Health and Social Care Bill

Public Bill Committee, 10 March 2011.

Clause 50

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I beg to move amendment 344, in clause 50, page 62, line 20, at end insert—

This minor and technical amendment will ensure that clause 50 functions as intended. New section 247A of the National Health Service Act 2006, which the clause inserts, will require co-operation between the Secretary of State and other people or organisations engaged in health protection activity, to ensure a joined-up approach to fighting the spread of disease and other dangers to health. Most provisions in the Bill extend to England and Wales only, but apply only to England. However, by virtue of clause 280(3), the intention is that clause 50 will apply across the UK, including the areas covered by the Governments of the devolved Administrations.

It is important that the Secretary of State can co-operate with the relevant authorities in other countries to protect the UK and international health. The amendment is necessary to ensure that the Secretary of State is able to provide assistance outside England under his duty of co-operation. Section 271(1) to the 2006 Act states that the functions of the Secretary of State

“are exercisable only in relation to England.”

The amendment will disapply the section and allow the Secretary of State to provide assistance outside England under his duty of co-operation, for example, by assisting developing countries to develop strategies for fighting disease.

Clause 192

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I beg to move amendment 345, in clause 192, page 163, line 3, leave out ‘by virtue of’ and insert ‘under’.

Mike Hancock (Liberal Democrat, Portsmouth South)

With this it will be convenient to discuss Government amendments 346 and 347.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

These amendments to section 276 and schedule 17 of the 2006 Act are consequential provisions in clause 192. The clause replaces sections 146, 149 and 150 of the 2006 Act with two new sections that enable the NHS commissioning board to make regulations that make provision for the preparation, maintenance and publication of lists of performers of pharmaceutical services.

Amendment 345 makes a minor alteration to the wording of new section 147B so that it reads “under” rather than “by virtue of”. Amendment 346 removes from the index of defined expressions in section 276 the words “supplementary list”, as that definition is no longer necessary. Amendment 347 amends paragraph 13(1)(b) of schedule 17 to the 2006 Act to ensure that the provision will contain the correct reference to new section 147A, instead of section 146, which is being repealed.

Clause 166

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I beg to move amendment 415, in clause 166, page 139, line 2, after ‘with’ insert ‘information and’.

Mike Hancock (Liberal Democrat, Portsmouth South)

With this it will be convenient to discuss amendment 348, in clause 166, page 139, line 2, at end insert

‘and the Commission shall respond in writing to the committee about its response or proposed response to the advice’.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I will speak primarily to the Government amendment—the lead amendment. It is perhaps worth saying at the outset that I am aware that some people argue that HealthWatch England should be a separate organisation from the Care Quality Commission, or should have a greater degree of independence from its workings. I certainly understand their concerns. I also understand the strength of feeling behind ensuring that the patient voice is heard throughout the health and care system. However, let me explain why I believe that having HealthWatch England as a committee, as part of the Care Quality Commission, is the right choice and very much in the interests of patients and service users.

As hon. Members will know, our vision for the NHS is built around the patient. It includes bringing commissioning decisions closer to patients through the establishment of commissioning consortia. It also includes the provision of far more information about the quality of services through the information revolution, on which we published a consultation last year; we will publish our reply to the many responses we received to that consultation in due course. However, the new NHS will not deliver on that ambition if we do not make sure that patients have a stronger voice in the system. We have considered how best that can be achieved and how the patient voice can be amplified through the new NHS commissioning architecture. As part of the CQC, HealthWatch England will have a real influence. It will work in partnership with the commission, with the clear ability to escalate local concerns.

As the National Institute for Health and Clinical Excellence said in response to our White Paper consultation,

“The connection between local HealthWatch and HealthWatch England, based in the Care Quality Commission, should greatly increase the likelihood that public and patient concerns about the quality and safety of local NHS services will be heard and acted upon.”

Liz Kendall (Labour, Leicester West)

The Patients Association, which speaks on behalf of many patients in the country, unlike NICE, says:

“We are concerned that HealthWatch England will sit within the CQC. How will the public be convinced of the independence of HealthWatch England when it sits within the regulator?”

Indeed, the Government’s own impact assessment says:

“Setting up HealthWatch as a statutory committee of the CQC [means] it would not be formally independent of the NHS and social care system.”

Does the Minister not believe that his own mantra, “nothing about me without me,” should mean that patients have a strong independent voice, not necessarily sitting within the regulator?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

The hon. Lady almost predicts the remainder of my speech, which will attempt to allay the concerns that the Patients Association and she, on its behalf, have expressed. To be honest, we do not feel that it would be in the best interests of patients to set up a stand-alone body, which would not have adequate—

Liz Kendall (Labour, Leicester West)

Will the Minister give way?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Let me at least complete the sentence, so that the argument is clear before the hon. Lady attempts to rebut it. The point I was to make was that a stand-alone body would not have adequate equipment or resources to be able to deliver for patients. As a committee of the CQC, HealthWatch England will be able to take full advantage of its infrastructure and expertise: for example, it will be able to draw upon the CQC’s extensive information networks and analytic ability. Returning to the consultation responses, a member of the public said that the role within the CQC will give HealthWatch “substantially more weight”.

