon. Friend the Member for Bedford’s amendment would have it.

The amendments and the debates around this clause strike at the very principles that underpin local government funding. Promising the end of ring-fenced funding is an easy way to get a round of applause at the Local Government Association conference, as the right hon. Member for Witney (Mr. Cameron) discovered last July. It is a different thing altogether when one looks at some of the many functions that local government provides, especially under a regime of devolution and partnership working. In practice, one applies pragmatics to the deliberations. Local councils, as has already been said, will always present a gross bill for their new functions. In my experience, they have never presented a net bill of the savings as well as the new costs. I do not expect them to do so, but I always hope that they will. We therefore have to be wary in our implementation of the new burdens policy—a policy to which the Government are committed and for which, as has already been established, we do deliver the money.

We shall deliver the money for the LINKs function, but one has to be has to be realistic in preparing new burdens grants and ensure that that they are meeting net costs and not paying an invoice that has arrived from 150-plus local authorities around the country. I am not suggesting that treasurers would over-egg the pudding—they do not need me to suggest that. They put together the most ingenious, innovative reasons why every one is unique. Sometimes they are right—sometimes there are real needs, as described by my hon. Friend the Member for High Peak. It would therefore not be sensible to make legislation that precisely prescribed a mechanism that would result in, in effect, a blank cheque. On the other hand, it is entirely desirable that the functions are properly financed, both in their establishment and in their operation. Let me explain how we propose to do that.

There are four parts to amendment No.180. The first proposes that a requirement be put on the Secretary of State to ensure sufficient funds are available to cover a local authority’s costs in its work to put in place contractual arrangements that enable the establishment of LINKs. The intention, as the Committee knows, is that the Secretary of State will make a grant to each local authority to enable it to fund its activities to procure a host organisation—those are the establishment costs—and subsequently to fund the activities of the LINK itself. We propose that the grant should be made under section 31 of the Local Government Act 2003. The grant will be explicitly targeted to provide funding for the purpose of making arrangements to establish a LINK. In relation to this part of the Bill, it is Department of Health money that I am spending on the champagne.

Robert Syms (Conservative, Poole)

I bet it’s cava.

Phil Woolas (Labour, Oldham East and Saddleworth)

We have better than cava in our Department.

In making the grant, the Secretary of State will assess what levels of funding will be necessary for each local authority to cover its costs and ensure that there are sufficient funds to enable arrangements to be made to fulfil the activities set out in the Bill. The grant will go to the council in recognition of the fact that the council has a statutory duty to fulfil those activities, but will not prescribe the money too tightly, as ring-fenced budgets in other areas do. That will give the local authority some flexibility in making arrangements.

In anticipation of the new arrangements, we are working with local councils and with the Local Government Association, which is once again carrying out an essential function on councils’ behalf, to determine the costs associated with administering and monitoring contracts between councils and host organisations, which will vary according to the nature of the area and the local authority’s infrastructure. Funding will be allocated to local authorities according to a mechanism that takes into account factors such as variations in size and arrangements with health care-providing organisations. We believe that to put all that on the face of the Bill would create a self-fulfilling prophecy of complications and bureaucracy. At the end of the day, it would not give the taxpayer the best value for money.

Alistair Burt (Conservative, North East Bedfordshire)

May I ask the Minister to note that an issue about formula funding in health care and local authority matters is arising in rural and semi-rural areas? There is a concern that formula funding does not properly take into account some of the problems of such areas, such as distance and isolation. I am keen for him to indicate that any formula should take into account such issues, because there is a debatable point about how they are currently handled, and I want that to be noted.

Phil Woolas (Labour, Oldham East and Saddleworth)

The ears of my hon. Friend the Member for Wigan are twitching after that intervention. He represents Wigan and the metropolitan authorities and he is conscious that if I answer in the affirmative, the metropolitan authorities will get a smaller slice of the cake, other things being equal. That is the problem faced by any Government in distributing funds—a point that I urge hon. Members to raise with proponents of the Sustainable Communities Bill, as that fact of basic arithmetic seems to have gone missing. My answer is yes: sparsity is a factor in the proposed distribution calculation.

Hon. Members will point out the apparent differences between the health funding formula and the social care funding formula. Under the social care funding formula, we take into account the number of people over 90 in an area, but I believe that in health funding the cut-off age is 85. That represents a sensible policy relating to prevention and health. As health and social care are brought closer together, funding formulas must be rational and transparent. We all desire that. What we do not want to do in recognising the different pressures on different areas is to create a complicated formula, because complicated formulas are the enemy of transparency and accountability. They are also the enemy of a happy state of mind for Ministers for Local Government.

Patrick Hall (Labour, Bedford)

The formula, complicated or otherwise, is to do with the amount granted to a local council to set up hosts and LINKs. My question is not only about whether that amount will be enough, but whether the money will be used for the purposes for which it is allocated.

Phil Woolas (Labour, Oldham East and Saddleworth)

The answer is that yes it will. Special grants over and above the revenue support grant are often described as ring-fenced. When there is flexibility, the money is given in the expectation that a council will carry out a function. We do not prescribe and create a situation in which if x amount of money is given, it must be spent specifically on certain expenditures because there are different ways in which functions can be undertaken. For example, if one wants good use of buildings, one might enter into an arrangement with a health authority to rent one. Is the money involved to be accounted for by LINK, or should the accounting of it be proportionate to the fact that the building might be used by another part of the health and social care service, or by an independent tenant?

The formula and special grant, under the 2003 Act, does not prescribe exactly; it meets the purposes that my hon. Friend, on behalf of LINKs and the people hoping to be involved, quite rightly outlined. Can we guarantee that the money given to a council will be passed on to LINKs, or does the fact that councils control the money give them sway over LINKs that may be detrimental to independent scrutiny and accountability? I give my hon. Friend the assurance that the mechanisms of the grant-making powers in the 2003 Act are designed to do the former. That is also why I teased my hon. Friend the Member for Wigan when he talked about the abolition of ring-fenced grants: there is a general predilection against them when one talks to local councils, and a general predilection in favour when one talks to pressure groups and charities.

The 2003 Act provides for a mature way in which to fund councils, whereby there is an expectation that functions are delivered without the unnecessary bureaucracy that the present and previous Governments have imposed in the past.

Tom Brake (Liberal Democrat, Carshalton and Wallington)

May I bring the Minister back to the subject of complex formulae? He expressed a preference for simple formulae. Do I take it from that that the presence of a prison will not influence the amount of funding for a LINK?

Phil Woolas (Labour, Oldham East and Saddleworth)

The most extreme example I can remember of an argument for change to a funding formula in social care involved a local authority, which said that because it had an above-average number of blocks of flats with an above-average number of stairs, it took social workers in the area longer to meet clients than elsewhere. The hon. Gentleman knows—we have debated this before—that formulae cannot be too complicated. I said simple formulae, not very simple formulae; that is important. The judgment will be based on factors such as the size of an area, the nature of the population, demographics and so on. It will perhaps also be determined by factors such as the one he mentions.

For the hon. Member for Bromley and Chislehurst, I can confirm that prison medical services will be covered by LINKs. LINKs will make representations about and will cover prison medical services on behalf of the patient, which is to say the prisoner, not the prison. Therefore, what matters is how many prisoners a local authority area has, not whether they are imprisoned in their local authority. I am certainly not going to suggest that some local authority areas have more people in prison than others, but hon. Members will be aware of the delicate balance.

Alistair Burt (Conservative, North East Bedfordshire)

I do not want to hold up proceedings unduly and the Minister may not be able to answer this question just now. Yarl’s Wood, which is the largest asylum detention centre in Europe, is in my constituency. It has had some issues relating to medical and health care. What provision is being made to ensure that detained asylum seekers and their representatives have access to health LINKs? I do not expect the Minister to have the answer at his fingertips, but I would be very happy to receive a letter on that in due course.

Phil Woolas (Labour, Oldham East and Saddleworth)

The hon. Gentleman is entirely accurate when he says that he cannot expect an answer to that question now. None the less, he makes a good point. Yarl’s Wood is in his constituency and for many years he has argued—very conscientiously in my view—on behalf of the asylum seekers or failed asylum seekers when it would be easy for him not to do so. I will give him an answer on that important point. I suspect that it will involve letters around Government and a flurry of activity, but he makes a good point.

Tom Levitt (Labour, High Peak)

I just want to make a helpful passing comment to the Minister. The issues being raised by the hon. Member for North-East Bedfordshire are not any different to those in respect of patient advice and liaison services. When an individual has a complaint that they want make, they use the PALS procedure. It is already established that PALS will take a complaint from anyone who lives within the PALS area.

Phil Woolas (Labour, Oldham East and Saddleworth)

My hon. Friend makes an important point, and it applies to many representative and advocacy bodies.

Bob Neill (Conservative, Bromley and Chislehurst)

I appreciate the spirit in which the Minister has approached the question of prisons, and I hear what he says about funding. My intervention also relates to access, which is a point my hon. Friend the Member for North-East Bedfordshire has raised as well. There is concern among the prison population in particular that prisoners can be transferred between a number of institutions and moved from the care of one trust that is providing for a number of prisons into the care of another. There is a long-standing concern about the handover of prison records to ensure continuity of treatment, medication and so on. Again, I appreciate that the Minister will not have the answer at his fingertips, but can we have some assurances in writing about how LINKs will work to ensure that there is scrutiny of the prison medical service, and about how prisoners and their families can get access? Their specialist advisers will need access as well because they may need the right medical reports to put before a court.

Phil Woolas (Labour, Oldham East and Saddleworth)

The hon. Gentleman makes a good and fair point. He will know also of the circumstancesin which a prison can commission a number of health providers. Even when the prisoner and patient isunder their jurisdiction, they are not necessarily in the same hospital. Therefore, I will comply with his request.

In proposed subsection (4B), it seems that my hon. Friend the Member for Bedford is aiming to allow local authorities to spend more on making contractual arrangements than the allocation provided by the Health Secretary. There is nothing in the Bill to prevent councils from making additional funds available for LINK activities. I hope that my hon. Friend willagree that the amendment is not necessary in that respect.

I can see what is being proposed in subsection (4C). It is a means by which a local council can be identified if it has chosen to use some of the funds provided on expenditure that is not LINKs related. As I have said, I think that it is right that local councils be able to spend funds in a way that best enables them to make appropriate arrangements. That they have to make the arrangements is what the Bill is designed to ensure.

When the Secretary of State makes grants to fund LINKs to local authorities, the amount of the grant is in the public domain. As it is a special grant, unlike the revenue support grant, it is possible to identify how much has been allocated. That is not the case for other items. The most recent example that occurs to me is the concessionary bus fare scheme, in respect of which money was put through the revenue support grant formula. It is not possible to identify specifically how much is being given in such cases, but it is possible in the present case, which is the reason for having chosen the funding mechanism that has been adopted.

It follows that local authorities will have to account for their monies, and the monies that they make available to fund LINK activities will be covered by the annual audit. LINKs will be able to say how much money local authorities made available to fund their arrangements, and they will know how much the Secretary of State provided. I imagine that they will be professional and vigilant in holding any diversion to account.

The problem on subsection (4D)—my hon. Friend the Member for Bedford acknowledged it—is that the resulting process for arranging statements and national auditing might be too complicated. Money will be made available to local authorities, and they will be accountable. They will have to make decisions in line with the thrust of the Bill, which is designed to give greater local freedoms and flexibilities. The Government will ensure that grants are open and transparent, and LINKs will know how much money has been made available.

I believe that the Bill achieves approximately the right balance, and I hope that my hon. Friend the Member for Bedford and the Committee will agree.

Patrick Hall (Labour, Bedford)

I have listened carefully to the debate, and it has been helpful. My hon. Friend did not refer to the total sums that might be available, and I cannot quite understand that. There is a lot of speculation about whether that total will correspond to the amount spent on patients forums and on the commission, or be equivalent to community health council spending. Although the Minister might not be able to state the amount now, I hope that he will write to me to give a broad indication.

Phil Woolas (Labour, Oldham East and Saddleworth)

I apologise that I did not answer that question. The answer is that the amount is not yet known, because we are entering discussions with local authorities to identify their needs. There is an obligation to provide sufficient funding, however. The budget for the Commission for Patient and Public Involvement in Health for 2006-07 is £28 million. If the Bill passes, that money would be taken into consideration.

Patrick Hall (Labour, Bedford)

I thank my hon. Friend for that. I think that many of people’s understandable fears will be answered when people consider what he said about section 31 of the Local Government Act 2003 and the special grant nature of the money. Local councillors will also know that there will be a great deal of interest in such matters as the time approaches, and I am sure that they will wish to ensure that the process is properly handled and that others are watching. In view of all, that I am happy with my hon. Friend’s response, and I beg to ask leave to withdraw the amendment.

Clause 154

Alistair Burt (Conservative, North East Bedfordshire)

I beg to move amendment No. 199, in clause 154, page 110, line 15, at end insert—

‘(2A) A local involvement network must consist of—

(a) individual members;

(b) representatives of organisations; and

(c) mechanisms for participation of individuals in A’s area who are not members.’.

Christopher Chope (Conservative, Christchurch)

With this it will be convenient to discuss the following: Amendment No. 200, in clause 154, page 110, line 17, at end insert—

‘(3A) In making the arrangements, H must invite all members of patients’ forums in A’s area to become individual members of the local involvement network.’.

New clause 16—Form of local involvement networks—

‘(1) The Secretary of State shall make regulations making provision in relation to the activities specified in section 153(2).

(2) The regulations shall in particular make provision as to—

(a) the appointment of members, categories of membership and governance,

(b) the minimum number of members,

(c) any qualification or disqualification for membership,

(d) terms of appointment,

(e) circumstances in which a person ceases to be a member or may be suspended,

(f) proceedings of local involvement networks,

(g) the discharge of any function of a local involvement network by a committee of the local involvement network or by a joint committee appointed with another local involvement network,

(h) the appointment, as members of a committee or joint committee, of persons who are not members of the local involvement network or local involvement networks concerned,

(i) the funding of local involvement networks and the provision of premises, other facilities and staff,

(j) the payment of travelling and other allowances to members of a local involvement network or of a committee of a local involvement network or a joint committee of two or more local involvement networks (including attendance allowances or compensation for loss of remunerative time).

(3) The regulations must provide that no less than half of the members of a local involvement network are persons who are members of or representatives of voluntary organisations whose purpose, or one of whose purposes, is to advance the interests of—

(a) persons for whom care services are being provided as specified in section 153(5), or

(b) persons who provide care for such persons, but who are not employed to do so by any body in the exercise of its functions under any enactment.

(4) The regulations may include provision applying, or corresponding to, any provision of Part 5A of the Local Government Act 1972 (c. 70) (access to meetings and documents), with or without modifications.’.

Alistair Burt (Conservative, North East Bedfordshire)

This group of amendments relates to the membership of LINKs. The Bill’s ambiguity on membership is an issue about which our consultation with forums and their members indicates concern.

Amendment No. 199 addresses a point that I hope can be quickly dismissed, which is that there is nothing in the Bill requiring LINKs to be comprised of real people, so LINKs could comprise an entirely virtual arrangement—a concept that is not unusual nowadays. The whole process could be undertaken not with individual people operating in a personal capacity, but by means of the web, or another virtual mechanism. Colleagues will remember that Elizabeth Manero and Sally Brearley of Health Link gave witness evidence earlier in our deliberations. A website could be a means of carrying out the activities of a LINK. Our amendments set out clearly that people should be involved in LINKs, but I hope that the Minister can reassure us quickly about such matters.

The amendments also specify our concern about who might be on a LINK. On 8 February in Westminster Hall, I had a meeting with 23 representatives of individual patients forums throughout the country. It was organised by Ruth Marsden, the chair of the PPI forum for Hull and East Yorkshire Hospitals Trust and the lead member of the associated forums of London, Leicester, Rutland, Yorkshire, Humberside and Teesside. We had a good cross-section of members of patients forums in Westminster Hall that day. Their concern ranged across the board from the abolition of forums to the introduction of LINKs. I have referred to some of their worries in earlier debates and I shall be using them in future.

Two concerns were expressed about membership. They were worried that the membership of LINKs is moving away from pinpointing patients’ concerns and patient involvement with those members from a much wider group who have an interest in health services and social care services. The specific concern was that the views of patients will be swamped by the views of those representing professional organisations. A member of the forum from Dorset said at the Westminster Hall meeting:

“Dorset is an early adopted project for LINKs. There was a meeting in January. only two forum members were there. A few were other people, all outnumbered by loads of health care professionals.”

Individual patient representatives are worried that the new expansion of LINKs, which is full of the right wording about involving more people, actually means diluting the emphasis that is being placed on the voices and needs of patients. That is terribly easy to do in a health care context. We all know how easy it is to sit round a large table when those whose profession it is to talk and represent others daily can be intimidating for ordinary members of the public who do not do it very often. Even if they become skilled, they can still feel that they are in the presence of those who can make life difficult for them.

Tom Brake (Liberal Democrat, Carshalton and Wallington)

Does the hon. Gentleman agree that individual patients, as we know from contact in our surgeries, often feel threatened about the presence of some professionals, especially if at some point they need to go back into the health service and perhaps encounter the same people about whom they wanted to make a complaint?

Alistair Burt (Conservative, North East Bedfordshire)

The hon. Gentleman is right. There is a further variation of what he said. It is worth noting and is serious enough for the Minister to have in mind. Also at the Westminster Hall meeting and in discussion with representatives of patients forums, the fact was raised that they receive a number of complaints and concerns from members of staff in hospitals and trusts. They find themselves a valuable sounding board for those who, for one reason or another, feel uncomfortable about voicing their concerns about what is happening in a trust through the formal trust mechanism because they might be identified. We all know how the world works: no one wants to be identified as a troublemaker or anything else. The involvement of health care professionals sitting round the table may make it less likely that the forums are used as a necessary safety valve by members of staff in the NHS to make their points.