The next point is important because it starts to address directly the concerns of the Patients Association, for which organisation we have great respect. We wanted to ensure that HealthWatch England had a distinct identity within the CQC. That is why it will be a statutory committee, represented on the CQC’s board by its chair, who will be appointed by the Secretary of State. The Bill sets out clearly the committee’s powers to provide advice to the NHS commissioning board, the Secretary of State, the CQC and Monitor.

Opposition amendment 348 would require the CQC to respond in writing to advice and information that it receives from HealthWatch England committee. I sympathise with the point the Opposition are trying to make on behalf the Patients Association, with the intention of ensuring that HealthWatch England is able to have its own distinct identity within the CQC. However, the amendment could work against the building of effective working relationships between HealthWatch England and the CQC. Staff working for the committee and the wider commission should be having an open and ongoing dialogue about their work. Formalising that as the amendment proposes would give the impression that communication between the committee, with its independent role, and the CQC should be conducted by means of correspondence rather than open and ongoing dialogue. For that reason, we do not support that approach to prescribing the nature of that relationship.

Government amendment 415 is simply intended to correct a minor drafting error with regard to the terms “information” and “advice”. New section 45A of the Health and Social Care Act 2008, inserted by the clause, deals specifically with the functions to be exercised by HealthWatch England. Under new section 45A(3) HealthWatch is to provide the Secretary of State, the NHS commissioning board, Monitor and English local authorities with information and advice on the views of people who use health and social care services and other members of the public on their needs for and experiences of health and social care services. Similarly, HealthWatch England is to provide information and advice on the views of local healthwatch and other persons, on the standard of provision of health and social care services, and on whether or how the standard could or should be improved.

Derek Twigg (Labour, Halton)

Can we be clear on one point? If the Secretary of State rejects any of the advice that is given to him, will he have to publish his reasons for doing so?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

The important thing is that Healthwatch England has the ability to give that advice. If the advice is not followed, that would be made obvious by the fact that it is not followed. Where the Bill requires a communication that expresses and seeks to provide advice to the Secretary of State, the NHS commissioning board or others, it would, of course, require such a conversation.

Derek Twigg (Labour, Halton)

With respect, the Government have made a great deal of how they are improving scrutiny, local accountability and general accountability for the national health service, so Healthwatch England is a very important body. If the Secretary of State rejects the advice of such an august body, given the Government’s wish for transparency, accountability and greater scrutiny, should not the reasons for the rejection be published?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

The hon. Gentleman is absolutely right, and we agree that HealthWatch England and local healthwatch are an important part of the new architecture and an important way in which the patient voice is heard. I draw attention to proposed new section 45A of the 2008 Act, which addresses the advice given by HealthWatch England. Subsection (5) states:

“A person provided with advice under subsection (3) must inform the Healthwatch England committee in writing of its response or proposed response to the advice.”

That would apply to the Secretary of State. It is there in black and white on the face of the Bill, which is a novelty in legislation. Hopefully the hon. Gentleman will welcome the fact that we do not leave the matter to regulations, as used to be done in the past. I hope that reassures him.

I conclude my remarks by saying that the amendment provides greater consistency by providing that HealthWatch England may provide the commission with both information and advice on such matters.

If I have not been able to persuade and reassure Opposition Members and they choose to press amendment 348, I urge my colleagues to oppose it.

Emily Thornberry (Labour, Islington South and Finsbury)

I am grateful to my hon. Friends for their assistance. We seem to have strayed into a clause stand part debate. I seek your guidance, Mr Hancock, on whether I ought to address the amendments or discuss the wider issues.

Mike Hancock (Liberal Democrat, Portsmouth South)

I think we should stick to the amendments.

Emily Thornberry (Labour, Islington South and Finsbury)

Thank you. I will come back to the clause stand part debate in a moment.

Amendment 348 would place a duty on the commission to respond in writing to HealthWatch England with its response or proposed response to the advice. The reason for the amendment, as the Minister has already anticipated, is that there is spreading and deepening concern about the place of HealthWatch England in the CQC. We all agree that we should have a national healthwatch informed by local healthwatch bodies. That is greatly to be welcomed, but a structural problem is being created by the Bill in that HealthWatch England will have a place within the CQC.

The CQC is, of course, a regulator; it is supposed to conduct investigations. I have been thinking about what would happen if, for example, HealthWatch England was suddenly to tell CQC that 40 different hospitals or areas need urgently to be investigated. The CQC, as we all know, will not have an ideal amount of investment and will not be of an ideal size. The Minister frowns, but he knows that. The CQC needs to be much larger than it is to do its job effectively and make the number of visits it needs to make.

The concerns go together. There is a concern about the amount of money being spent to set up the CQC and the number of visits it will be able to make to old people’s homes, for example. On the other hand, HealthWatch England is supposed to be independent and it might need to suddenly tell the CQC that it has to do 40 different investigations for which it simply does not have the staff. They are sharing a building and HealthWatch England is part of the sub-committee of the CQC. One could imagine the good edges of HealthWatch England being knocked off by a close relationship with the CQC and by being dependent on the CQC for its funding, its place and everything else.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Will the hon. Lady confirm that the legislative basis for the CQC and in its current arrangements for dealing with essential standards of quality and safety were put in place during the last Parliament by the Labour Administration, and that all of the decisions on staffing levels and budgets were made by that Government?

Emily Thornberry (Labour, Islington South and Finsbury)

Yes. What I am saying to the Minister is that HealthWatch England should not be part of CQC—for the arguments already made—if it is to have a role that stands up, makes sense, and does everything that the Government claims it will. I am quite prepared to be straightforward with the hon. Gentleman on this issue: I want HealthWatch England to be a strong independent voice for patients nationally, and for local healthwatch organisations to be the same locally. My concern is that the legislation does not do this, and it is quite clear to any open-minded and fair-minded person looking at the Bill that there are fundamental flaws in the arrangement. That is why the amendment has been tabled.

It may seem somewhat clunky for CQC to have to write back to HealthWatch England, particularly if they are in the neighbouring office, but the point is that there is supposed to be some form of separation between the two bodies. The amendment simply puts some acknowledgement of that into the Bill. Otherwise we are setting up a body to fail, and that is the last thing that we want.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I take issue with some of the language used, for example, “spreading and deepening concern”—that is a very interesting flourish, but I do not think it is evidenced by the responses to the consultation on the White Paper last year. More than 6,000 organisations responded, and I quoted just a couple of the well respected organisations that expressed support for the Government’s approach. Of course we listened carefully to all of the respondents to the consultation, and indeed we made many changes. We are trying to make sure that the Bill does exactly what the hon. Lady says and exactly what we have intended all along. That is to have a clear, distinct and powerful voice for the patient and public interest, both at a national level—which does not currently exist—and at the local level.

Emily Thornberry (Labour, Islington South and Finsbury)

The difficulty the Minister gets into is that he tries to set up, with a flourish, bodies that most people agree with, but when we tell him that although the motivation and ambition are good, it is not being done in the right way, he does not listen. He says that there is no spreading and deepening concern. I hope he will be attending Liberal conference this weekend, where he will hear much concern expressed about precisely these sorts of bodies.

Mike Hancock (Liberal Democrat, Portsmouth South)

We are all grateful for that plug for our conference.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I am sure that will increase the numbers attending and I am very grateful to the hon. Lady for the additional publicity, although I suspect that we will already have a very good crowd over the coming weekend, both inside and out. I look forward to taking part in many a debate about the very liberal nature of the reforms that we are introducing to the health service, which are very much about respecting organisations’ autonomy; devolving power in the system; ensuring that the patient’s voice is properly heard; and the fact that we trust clinicians to exercise their judgment.

Jeremy Lefroy (Conservative, Stafford)

I am sorry to interrupt the Minister in full flow. Does he feel that the arrangements, as proposed, would help to counter the problem we faced in Mid Staffordshire, where concerns raised all the way through—right up to the top and the office of the Secretary of State—were ignored or passed down because people said that they were not their responsibility? That is a concern of mine.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

During the Committee’s proceedings, the hon. Gentleman has rightly articulated those concerns at all of the key points considered so far. As he knows of course, there is currently an independent inquiry taking place, and we are paying very close attention to those hearings. If we find that there are further matters to be addressed, we have every intention of making sure we pick them up.

I have already assured the hon. Member for Halton about the need for the Secretary of State to write back to HealthWatch England were it to express concerns, which is evidence for how this set of arrangements will be far more transparent. The very existence of HealthWatch England puts into the new architecture something that does not currently exist and, hence, an additional safeguard.

Derek Twigg (Labour, Halton)

Let me pursue the point a little further, because I am not sure that the Minister answered my question fully. Writing to the Secretary of State and publishing the information are slightly different things. Will the responses from the various bodies given advice have to be published, or will they be obtainable under the Freedom of Information Act? Will the information be published for people to see, or will we have to ask for it?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Under the provisions, HealthWatch England will be able to publish the Secretary of State’s advice as part of its report. The intention is for the information to be available, and HealthWatch England will be able to publish it.