As a separate point, there was great concern about the loss of expertise. Everybody mentioned the fact that it is not easy these days to get people to come forward to take part in mechanisms such as the patients forum. It took painstaking work to bring people on board. We have discussed people’s concern that the abolition of forums means somehow that their views and efforts have been cast aside—we might return to that point when we debate clause 160 stand part—but many forum members also mentioned the difficulty of bringing people on board and keeping them there.

Hence, amendment No. 200 would passport existing forum members to the new LINKs. They do not want to apply for positions to find that those responsible for setting up the new LINKs are picking out individuals and saying, “They may have caused trouble in the past, so we’re not going to put them on.” We have evidence from people who have been excluded from forums. There is concern about that, so amendment No. 200 would passport existing members of the forum.

I hope that the Minister will accept the amendment. When his colleague and counterpart the Minister of State, Department of Health, the right hon. Member for Doncaster, Central (Ms Winterton), came before the Committee as a witness, she said that she hoped that everybody who was already a forum member would come forward to ask to be a member of a LINK. We could make her wish come true by removing an element of the application and simply bringing into the LINKs all those who are already forum members.

I have a point to make about numbers. Worcestershire patient and public involvement in health forum sent the Committee a note dated12 February that said:

“Meredith Vivian”—

a senior official at the Department of Health—

“is on record as saying that he envisages up to 1,000 people/organisations being involved in a local LINK. There are great risks with such a large body, particularly in decision making”.

I think that we all agree that once a body gets so large, it can be a great talking shop, but its ability to do something will be hampered. How large will the LINKs be? How will we get the necessary balance between involving Uncle Tom Cobleigh and all and forming a small group of people experienced enough to go into trusts and do the job that they are required to do? How easy will it be for trusts to say, “This body is too large and unwieldy, and there aren’t enough people with specific experience, so we won’t give them access to our premises because we don’t believe that they’ll be capable of doing the job”?

The issues are serious. If LINKs are too large, how will the training be done? Where will the funding come from for new, expanded LINKs taking in so many people? The figure was that 1,000 people in an area will have an interest in health and will therefore be eligible to join a LINK. How on earth will that number be restricted and made more manageable? Nothing in the Bill indicates it.

Having raised those issues, I shall mention one further point. I have looked at the evidence to the Select Committee on Health dealing with patient and public involvement in the NHS. This debate gives me an opportunity to say again how concerned forum members are that the Bill has been introduced when the Select Committee has not completed its deliberations on the very issues that the Bill deals with. If the Minister dips into the evidence, as I am sure he has, he will understand the reasons for it. I cannot claim that I have read every word in the extensive volume of written evidence to the Committee; I have not needed to. If he dips his thumb into a submission by virtually any forum, he will find a familiar range of concerns illustrated. I pick out two for reasons of time.

The first comes from evidence submitted by the Kettering general hospital forum. It says:

“If membership is too large, LINKs will be unwieldy and expensive and not good value for money.”

Evidence submitted on membership by the Kingston forum says:

“This is a very grey area. In order to prevent interest groups taking over, independent members should be a majority. Very unclear as to which voluntary organisations should be members—no definition of membership.”

If the Minister dips into this volume, he will find similar comments replicated all the way through, but at least they are public. Evidence has not been published from the Department of Health’s consultation process on a stronger local voice, in which information was submitted by forums. The Department of Health has not made available to this Committee, or to anyone else, information on the feelings of forum members. I close on that because I do not want to go on too long and we still have more clauses to come.

Robert Syms (Conservative, Poole)

Hear, hear.

Alistair Burt (Conservative, North East Bedfordshire)

However, we must make some progress on membership, as I am reminded by my hon. Friend, who is no doubt speaking for his colleague in the Whips’ mafia. My points are serious, how is it to be decided? How is this expertise to be retained? How are the individual voices of patients not to be swamped by those of professionals in the health service? In terms of size, how are LINKs going to be manageable? How is training—and funding for it—going to be available to ensure that people can do their jobs?

With those remarks, I hope that the Minister will feel that we are not simply raising a political issue but speaking very definitely on behalf of those people who make up the membership of these forums up and down the country and who are very concerned. I would be grateful for some reassurance at this stage, although I cannot say either that these amendments will not be pressed or that they will not reappear at a later stage in the proceedings on the Bill.

Patrick Hall (Labour, Bedford)

I echo the comments that the hon. Member for North-East Bedfordshire has made about much of our debate being informed by the views of patients forum members, as I said myself earlier this morning. Indeed, the amendments tabled in my name are inspired by discussions with patients forum members.

However, it is important to recall—and I think I have mentioned this—that matters of public involvement in health and social care are not only the property of patients forum members. I have thanked patients forum members for their excellent work and dedication, and for being so well informed. However, many others who are involved in local voluntary organisations and members of the public, particularly the latter, rarely, if ever, dip into these matters. Therefore, I commend the Government for trying to embrace them and givethem an opportunity to be heard. That raises many questions that are the purpose both of the amendments and the scrutiny under which this Bill is being placed today.

New clause 16, tabled in my name, deals with regulations. The Bill, as drafted, does not allow the Secretary of State to make regulations on membership and governance of LINKs. The new clause provides the Secretary of State with those powers so that should there be concerns in the future about matters of membership and governance—which inevitably there will be up and down the land—he or she will not be able to intervene. It will be for others to resolve those matters. There is always a risk that if there are no national criteria—minimum standards—to avoid inconsistency in membership and governance arrangements around the country, there will be greater necessity to have recourse to the courts to deal with those matters. That is always open to people but it would be better if we made it necessary or at least closed down the number of opportunities or requirements to do it.

Having no statutory basis for rules governing membership and governance might lead to a perception that the bodies that are so set up, are in some ways weaker than if those matters were dealt with on a statutory basis. I note that the draft documents were made available last week—the hon. Member for North-East Bedfordshire may not have had the chance to read them cover to cover any more than I have—none the less, their existence shows that the Government intend to address some of those matters. Page 4—from paragraph 221 onwards—of one of those draft “do not copy” documents touches on Government arrangements, but it is a very light touch. Presumably, as I said earlier, the intention is to consult before publishing guidance, but, as mentioned elsewhere in the documents, it will not be prepared until after the Bill receives Royal Assent.

John Pugh (Liberal Democrat, Southport)

What the hon. Gentleman is suggesting is entirely sensible. Perhaps we should regulate that body, but is there not a prior difficulty? We simply cannot identify what such a body looks like. And we cannot regulate what we cannot identify.

Patrick Hall (Labour, Bedford)

Indeed. That is why we are debating and probing those matters in Committee. Significant elements of the landscape and architecture might become clear to us later, but the plan is that the descriptions and guidance will not be made available until after Royal Assent. That is why I am raising those issues now. We have been promised detail after Royal Assent, but that will come too late for legislative scrutiny. We need a bit more detail now.

I am hoping that my hon. Friend the Minister will be as helpful as he can, as indeed he always is, and provide an explanation. There are difficulties because it is not planned to make some things available until after the Bill has proceeded through Parliament. That raises one question: why can he not accept the new clause? Presumably, the draft policy documents and so on will deal with the same matters. Furthermore, what are his views on LINKs having a minimum number of members—a core or board as it were? Some or all of them could be checked by the Criminal Records Bureau. The hon. Member for North-East Bedfordshire referred to patients forum members—they are checked by the CRB. Making use of such people would have advantages for time and bureaucracy. However, they should be used only if they want to be made use of. They should not be compelled, which is possibly the implication of earlier amendments.

We need to ensure that LINKs have sufficient people to carry out their functions, which would mean having people checked by the CRB in that way. How does my hon. Friend the Minister think that we can ensure that potential conflicts of interest can be identified? For example, a voluntary organisation might want to be part of a LINK and to get a contract from the local council to deliver care services. That might make sense. However, how can we ensure that a LINK is not used by a local campaign that is very intense for a few months, whose members join and take over the LINK, achieve their one-off objective and then disappear again? Obviously, that is not the intention of the provisions, but we need to probe those matters and ensure that there is some protection to allow the LINK to continue with its main task as well as to take on board concerns raised by the public, as will happen now and then.

There are all sorts of questions, and all sorts of solutions. We have mentioned a core governing body, around which there could be a federal structure involving different people and organisations concerned with different topics, which could be opened up to greater numbers of people as needed. Will there be a requirement on LINKs to operate according to standards such as those advocated by the Independent Commission on Good Governance in Public Services? I have a few documents from the commission that set out some of the standards that it advocates. A number of questions have been raised today about those matters and it is important that they are answered or, at least, that the direction of travel is indicated so that we can be confident that the LINKs will achieve the Government’s ambitions.

Phil Woolas (Labour, Oldham East and Saddleworth)

Clause 154, which hon. Members are seeking to amend, deals with how a LINK is established by a council and how the host organisation is set up. Subsection (4) proscribes who cannot be involved in the LINK. It sets out who the third party is to support the LINK, and that the host organisation may not be the LINK itself. We are talking, therefore, about three bodies. The first is the local authority that commissions and contracts with the host. The second is the host organisation, which may be a voluntary body. In response to later amendments, we will debate what cannot be a host organisation. Thirdly, the clause describes how a LINK can be established.

If I was looking for a populist headline—and I have never knowingly not done so—I would say that we are scrapping a £28 million quango and giving the money to local voluntary groups so that they can hold their health and care services to account. [Hon. Members: “Hear, hear.”] Thank you. I am convinced that if the hon. Member for North-East Bedfordshire had said that, Opposition Members would have said “Hear, hear.” Often, Members listen not to what is being said, but to who is saying it—but that is a debating point.

The clause enables the local authority to make payments to the body that hosts the LINK and provides its administrative support. It also requires it to make arrangements that include provision for annual reports, which I have mentioned before. The amendments relate directly not to the contracted arrangements in clause 154, but to what is being contracted—what its function is, and how we can ensure that there are regulations to set boundaries for its activities.

At this point, there is a difference in opinion. The Government intend LINKs to be flexible enough to fit the circumstances that work locally, and free, as far as possible, from central control. That is partly because we want to ensure that they are independent, and are seen to be so, and partly because it is a devolutionary measure and therefore the necessary regulation—I am not talking about formal regulations—should be subject to different mechanisms. We intend to give each local authority with responsibility for social services guidance on and procedures for how the contracts should be drawn up.

The Government believe that it is vital that any system supporting user and public involvement is independent from external control, either from the health service and social care, or from political influence. LINKs will be established at the level of local authorities but will not be run by them. The clause makes it explicit that the local authorities will not host them directly. That is important in ensuring their independence. It is intended that the host organisation for each LINK should be procured through a tendering process. We are putting no limits on what type of organisation can perform this role—although there are some limits that we will come on to—but we think it likely that voluntary or community sector organisations will be well placed to demonstrate the local knowledge essential successfully to undertake this contract.

The host organisation will be required to use its funds to support and promote the activities of its LINK. It will spend the funds as the LINK’s governance structure directs. We come, therefore, to the points that hon. Members made in their amendments about how such arrangements can be delivered—I shall not use the word “controlled”, because that would have an unfair implication—and how we can ensure fairness, probity and so on. The Government take the view that LINKs should not be subject to diktat from the centre and we therefore want flexible arrangements. The means of influencing the arrangements would therefore be the contract between the local authority and the host, as well as the guidance that is issued.

I therefore return to the point that I made on a previous amendment: the experience of patients forums was that the legislation was overly prescriptive and limited their ability to adapt to local needs or changes in circumstances. For example, the statutory nature of membership has limited the diversity of their membership and their ability to involve a wider range of people, although that is not at all to devalue their work.

That goes to the heart of the point that the hon. Member for North-East Bedfordshire made in moving his amendment. He seeks to protect LINKs from being influenced by professional bodies and perhaps organised infiltration, if I can use that emotive phrase.

Alistair Burt indicated dissent.

Phil Woolas (Labour, Oldham East and Saddleworth)

The hon. Gentleman does not like that phrase, and the Government certainly do not. My argument, however, is that too narrow a definition of membership will not allow the public as a whole to be involved. The draft contract and the guidance therefore contain the idea that not only individuals, but voluntary organisations should be involved. We are trying to harness the vast knowledge, energy and benefits that individuals and groups can bring to the health and social care services. Let us imagine all the support groups and informal and formal networks that exist in our constituencies—the stroke associations, diabetes associations and disabled users’ organisations. A whole range of people and voluntary organisations can therefore become involved in LINKs.

Patrick Hall (Labour, Bedford)

I understand what my hon. Friend is saying about vast numbers of individuals and groups becoming more formally involved with LINKs, but he must be sensitive to the strongly held view among many patients forum members up and down the land that they have already established such links—if I can use that term—and that their forums’ constitutions and set-ups have not prevented them from making a vast range of contacts with local voluntary organisations. I am not saying that that is the case throughout the country or that the situation should not be improved on, but my hon. Friend must be aware that there are people out there who think that they are already doing much of what he says.

Phil Woolas (Labour, Oldham East and Saddleworth)

That is of course the case, which is why evolution, and our debate last week about how to describe these things, is important. However, we should not be too prescriptive or centralist, and we should recognise—this is an important point, which came out of the contribution by my hon. Friend the Member for High Peak—the different natures and health needs of different areas. The statutory nature of membership has limited diversity, and we want LINKs to be more flexible to reflect the nature of their local communities. We do not want, as new clause 16 does, to prescribe details of membership such as the proportion of members who should be individuals or voluntary organisations.

My hon. Friend the Member for Bedford is right to ask whether LINKs are covered by the good practice and probity models. Of course, they are statutory institutions, and interests must be declared in accordance with standards in public life, under the Nolan principle. Conflicts of interest are important, which raises the question of what people do if the charity or voluntary organisation is a service provider and an advocate, as is often the case. That is why it is important that that point is dealt with.

Alistair Burt (Conservative, North East Bedfordshire)

I do not want this essential point to be lost. As the hon. Member for Bedford said, nothing that currently happens in the health service prevents the various organisations and representative bodies that the Minister has spoken about from being involved with their local health service and making all the representations that they need to make. In addition to the access that they already have, a distinct patient voice exists in the forum. However, the new LINKs do not add anything to the representative organisations’ ability to do their job and they remove the mechanism for the distinctive patient voice to be heard on its own. That is the members’ fear. If there is no provision to ensure that, say, individual patient members constitute a majority of LINKs, that voice will be lost. The fear out there is based on the concern that this grit in the oyster can be uncomfortable. If the patient voice is subsumed in a larger body, it will be diluted and eventually lost. That is the reason for pressing for the distinctive patient voice, which will not be heard in the larger LINK proposed by the Government.

Phil Woolas (Labour, Oldham East and Saddleworth)

I understand the concern that the hon. Gentleman has expressed on behalf of some of the patients forums. I said at the beginning that there is an honest disagreement here. Judging by the evidence that has been given, there is certainly fear in patients forums that that voice would be diluted. However, large numbers of people do not feel that they have access to advance their point of view. Organisations that are often loosely based and without professional back-up, and which often do not have knowledge of or access to computers, are facing the daily struggle to care for family members—and they have to consider the range of health and social care provision. Those people are not often minded to be involved in formalised membership organisations.

Our approach provides the flexibility to ensure that local areas can have the best of both worlds and that, through the guidance and the draft contract, provision is made for the establishment of the sorts of rules that the hon. Gentleman mentioned, under which the number of members and the board would be prescribed, as would the different functions of LINKs, through which there may be a focus on the patient experience of transport access, as the hon. Member for Carshalton and Wallington said. The LINKs might want to consider the provision for patients with a certain condition, such as stroke victims, and how health and social care could cope with them. They might wish to look at a local hospital’s catering provision. That broader flexibility allows the LINKs to have the best of both worlds.

One has to be realistic about fears that the patient’s voice would be lost. There is the voice of the patient in general, which is the voice of the public, and there is the voice of the patient in assessing needs and experiences, which this part of the Bill addresses. In a debate on an earlier clause I said that this is about the interface between participation and representative democracy. Prescribing how constitutions, rules, standing orders and structures should be made would not achieve the objectives that Committee members wish to be achieved.

Amendment No. 200 seeks automatic transfer for forum members. I hope that I will not be interpreted as being anything other than supportive and appreciative of what has been done, but to prescribe terms of membership in that way would, again, take away flexibility. Forum members can become members of LINKs, and we will encourage them to do so. I imagine that in many cases they will need no encouragement. However, I recognise, as in the evidence, that there may be individuals who feel that their work is not being valued and that they do not want to take part in LINKs, which we would not at all want to encourage.

At heart, there really is a disagreement as to what we are trying to do, which is why I feel unable to serve any champagne. I believe that the points made in local areas will come to fruition through the contractual arrangements agreed and through the obvious necessity to balance participation against probity and fairness. Automatic transfer would cut against practicalities and against the idea of a bottom-up structure instead of a top-down one. I hope that those who expressed their desire for devolution—such as the hon. Gentleman who is about to intervene—will support my point of view and not the amendment.

Tom Brake (Liberal Democrat, Carshalton and Wallington)

I prefer, as the Minister said, the bottom-up approach. However, given the diversity of the LINKs that will no doubt emerge, would he reflect on how it might be possible to ensure a national view of what is happening in those diverse LINKs?

Phil Woolas (Labour, Oldham East and Saddleworth)

That brief intervention takes us down an avenue that I think is covered elsewhere in the Bill, but the hon. Gentleman makes an important point. My answer is to call on Parliament, because that is Parliament’s job in part. He has a serious point; the Bill does not prescribe for a national LINKs, although it does not take away the possibility—or the probability. Because of the overlap of boundaries—the High Peak or Glossop point, as opposed to the Bedford point, if I may put it that way—in many areas such arrangements will need to be put in place. However, Mr. Chope, I think you would stop me if I strayed down that road. I give way, very finally—

Alistair Burt (Conservative, North East Bedfordshire)

The Minister has forgotten one part of the argument, which was the business of whether or not a LINK is a virtual body or one of a different sort. The clause says that a local involvement network is either to be “a person” or constituted by “(b) any other means”. I understand that there was a discussion about this during oral evidence to the Select Committee on Health; the two chief architects of the policy, Harry Cayton and Meredith Vivian, appeared to differ in their views on that important question, unable to decide between them whether the question should be left to local discretion or whether a LINK must have members. Would the Minister enlighten us as to precisely what “(b) any other means” might mean? Is it the intention of the Government that there should be virtual LINKs in some areas, rather than real people doing a real job?

Phil Woolas (Labour, Oldham East and Saddleworth)

I have to correct myself in two ways. First, it is not logical to be very final—one can be final or not final. I apologise. Secondly, I congratulate the hon. Gentleman on his powers of scrutiny, because there is indeed an “or” in there. Under the enlightened, modern, devolutionary legislation, setting up a virtual LINK is possible. That is not going to happen, but it is technically possible. LINKs could be carried out virtually, but that is clearly not our intention. The Bill allows for some flexibility, but I cannot imagine circumstances in which a LINK would be exclusively virtual. Thanks to the geography of certain areas, there might be advantages in the procedures, and we would want to ensure that there was fair access to such virtual arrangements. In any event, I congratulate the hon. Gentleman on his powers of scrutiny in discovering the “or” between paragraphs (a) and (b) of clause 154(2).

Alistair Burt (Conservative, North East Bedfordshire)

This provides a fundamental difference between us. I have listened carefully to the Minister’s explanations, but I do not think that they do the job of satisfying the many people who are profoundly concerned about the way in which the Bill is going. Let me make it clear that I shall withdraw the amendment only because I intend to return to the matter and to vote against the abolition of the forums, which comes up later in the Bill, and that covers the debate that we are having. I am not willing to divide the Committee, because that takes time and we have other things to do, but I am not satisfied with the answers, nor do I think that those outside this place will be. I shall come back to the matter in other discussions, including that on clause 160 stand part. I beg to ask leave to withdraw the amendment.

Alistair Burt (Conservative, North East Bedfordshire)

I beg to move amendment No. 201, in clause 154, page 110, line 17, at end insert

‘and who does not commission or provide local care services’.

Christopher Chope (Conservative, Christchurch)

With this it will be convenient to discuss the following:

Amendment No. 183, in clause 154, page 110,line 17, at end insert—

‘( ) In making arrangements, A may select as H either the National Health Involvement Network or such other person who in the opinion of A is able to deliver such an arrangement under section 153(1) so that it meets the general duty as set out in section 3 of the Local Government Act 1999.’.

Amendment No. 184, in clause 154, page 110,line 27, at end insert—

‘( ) The arrangements must provide that a local involvement network is provided with the staff, premises and resources that are necessary in the opinion of A for the local involvement network to carry on in A’s area activities specified in section 153(2).’.

New clause 15—National health involvement network—

‘(1) There shall be a body corporate to be known as the National Health Involvement Network to exercise the functions set out in section 153(2) to (5).

(2) The National Health Involvement Network has the following functions—

(a) advising the Secretary of State, and such other bodies as it may consider appropriate, about arrangements for promoting the involvement of people in the commissioning, provision and scrutiny of care services;

(b) representing to the Secretary of State, and such other bodies as it may consider appropriate, and advising him and them on the views in England of people about their needs for, and their experiences of, care services;

(c) representing to the Secretary of State, and such other bodies as it may consider appropriate, and advising him and them on the views of local involvement networks in England on their activities as respects section 153(2);

(d) facilitating the coordination of the activities of local involvement networks;

(e) advising and assisting local involvement networks in England;

(f) setting quality standards relating to any aspect of the way local involvement networks exercise their functions, monitoring how successfully they meet those standards, and making recommendations to them about how to improve their performance against those standards;

(g) promoting the involvement of people in the commissioning, provision and scrutiny of care services;

(h) such other functions in relation to England as may be prescribed.

(3) The Secretary of State shall by regulations make further provision in respect of the National Health Involvement Network and these may include such matters as status, powers, membership, appointment, staff, payments to, accounts, audit and reports.’.

Alistair Burt (Conservative, North East Bedfordshire)

This amendment is intended to ensure that those who can set up a LINK do not include people who will be involved in commissioning health services—that is to say those who are not named in clause 154(4). Because health services are now commissioned by more than just the statutory providers with which we are familiar, it has to be made clear that those who commission or provide local care services privately cannot also host a LINK. That is the purpose of the amendment.

Patrick Hall (Labour, Bedford)

If I had caught your eye on the last set of amendments, Mr. Chope, I would have asked my hon. Friend the Minister about the points that he has just made on the guidance on governance structures that he plans to make available after Royal Assent. Would he consider making available, as the Government have helpfully done on the draft contracts, an advance copy or outline of that guidance, so that we can get answers on certain matters?

New clause 15 seeks to do something to address an issue that is frequently raised by patients forum members and others in the context of LINKs. That is the absence, to which my hon. Friend has already alluded, of a national body. The new clause would introduce such a body to serve local involvement networks. That would constitute the rebirth of a quango, so would be another opportunity for my hon. Friend’s press office to launch a populist campaign against it. The role of a national body would be to promote co-ordination, to share work, to improve communications between LINKs, to provide information, to organise training and support for LINKs across the country and, in so doing, to achieve the efficiencies and cost-effectiveness that 152 separate organisations would struggle to achieve.

It is important to share information and improve communication among organisations across the country, because many issues are not just local. Many health and social care issues are regional and national in nature, and it might make sense for local examples to be considered and reflected upon in the national context. Some things are best done from the viewpoint of a national dimension.

For example, under the present organisational system of commissioning, patients forums have recently carried out two national surveys into hospital bedside telephone services and hospital catering. These surveys, known as Fair Talk and Food Watch, were assisted by the existence of a national organisation—the Commission for Patient and Public Involvement in Health—which advised participating forums on how to conduct a survey, and how to collate and to publish its outcome. As I understand it, a similar survey is being undertaken this month by patients forums in England into patient dignity on hospital wards.

The telephone service exercise asked hospital patients and visitors about the cost of making outgoing phone calls using bedside telephone equipment. That certainly highlighted an issue of national concern, yet it was done in local areas up and down the country. The survey found widespread unhappiness with the high cost of calls, and that work contributed to the Department of Health patient power review group’s examination of those matters. A national body would also assist in scrutinising decisions that have a regional or national dimension, of which, as we know, there are many in the national health service.

Given time, it is true that, in the absence of a national organisation, LINKs would themselves want to develop mechanisms to communicate across the regions and nationally—and that might be sooner rather than later. I think that my hon. Friend the Minister was alluding to that a few minutes ago. A membership body is an alternative approach, but that does not exist yet, and in order to set one up the component members need to have enough resource to contribute to it. Although I am not certain of this, there is a question mark over whether a voluntary membership body that is not set down in statute is the weaker for it.

However it is dealt with, whether in the Bill by setting up an organisation, or by a grassroots-up membership body, it is vital for LINKs to have a national voice. I do not see how LINKs can be at all effective unless that develops. The national health service is going through radical change, to which the Minister already referred. That internal reconfiguration is partly based on medical and scientific improvements, as well as the need for reform. For some, that is presented as a threat; it is certainly controversial. Yet while it has the potential to deliver better health services, what is required at every step of the way is for as many people as possible to be informed—that is, not only seeing what is happening in their towns or villages, but putting that into the wider context of their region or country. Every area is, or will be affected by that.

Patients forums are already engaged in these matters and, later, LINKs will continue to be. They will have to be deeply involved—and they must be, if the voice of the public is to be heard while being informed. While much of that work will rest upon local context and knowledge, one cannot address these matters unless there is a wider dimension. Indeed, the driver behind much of this comes from the Department of Health, through strategic health authorities; therefore, it goes beyond the local straight away. There needs to be scrutiny on a wider geographical basis than is envisaged by the 152 LINKs dealing with these things independently. It is important to plug the bigger picture into the local network of LINKs, and I hope that the Minister will take that point fully on board.

I have tabled two other amendments. Amendment No. 183 is dependent upon new clause 15 being accepted and there being a national body. It would allow a local authority to enter into a contract with the national body in order to act as the host of a LINK, should that be the best way of doing it. In some parts of the country there may not necessarily be a suitable local voluntary organisation to act as a host. There may be some that are capable of doing it. It is also possible that such organisations may already be contracting with the local authority to deliver social care, for example. The amendment simply offers that option.

Amendment No. 184 touches on the point that the hon. Member for North-East Bedfordshire raised earlier in giving a general view of these matters. Its purpose is to give LINKs physical, rather than virtual form. In the draft document that was made available last week, there was a reference in paragraph 4 on page 8 to premises and venues for meetings. But that is in a section dealing with hosts. The document says that hosts should have premises, which should exist. It does not go on to say anything about the LINK. Because of the way that that is written—I confess that I have not read the document from cover to cover—there is a danger that LINKs might be regarded as secondary to the hosts.

The hosts will have an office, but LINKs might not have to. Hosts will look after the LINKs budget, too. The LINKs might not have a bank account, I suppose. There are a number of issues here that I look to the Minister to address. If some of them entail looking at that document and writing to me, I will be happy to accept that. He may not have read it from cover to cover over the weekend, missing breakfast, lunch and dinner in order to do so.

Phil Woolas (Labour, Oldham East and Saddleworth)

It would be breakfast, dinner and tea where I come from.

One of the criticisms that members of Committees often make of Ministers is that we are against something on the ground that it was not invented here. I find myself in the interesting situation that, although my Department is not the author of these policies, in preparing for the Committee I have a duty to consider whether I agree with the policy. [Interruption.] My hon. Friend—

Alistair Burt (Conservative, North East Bedfordshire)

What goes beyond a magnum? Is it a Methuselah moment?

Phil Woolas (Labour, Oldham East and Saddleworth)

We are not getting anywhere near jeroboams.

I am amazed by the cynicism of members of the Committee and the idea that Ministers would not consider whether they agreed with the policy. The more I have thought this policy through over the past few months, the more I commend it to the Committee. This is a way that we believe we can have participation in these affairs without adopting a top-down approach. There is some consistency here. When we debated the clauses on the Valuation Tribunal Service, we said that we did not wish to set up by statute a national body of members of tribunals. The Valuation Tribunal Service would be national—the civil service of the tribunals—but we did not think that it was right to set up on a top-down basis a national body of members of tribunals. Such a body would exist and would be an important part of the function of tribunals, but it would be created from the bottom up.

Similarly, if the LINKs wish to establish—and I imagine they will—a regional or national structure, perhaps to examine specific issues, I am sure that that will happen. However, to prescribe it on a top-down basis would lead to the accusation that the Government are creating quangos, and a public belief that the body in question is not independent of the state or Government.

If we are as a country to improve participatory democracy we must ensure that relevant bodies are not only independent but seen and believed to be so, so that the people who make their views known do not think that they must persuade the men and women in suits in the statutory bodies, but can instead access the organisations in question. There is a genuine difference. I believe that in practice regional and national groups will be established for the sharing of experience and findings. Nothing in the Bill prevents that, and there is indeed some encouragement from the Government in the relevant policy area for such proper help for LINKs. The Department of Health has recently contracted with a consortium led by the university of Warwick to provide advice and guidance on patient and public involvement. The NHS Centre for Involvement will perform some, not all, of the activities that are listed in new clause 15—in particular providing advice and good practice on patient and public involvement and reporting to the Secretary of State on how patient and public involvement is working.

We shall go on to debate the future of the Commission for Patient and Public Involvement in Health and I respect the remarks made by the hon. Member for North-East Bedfordshire on his last group of amendments; I think that it is clause 160 that gives us the opportunity. In any event LINKs are, as we have discussed, very different from patients forums, and to establish another body like the commission would be to set up an organisation not best fitted to the job that LINKs members would want to do. We are clear that there will be many local bodies able to provide the support needed by LINKs. Procurement will be through an open tendering exercise and the bodies will need to show that they have the qualities necessary to perform the role that is being contracted. Funding a national corporate body—even if such a body were necessary centrally—would represent a major diversion of funds that are needed at local level. I am sure that there will be no shortage of voluntary and community-sector organisations ready and willing to bid for the job of supporting LINKs. We certainly would not want to fund another body to perform that role when the capacity, local knowledge and familiarity with health and social care services is already available.

Amendment No. 183 would provide local authorities with the power to decide whether to choose the national health service health involvement network that would be set up under new clause 15, or an organisation that the local authority believed to be well placed and equipped to do the job. I have already spoken about the suggested national health involvement network, and I agree that local authorities should be able to choose the organisation that they think is best equipped to carry out the functions of the host of a LINK. We are clear that local authorities should be left to make those decisions themselves. That is precisely why we are giving them the money and freedom to make the assessment of the necessary arrangements themselves. I do not believe that the amendment is necessary, because, by providing the funds, we are telling local authorities “Over to you” and leaving it to them to get the best organisation for the job.

Patrick Hall (Labour, Bedford)

I have listened carefully to my hon. Friend’s response and, not only today but every day in Committee, we are treated by him to some careful, sometimes amusing, but always honest reflection on matters. Today for the first time—

Christopher Chope (Conservative, Christchurch)

I remind the Committee that with this we are taking the following: Amendment No. 183, in clause 154, page 110, line 17, at end insert—

‘( ) In making arrangements, A may select as H either the National Health Involvement Network or such other person who in the opinion of A is able to deliver such an arrangement under section 153(1) so that it meets the general duty as set out in section 3 of the Local Government Act 1999.’.

Amendment No. 184, in clause 154, page 110, line 27, at end insert—

‘( ) The arrangements must provide that a local involvement network is provided with the staff, premises and resources that are necessary in the opinion of A for the local involvement network to carry on in A’s area activities specified in section 153(2).’.

New clause 15—National health involvement network—

‘(1) There shall be a body corporate to be known as the National Health Involvement Network to exercise the functions set out in section 153(2) to (5).

(2) The National Health Involvement Network has the following functions—

(a) advising the Secretary of State, and such other bodies as it may consider appropriate, about arrangements for promoting the involvement of people in the commissioning, provision and scrutiny of care services;

(b) representing to the Secretary of State, and such other bodies as it may consider appropriate, and advising him and them on the views in England of people about their needs for, and their experiences of, care services;

(c) representing to the Secretary of State, and such other bodies as it may consider appropriate, and advising him and them on the views of local involvement networks in England on their activities as respects section 153(2);

(d) facilitating the coordination of the activities of local involvement networks;

(e) advising and assisting local involvement networks in England;

(f) setting quality standards relating to any aspect of the way local involvement networks exercise their functions, monitoring how successfully they meet those standards, and making recommendations to them about how to improve their performance against those standards;

(g) promoting the involvement of people in the commissioning, provision and scrutiny of care services;

(h) such other functions in relation to England as may be prescribed.

(3) The Secretary of State shall by regulations make further provision in respect of the National Health Involvement Network and these may include such matters as status, powers, membership, appointment, staff, payments to, accounts, audit and reports.’.

Patrick Hall (Labour, Bedford)

We have had the opportunity to have lunch, and I shall now conclude the remarks that I was about to make when we adjourned.

My hon. Friend the Minister has approached the Committee’s work with an open mind, and has been helpful and honest. It was not that that was new this morning, because we have been getting used to his approach throughout the Committee, but he injected the new and enlightening suggestion that Ministers should agree with proposals that they advocated. The hon. Member for North-East Bedfordshire showed some surprise at that suggestion, and I wonder what his reaction would be if I mentioned the Child Support Agency. Perhaps that is a little unfair.

Alistair Burt (Conservative, North East Bedfordshire)

The hon. Gentleman was reading my expression as I was being teased. We had the tantalising prospect of the Minister announcing that he was thinking through a colleague’s policy before concluding whether it was right. That raised the prospect in our minds of him going to the Department of Health, knocking on the Minister’s door, and saying, “Rosie, I just can’t do this.” He then let us down by saying that having thought the matter through carefully, surprisingly, he agreed with his colleague. That was the surprise that the hon. Member for Bedford detected.

Patrick Hall (Labour, Bedford)

Even more enlightenment is shining upon us today, and I thank the hon. Gentleman for his comments.

Turning to the matters of greater substance that are before us, and the need to set up a national top-down body—that is proposed in my amendment—I understand the arguments and the logic for not accepting that, but the need for a national dimension to assist local involvement in health networks in doing their job remains, and the case for that is strong. On day one of LINKs’ existence, there will be no such body, and if they eventually get together and create a membership organisation, they will need the resources to do so. I urge my hon. Friend the Minister to bear that in mind. Funds must be sufficient for that task.

My hon. Friend did not have time to deal with the issues that I raised on amendment No. 184, and perhaps they can be looked at elsewhere. The question in my mind, having dangerously dipped into the draft contract documents that were made available last week, is whether it might be possible for the role of the host to be more significant than that of the LINK. We shall have to explore that further, but there has been sufficient movement on these matters and acknowledgement of their importance for me not to press the amendments.

Alistair Burt (Conservative, North East Bedfordshire)

The Minister addressed his hon. Friend’s amendments well, but I just want to indicate the purpose of my amendment No. 201—he may want to intervene—because I stumbled over it, and he may not have picked up its purpose.

The clause makes it clear that a local authority could not be a host organisation, but does not make it specifically clear that any other provider of care services—such as a national health service organisation—could not be a host organisation. The point of the amendment is to indicate that it would be just as awkward for the independence of LINKs if they were hosted by an NHS or any other organisation providing services as it would be if they were hosted by a local authority.

That is the purpose of my amendment, and I would be grateful if the Minister could help me out on that.

Phil Woolas (Labour, Oldham East and Saddleworth)

The hon. Gentleman makes an important point. The amendment would insert the words

“and who does not commission or provide local care services”.

Clause 154 does not allow a local authority or an NHS trust to be a LINK. It is possible as we stand that the host may be a local health organisation.