I want to return to something the hon. Member for Islington South and Finsbury discussed. Again, we had an attempt to paint a picture of this Administration’s decisions on the CQC around inspection methodologies and its staffing. I was grateful for the hon. Lady’s candour when she accepted that those decisions on the framework governing the work of the CQC and the resources available were made by the previous Administration. We are keen, as is the hon. Lady, to ensure that the CQC does an effective job of upholding the essential standards of safety and quality.

Emily Thornberry (Labour, Islington South and Finsbury)

I have reminded the Minister before, but I suspect I will need to continue doing so: we are talking about this Bill, the creation of this new body, and whether this new body is being created sufficiently rigorously, with sufficiently deep thought, to ensure that what is established by the legislation can do the job we want it to do. We are not debating the establishment of the CQC, but that of HealthWatch England.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I was merely attempting to give a full response to the debate. The hon. Lady mentioned the CQC, so I was responding in kind.

Also, the proposed changes to the commission will strengthen its role of protecting the safety and quality of health and adult social care, by focusing the commission’s attention on the concerns of health and social care consumers, by working with other bodies to reduce the regulatory burden on providers and by ensuring that reviews are conducted in the most appropriate part of the system. I was asked specifically about what would happen if the CQC needed to investigate 40 hospitals all at the same time. The CQC would work with HealthWatch England, to act on its concerns. That is precisely the value we attach to having HealthWatch England within the CQC but with clear indications of its functions and responsibilities.

We do not promise that the relationship between HealthWatch England and the CQC will be easy. Indeed, there needs to be an edginess to it, to discharge the respective responsibilities. The committee of HealthWatch England will be able both to challenge and to work collaboratively with the CQC.

I hope I have been able to reassure the hon. Lady, although I fear I might not have done so, that I, the Government Members in Committee and the Government are open-minded, fair-minded and determined to ensure that the Bill is as good as possible, to deliver the results we want—better-quality care for all.

Emily Thornberry (Labour, Islington South and Finsbury)

I do not really care about the Minister’s motivation, I care about the Bill and whether it will stand up as legislation. The legislation might have an impact on this country for much longer than the hon. Gentleman is in his current post. Whatever his motivation is does not really matter—what matters is that the legislation is good, rigorous and makes sense.

The Minister, in answer to questions from the hon. Member for Stafford, did not give a sufficient response. He should think more carefully about the hon. Gentleman’s question. Given what happened at the Mid Staffordshire hospital and that patients were not listened to, it is important to have a robust organisation—HealthWatch —fed into by local healthwatch organisations. The hon. Gentleman’s question needs a better answer than, “Well, we have an inquiry going on, I am grateful for the question and we are setting up HealthWatch, which didn’t exist before.” That is not sufficient.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

If that was all I had said, of course it would not be sufficient, which is why I also emphasised that the Bill establishes HealthWatch England as an independent committee of the CQC—a body that did not exist when the terrible incidents occurred at Stafford under the last Government’s watch.

Emily Thornberry (Labour, Islington South and Finsbury)

The Minister has underlined what I have just said. It is not sufficient for him to simply say that this is an independent committee of the CQC. In reality, it would be very difficult for it to be properly independent, and as they begin to understand the legislation a large and increasing number of people and groups are saying that it is not sufficient. I implore the Minister to look at this again. If he is going to set up such an organisation, let us have a good one. Let us look at this again to ensure that it is properly independent and has a proper voice on behalf and for the sake of patients.

Mike Hancock (Liberal Democrat, Portsmouth South)

Emily, do you want to press amendment 348 to a vote?

Emily Thornberry (Labour, Islington South and Finsbury)

No. I have said what I wanted to with, I hope, sufficient clarify for the Government to listen to it.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I beg to move amendment 416, in clause 166, page 139, line 16, leave out

Mike Hancock (Liberal Democrat, Portsmouth South)

With this it will be convenient to discuss Government amendment 417.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Amendments 416 and 417 are minor and technical amendments relating to HealthWatch England. Amendment 416 corrects a minor inaccuracy in the drafting. Proposed new section 45B(1)(b) of the Health and Social Care Act 2008 provides that, as soon as possible after the end of the financial year, HealthWatch England must publish, I quote,

“a report on the way in which it has exercised its functions”.

It is important to note that the functions set out in clause 166 are those of the Care Quality Commission. The commission must arrange for these functions to be carried out on its behalf by HealthWatch England. The amendment reflects this distinction and properly ensures that HealthWatch England has to report on the discharge of those functions by referring to its publishing a report on the way it has exercised, during the year, functions exercisable by it. In other words, the report of HealthWatch England will need to cover all the functions it is responsible for exercising on behalf of the Care Quality Commission under section 45A.