Alistair Burt (Conservative, North East Bedfordshire)

I appreciate that. In that case, my amendment has not been covered. The point of the amendment was to say that the same logic would surely apply. If the Minister and the Department did not feel that a local authority was an appropriate host because it also provided services, surely it would be equally logical that, as well as not being a LINK, other such organisations should not be a host either. If the Minister and the Department do not agree, I will welcome an explanation of why there is an inconsistency between the two. I am not satisfied that the point has been dealt with.

Phil Woolas (Labour, Oldham East and Saddleworth)

The hon. Gentleman has a point. I think that that will be covered in the next group of amendments. We may be able to debate it and seek the views of the Committee at that point.

Alistair Burt (Conservative, North East Bedfordshire)

In view of that, we can always consider the point further, so I beg to ask leave to withdraw the amendment.

John Pugh (Liberal Democrat, Southport)

I beg to move amendment No. 228, in clause 154, page 110, line 26, at end insert—

‘(h) any organisation providing local care services.’.

Christopher Chope (Conservative, Christchurch)

With this it will be convenient to discuss amendment No. 229, in clause 154, page 110,line 29, at end insert—

‘(7) No chair of an organisation listed under subsections (4)(d) to (4)(h) shall also be a leader of a Local Involvement Network.’.

John Pugh (Liberal Democrat, Southport)

I shall be as brisk as I can, because some of the territory has been covered.

I have a lot of sympathy for the Minister. He has been endowed with the brilliant idea of LINKs by the Department of Health, and has done his best to explain it with as much clarity as possible. The idea remains fundamentally unclear to a number of us. I understand that a LINK is an organisation that can morph—I think the Minister used the word “flexible”. In other words, it can co-opt people as and when it wants; it is a moveable feast. It is not like a forum or a community health council, with an established or defined membership—a core membership was the expression used by the hon. Member for Bedford—but it is said to be more versatile, more potent and more effective in some ways. We all find the absence of defining regulation just a little worrying. I accept the Minister’s response, which was that all will be defined by some sort of contractual arrangements when LINKS are established. As we are unfamiliar with the contracts that will be established, we are none the wiser about what a LINK will be.

We seem to know what a LINK is not, and what it cannot be. A list of conditions in paragraphs (a) to (g) gives various things that it definitely is not. That list is a mixed bag, which covers providers, commissioners, some things that are trusts and some that are not, but it does not seem to be complete. Private providers, who are now clearly part of the health service, are omitted. That might have been what amendment No. 201 was getting at. I will not go over the arguments in connection with that. There seems to be a benefit in specifying a level playing field, even though I think it pretty unlikely that any private provider would wish to become a LINK or would be acceptable as one.

Amendment No. 229 follows up on a point raised by the hon. Member for North-East Bedfordshire, which is the spectre of Joe Public coming along to his first LINK meeting and finding himself surrounded by health officials, health professionals and health apparatchiks of one kind or another, and feeling restrained in what he could say. The legislation lays out quite clearly that trusts cannot be LINKs, but it does not seem to lay out so clearly what trust members can be or cannot be. I have had occasion to observe that people who belong to one quango reappear almost magically in another. If they are affiliated to one organisation, they get themselves affiliated to an associated organisation.

Amendment No. 229 attempts to make it clear that, whoever is on the LINK, it will not be people with a prominent position on any of the trusts. In considering the matter, I decided that there is not an overwhelming case for excluding all trust employees, because an awful lot of people work for the health service in one capacity or another; the result would be the exclusion of enormous numbers of people and of a wide range of relevant expertise.

The hon. Member for North-East Bedfordshire alluded to the fact that there are occasional possibilities for conflicts of interest. For example, if a midwife were a LINK member—I cannot see why she should not be—what would be the appropriate course of conduct if the subject of discussion were the closure of maternity units? Likewise, what would be the appropriate course for ambulance people if the positioning of an accident and emergency department were under discussion? Those are relevant issues, and amendment No. 229 is intended to probe how conflicts of interest will be addressed.

Amendment No. 228 would add what I believe to be a necessary completing provision to the proposed legislation. If health providers are to be excluded in general, let us exclude all of them, rather than just those that are NHS trusts.

Phil Woolas (Labour, Oldham East and Saddleworth)

A number of amendments have been proposed on the issues of who can or cannot be a LINK, on hosts and on conflicts of interest.

Amendment No. 228 would include independent sector providers in the list of bodies that cannot become a LINK. The Government have an open mind on the amendment, because one can see its purpose exactly. Let us take the case of a BUPA hospital—not that the Government have anything against BUPA hospitals. Clearly, there would be an inconsistency if the clause as currently drafted did not allow an NHS foundation trust to be a LINK, yet allowed an independent hospital to become a LINK. One can see that there might be circumstances in which a local authority would wish to contract in that regard. On the other hand, it might be desirable to have bodies such as Mind or a voluntary service organisation as a LINK, the difficulty being that the relevant body might be a service provider of social care.

The Government have difficulty with the wording of the amendment. The phrase

“any organisation providing local care services”

is comprehensive. Bodies such as Age Concern might provide, for instance, meals on wheels services to a particular neighbourhood, yet be a minor provider of services in the area overall. Therefore, although the amendment has a valid purpose, we have difficulties with the definition.

Amendment No. 229 seeks to ensure that the chair of any organisation that provides local care services cannot become the leader of a LINK. Again, on the face of things, there is a potential conflict of interest in that situation. However, two arguments present themselves. The first is, I admit, a weaker argument, which concerns flexibility. In a certain area, the LINK might want to appoint a respected and knowledgeable individual who is the holder of a position with a local care service delivery organisation. The second argument is stronger. It is that conflicts of interest will be covered by the codes of conduct to which reference was made in the previous debate. In answer to my hon. Friend the Member for Bedford, I made the point that the principles of conduct in public life covered by the Nolan commission apply.

Andrew Stunell (Liberal Democrat, Hazel Grove)

Will the Minister acknowledge that the strength of the argument advanced by my hon. Friend the Member for Southport is that the presence of a person listed in subsection (4)(d) to (h) in the chair of the LINK might inhibit its capacity to look at a particular service area, even when an interest has been declared?

Phil Woolas (Labour, Oldham East and Saddleworth)

It may do; it may also do the opposite, because such a person would carry a great deal of weight. In line with the policy of being as least prescriptive as possible, we believe that the codes of conduct in public life are a better way of dealing with the issue of conflicts of interest. Obviously, local LINKs will take such matters into consideration when they are established.

Straying from my brief and referring to amendment No. 201, the Government want to enable independent providers to be hosts of LINKs, although we have a problem of definition regarding whether they should themselves be LINKs. Whether or not independent providers deliver care services, demonstrating to a local authority that they can manage any potential or perceived conflict of interests would be an issue dealt with in the contract. It is a matter of definition—an inevitable consequence of the fact that we are trying to introduce a broader regime and to join organisations. We want LINKs to be as free as possible to decide how they are governed, and we believe that the codes of conduct are a better way of addressing that than prescription in legislation. For those reasons, I resist amendments Nos. 228 and 229.

John Pugh (Liberal Democrat, Southport)

I thank the Minister for speaking to the amendments on their merits. I appreciate his dilemma, and I am grateful that he has been so frank and open minded about it. Clearly, there is a problem with a situation in which an independent provider also functions as an advocacy body, because one would not want such a body to have its feet under the table of a LINK. That is something that perhaps members of the Committee will want to take away and think about, because there is a problem of establishing a level playing field, and a need to exclude a BUPA hospital from effectively becoming a LINK.

It has been entirely appropriate to point the Committee to the Nolan requirements, which have been used as an argument against previous amendments. However, the requirements work best when applied to relatively formal organisations that have an officer whose job it is to advise people when they step out of line. We are supposing that LINKs will be a relatively flexible arrangement in that there might not necessarily be a defined structure or an officer to offer the proper advice at the proper time. Therefore, while the Nolan requirements are a good answer in theory, we might get into all sorts of difficulties in practice.

Phil Woolas (Labour, Oldham East and Saddleworth)

The hon. Gentleman is probing right to the heart of the principles of the Bill, and I congratulate him on doing so. In the regime that the Bill proposes, the function of giving proper advice would be undertaken by the host organisation. Just as a monitoring officer or a section 151 officer in a local authority has a relationship with elected councillors, a host organisation would have a relationship with a LINK. That is common practice in this country, and I would argue that such relationships are well established. I think that that answers the hon. Gentleman’s point.

John Pugh (Liberal Democrat, Southport)

I am grateful to the Minister for that and will go away to reflect on it. I beg to ask leave to withdraw the amendment.

Clause 155

Alistair Burt (Conservative, North East Bedfordshire)

I beg to move amendment No. 202, in clause 155, page 111, line 2, at end insert—

‘(f) any other organisation contracted to provide care services.’.

Christopher Chope (Conservative, Christchurch)

With this it will be convenient to discuss the following amendments: No. 230, in clause 155, page 111, line 2, at end insert—

‘(f) any care provider commissioned to deliver local services.’.

No. 231, in clause 156, page 111, line 10, after first ‘a’, insert ‘locally funded’.

No. 232, in clause 156, page 112, line 10, at end insert—

‘(f) any care provider commissioned to deliver local services.’.

No. 204, in clause 156, page 112, line 10, at end insert—

‘(f) any other organisation contracted to provide care services.’.

Alistair Burt (Conservative, North East Bedfordshire)

We are in similar territory, so I shall not take too long. I am sure that colleagues on the Liberal Democrat Benches will do the same. The clause refers to the duties of services providers to respond to local involvement networks and defines under subsection (2) the services providers. The amendment would include within the definition

“any other organisation contracted to provide care services”.

Again, the definitions seem unduly narrow, bearing in mind the breadth of bodies and organisations that provide such care services. Hopefully, the amendment will be helpful to the Government in that it would widen the range of those who need to respond to local involvement networks. If they are included elsewhere, I should be grateful if the Minister helped us out. If they are not, our purpose is genuinely to open them up to the same scrutiny and duty to respond as any of the other defined providers.

John Pugh (Liberal Democrat, Southport)

Essentially, all the amendments are more or less on the same track, but this matter is possibly of greater significance and does not fall to some of the arguments that the Minister has presented so far.We are talking about private providers not in so far as they are advocates or anything else, but in so far asthey have a duty to respond. I suspect that the Government’s response will be that private providers are usually commissioned by a primary care trust or a public body and that, if LINKs have complaints, they ought to take them up at first base, which is the PCT that has the permission to service. That strikes me as a poor model of patient involvement.

I wish to cite a couple of real examples. I have been involved in a debate in this place about the Cornwall out-of-hours service, which was presumably commissioned by the Cornwall PCT. When critics tried to find out problems about its performance, they found it extraordinarily difficult and had to resort to the Freedom of Information Act 2000 to get any valid information to assist them. The public were fairly confident that things were going wrong, but getting any real response from the provider organisation was the devil’s own job.

In similar circumstances, by and large the Merseyside PCTs commissioned a private provider. That provider has had difficulties. Identifying the difficulties has been very hard. In one case, a senior member of the private provider’s IT staff actually left, complaining that the service was delivered wholly inadequately, but was subject to a gagging order. When inquiries were made to the PCT about what was going wrong, we were told that it could not define exactly what was going wrong because certain things were commercially confidential, and that there were certain things that it, frankly, did not know about and had to find out. LINKs do not have the capacity to go directly to the private provider and say, “You are providing national health services. What is going on?” Worse still, without such an amendment, it will not have to respond at all. That is wholly inadequate. It should be able to respond, if only to say that it is working to its contract with the PCT, the PCT is satisfied, so ask the trust next. However, to have a situation in which our major services, such as out-of-hour services, can be delivered—

Alistair Burt (Conservative, North East Bedfordshire)

A patient’s journey through any part of the health process should be capable of being monitored. It should be the same process and as easy right the way through, notwithstanding the fact that the services may be provided by different groups of people. If it were made more complicated, that would get in the way of the patient involvement that we are so keen to provide.

John Pugh (Liberal Democrat, Southport)

Patients essentially want a response from the provider. The majority of people do not even understand what a PCT is, let alone how to approach it. They simply know that there are people delivering services. They know—or will know—that there is a LINKs organisation designed to find out why the service is not being delivered particularly well and they will expect a response from the service providers, not a remote response after the PCT has had a board meeting and discussed the issue.

Phil Woolas (Labour, Oldham East and Saddleworth)

I suspect that hon. Members on the Labour Benches in this Committee will agree with the sentiments that have been expressed by Opposition Members. In simple terms, should not the private and voluntary sector be subject to the same regime as the statutory sector if they are providing health and care services? That seems entirely reasonable. I want to explain how that point can be met by the legislation. We have a convincing argument—the hon. Member for Hazel Grove raises his eyebrows.

We have a similar problem to that which we had when we debated the statutory duty to co-operate. As a principle of policy, it is not desirable to impose statutory obligations on independent providers. Traditionally, it is not done in this country. It conflicts with the points being pushed by the hon. Members for Hazel Grove and for Southport. Having said that, we will ensure that independent providers of publicly funded health and social care comply with LINKs’ powers by ensuring that commissioners of the service include the requirement—in this case, the obligation for access—within the contracts, through the directions of the Secretary of State.

While it is consistent to say that it is not desirable to impose statutory duties directly upon providers, it is reasonable for the taxpayer to say that, if we are commissioning said organisation to provide health and social care services, as is the case under the clause, the contract into which it has voluntarily entered to provide those services, brings with it a responsibility to comply with the duties that are on the statutory sector. That is a perfectly reasonable policy to hold. It is in line with wider Government policy and it is the arrangement that is in place in relation to patients forum powers over health services.

There are some 28,000 contracts between the public sector commissioners and the private or independent providers of social care. It is not our intention, or that of the Committee, to force the renegotiation, mid-term, of those contracts because of the costs that that would entail and, more important perhaps, the disruption that there would be to patients’ services.

We accept that, in the short term, there will be differences between the public sector and the independent sector in relation to LINKs’ powers. However, we will require those powers to be included as new contracts come into place. In the meantime, any independent providers will be expected to be positive in their working relationships with the LINKs. That is our approach to the amendment.

To give further reassurance to the hon. Members who tabled the amendment, under which the definition of services providers would include any provider of services, including the independent sector, the clauses allow the definition of services provider to be extended by regulations, therefore allowing future flexibility to reflect changes in the organisation of the NHS, or other circumstances—what I refer to as the Bromley and Chislehurst point: we have to legislate for the unforeseen as well as for the foreseen.

Therefore, measures in the Bill meet the concerns outlined in the amendment tabled by the hon. Member for Southport, without taking what I argue is the undesirable step—and possibly one subject to challenge—of placing statutory duties on independent bodies. I hope that that satisfies hon. Members who tabled the amendments.

John Pugh (Liberal Democrat, Southport)

That is not exactly a champagne moment, but it is a significant clarification, because it achieves the same effect as the amendment by a different route. That is entirely laudable, but given that the Minister spoke about the private sector’s tendency to challenge a decision to lay statutory duties upon it, one hopes that we will not find further down the line that the private sector will find another cause for challenge under competitive tendering legislation. If it does not, I will be satisfied with his response.

Alistair Burt (Conservative, North East Bedfordshire)

The discussion has been quite thorough. I am content to withdraw the amendment at this stage. I beg to ask leave to withdraw the amendment.

Clause 156

Patrick Hall (Labour, Bedford)

I beg to move amendment No. 219, in clause 156, page 111, line 9, leave out ‘may’ and insert ‘shall’.

Christopher Chope (Conservative, Christchurch)

With this it will be convenient to discuss the following amendments: No. 203, in clause 156, page 111, line 11, leave out ‘view’ and insert ‘inspect’.

No. 220, in clause 156, page 111, leave out lines 15to 19.

No. 221, in clause 156, page 111, leave out lines 22to 38.

Patrick Hall (Labour, Bedford)

Amendment No. 129 raises that old chestnut in the drafting of Bills: the difference in meaning between “shall” and “may”. It would substitute “shall” to require the Secretary of State to make regulations requiring providers to give access to LINKs for the weaker “may”, which implies that there is no such requirement.

I turn to amendments Nos. 220 and 221. The clause will give the Secretary of State regulatory power to create the conditions that must be satisfied before the LINK can gain access for the purpose of observation. If the management of premises are not keen to allow access, the conditions listed in the clause—there are many of them—could be used to assist them in resisting or delaying LINK access. It could be rather bureaucratic and time consuming for a LINK to present a case for why it should have access and to have to overcome hurdles and so on before gaining agreement.

Furthermore, when in disputed cases it is agreed in principle that access can be granted, that access will be subject to limitations set out in regulations on the extent of a duty, whether generally or in a particular case, and provisions imposing or authorising the imposition of conditions and restrictions. Regulations might also limit the duty to allow entry to certain types of authorised representative, the number of authorised representatives and the hours during which a duty applies. Such regulations could be used to place hurdles in the way of LINKs trying to carry out their job.

I ask the Minister to consider, for example, the limitation on hours. It could be seen as entirely reasonable if used to limit access to within working hours, but it could also cause problems if a LINK comprising mainly volunteers, as LINKs will, wished to visit in the early morning or evening because some of its members might otherwise be at work. It is worth recalling that at present, under the 2003 regulations, patients forums enjoy a presumption in favour of inspection

“except where, in the opinion of those persons or bodies, this would compromise the effective provision of health services or patients’ safety, privacy or dignity”.

There is a presumption in favour of access subject to those limitations, rather than a host of potential obstacles, of which I should be interested to hear some explanation. My amendments will not strike out subsection (2)(d), which refers to checks by the Criminal Records Bureau.

I have also looked at the documents helpfully made available by Ministers last week and to which I have referred. One of the documents is labelled “Restricted—Policy”. It contains several pages on these matters and states that regulations will be preceded by consultation, which will seek views on a number of questions.

In responding to the debate, will my hon. Friend the Minister describe how the power to enter and view will apply to public sector organisations as well as to private and voluntary sector organisations, many thousands of which deal with social care and have thus far not had to agree to that kind of access?

David Burrowes (Conservative, Enfield, Southgate)

I shall speak to amendment No. 203 on inspection.

Definitions are very important in any Bill. As a lawyer, I take due note of definitions. I want to draw out the definition of inspection. The obvious place to look first, albeit not over lunch, is the “Oxford English Dictionary”—a dictionary for which I have great respect, not least because my wife, when she was ill, did the extraordinary thing of reading through it. That is not something that necessarily attracted me to her, but it has given her the upper hand in Scrabble and has given me due reverence for the book.

When looking up the definition of inspect, there is an important and significant point to bear in mind. We need to see whether that definition matches up with the Government’s intention as set out in their draft policy. In the Bill, the Government seek to put some flesh on the bones of their intention in relation to the duty merely to enter and view. It is important to see how that compares with what is a proper duty to inspect, which is, at the moment, a statutory duty relating to forums. The definition in the “Oxford English Dictionary”, as my wife would no doubt have told me if I had not looked it up myself, is

“to look carefully into; to view closely and critically; to examine (something) with a view to find out its character or condition”.

In that definition, to inspect plainly means more than to view. The important word is “critically”. To find out something’s character or condition requires a proactive step beyond viewing.

That is important because when one looks at the policy statement that was helpfully provided to the Committee, the intention referred to on page 2 is

“to enable LINKs to gather information about the services provided to local people. There will be times when it is right to see how those services are provided and to collect people’s experiences whilst they are currently using them.”

It goes on to state how important it is to observe the nature and quality of services. The concern is that that is only one stage. It is dealing with LINKs on the basis that they are gathering information and intelligence, but it does not take it any further. There is a recognition in that statement that LINKs make an important contribution to the process of service improvement, to supporting the work already undertaken by the regulators, and to incorporating the user perspective in their work.

The concern that has been expressed to me by the Barnet and Chase Farm Hospitals Forum as well as by others before the Committee is that the efforts to mainstream effectively the operation of LINKs in terms of entering and viewing does not properly deal with the true value of forums at present. The concern is that the aim is simply to incorporate their work within the regulators’ current work. I invite the Minister to give examples of where there has been duplication of work with the regulators that means that LINKs have to be effectively mainstreamed within the regulators’ own inspection regime.

Why does the Minister not pay regard to best practice around the country, not least in areas such as Barnet and Chase Farm, where the forum has carried out proper inspections in the past months in anti-coagulation clinics, wards, catering services, accident and emergency, and patient phone services and is to follow that work in relation to blood testing facilities, stroke facilities, maternity and obstetrics, pharmaceutical and cancer services. They are all areas in which the statutory duty to inspect has been properly carried out by that forum among others, and it should be incorporated in the Bill.

The chairman and the secretary of my local forum say that the abolition of the right to inspect would be catastrophic, and that in some ways the

“spot inspections of cleanliness and patient management are far more effective than planned inspections by organisations such as the Healthcare Commission.”

The forum has a role, and it should not be absorbed by the existing regime of regulators and inspection.

The draft policy statement goes on to say that LINKs will provide important intelligence to the regulators, which does not give due respect to the forums’ work. They are not simply intelligence gatherers for the regulators; they in their own right have a proper role of inspection on behalf of patients. That role should not be taken away or absorbed, but that will be the effect of not having “inspect” on the face of the Bill. Why is “inspect” not in the Bill? Is “The Oxford English Dictionary” definition incorporated in the Bill in terms of the LINKs’ role of entering and viewing? If not, their role should be expanded to include inspection.

On the inspection issue, I pay tribute not only to the OED, but to Jonathan Swift and “A Tale of a Tub”, which was:

“Written for the universal improvement of mankind.”

No doubt the Minister would like to pursue that goal. The critique was of a teacher who restricted his pupils’ exposure to knowledge, and there was a concern that prosperity would suffer if they were kept in ignorance. It is not necessarily the intention to restrict the LINKs’ pursuit knowledge or to keep them in ignorance, but we should give due regard to Swift’s words, in which it is resolved

“to keep you in an almost universal ignorance of our studies, which it is your inherent birth-right to inspect.”

Will the Minister reassure me his intention is not to keep the LINKs on behalf of patients in universal ignorance? The concern is that the Bill should at least include a power to inspect. It may not be an inherent birthright of LINKs or of patients, but because of the money that we pay in taxes and because of their value, the Bill should at least include the right to inspect. The policy statement does not leave me content or in a spirit of happiness. To draw on Swift again, however, his definition of happiness is

“a perpetual possession of being well deceived,”

so perhaps the Minister will make me happy.

Bob Neill (Conservative, Bromley and Chislehurst)

I shall follow on from the point that my hon. Friend the Member for Enfield, Southgate made about the particular value of spot checks. The point has been made to me, too, by people with whom I have spoken. I am concerned by pages 4 and 5 of the policy statement, which set out a significant diminution of the current rights of patients’ forums to enter and inspect, and to make spot checks.

The statement says that LINKs will only be able to enter and view, rather than inspect, and only with prior notice, rather than carry out spot checks. It then sets out a number of other savings and restrictions. The LINK will have to have

“written to the relevant regulator, indicating their intention to visit a facility, and received a reply”.

Page 5 states that a ground for exempting the LINK’s right to enter and view—never mind inspect—is that it has not given prior written notice. The proposed regime is far more restrictive than the current one, where the only restriction is on anything that would interfere with patient safety or well-being. What is the justification for that? On the face of it, the new regime will be much weaker in terms of involvement than the previous one.

Patrick Hall (Labour, Bedford)

Does the hon. Gentleman agree that it would be interesting to hear the Minister’s response to my point that what we have now is simply a presumption in favour, subject to some sensible limitations, and what is proposed would be less than a presumption? We would like to see the presumption continue, even if the words are slightly different.

Bob Neill (Conservative, Bromley and Chislehurst)

I am inclined to agree with the hon. Gentleman. However the language is dressed up, the thrust of the provision—the presumption—ought to be to facilitate inspection and to put the minimum number of obstacles in the way of it, consistent with safety and patient well-being. Many people involved in the patients forums are suspicious about whether the diminution of their right is yet another manifestation of the “get rid of the turbulent priest” scenario that I mentioned earlier.

Alistair Burt (Conservative, North East Bedfordshire)

I am pleased to support my hon. Friend the Member for Enfield, Southgate. We thank him for opening this debate by mentioning Jonathan Swift, whose name and character is always relevant to proceedings in the House of Commons, although even his great powers of satire would be stretched to cover the present Government. On occasions, he would have been forced to conclude as he retired and sheathed his pen that nobody could have made up what he had heard that day. As well as mentioning Jonathan Swift, my hon. Friend introduced us to the formidable Mrs. Burrowes. None of us will play Scrabble against her for money. We have all been well warned about the formidable lady and we will brush up our language when speaking to her.

My hon. Friends the Members for Enfield, Southgate and for Bromley and Chislehurst have raised further serious concerns about the Bill and the unnecessary translation from forums to LINKs. I should like briefly to build on what they said. Definition is not the sole issue, although that is important—as are words. There has to be a reason why the term “inspect” has been removed from the legislation. That puzzles all the people whom we speak to in the forums. The subject came up when I met representatives from some 23 forums last month. My note says that

“Patient representatives need to be able to gain access to any facility where patients were being treated, and ask the necessary questions. Whether a power was defined as inspection, or audit, or something similar it was important that the NHS did not have the power, except in the most obvious and understandable circumstances, to exclude patient representatives.”

The fear that something has been done to them in relation to this change is held widely among those who have contacted us and submitted evidence.

Again, I turn to the published evidence submitted to the Health Committee, which has been dealing with this matter. Without spending too much time on this, it has not taken me long to find things relating to inspection. The Norfolk and Norwich University Hospital Forum says LINKs should have

“At least the same remit as PPI Forums to cover Social Care as well as Health. A critical friend plus statutory duties to monitor services and gather public opinion. With rights of inspection.”

The Royal Brompton PPI Forum says:

“LINks to retain right of inspection.”

Perhaps more telling, in evidence from Hounslow—[Interruption.] If the Committee will indulge me for a second, I seem to have lost that.

Patrick Hall (Labour, Bedford)

Have you lost Hounslow?

Phil Woolas (Labour, Oldham East and Saddleworth)

We lost Hounslow. [ Laughter. ]

Alistair Burt (Conservative, North East Bedfordshire)

I am not sure who would be most guilty of carelessness in losing Hounslow, but I wish that I could find the relevant papers.

Andrew Stunell (Liberal Democrat, Hazel Grove)

The hon. Gentleman is clearly in the midst of an important point, and I think that he deserves a slight recess to establish exactly which point he was making.

Alistair Burt (Conservative, North East Bedfordshire)

I am grateful for that intervention, because the short recess has refreshed me and has allowed me to find a key quote from Hounslow. The Hounslow Primary Care Trust, West Middlesex University Hospital, Ealing Hospital, Ealing Primary Care Trust, Hillingdon Primary Care Trust, Hillingdon Hospital And The West London Mental Health Trust PPI Forum says, in is submission:

“If the new LINks do not have the power of access to premises providing NHS services, many Trusts will breathe a sigh of relief. Without regular monitoring/inspections the LINks will not have the information they need to help the Trusts to improve.”

The point about health trusts breathing a sigh of relief may be confirmed by evidence from the NHS Confederation, which represents the leaders and managers in the health service. They are not bothered about the power of inspection being lost—perhaps because that suits them. The Commission for Patient and Public Involvement in Health has some expertise in the area. In its submission, it says the following about the change in the inspection power:

“This would replace PPI Forums’ existing power to inspect premises and it appears to be a more limited right than that currently enjoyed by PPI Forums, which gives them the power to inspect, for any purpose relevant to the Forum’s functions, premises owned or controlled by Strategic Health Authorities, PCTs, NHS Trusts, NHS Foundation Trusts, local health boards, local authorities, GPs and ophthalmic services.”

So, forums themselves think that there is something suspicious about the change in the wording, and about the loss of the inspection power, and the CPPIH thinks the same, but the NHS Confederation, which represents managers, does not. As my hon. Friend the Member for Enfield, Southgate asked, “Why the change?” What is the distinction that is intended in removing the power of inspection? If it is intended to give forums exactly the same rights as before, why change the wording? If the concern is that the powers of inspection are too onerous on trusts, where is the evidence?

My hon. Friend the Member for Bromley and Chislehurst referred to the regulations, which mention spot checks. Of course, the more paraphernalia that must be gone through for an inspection, the easier it is to cover up anything that might be wrong. I am not suggesting that that kind of thing might occur deliberately. However, if one is looking for evidence of things that might have gone wrong and that might be affecting patients, there is good reason to bring out that evidence. Some of the cases on Clostridium difficile have been discovered as a result of spot checks by patient forums.

There should be a reason for the proposed change, but at the moment, I cannot see that the change suggests anything other than a step back from the sort of access and monitoring that we would like to see. There is general suspicion about it. If it is designed not to alter the powers of forums, it should not be made, and if the change is significant, the significance should be spelt out. At present, it looks like a diminution of powers—one that is unwelcome to those who know most about the matter, and to those who represent patients as opposed to managers.

John Pugh (Liberal Democrat, Southport)

I want to say a few words on inspection. The problem facing us is that we still do not know what LINKs will be, which makes it almost impossible to generalise about the powers that they should have, about the need for criminal record clearance, or about the issues that their visits to hospitals will raise. That seems to be the root of the problem.

I have some sympathy with the idea that we need a spot-check principle. Something like poor hospital food, or even whether patients eat the food that they are given, can be discovered only by spot check. If any advance notice is given, no food will be found lying for hours by the hospital bed.

We do not underestimate how complex a process inspection can be, so I understand to some extent why there is a debate and why it is not evident that one side is right and the other is wrong. Years ago, when as a student I worked in an old-fashioned mental hospital, I was familiar with hospital visitors trooping through with what was called a tour of inspection. The day that the tour of inspection took place was a day of absolute misery for the patients for whom we were supposed to be caring. They were swept aside while we cleaned every surface we could find and spread disinfectant around the place. The visitors were thoroughly satisfied that all was well, because everywhere looked spick and span. That is not an adequate inspection.

Inspection is a relatively complex process and needs to be done thoroughly and effectively. I would have thought that that would make a case for more consultation—I hate to make a case for more of it—with the hospitals that are inspected and the people who want to inspect. A regime can be established that is satisfactory to both, and if the Department of Health were to conduct such a consultation and publish the results, we could reach a conclusion with which everybody would be satisfied.

Phil Woolas (Labour, Oldham East and Saddleworth)

The answer to the last point is that that will take place.

The point that I want to get across to the Committee is that the powers proposed in clause 156 will allow the Secretary of State to impose a duty on the service providers, as we have discussed in respect of previous clauses, to allow authorised representatives of LINKs to enter, view and observe—I shall come back to the OED in a moment—the carrying on of activities on premises controlled by service providers. Those regulations, provided for in subsection (1) of, require two things. First, they require consultation. I find myself in the position in which Ministers often find themselves in such debates when members of the Committee ask, reasonably enough, to see the results of the consultation on the regulations. I am asking for a power for the Secretary of State to make regulations subject to that consultation, which will cover the point made by the hon. Member for Southport.

I can reassure the Committee that those regulations will be subject to the affirmative procedure, so the points that have been made in respect of the amendments can be made in respect of the regulations. It is reasonable to ask for powers to place some conditions and limitations on the duty—on the number of people who could conduct a visit at a particular time, for example, or the hours during which a visit can take place.

Hon. Members have made comments about health services, and hospitals in particular. We are talking about the full panoply of care services, and I see why there might be some scepticism given the fact that a visit could be undertaken only by an authorised person. To enable LINKs to gather information on all aspects of service provision, there are of course times when it will be appropriate to enter the premises and view the range and quality of the services provided. We therefore plan to provide LINKs with the power to enter health and social care premises, which will give them the opportunity to hear from people as they use the services. The inclusion of social care premises is a big step forward, as patient forums have the power to enter only health services. That is important to enable LINKs to gather the views of those who use the services, who often have little opportunity to make their voices heard.

The need for safeguards to be in place and for some services to be exempt is met for the protection of vulnerable people. For example, we do not think that it would be appropriate for LINKs to have powers to enter people’s homes, although social care services can be provided in people’s homes. I am sure that hon. Members would agree with that. My argument is that the bottle is half full, whereas the sceptics are arguing that it is half empty. I see their point, and suggest that regulation and consultation is the way forward. However, the powers to enter will help a LINK to form a view of the services by giving people in receipt of those services the opportunity to feed in their views.

Secondly, not all those involved in LINK activity will need to undertake that role. Those who are able to exercise the power must have the right skills, perhaps have the right training, be cleared by the Criminal Records Bureau, and be able to demonstrate an understanding of patient confidentiality and the right level of sensitivity. When the details have been finalised, we will specify which premises a LINK may enter and view. We will provide a new code of conduct on visiting to set out for LINKs, their hosts and the organisations that will be visited how the arrangements will work. LINKs will be expected to co-operate and to co-ordinate their activities with the regulator. We will ensure that that duty is in regulations, and we will consult widely.

I asked whether the “Oxford English Dictionary” provides a definition that the law recognises. The answer, as you might expect, Mr. Chope—I mean no disrespect to learned friends, and I will not be charging any guineas for this advice—is that a court must take into account the normal meaning of words.

David Burrowes (Conservative, Enfield, Southgate)

I can think of many a case in which I used the “Oxford English Dictionary” as a recognised authority on the ordinary meaning of words. Obviously, there may be different opinions about the ordinary meaning of words among our great populace, but it is a recognised authority on and source of ordinary meaning.

Phil Woolas (Labour, Oldham East and Saddleworth)

Courts must take account of normal meaning, and there is a difference between normal meaning and the “Oxford English Dictionary”. I learned some of the differences when I worked in the industrial world, but I shall not repeat those differences for the benefit of the Committee.

The serious point is that we believe that “inspect” carries the connotation of inspectors, such as the Healthcare Commission and the Commission for Social Care Inspection, and that “view” and “observe” carry the normal meaning and not the connotation of a formal inspection role. LINKs’ members are not inspectors or regulators as covered by the inspectorate regime. The hon. Member for North-East Bedfordshire is reaching for the “Oxford English Dictionary”.

Alistair Burt (Conservative, North East Bedfordshire)

If only. It is hard enough for me to find my place, let alone to consult the “Oxford English Dictionary”.

The Minister has got to the heart of the matter, but what is the point, apart from changing the word? Is he declaring that there is no change whatever in the power that forums previously had to do their work when they entered premises and inspected? Can he guarantee to the Committee and every member of forums that nothing in the Bill will prevent them from doing anything that they previously did because the word “inspect” is not there, and that it has been changed only because someone might think that LINKs were inspectors?

Phil Woolas (Labour, Oldham East and Saddleworth)

The hon. Gentleman makes a fair point, and I shall choose my words carefully. The purpose of changing the word from “inspect” to “view” and “observe” is not to change any powers. That is not the intention. There is no restriction, limitation or curtailment of the powers of the patients forum in connection with the word “inspect” as opposed to the powers of LINKs in connection with the words “view” and “observe”. There is also no intention to omit powers. The difficulty for me in arguing the case is that the consultation on the regulation may result in some variation, but it is not the intention to change the meaning of the word “inspect” from that in the “Oxford English Dictionary”. I am trying to be as open as I can with the hon. Gentleman, but the hon. Member for Enfield, Southgate wishes to push me a little further.

David Burrowes (Conservative, Enfield, Southgate)

I hear the Minister saying that, in a sense, the clause is spurred on by concerns about connotations. That works both ways. The natural connotation of the words “enter and view” is passive. As applied to the activities of LINKs, the concern is that they will have a passive role of gaining intelligence, whereas the words “spot inspection” and “inspection” would denote a more active role. The connotations, to use the Minister’s phraseology, go against what the Minister is saying. He said that the existing roles will continue.