Amendment 417 ensures consistency in the provision governing the Secretary of State’s power to direct HealthWatch England if it is failing in relation to the discharge of functions. It also ensures that he or she can direct HealthWatch England where it is failing or has failed properly to discharge a function it is required to discharge, along with functions under section 45A,. That brings the position in line with the power of direction under section 82, new subsection (1A)(a), which relates to the Secretary of State’s power of direction where HealthWatch England is failing or has failed to discharge those functions.

For the reasons I have set out, Mr Hancock, I hope that the Committee will feel able to support these amendments.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I beg to move amendment 418, in clause 166, page 140, line 9, at end insert—

Mike Hancock (Liberal Democrat, Portsmouth South)

With this it will be convenient to discuss Government amendments 419 to 422.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

The amendments are, again, technical in nature, but they are important none the less. As hon. Members on both sides of the Committee know, transparency and accountability are the cornerstones of the Government’s health reforms, and the amendments further ensure that both are at the core of HealthWatch.

Amendments 419 and 420 ensure that the meetings of HealthWatch England and of local healthwatch organisations generally have to be held in public. Amendments 421 and 422 ensure that members of HealthWatch England and local healthwatch organisations are barred from being Members of the House of Commons and of the Northern Ireland Assembly. Members of local healthwatch organisations will be drawn from local communities, so it makes sense for local people to have an organisation that puts forward the local consumer voice about health and social care services. It would therefore be inappropriate for a Member of Parliament or a Member of the Northern Ireland Assembly to be a member of a local healthwatch organisation in England at the same time.

Emily Thornberry (Labour, Islington South and Finsbury)

I believe the Minister said that the meetings of HealthWatch England and of local healthwatch organisations would generally be held in public. In what circumstances would they not be?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

We intend to apply the provisions of the Public Bodies (Admission to Meetings) Act 1960, which sets out in great detail the circumstances in which a body may exclude the press or public from its meetings. That generally applies when, for example, matters of commercial confidentiality are being discussed. In local authorities, it is a typical procedure which is used only as required, and that is not often. For the reasons that I have set out, I hope the Committee will support the amendment.

Emily Thornberry (Labour, Islington South and Finsbury)

The amendments are technical, and although I was attempting to understand them at 11 pm last night, there were some that were beyond me, so I have been listening with care to the Minister. Much of what I wanted to say in relation to clause stand part has already been said, but I will outline our difficulties briefly.

Broadly, we welcome the establishment of HealthWatch England, which provides an opportunity for increasing patient engagement. We are pleased that there will be a national body representing the views of users of health and social care services—the public—and that there will be local healthwatches. HealthWatch England will advise the Secretary of State, the national commissioning board, Monitor, English local authorities and the CQC, which is to be welcomed. We understand the need for a national body such as this, but it is not an alternative to proper patient and public representation on key decision-making bodies, such as the board, consortia and so on, and there will be scrutiny of that, too. Having patients on HealthWatch England and having local healthwatch bodies is to be applauded, bit it is not sufficient in itself, and we need to ensure that there are checks and balances throughout the system.

Given HealthWatch England’s remit, it is a shame, first of all, that the name HealthWatch does not reflect its responsibility in relation to social care services. I am sure that the Minister shares my disappointment that social care is always the Cinderella service when it comes to health care, because some of the most important care that happens in this country is social care. If HealthWatch has a responsibility for not only looking after people’s health, but social care, we want to ensure that people have a clear signpost. Ensuring that it is called health-and-social-care watch is a small thing, but it would make a difference. As some of the most fractured service areas are in social care, some of the most important work that HealthWatch is likely to be doing nationally and locally will be to ensure that the most vulnerable are getting the care that they deserve, and that people know that they should go to health-and-social-care watch. That would be helpful. It is a small opportunity that would cost nothing. Again, it is a symptom of the pace that the Bill is going through. It is unfortunate that we have not had a chance to think through such issues. Had we had that chance, perhaps it would be entitled properly, and the Government could have thought more carefully about where HealthWatch should be instead of in the centre of the CQC.

HealthWatch will provide advice and information to local healthwatch organisations on their functions, but it will not fund them. One of the strengths of HealthWatch England is that it will be a national voice for patients, but unfortunately it will be put under the CQC. That is another structural problem. Presumably, it will be well informed, know what is going on nationally, be a national voice for patients and have a relationship with local healthwatches. However, because it will not have a financial relationship with local healthwatches, there will not be a close relationship that would be ideal. There is a phrase, “Who pays the piper.” It will be local authorities that will pay for local healthwatches, which are supposed to have a close relationship with the national HealthWatch. Again that seems to be a structural problem in the establishment of local healthwatches. I know that the Minister has received those sorts of responses in the White Paper consultation, and it is unfortunate that more credence has not been given to those sensible criticisms. We want to have a patient organisation that has a strong voice and works. As I said earlier, I am profoundly concerned that the noble ideal has been set up to fail.