Phil Woolas (Labour, Oldham East and Saddleworth)

I am advised that there is no change in definition, but the hon. Gentleman makes a fair point. The counter-argument is that the connotation would be held by employees and potentially by patients themselves. People see “inspectors” and “visitors” in different ways. For the record, the Government’s intention is simply to avoid confusion with professional regulatory bodies such as the Healthcare Commission. The people who will be involved in LINKs are lay people, however much experience they have, which is why they are being asked to undertake the functions that we are discussing. As such, they will be able to take up the view of the patient and adopt a service-user perspective and feed that into a regulator’s assessments by, for example, informing the Healthcare Commission’s health check process.

Alistair Burt (Conservative, North East Bedfordshire)

I am grateful for the Minister’s concession—this is an important part of the Bill. What precisely is he saying has arisen because of the confusion about inspectors? Is he in some way saying that those who are being inspected are confused, and that that is a problem? Is he saying that the confusion is in the minds of members of forums because they are placed in an unfortunate position by being considered to be inspectors, and that they therefore cannot build appropriate relationships with trusts? Is he saying that it is more important to have inspections conducted by inspectors, and that what forums do is less important? The powers to visit, to see, and to be proactive—forums raise issues publicly and get things done, as my hon. Friend the Member for Enfield, Southgate said—are as important as anything that the Healthcare Commission or any other body has. What is the problem with a confusion over inspection? Why should such confusion cause a difficulty that the Government want to address? Where is the evidence that a problem has been caused by the issue of, and confusion about, definition?

Phil Woolas (Labour, Oldham East and Saddleworth)

I thank the hon. Gentleman. I had not expected such a forceful probing about the word “inspect” and the words “view and observe”. I take the common-sense view. The word “inspect” carries a connotation of professional inspection; the words “view and observe” do not, but that does not rule out the idea that viewers and observers can go to an establishment and be awkward so-and-sos. My personal view is that if I were a member of the public, I would sooner trust a group who have experience of holding hospital and care services to account in my local area, which can refer that to my council’s overview and scrutiny committee and get the local press coverage that would no doubt result. Such a group is a lot more powerful than a few suits coming up from London to stay in the Malmaison hotel for the weekend, which is what normally happens, although I am not decrying the professionalism of the inspectors in any way, or doing down the professional standards of Malmaison hotels.

The hon. Gentleman is reading too much into the Government’s intent. The change of wording from “inspect” to “view” clarifies the role of LINKs and is a more accurate description of what they do. To reassure him, the change will not represent a curtailment of the power of the patients forums.

Patrick Hall (Labour, Bedford)

May I just be clear? Is my hon. Friend saying that in practice, what patients forums do now is effectively to enter, view and observe rather than inspect, as we are now having a debate about those words? I should like clarity on his point that the Healthcare Commission’s inspectors are mainly lay people. I take it that we are talking about the extent and nature of people’s training to carry out the function either of inspection or of entering, viewing and observing.

Phil Woolas (Labour, Oldham East and Saddleworth)

On the point of definition, I can confirm that that is the case. Regarding lay people, I believe that I made the reference—I certainly intended to—in respect of LINKs rather than of professional bodies that inspect. That was the distinction that I was trying to draw.

I have covered the points made in amendmentsNos. 220 and 221 regarding access, but I have not covered amendment No. 219, tabled by my hon. Friend the Member for Bedford. He wishes to delete the word “may” in subsection (1) and insert the word “shall”. To be consistent and to back up my arguments about the other amendments, I must accept his amendment. To give the Secretary of State discretion over whether she or he makes regulations would negate the arguments that I have made to reassure hon. Members on the other amendments. Therefore, I propose to accept the amendment to give that reassurance.

As well as acknowledging the Committee’s role, accepting the amendment makes an important point. If one allowed circumstances in which the Secretary of State could not make regulations, the LINKs could not do their job as the Committee and the House have described it. I am assured by my advisers that I need not change line 1 of subsection (2), because if the Committee accepts my hon. Friend’s amendment, there shall be regulations. I urge Committee members to accept that amendment, reject the others and return to the points made about the regulations in consultation and debate.

Andrew Stunell (Liberal Democrat, Hazel Grove)

I rise to ask the Minister to clarify how the measures will work in respect of tertiary health care. I do so in connection with an institution with which both he and I are familiar—the Christie hospital in south Manchester, which provides specialist cancer care for a large number of people in our area, right across Greater Manchester and beyond. A significant number of LINKs would be involved in monitoring what is going on there. At the moment, there is a separate specialist patient and public involvement in health forum covering the Christie hospital. Its work is valued by the hospital, and it is believed to be very effective in doing it.

Until now, we have been discussing primary and secondary care—district general hospitals and units that provide care for a comparatively restricted area, where co-ordination and co-operation across local authority boundaries is more or less trivial to achieve. However, in that particular case it seems that there would be a significant number of local authorities and LINKs. I have received representations from a member of the existing Christie forum, who is a constituent of mine, saying that there seems to be a real risk that the valuable work that is done in that specialist area of monitoring via the existing body could be lost. I wonder whether the Minister would give us some indication of how he sees the process working in those specialist circumstances, and what assurance can he give to my constituent who serves on the existing forum.

Phil Woolas (Labour, Oldham East and Saddleworth)

I was fearful then that just as the hon. Gentleman could not find Hounslow, I would not be able to find Christie’s, but I have located it in south Manchester. The hon. Gentleman’s point presents a similar challenge to that of my hon. Friend the Member for High Peak with regard to bodies that cover more than one area. His experience will be the same as mine: however much local people insist on having local services on their doorstep as far as certain types of health provision are concerned, when it comes to cancer and other related diseases, their first question will be, “How do I get to Christie’s?” It is an acknowledged world centre of excellence.

On the debate on the duty to co-operate, it is interesting to note the caveat that I expressed regarding some health trusts in relation to the example of Great Ormond Street. I asked the Committee to consider the danger that many local authorities throughout the country would try to enter into agreements with Great Ormond Street. That example, and that one only of all last week’s deliberations of the Committee, made it into the Local Government Chronicle. That rather shows the journalistic values of the LGC, but it also shows the seriousness with which people take these points.

The LINK for the area in which the tertiary health service exists will be able to enter, view and observe, and so on. We expect that other LINKs will enter into agreements with that body to provide a specialist way in which the tertiary service can be provided. As the hon. Member for Hazel Grove said, there are specific arrangements in place at the moment and because patients come to Christie’s from all around the country, not just our region, that seems a sensible arrangement.

Andrew Stunell (Liberal Democrat, Hazel Grove)

I appreciate what the Minister is saying, but to some extent he has drawn attention to what will be the real risk. If everything falls to the south Manchester LINK, or any Manchester LINK, not only will it have the job of managing or monitoring the primary and secondary health service in its area, but the specific job of managing Christie hospital, which draws on patients from a much wider area, as the Minister rightly says. The existing forum is made up of people drawn from the much wider area. The constituent to whom I referred was somebody who had an experience of treatment at the hospital, and who subsequently became a staunch friend of the hospital and a member of the forum. If we narrow the field from which a LINK might be drawn on a narrow geographical basis, it might lead to a considerable loss of expertise. Bearing in mind the point, which the Minister undertook before, that existing members of forums would have a route into the new system, he might like to consider how we might deal with what are perhaps not more than 20 or 30 specialist hospitals throughout the country, which are acknowledged centres of excellence, drawing from a very wide area.

Phil Woolas (Labour, Oldham East and Saddleworth)

I thank the hon. Gentleman for that intervention. I did not respond to the Jonathan Swift quotation, but I shall respond now by referring to Chairman Mao, who wisely said that the goat that belongs to everyone starves to death. In other words, if it is nobody’s job to do it, it does not get done. The hon. Gentleman is making an important point through the example of Christie’s, and my response to it is twofold. First, we were wise to resist amendmentNo. 198, which related to resources. Manchester city council would have to call on extra resources if it were asked to provide additional services in Christie’s, for example, through its host contract and its LINK. That would have to be reasonably taken into account. Secondly, the LINK for that area would be able to take on, under the flexible arrangements put forward, specific roles, functions and categories of membership to ensure that institutions such as Christie’s would be subject to proper scrutiny in this way and that a person from outside the area could be a member of that LINK.

Therefore we do envisage providing bespoke coverage for these very important bodies and institutions, but providing it through this framework means that it is somebody’s job to ensure that that happens. The danger in other examples—I appreciate the point the hon. Gentleman makes about the existing provision, with which I am familiar, as he would expect—is that they would fall between two stools. Therefore I agree with him and hope that he is satisfied by my response.

Tom Levitt (Labour, High Peak)

My hon. Friend’s answer is illuminating. I think that he has got the balance right. On one end of the scale, dozens of LINKs might want to make their own inspection of Christie hospital. At the other end of the scale, only the area in which the hospital stood would be able to have any input at all.

The hon. Gentleman has just spoken about people from outside a LINKs area being able to be on the LINK for that area. That is a way forward, as is the need—which I think I mentioned earlier—for LINKs to liaise with each other and for a mechanism to exist whereby a LINK that has a concern with Christie hospital is able to work closely with the LINK for that area to make sure that those concerns are taken forward.

Phil Woolas (Labour, Oldham East and Saddleworth)

I thank my hon. Friend and agree with him. That is indeed what we are trying to do. In practice, that will happen because of the cross-border relationships that exist. I have always wished that the world was divided neatly according to local authority boundaries, as that would make life more straightforward. However, he makes a fair point.

I am conscious of Committee members’ concerns about the provisions in this clause, and that they will wish to see the regulations and the result of the consultation on those. I am also conscious of the paradox always faced by Ministers in asking for a power without the regulation: not being able to promote genuine consultation and yet be not too specific for Committee members. Therefore I hope that I have answered the points to their satisfaction, particularly in relation to the meaning and interchangeability of the words “inspect”, “view” and “observe”. On that basis, I ask for support for the clause.

Clause 157

Alistair Burt (Conservative, North East Bedfordshire)

I beg to move amendment No. 205, in clause 157, page 112, line 13, leave out ‘social’.

Briefly, the amendment is about definition. This clause makes reference to the ability of a LINK to refer a matter to the overview and scrutiny committee concerning social care services, but why not health care? Does the power to refer health care matters exist elsewhere? If it does, I should be grateful if the Minister would provide details of that. If it does not, the amendment proposes putting it in the Bill. If the Minister will help us out by telling us where we might see such an equivalent power, the amendment will have served its purpose.

Phil Woolas (Labour, Oldham East and Saddleworth)

Well spotted and well predicted. The hon. Gentleman has spotted what appears to be a gap in the Bill but has predicted that there is an answer to that. He is right. For the Committee’s information, there is an existing regulation-making power in section 7(3) of the Health and Social Care Act 2001, which can be used and is used to prescribe that overview and scrutiny committees respond to LINKs on health service matters. Again, that shows the joined-up nature of Government policy—all Labour Members were aware of that provision. However, other hon. Members will know that, in practice, overview and scrutiny committees already take up the power. That is the answer to the hon. Gentleman’s successful spotting of an apparent gap.

Alistair Burt (Conservative, North East Bedfordshire)

The Minister’s masterful flexibility never ceases to enlighten the Committee. One moment he quotes Chairman Mao; the next, he professes his support for private health—and presumably for Trident. The flexibility of the modern Labour party causes us much distress, because we remember the time when he and all his colleagues carried the little red book. We knew where we were with socialism in those days—it has become a lot more complicated now.

There is no actual flexibility in the present case. The Minister is saying that the same power exists in other regulations, such that LINKs have the power to refer health matters to an overview and scrutiny committee, which is what we wanted to find out. We appreciatethe response. I beg to ask leave to withdraw the amendment.

Clause 159

Clause 160

Christopher Chope (Conservative, Christchurch)

With this it will be convenient to discuss amendment No. 181, in clause 175, page 124, line 37, at end insert—

‘( ) Sections 160, 161 and 162 shall not come into force until the Secretary of State is satisfied that a local involvement network is in place and is functioning in each local authority area.’.

Alistair Burt (Conservative, North East Bedfordshire)

I intend to vote against not only the amendment but the clause. I gave the Minister and the Whip notice of that well disguised ambush this morning, so I can scarcely be accused of being a troublemaker.

The clause relates to abolition of the functions of patients forums. I shall oppose it on behalf of all those who submitted information about the forums to the Health Committee and to this Committee, together with all those who appeared as witnesses and all who have been speaking to me and my colleagues about the issue. I do not think that we have had an adequate explanation of why patients forums are being abolished. I do not think that anything is being added to patient rights by removing the forums, nor do I think that anything is being added through what is being included in LINKs. For the reasons that I have already stated in relation to previous amendments, I believe that the powers of patients will be diluted.

I appreciate everything that the Minister has explained on the background to Government policy. However, despite the words and the intention, experience demonstrates that good intentions can often turn out in practice to be another tightening of the centralist screw that keeps control where it needs it, and makes it more difficult to hear the voice of the patient and of the ordinary citizen. We still do not really know what LINKs will be. We are pretty sure that they will not be virtual entities, although we cannot be certain. It will be left to local discretion and we do not quite know what LINKs will look like. We do not know how many people will be on the LINKs. We do not know whether LINKs will be small enough to be manageable, effective and do their job or large enough to include everyone who wants to be part, but who will therefore be rendered ineffective because of that. We do not know whether there will be sufficient money for the training of all those people, not least those who will have the ability to look at premises and inspect, monitor or audit them. However, they must be capable of doing their job, and if there are large numbers of new people, where on earth is the suggestion coming from that there will be enough funding to train them?

We do not know whether LINKs will be an authentic patient voice or drowned out by the other people who will now be encouraged and urged to join them to dilute that voice. We do not know whether the expertise of members of forums will be retained. People have already complained about being messed about by constant change. We do not know whether they will hang on in there and bring their expertise. They will not be invited to transfer automatically into LINKs should they wish, so we do not know whether that core of expertise will be retained. Despite best intentions and discussion of precisely what they will be allowed to do, we still do not quite know. Will the power of inspection indeed mean exactly what it says or has it been changed subtly to the advantage of managers and to the detriment of patients? We are concerned because we have not received an explanation.

I turn again to the evidence that was provided to the Select Committee. Leicestershire and Rutland PPI forum said:

“We fail to see why PPI Forums should be abolished rather than being enabled and encouraged to evolve in partnership with the voluntary sector. Such disruption is very disheartening to the volunteers who have invested considerable time and effort into the PPI Forums.”

Asked by the Select Committee gathering evidence,

“Why are the existing systems for PPI being reformed?”

Norfolk and Norwich University Hospital PPI replied:

“A very good question, because Forums, after a great deal of hard work, are already monitoring their areas and gathering public opinion; plus building relationships across the voluntary sector.”

I have now at last reached north Oxford. The Northern Group of Oxfordshire PCT PPI Forum was asked by the Select Committee,

“Why are PPI Forums being reformed after three years?”

to which it replied:

“The DoH has offered very little information about what they think has gone wrong with Forums, however it was the DoH which killed off the Community Health Councils and we wonder if the same kind of chop and change policy is being repeated for the sake of being seen to be doing something—anything!”

The Oxford and Bucks Area of South Central Ambulance Service PPI Forum said simply:

“It is outrageous that PPI Forums should be abolished after only two years and that the Government has been aided/abetted in this by collusion with the ‘Panel of Experts’.”

At this stage, we now put our broad concern to the Government. Widening the involvement of bodies and parties in the process of monitoring and scrutinising the health service is well intentioned, but there is a danger of losing baby with the bathwater. I do not think that any of us have had presented to us—and in all fairness, I do not think that the Minister sought to present to us—the fact that anything had gone drastically wrong with the forums. There were no criticisms of their work; no evidence was presented of how they had fallen down on their job; there was no evidence of the system being disrupted by the activities of forums; and there was no suggestion that individual troublemakers were causing difficulties for those who managed and worked in the trusts or the staff who work so hard in the health service. There was no evidence of any problems with the forum. What we see here once again is the desire to meddle and the desire to change, coupled with the sense that something is being taken away and that the power of the centre is being strengthened.

For that reason, and because those who work so hard in the forums feel so angry and upset about what has happened—but, no doubt, if the Bill is passed and the measure goes through, will commit themselves to serving the health service and patients wherever they may be, and will probably stick with it—we say on their behalf that we do not think that the forums should be abolished at all. It would have been better to take the route of reform and evolution.

We oppose clause 160. We will not vote on clause 161, although we could have done so, because it has the same effect, but we are putting down a marker. We do not think that patients forums should be abolished, and we do not think that a case has been made for doing so.

John Pugh (Liberal Democrat, Southport)

This is the latest in a series of abolitions. Community health councils have been abolished, and forums are now being abolished and replaced by LINKs. All those organisations have certain things in common: they are all essentially consultative organisations. They differ in structure, membership and influence. They are all affected by the changes. The constant change affects their ability to function and be effective. There is also a loss of institutional memory. However, to be fair, none of them is a decision maker. The decision makers in the health service are invariably the quangos. I turned to my community health council when the children’s A AND E moved out of my town. It agreed with much of what I said but was powerless to prevent the move.

Later on, consultants suggested that the adult A AND E move out of town. I turned to the patients forums and they backed me wholeheartedly. Although I was grateful for their backing, the decisive factor was a change of mind by the trust, which had as much to do with finance as it did with the delivery of services.

Looking at things in the round, the proposals are endeavouring to address a genuine democratic deficit. One would have thought that the democratic deficit would easily have been solved by making the quangos themselves accountable to local people or having local people or locally elected people make the decisions.

The Government seem to take the view that health decisions, or decisions about health services, are best made by the experts. They suppose that the people on the quangos are experts. Things being done another way appears to them to lead to madness, chaos, populism, liberal democracy or whatever. The Government basically have that rooted view.

However, there is a clever new argument that the Minister has presented in the course of these deliberations, which has also been presented by other Ministers, and that is to distinguish between participative and representative democracy. The former is a democracy in which people do not actually decide. They just in some way participate. They get consulted and informed. That is obviously better than not being consulted and not being informed, and obviously good consultation is better than poor consultation. What we are arguing about here is simply models of consultation. I accept that consultation by itself is a type of restraint. Consultation that is coupled with a power of further reference is a further restraint, but it falls a long way short of what I would like to see, which is democratic accountability. However, the Government clearly do not envisage that happening in the immediate future. All that we appear to be doing here is making a few timid steps in that direction. None the less, I am grateful for that because over the past few years, things have been moving in the opposite direction.

I cannot predict how LINKs will grow and flourish. I would not like to lay bets on what we will be saying about them in years to come. However, it is a risk to change things. There is always a risk in doing that and one always assumes that in taking the risk there must be some prima facie case that the Government are looking at that says previous arrangements have not worked as well as expected, or not done the job intended.

The Government are not saying that the patients forums have not taken the quangos to task in a sufficiently robust manner. If that was their rationale and they thought that they had a better way of doing that, I would warm to their proposals. If that is not their reason, they must have another one. The fact that they have another reason renders me fairly suspicious of their intentions and supportive of what is being moved.

Patrick Hall (Labour, Bedford)

I should like to speak to amendment No. 181. Before doing so, may I just say that I would not want the further champagne moment on amendment No. 219 to be allowed to pass unnoticed. I am surprised that the hon. Member for North-East Bedfordshire forgot to mention it. Amendment No. 181 is designed to provide a proper transition between PPI forums and LINKs, so the position is not the same as that which the Conservatives have taken. If LINKs come about, we will have to deal with how we go from where we are now to where we want to be. My understanding is that the Bill will be enacted by the end of this year—assuming that it achieves Royal Assent, that is—and that patients forums and the commission will be abolished, say on31 December this year, with LINKs coming into force the day after. Whenever that happens, there will have to be a means of dealing with the changeover as cost-effectively and smoothly as possible.

Alistair Burt (Conservative, North East Bedfordshire)

I am grateful to the hon. Gentleman for giving way because, first, he has given me an opportunity to acknowledge his genuine champagne moment in achieving an amendment. We should accept it, because we know that he will be generous with the champagne on being successful. Secondly, on his point about transition, he will remember the long-drawn-out demise of the CHCs and the difficulties in staffing, contracts and everything else. He will want to make the point to the Minister that surely we do not want to go through that again.

Patrick Hall (Labour, Bedford)

I do not need to make that point, which I was going to make, because the hon. Gentleman has just made it for me, which is absolutely fine. If LINKs come about, I am sure that the hon. Gentleman and others from all parts of the House will want the system to grow and to start as strongly as possible.

The new duty on local councils to contract for LINKs will come into force at the right time after the abolition of the forums, but that is not the same as LINKs being in place and fully functioning on the day after forums cease to exist. It is important that we consider such matters, because if there is a hiatus, or confusion and gaps of one kind or another up and down the country, we will miss out on the opportunity to get the public involved in something that many may wish to do, including those who are not the sort to have been involved in committees in the past and might not have been on CHCs or patients forums.

We might also miss the opportunity to have as many members of patients forums as possible joining LINKs. The Minister of State, Department of Health, my right hon. Friend the Member for Doncaster, Central(Ms Winterton), has gone out of her way to say again and again that there would be nothing better than for all members of patients forums to become members of LINKs. LINKs would involve many more people than just those people; none the less, they would form an important basis of stability for the new LINKs. However, if we do not have a proper transitional arrangement, some of those people will disappear and opportunities will be lost.

The concept of LINKs, in the way that the Government have presented it, is highly ambitious. We have never tried anything like it before. It is easier to think in terms of the committee—we are all used to committees. Local government wants to have the new responsibility and welcomes it. That is welcome, but we saw in our evidence sessions that although the leaders of local government whom we questioned very much supported the principle of LINKs, they had not had the time to go into the detail, which I fully understand. I suspect, therefore, that the level of awareness throughout the country of what will be needed, in setting up hosts and so on, will be variable to say the least.

Bedfordshire is already quite well advanced on that, however. I recently met two members of staff from Bedfordshire county council whose job it is, or will be, to concentrate entirely on helping to deliver the links of the LINK in Bedfordshire. However, that will not be the case everywhere and there will be variable states of readiness. Once the legislation is in place, we will need to wait for further regulations and guidance. Consultation on some of those documents will be needed, which is welcome. Budgets will need to be in place. Advertisements will need to be published to attract potential host organisations, and discussions and negotiations will be needed with host organisations about what is needed in particular parts of the country. That will all take time.

We all want the process to take whatever time is necessary. We hope that it will not drag on for too long, but it needs to be done properly if it is to be done at all. I will need some persuading to believe that it will take place by 1 January next year. Some comments from my hon. Friend the Minister on that point would be welcome. If that should prove to be the case and it should be obvious by 1 September that the delivery will not take place throughout the country, I hope that my hon. Friend will be able to show willingness and open-mindedness towards delaying the abolition and so on of the forums and the commission by three or six months to ensure that the new system, when it starts, works as fully as can be expected and, to use a phrase that is used increasingly in government and elsewhere, that there is a seamless transition and service.

Philip Dunne (Conservative, Ludlow)

I rise to support the amendment of my hon. Friend the Member for North-East Bedfordshire and to probe the Minister on one or two aspects of the intent behind his determination to abolish a body that was set up by the Government only three or so years ago—

Phil Woolas (Labour, Oldham East and Saddleworth)

Five.

Philip Dunne (Conservative, Ludlow)

I believe that it came into effect in December 2003. Why did the Government not learn the lessons from setting up the patients forums in whichever year that took place? We must remember that everyone who sits on a forum does so voluntarily, and 4,500 people around the country have developed expertise and experience in similar things to what the LINKs will be expected to do. It seems most perverse not to take advantage of that experience. My understanding is that when the CHCs were abolished members were allowed to become members of the forums. They were not encouraged; it was not an automatic process, and as a result the development was haphazard. Some joined, some did not.

If we must have LINKs, why not base them on the forums? Instead of transferring the assets of the forums back to the Department of Health, the assets and personnel should form the core of the new LINK. That would seem a logical progression, and a perfectly sensible and joined-up thing to do. The Government could benefit from the individuals’ expertise. If some did not want to participate as a member of a LINK, fine. They could look for other people to take on that role. I have yet to hear a single argument from a Government Member about why it is appropriate to proceed in the way that they propose.

Let me pick up on the point made by the hon. Member for Bedford about transition arrangements. He mentioned what is happening in Bedfordshire country council, and he will not be surprised that Shropshire needs to get a look in. Shropshire has thought ahead—because the provisions in the Bill do little to help determine how the LINKs will be established—and will convert the forum into a LINK. The county council has set up a body whose title does not easily trip off the tongue: it is called the Shropshire PPI self-adopter committee. The chairman of the Shropshire County primary care trust PPI forum has been appointed as a facilitator, effectively to step into that role and to start to work with interested bodies on how the LINK should be formed. That is clearly a sensible model. The Minister might say that that is what should happen around the country. I hope that he will, because it will show that Shropshire, as usual, is ahead of the Government and ahead of the game—well, for the purposes of this Committee, it shares that honour with Bedfordshire. If he does not say that, he must explain what he expects the existing forums to do. I hope that he will take this opportunity to do so.

Tom Levitt (Labour, High Peak)

I begin by echoing a few points that I made earlier. First, I do not think that there is anyone in the room who does not regret having had to go through two reorganisations in such a short space of time. Obviously, it would have been better if we had not had to do so. Secondly, “abolition” is a very emotive word, but it is also a technical term that is necessary to the Bill. If clauses 160 to 162 were called “Seamless merger of patients forums etc.”, I am sure that there would not be any such problem.

Andrew Stunell (Liberal Democrat, Hazel Grove)

Does the hon. Gentleman recognise that “execution” is also a technical word—with a very specific meaning?

Tom Levitt (Labour, High Peak)

It has several specific meanings. The hon. Gentleman executed his intervention very well indeed. Just as an aside, I recall that 10 years ago almost to the day, the hon. Gentleman and I—the Tories did not turn up—were debating health policy at Stepping Hill hospital. One question was, “Could you explain the fundamental difference between the health policies of your two parties?” The hon. Gentleman expounded Liberal policy at great length, and when it was my turn to reply, I said, “The difference is that we will put ours into practice,” which we are and have been doing successfully.

Everyone accepts that there were some very good community health councils, but that equally there were others that we did not hear of, and others still that we would rather not have heard of, because they did not do their job as well as others. I do not know the forums’ movements quite so well, but I hazard a guess that the same is true now.

Indeed, the hon. Member for Ludlow just reminded us that there are 4,500 forum members in the country, which averages out at seven people per constituency. I know only one member in my constituency, although that may be my fault, because there may well be more. However, an average of seven people per constituency does not represent a huge level of public involvement.

Alistair Burt (Conservative, North East Bedfordshire)

I am following the hon. Gentleman’s argument closely. If, as part of a national body, a number of organisations are under-performing, is not the right answer reform, rather than abolition of the whole lot?

Tom Levitt (Labour, High Peak)

The hon. Gentleman is right. I am about to spell out why the need for that reform—at the moment—is fundamental. Indeed, there are opportunities for reform which did not previously exist. There are three reasons why there must be reform now. First, to stop the trichotomy between the good, the not so good and the best, the LINKs or the patient involvement forums—whatever form the bodies take—must be subject to scrutiny and oversight. The Bill links that—with a small “l”—to the local authority process of scrutiny, which only three or four years ago was still in its infancy. There is now in local authorities a more mature system of scrutinising what happens not only in the local authority world, but in the public sector generally.

Secondly, we must expand the sphere of influence and take in care, which means examining how the voluntary and private sectors provide care. That in turn would involve legal changes to the patient involvement process. Thirdly, there is now a huge grey area between local authorities and health bodies and their responsibilities for promoting public health. Barriers have been imposed on what forums can scrutinise and examine, and it is necessary to break them down. Those are three reasons why we can improve on what we have now, and we must move forward.

Throughout the Bill, but particularly during the few hours in which we have discussed part 11, I have been impressed with the way in which the Opposition, and the hon. Member for North-East Bedfordshire in particular, have taken such a constructive view and engaged with the Bill. However, by voting against any one of the three clauses, he would be suggesting that we should have LINKs as well as the forums. That would be the consequence of voting against any of the clauses, unless, of course, he votes down the whole Bill. I think that he would agree that if we did not have a patient involvement process at the moment, he would be hard pushed to fault the proposal for LINKs. Only the fact that we are moving from one process to another is causing disruption.

I refer the Committee to our earlier proceedings when I put the point about abolition to the Minister of State, Department of Health, my right hon. Friend the Member for Doncaster, Central. She replied:

“We need a strong body that is able to scrutinise decisions and increase patient and public involvement rather than organisations that are, in a sense, tied to institutions, as patients forums are. We want the members of the forums to be involved in the new LINKs.”——[Official Report, Local Government and Public Involvement in Health Public Bill Committee, February 2007; c. 110.]

There are only a small number of forums, and quite frankly, in many parts of the country, they do not have a high public profile. Furthermore, they are not linked to the democratic process and to democratic accountability—points made by the hon. Member for Southport. Those concerns must be addressed. We have a local authority scrutiny process, which was not available before, but into which we can tie the new proposals. I hope that we can get over the emotional response to the word “abolition”, and move on in order to build a better process, seamlessly, on new year’s day.

Phil Woolas (Labour, Oldham East and Saddleworth)

I thank hon. Members for the debate so far. It occurs to me that when the Government propose the abolition of a quango, we are accused of getting rid of accountability. When the Conservative party proposes the abolition of regional assemblies, which would hand power back to Whitehall, it puts forward its argument for greater democracy and accountability.

Alistair Burt (Conservative, North East Bedfordshire)

The Minister admits much.

Phil Woolas (Labour, Oldham East and Saddleworth)

I admit much, but I am consistent on that point. I suspect that the hon. Gentleman knows that.

The hon. Gentleman makes a strong case. He asks the questions that it is the duty of the Opposition to ask: are we making change for change’s sake, and, if we can convince the Committee that it is worth it, will the change be made in a way that is beneficial? Those are his two fundamental questions. He asked the first not just from the point of view of the Opposition, but from that of Conservative policy, with which he is consistent. He is quite right to ask those two questions and it behoves me to persuade the Committee that the case for change is strong and not to repeat the arguments made by my hon. Friend the Member for High Peak, in order not to duplicate comments.

It has been five years since the legislation that established patients forums came into effect. It was taken through Parliament in 2001-02. Evidently, there has been significant change in health and social care provision during those five years. The Government believe that the arrangements are needed to support a stronger voice for users and citizens and to keep pace with that change, and that a system based on the scrutiny of individual institutions is no longer appropriate. We want the new system to be able to consider both health and social care so that arrangements to promote and amplify the voice of users and the public can be joined up across the entire system.

The hon. Member for North-East Bedfordshire raised the fear that the focused voice of patients could be swamped if the Government are successful in their goal of widening participation. On the contrary, such a strengthened body, involving a swath of voluntary organisations, and support, patients and carers groups, and so on will in fact strengthen the umbrella body of the LINKs and give greater weight and authority to the focused voice of patients, in particular owing to a more widespread and professional approach.

As my hon. Friend the Member for High Peak hinted, there is a patients forum for every NHS trust, foundation trust and primary care trust in England. Each forum has on average eight members who, although I do not criticise their work at all, clearly do not represent all the people in the areas covered by their trusts. Forum members tend to speak about their own concerns—that is understandable; it is what we have asked them to do—rather than about those of the wider community. Membership of forums is formalised through a process that tends to be exclusive. I recognise that that was wrongly anticipated in the legislation. Thus they attract only a narrow section of the population. The LINKs, by contrast, are intended to seek the participation of a wider group of people, including members of voluntary and community sector organisations and individuals from each local area, and do not involve a formal appointment process.

The proposed changes are necessitated by the significant changes that are taking place in the health and social care system—for example, the changing configuration of primary care trusts; the changing role of PCTs in relation to the commissioner of services; and the move towards the joining together of PCTs and social services, which is a key aspect not just of better provision of services but of covering the health and social care of our population in an efficient and affordable way. The movement that has occurred in Herefordshire, where the PCT and the social services are joining together in a single trust, is of enormous importance. Notwithstanding that example, the local area agreement process and the other measures in the Bill are bringing together the partners in this sector. In order to reflect those changes, we need an accountability framework as well as the performance framework that we have already debated.

We are also moving towards greater choice in service delivery. There is a more comprehensive range of means of delivery, and quite right too. The edges between the statutory sector and the private independent sector are becoming blurred, to the benefit of patients and citizens more widely. Finally, on this point, the increased joint commissioning across health and social care is important.

Opposition Members and colleagues on my side of the Committee would be right to ask, “Where have these changes come from? Are they a bolt from the blue?” It is possible to follow the development of policy over the past seven to eight years, including at the time when the patient forums were being introduced. Hon. Members may have seen House of Commons Library research paper 07/01 on the Bill. The Library should be commended for the excellent way in which it presents such information for our benefit. That document points out on page 92:

“On 22 July 2004 the Government published the report of a review into NHS ‘arm’s length’ bodies. John Reid, then Secretary of State for Health, announced that the number of such bodies would be reduced, saving at least £500 million—”

that is from a Government who are accused of establishing quangos; the reality, in that area as in all areas, is the opposite—

“and increasing resources that could be channelled directly to frontline NHS patient care. One of the ‘arm’s length’ bodies affected was the Commission for Patient and Public Involvement in Health, which would be abolished.”

We will come on to that when we consider clause 162. The document continues:

“The review document said...Stronger more efficient arrangements to provide administrative support and advice to Forums will be put in place.”

That was written in July 2004.

The research paper points out that the Commission for Patient and Public Involvement in Health, which was involved in the review, took part in the review of patient and public involvement that followed the 2004 report. Extracts from the overview paper that it submitted to the expert panel set up by the Government early in 2006 are reproduced in the report. I advise the Committee to look to the words of the commission:

“The Commission argued that it was not feasible to continue with the current system and instead recommended a system of local networks.”

Its description of the failings of the current system included

“the high levels of frustration within the system caused by discordance between vision in legislation and implementation”.

That may be a fault of legislation as well as of implementation, I admit, but it is real nevertheless. Secondly, it states that the Department of Health emphasises that

“the service improvement function, monitoring and review of services is too often the sole pre-occupations of Forums.”

Thirdly, it says:

“Too much has been expected of too few people. It is unrealistic to expect volunteers, however committed, to do all the things that are expected of Forums to improve all of the NHS services in their area, as well as to engage the wider community in holding the NHS to account.”

It then deals with other problems, not criticisms of the activities of the individual, and it recommends the setting up of networks similar in concept to those that we are debating now.

The force majeur for change is to be found in the evidence of what is happening on the ground. It is a result of the changes that are taking place. It is not reform for reform’s sake. It is creating a framework of accountability to supplement the other changes proposed under the Bill within the framework of sustainable community strategies, the statutory duty to co-operate on partner organisations and local area agreements. One of the four main funding streams is meant to join health and social care in order to provide services to suit the individual rather than the service provider. I believe that the case for change is strong.

Amendment No. 181, tabled by my hon. Friend the Member for Bedford, deals with my hon. Friend’s concern that organisations should not fall between two stools. My contention is that all patient forums as well as the commission should remain functional until all links have been established. If only one local authority were slow to establish a link for its area, every other area would have to run the two systems in parallel. Not only would that be impractical, but it could be hugely expensive. To meet the hon. Gentleman’s second point, my hon. Friend is keen to ensure that change is done in a way that will lead to improvement. He is right to point out that the Government should not and cannot be hasty in implementing those changes.

There is no commencement date on the measures before the Committee, but we envisage that it will be in the spring of 2008. Many of the measures that have been put forward in the Bill ensure that new frameworks are in place for April 2008. That is the beginning of the three-year spending period within which we intend to provide stability for the funding of public services. It explains why we are going through what we are going through in terms of PCTs’ historic deficits. It explains why we are creating the new accountability framework. It explains why, in my answer to the hon. Gentleman about the commencement date of the new performance risk management, I said that 2008 would be a desirable date. That puts into the jigsaw that crucial piece required to ensure service improvement in a devolved era—namely, allowing participation by a wide group of patients and potential patients in the improvement of services.