Liz Kendall (Labour, Leicester West)

The Government have made a great deal about the importance of giving patients and the public a much stronger and clearer voice within the NHS, a goal that I support. However, I do not believe that HealthWatch England as it is currently constituted will achieve that goal. I would like to make four points.

First, under the Government’s new architecture for the NHS in the Bill, there will be three big players—the national NHS commissioning board run by Sir David Nicholson; the Care Quality Commission, which will ensure that basic standards of care are met, run by Cynthia Bower; and Monitor, which will promote competition as a means of improving quality—or so the Government claim—run by David Bennett. However, there will not be a fourth, crucial arm, which is a much stronger voice for patients and the public. I do not agree with the Government’s approach. I firmly believe that if patients and the public are to have far greater say, equal to—arguably, it should be more important than—any of those three bodies, HealthWatch England should be an independent body.

Secondly, HealthWatch England will lack independence as it will sit within the CQC. There are two problems with that. Obviously, HealthWatch England would have to work closely with the CQC, as it would do with any of the other bodies, including the national commissioning board, because it would want to ensure that its information was passed up through into the CQC to allow it to conduct inspections and investigations. However, what if HealthWatch England thought that the CQC had failed to do its job or work as effectively as it should have? The hon. Member for Stafford will know that many players did not act as they should have over the problems with Mid Staffordshire. How would a committee that sat within the CQC be able to say, “You have failed to pick up a certain piece of information locally”?

Nick de Bois (Conservative, Enfield North)

I know that we are looking specifically at the clause, which deals with HealthWatch England. However, I do not think that we can look at it without including the power and influence of the local healthwatch, which is extremely important and feeds into the matter. But my main point is that HealthWatch England will have more influence if it has a seat at the table, backed up by its statutory role, to influence any Care Quality Commission issues. I want it to be at the table, and not another separate body that just makes another report. Let it be at the table to fight its cause. That is worth considering, without assuming that it will just lie down and be complacent.

Liz Kendall (Labour, Leicester West)

I always listen carefully to what the hon. Gentleman says. If patients are truly to have an equal say in the service, I know—from experience in the NHS, which I know he also has—that it is the big organisations and big players that push the real decisions and have the real power. Yes, patients can have a seat at the table, but I firmly believe that they should have their own table.

The other problem related to HealthWatch England sitting in the Care Quality Commission is about resources, as my hon. Friend the Member for Islington South and Finsbury said. I take the Minister’s point that the plan for CQC was established under the previous Government and was absolutely the right approach, but let us be clear and honest. By the end of 2012 the CQC has to register 30,000 new providers, including 9,000 from primary medical services which have never been registered before and 12,500 new providers in social care. That is only the providers, but it also has to inspect and register individual sites. That is a huge task and the CQC, like other arm’s length bodies, is having its resources reduced. I urge hon. Members not to underestimate how massive that task is. The real concern is that sufficient resources might not be put into HealthWatch England. If the Minister wants to guarantee a ring-fenced budget for it, I would be grateful for his confirmation.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

What I would like to do is to respond to the point made by the hon. Lady a few moments ago, which is worth putting on the record. She referred to the task of registering social care providers as if that is to be done in the future. I am sure that she would join me in applauding the CQC for successfully finishing that work on time and on budget.

Liz Kendall (Labour, Leicester West)

I do, but the Minister will realise that new social care providers regularly come into the system. I was talking about the overall number of providers that the CQC will have registered—I am sorry if I was not entirely accurate in my comments. Those things change all the time and, under the Government policy of any willing provider, many more providers might come into the system. It is a big task and I urge hon. Members to be aware that HealthWatch England might not receive the resources that it needs for its vital role.

My third point is also about independence. It is not just that HealthWatch England will be sitting within the CQC; it is—I hope I have read this accurately—that the chair of HealthWatch England will be appointed by the Secretary of State. I am not sure how independent that person will be, and some members—

Nick de Bois rose—

Liz Kendall (Labour, Leicester West)

Let me finish this important point. Some members of the committee of HealthWatch England will be elected—I assume that they will be from local healthwatches, but that is not clear—and others will be appointed. Questions have been raised with me and other members of the Committee about how independent those members will be.

Nick de Bois (Conservative, Enfield North)

I am grateful to the hon. Lady for picking up some sensitivity to that remark, because we should not necessarily be looking at the Bill from that end of the telescope. I am sure she would agree that the whole structure of the Bill will move democratic accountability a great step forward. It is not necessarily right to draw the conclusion that the Secretary of State therefore wants to micro-manage by default by making an appointment. That is clearly not the intention of the Bill.

Liz Kendall (Labour, Leicester West)

I am not saying that; I am saying that perhaps the chair of HealthWatch England might be appointed by the Appointments Commission, if Government Members were not abolishing it.

Dan Byles (Conservative, North Warwickshire)

I understand that the same levels of transparency and openness will apply to any such appointments. Surely the hon. Lady can only have concerns that that might not lead to independent appointments if she believes that under the current system any of the current chairs, of the CQC and so on, and others appointed under that open and transparent system are Labour party placemen and not entirely independent.

Liz Kendall (Labour, Leicester West)

Alas, we are not in government any more, so none of them are Labour party placemen. The hon. Gentleman may wish to look at the various reports about Sir David Nicholson’s appointment as head of the NHS commissioning board. As reported in the Health Service Journal , he was not the Secretary of State’s first choice. The Secretary of State wanted somebody else but the Minister for the Cabinet Office and others intervened to ensure that he did not get his first choice.

My fourth and final point relates to something that made me spring up earlier to intervene on the Minister, but alas, he did not take my intervention very early on. He had said that the Government do not believe that it would be “in the best interests of patients” to have an independent body—he referred to a body that is independent of the CQC, sitting separately from it. However, patients’ groups—not only the Patients Association but Rethink, Diabetes UK, the Stroke Association, the British Heart Foundation, National Voices, which represents 100 charities, Asthma UK, the Alzheimer’s Society, Breakthrough Breast Cancer and Age UK—have all questioned this. There is a gap between rhetoric and reality. The charities say:

“The reforms will place £80 billion of the NHS budget into the hands of GPs, but plans to make GP consortia accountable to the public are far too weak.”

They go on to talk about the problems with local healthwatches, to which we will come. If the Minister genuinely believes that patients should have choice, control and a say over how services are run, surely he should listen to those organisations and give a far stronger role, not only to HealthWatch England, but to the local healthwatches.

Jeremy Lefroy (Conservative, Stafford)

From the experience of Mid Staffordshire, I know that the key to patient involvement is the ability, first, of people to make a fuss when it needs to be made, and secondly, of the people in authority to listen and respond. At the moment we have neither of those things in practice. We have had weak local organisations. The LINk organisations—local involvement networks—were variable across the country, but in my part of the world the LINk was particularly weak, and we had an organisation higher up such that when letters were written right up to the Secretary of State’s office, the response was, “This is not really our business, because you’re dealing with a foundation trust.”

Emily Thornberry (Labour, Islington South and Finsbury)

I am listening with care to the hon. Gentleman. We should all learn from his experience. Does he share my regret that an assessment of the lessons to be learned from LINks was not made before plans to establish local healthwatches were put into proposed legislation? Some LINks were successful and some were not. Perhaps it is important that we all learn why that was before attempting to establish an alternative.

Jeremy Lefroy (Conservative, Stafford)

It is always important to learn, but whether and when one puts that learning into effect is up to local people. In Staffordshire, the LINks were closed and re-established under the organisation of the county council, and I believe that they are better now than they were before. However, I am certainly not arrogant enough to say that we cannot go on learning all the time.

Fundamentally, a mechanism by which people’s voices are heard—not only heard but responded to—must be put in place by legislation. What is in the Bill is certainly an improvement on the current situation. I welcome the Minister’s comment that he is following the Mid Staffordshire inquiry very carefully. If the need for such a mechanism were to emerge from that inquiry, and if one of the recommendations by Robert Francis were to be around that issue, I would urge the Government to look at that very carefully. In my experience, patients have simply been ignored—not throughout the country necessarily; it depends very much on the local organisations. In other primary care trusts, strategic health authorities and foundation trusts, there may have been extremely responsive people who got things sorted out, but we must ensure that that applies across the country and is not variable and dependent on the nature of the people who happen to occupy those positions.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I welcome the debate, which rightly puts the spotlight on an important part of the Bill. Whereas I think we share a common purpose in ensuring that the patient voice is clear, we clearly have disagreements about the method that is being employed. None the less, I hope that members of the Committee will accept, even if it is not necessarily a reassurance, that the intention is clear. We want to ensure that patient voice—nationally—is much strengthened compared to that which pertains today.

My hon. Friend the Member for Stafford brings a particular experience that rightly needs to be at the heart of the Committee’s considerations. He is right to highlight some of the weaknesses in the current patient voice structures as being a cause—at least, a contributory cause—of what happened in Stafford. The Government set up the Francis inquiry specifically to ensure that we could learn lessons across the system. We had hoped that the inquiry would be in a position to conclude its work and report by now, but that has not proved possible. We do not deprecate that. It is simply the case that it is doing a thorough piece of work and we want it to have the time to do it.

I want to make it clear to my hon. Friend and reassure him that we will listen very closely during the inquiry’s hearings and take its recommendations very seriously. If necessary, we will introduce amendments to deal with any points raised. It is important to put that on the record at this stage. We would not set up an inquiry without the intention of actually listening to what it recommends. I put that on the record.