Patrick Hall (Labour, Bedford)

I find my hon. Friend’s remarks very helpful. When he referred to spring, I presume that he meant that the new system would be under way by April 2008. That gives us a bit more time. However, in order to prepare, money will need to be spent up front. Will he address that point in order to give us further reassurance?

Phil Woolas (Labour, Oldham East and Saddleworth)

I think that I can give that reassurance through the general powers of local authorities—they will be watching the progress of the Bill closely—and the money that will be made available through the new burdens procedure, because that procedure and the agreements with Her Majesty’s Treasury concerning in-year spending apply. It is obviously desirable that commencement dates coincide, when possible, with financial years. For some reason, the financial year in this country runs from April to the following March. I have never understood why, but it is probably something to do with accountants’ holidays. We have criticised lawyers, but let us not go on to accountants.

I hope that I have convinced the Committee that the case for change is strong. I also hope that hon. Members are convinced that that will provide the direction of travel, which they say they want and which we want, towards more devolution and decentralisation. I ask the Committee to resist the opposition to the clause.

Alistair Burt (Conservative, North East Bedfordshire)

I appreciate the Minister’s comments, and I shall not bat each and every one back to him. The Library’s very good research paper enables me again to quote the then Minister, Melanie Johnson, on page 91. When the Government announced in July 2004 that the Commission for Patient and Public Involvement in Health would be abolished, she made it clear in relation to the forums:

“They will not be abolished, nor will their independence be undermined.”

That commitment has obviously been broken.

Secondly, I draw attention to the fact that we have forced from the Minister the tough expression that effectively the patient forums are the wrong people to do their job. They are being blamed for the fact that although they volunteered, others did not, and that is why they are seen to be exclusive.

Tom Levitt (Labour, High Peak)

Will the hon. Gentleman give way?

Alistair Burt (Conservative, North East Bedfordshire)

No, I will make my point. I hear what the Minister says, and I know that it comes from the commission review—that is my third point—which is again a top-down analysis of what is wrong. That contrasts with the evidence given by forums to the Select Committee. It is a difficult point. I know that the Minister is not criticising the individual members of the forums—no one here has done that—but somehow, because they do not institutionally represent a wide enough group of people, that seems to be their fault, and yet another attempt is being made to broaden, deepen and widen. That attempt was made when the forums were set up after abolition of CHCs in 2000. What will happen if the right people do not come forward to provide the base material for the LINKs? Will they too be scrapped?

The feeling is left that those who constituted CHCs and the forums have, despite their best efforts, not quite performed institutionally as the Government wanted, so they are digging them up and starting again. How many times will that be done? A line should be drawn in the sand on their behalf to say, “Enough”. We take the Minister’s point, but we do not agree. There is a question mark over the process that has left so many people at grass roots level dissatisfied. Accordingly, I move that the clause does not stand part of the Bill.

Clause 162

Patrick Hall (Labour, Bedford)

We are now considering the abolition of the Commission for Patient and Public Involvement in Health. The word “abolition” is in the Bill and has definite meaning. However, it would be wrong to pass this clause without making one or two remarks about the commission, which, despite living under a sentence of execution for a long time, has continued to do what it was asked to do by the Government when it was first set up. It has helped patients’ forums to carry out a number of important tasks, which I mentioned earlier. Those tasks have a wider dimension than what is going on in a particular locality. I am referring to such things as national surveys on the use of telephones in hospitals and the quality of food in hospitals, and the current survey on personal dignity in hospital wards. It is unlikely that those things would have been done had they been left to individual forums. That goes back to the point that I made about the need for a national dimension to be organised.

I understand what the clause is about, but we should not let it pass without at least acknowledging that the commission has done what it was asked to do and has continued to do that in what have been conditions of uncertainty for some time now. We should thank the staff of the commission for sticking to the job that they were asked to do. Judging by what my hon. Friend the Minister said, abolition will take place possibly in March or April next year. I am sure that between now and then the staff will be professional enough to continue to carry out their task as they have done thus far.

Phil Woolas (Labour, Oldham East and Saddleworth)

A previous clause—clause 160—related to the functions of patients forums, and the next clause, clause 161, related to the patients forums themselves. We now come to the commission. My hon. Friend is a long-standing supporter of patient involvement. I take his words very seriously and I hope that they are read and understood outside the Committee—indeed, I am sure that they will be.

You allowed me to range widely in speaking on clause 160, Mr. Chope, and I do not want to repeat my argument. I attempted to convince the Committee that the changes proposed in these clauses represent an evolution of policy, notwithstanding the debate about abolition and the way in which the hon. Member for Hazel Grove saw it. I genuinely believe that this is a move in the right direction, which will benefit patient involvement.

Clause 163

Alistair Burt (Conservative, North East Bedfordshire)

I beg to move amendment No. 206, in clause 163, page 117, line 4, at end insert—

‘(e) any other organisation contracted to provide care services;’.

The first amendment relating to this clause brings us back to familiar territory. In this case, we are simply trying to widen the duty of consultation in relation to what appears to be a restrictive list, which we have seen in other places in the Bill. The amendment would widen the duty to consult to include

“any other organisation contracted to provide care services.”

It is a simple recognition of the modern provision of health care. Will the Minister remind us why he does not feel that that needs to be included and why such bodies are not covered? That would be helpful.

To reiterate, we are seeking clarification on the clause to ensure that all the bodies that we wish to be involved in consultation are involved, just as earlier we wished such bodies to be inspected and to be able to respond to all the various other parts of the job of LINKs. The amendment would extend the power of consultation to include the other commissioning bodies.

Patrick Hall (Labour, Bedford)

I thought that the hon. Gentleman would take it in that way. Who knows? His proposal in amendment No. 206 may well be covered in other legislation, as he detected earlier from his ministerial experience. Does he agree, in terms of general common sense and use of English, that when such things happen in legislation, perhaps there could be a note stating, to help those reading the current draft, that there is a link somewhere else, so as to keep us in the picture?

Alistair Burt (Conservative, North East Bedfordshire)

That would be helpful, but those who work on Bills are under exceptional pressure, from my memory of those who work to assist Ministers in drafting and publishing clauses, and already have an enormous amount to do. Adding yet another aide-mÃ(c)moire for us might be asking them to go a little bit too far. Perhaps it could be covered in the notes to the legislation.

I think that we have made our point. This is a simple probing amendment to extend the duty to consult, unless the provision is already there somewhere else. I hope that the Minister will respond.

Phil Woolas (Labour, Oldham East and Saddleworth)

The answer to the hon. Gentleman’s question—I am grateful to him for giving me time to find it—is set out in section 242 of the National Health Service Act 2006. It covers both health and social care by using “care services”, which he used in amendments to previous clauses in part 11 of the Bill. We agree that the duty should be extended, which is why, as has been rightly said, the measures are an add-on to existing legislation.

The point about a note in the Bill was debated by the Modernisation Committee, and the explanatory notes provided work in that way. I understand that the hon. Gentleman’s point of view was resisted, and I add the other argument that it is helpful for the Minister to be able to draw on such examples to show that the policy is joined up. Section 242 of the National Health Service Act 2006 refers to section 11 of the Health and Social Care Act 2001.

Alistair Burt (Conservative, North East Bedfordshire)

The explanatory notes do, indeed, refer to section 242 of the 2006 Act, but do not indicate that that particular point was covered. My reading tonight must include section 242; then I will be, if not wiser, better informed the next time we discuss the measures. With that, I beg to ask leave to withdraw the amendment.

John Pugh (Liberal Democrat, Southport)

I beg to move amendment No. 223, in clause 163, page 117, line 9, after “representatives”, insert

“which shall include Local Involvement Networks”.

Briefly, the amendment deals with proposed new section 242(1B) of the 2006 Act:

“Each relevant English body must make arrangements, as respects health services for which it is responsible, which secure that users of those services are, directly or through representatives, consulted on”.

We wish to include the words

“which shall include Local Involvement Networks”.

The argument against our amendment is that that is tacitly understood or implied, but it is not actually spelled out, so the right of local involvement networks to be consulted at that point is not in the Bill. The amendment could be dealt with easily if the Minister expanded a little bit on the meaning of “representatives” and put on the record that the representatives would necessarily include the LINKs.

Phil Woolas (Labour, Oldham East and Saddleworth)

It does seem that a gap in the Bill may be created by not specifying the point that the hon. Gentleman is making. I will make it explicit that the NHS should consult. The Bill requires the NHS to consult LINKs. However, I recognise that it is a question of balance. Although we would expect NHS bodies to consult LINKs as a matter of course, the danger of singling them out in legislation is that it may provide cover to NHS organisations that only want to consult LINKs. There are examples of bodies only consulting the organisations specified in legislation.

The objective of Government policy would be that, in not too many years to come, organisations including LINKs would be consulted as a matter of course. It is a question of balance. We sought to ensure that NHS would consult LINKs through the mechanisms and procedures of contracts that we put in place. Specifying such a course of action may be used as an excuse not to consult other bodies. Much of the Bill is about the duty to consult and involve.

John Pugh (Liberal Democrat, Southport)

I beg to ask leave to withdraw the amendment.

Alistair Burt (Conservative, North East Bedfordshire)

I beg to move amendment No. 207, in clause 163, page 117, line 11, leave out ‘significant’.

Christopher Chope (Conservative, Christchurch)

With this it will be convenient to discuss the following amendments:

No. 208, in clause 163, page 117, line 13, leave out ‘significant’.

No. 222, in clause 163, page 117, line 14, at end insert—

‘(1BA) for the purposes of subsection (1B)(c) decisions affecting the operation of services shall include any decision that changes the organisation responsible for any of the services that are delivered.’.

No. 209, in clause 163, page 117, leave out lines 15to 20.

No. 210, in clause 163, page 117, leave out lines 21to 26.

No. 233, in clause 163, page 117, line 26, at end insert—

‘(c) the physical access and travel to those services by users.’.

No. 217, in clause 163, page 117, leave out lines 27to 29.

No. 218, in clause 163, page 117, line 30, leave out ‘subsections (1B) to (1E)’ and insert ‘subsection (1B)’.

Alistair Burt (Conservative, North East Bedfordshire)

I shall be succinct, rather than brief, because this is a serious matter. To those of a suspicious cast of mind, the introduction into the clause of “significant” and “substantial” is worrying. Surely that indicates a mechanism by which consultation can be restricted. It appears that this is a mechanism to cut out concerns that were considered trivial when raised in the past by those on forums. Who is to decide what is substantial and significant? It is suggested that the provision will avoid needless consultation on trivial matters. However, there is a danger that those deciding what is significant and substantial may not have the same point of view as, for example, those representing patient interests.

As well as mentioning the representations that we have received from forums, I again draw attention to the submission made by the Commission for Patient and Public Involvement in Health, which has drawn attention to those concerns. It said:

“There is a crucial difference between this clause and the previous legislation”—

the aforesaid section 242. It continued:

“Whilst CPPIH welcomes the government’s recognition of the need for clarification of when the duty to consult applies, we are concerned that under the Bill’s proposals this duty may apply in only a narrow range of circumstances.”

We would echo that.

Patrick Hall (Labour, Bedford)

On the debate about the meaning of “significant”, the hon. Gentleman is probably aware that the Health Committee has considered this matter and suggested that “substantial” is better. However, I am not sure what the difference is. I am not trying to put the hon. Gentleman on the spot, but would he find that word more acceptable? If he does, it would be useful to know why.

Alistair Burt (Conservative, North East Bedfordshire)

The hon. Gentleman’s last point is the most important. I am at a loss to know why this change should be made and I am also at a loss to know what the Health Committee will say, because it has not reported. I am sure that he would agree that knowledge of the conclusions that it had come to would have informed this Committee. Be that as it may, the question is this: why has the measure been introduced? Surely it is a restriction of the ability to consult, which looks as though it is damaging to patient interests rather than permissive and helpful to them.

John Pugh (Liberal Democrat, Southport)

I shall speak briefly to amendment No. 233. Given what the Minister has said, I do not think that there is any doubt in the minds of anyone in the Committee that significant change could involve changes in access to travel arrangements. Amendment No. 233 would add an additional paragraph, following on from paragraphs (a) and (b) of proposed new subsection (1D).

Looking at paragraphs (a) and (b) led me to question whether we were adding anything new, because there is recognition that that sort of thing should be captured in the paragraphs. As best I read paragraphs (a) and (b), I could not see that they implied what I wanted to put in or that they were logically equivalent to it. Given the Minister’s previous emphasis on the importance of transport arrangements as an aspect of service delivery, I commend the amendment to the Committee.

Patrick Hall (Labour, Bedford)

I shall speak briefly to amendment No. 222, the purpose of which is to ensure that there is an explicit duty to consult on decisions to outsource health services. I do not mean cleaning or catering services, but health services.

The issue arises from the outcome of a judicial review that was brought last year by an individual against the decision of the North Derbyshire primary care trust to tender for the provision of a family doctor service in north Derbyshire, a proposal about which the trust did not consult the public. That led to intense ideological debate around the fact that the tender was won by a United States healthcare giant called United Health, known in this country as United Health Europe.

My amendment does not tread on that territory, however. It addresses the duty to consult users of health services and the outcome of the High Court judgment in June 2006 that the duty may apply to contractual changes. That outcome was not altered by the Court of Appeal’s judgment in August that the decision to award the contract be quashed and the tender process started again with public consultation. I want to ensure that changes in providers of health services which are proposed by primary care trusts are subject to the duty to consult.

Phil Woolas (Labour, Oldham East and Saddleworth)

The group of amendments is wide ranging. The hon. Member for North-East Bedfordshire was brief and concise, and raised an important point about the inclusion of the word “significant”. Let me explain where we are coming from. The changes that we are making are to section 242 of the National Health Service Act 2006, which was formerly section 11 of the Health and Social Care Act 2001. They are important changes, the reasons for which I should like to explain.

As it stands, section 242 is a wide-ranging duty on the NHS to involve and consult patients and the public. It does not recognise the different scale of changes, however, and the fact that it might not be meaningful for NHS bodies to apply the same duty to involve and consult for all the changes that they make, however minor they may be. Furthermore, without some kind of threshold, the duty has the potential—this is a genuine fear—to bring about that often heard complaint of consultation fatigue. We are trying to ensure that the changes to service delivery that affect patients and service users are subject to consultation, but that minor, day-to-day decisions, which we fear could be subject to mischievous or vexatious interpretation, are not. By inserting the threshold, we are aiming to ensure that when a change has a significant impact on the range of services and the manner of their delivery, the consultation required by section 242 is undertaken. Without such a threshold, we fear that NHS bodies would have to consult patients and the public on even the most trivial changes.

Alistair Burt (Conservative, North East Bedfordshire)

Who decides a dispute? What happens if LINKs believe that a change is significant, but those who are delivering it do not?

Phil Woolas (Labour, Oldham East and Saddleworth)

The scrutiny regime that is being created would have a view on whether a change was significant. It would ultimately be a matter for legal interpretation. The professional inspectorate would also have a view of what constituted a significant change. If a hospital seeks to hide behind the idea of significance by saying that a change is not significant, we would point to those aspects of the legislation that refer to the delivery of services. The Government are attempting to take away some of the management operational decisions of trusts—I would not quite call them trivial—as opposed to the direct delivery of services.

Andrew Stunell (Liberal Democrat, Hazel Grove)

I suspect that everybody in the Committee understands that there is a level of triviality to which consultation ought not to descend. However, hon. Members will know of plenty of examples of individual cases that may in themselves be insignificant, but which have a much broader application. For example, complaints about a particular ward on a particular day may be said to be trivial or insignificant, but may be part of a broader pattern. Will the Minister throw some light on the grey area that the current wording of the Bill creates?

Phil Woolas (Labour, Oldham East and Saddleworth)

My argument is not that day-to-day management decisions do not have an impact on patient services, and I hope that it has not been interpreted that way. In some instances, such decisions can and do impact on patient services. By giving examples, I might be better able to explain the intent behind the measure. In every case, whether an issue is significant or substantial will be determined by a number of factors. A reduction in bed numbers, for example, might result from there being too much capacity in the hospital, or because there are other means of providing care that makes a number of beds superfluous. A GP may change their opening hours because services are being provided in a different way, but without any noticeable change for patients. NHS bodies will need to weigh up each case and apply the threshold appropriately.

The key is to ensure that patients and the public are properly consulted in planning for the provision of services. That is important in relation to section 242. The measure allows NHS bodies to plan and deliver effective consultation activity that is more likely to be meaningful to the patients and members of the public that it will involve. The crucial argument is about what affects patient services, the planning of decisions by NHS bodies, and the consultation of public and patients. The definitions of the words “significant” and “substantial” are open to interpretation, as with the word “reasonable” in a court of law. Cases on the cusp of the definitions will give rise to controversy. The Government are trying to ensure that there is meaningful consultation over the planning for the provision of services.

Amendment No. 218 is a consequential amendment that follows on from amendments Nos. 209 and 210, so I do not need to speak to it.

Having looked carefully at amendment No. 222, we consider that it will have no effect on what the clause already provides. If there is a change in the provider of services, the requirement to consult already applies assuming that there will be a substantial impact on the manner in which the services are delivered to their users. If, as I believe, the amendment is intended to extend that to any change of service provider, even if it has no effect on the manner in which services are delivered to users, we do not support that. It is likely that service providers will change over time, but just because a provider changes that does not necessarily mean that the service will too. We do not believe that it is sensible to consult patients and the public when the only change is to the name of the organisation providing a service.

Patrick Hall (Labour, Bedford)

Does my hon. Friend not acknowledge that even if what he says about the service not deteriorating or changing is absolutely right—presumably the reason for changing the provider is to improve the service—it is legitimate for the public to be concerned and ask questions about what might in some cases be perceived as the privatisation of national health services? Surely that is a perfectly legitimate matter for the public and others to engage in.

The rest of the debate is in Hansard.