Emily Thornberry (Labour, Islington South and Finsbury)

The Minister has anticipated my concern. If lessons are to be learned from the inquiry and the legislation can be amended to accommodate its recommendations, I am pleased to hear that the hon. Gentleman has an open mind and will amend the legislation if necessary.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

That is absolutely the intention. I need to be straightforward with the Committee. Depending on the actual point at which the inquiry finishes and publishes, we may have to consider a second Bill in this Session, which I suspect the hon. Lady and I will spend much time on in due course, and which will also deal with health matters. The intention is clear and good.

Emily Thornberry (Labour, Islington South and Finsbury)

I make the obvious point that the Government are in charge of the timetabling of the Bill. It is open to the Government to slow down and listen to what people say so that we can accommodate the helpful suggestions that have been made from all sides.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Sometimes I think perhaps I should not have given way. The hon. Lady made a number of points to which I will try to respond. She made the point that HealthWatch England should not be inside the CQC. That is a running theme in contributions from Opposition Members. She argued that we have not considered the matter enough. One of the recurring arguments is that the pace is too quick.

I think we should quickly rehearse the timetable. We had a White Paper published in July last year. We had a full consultation with more than 6,000 responses. We deliberated on those responses and published a Command Paper in December, which set out how we responded to the consultation and how we saw that being reflected in subsequent legislation. We then published the Bill in January. We are now in Committee. That does not seem like an undue rush; it seems like a considered, deliberative process that ensures that Parliament is able to do its part of the job, which is to properly scrutinise the legislation in the fashion of the hon. Lady in her attempts both to improve and to undermine it.

Emily Thornberry (Labour, Islington South and Finsbury)

I do not know whether the Minister was listening to “The Food Programme” on Radio 4 when the Secretary of State—his boss—was asked about trans fats and he said that it was impossible for him to introduce legislation quickly enough because of the timetable. We all agree that trans fats should be banned because they are dangerous. The Secretary of State said he had to have an agreement with food producers because it was quicker to do that than to legislate. It struck me that if he can produce a health Bill such as this one—with all its complexity and clauses, completely turning upside down the NHS within a short period of time—he could certainly sort out trans fats.

Mike Hancock (Liberal Democrat, Portsmouth South)

I do not think that intervention relates to clause stand part and I hope that Members will bear that in mind.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I shall take that as an instruction not to pick up that point and I will move straight on.

As I said, we want to have the maximum impact for patients, which means putting the measure at the heart, not on the sidelines, of the health care system; it would be on the sidelines if we did what Labour Members want us to do.

Why does HealthWatch England not fund local healthwatch? I have a clear recollection of the arrangements that were made when we last had a national body responsible for public and patient involvement. I had conversations at that time with the local organisations that were established under it, and I know that they felt very much at its beck and call. The relationship was not a healthy one. That influenced our decision to ensure that the commissioning of healthwatch at a local level should sit at the local level, to build on the existing strengths and relationships between local authorities and LINks and to ensure that we have a smooth transition to the new arrangements.

I should also like to pick up the point about funding. By having strong links into the local authority, local healthwatch organisations, as with LINks, will still be able to raise concerns about any commissioning or provision of social care. The hon. Member for Leicester West referred to the appointment by the Secretary of State of the chair of HealthWatch England. It is worth reminding the Committee that similar appointments apply to the big three, as the hon. Lady described them: the NHS commissioning board, Monitor and the CQC—and also, for that matter, NICE.

Monitor, the CQC and NICE were set up by the previous Government with those arrangements. It also worth pointing out that the appointments commission works only on behalf of the Secretary of State and as we remove that arrangement, all arrangements regarding public appointments will still be regulated by the Office of the Commissioner for Public Appointments. So the safeguards are there to ensure that this is not done in a partisan way, but that the best person for the job is appointed and able to discharge his or her duties in the public interest.

Can the funding of HealthWatch England be ring-fenced? Who would impose the ring fence and when does a ring fence turn into an artificial cap that limits the resources available to HealthWatch England? I am fearful that that could be the unintended consequence of such a ring-fencing and for that reason I do not support such a proposition. It is much better that the creative relationship that will operate between the CQC and HealthWatch England will provide access to all the analytical skills and other resources of the CQC.

I do not agree with the hon. Member for Leicester West when she describes the system architecture as having a big three. I am sure she will want to disabuse me of that in a moment, but let me develop my point. I do not agree that the NHS commissioning board, the CQC and Monitor are the only big three. She has missed out two important ingredients. I think patients’ voice is an important part of that and the architecture of the Bill ensures that it will be. Moreover, there is a change in the relationship between local government and the NHS; local government becomes part of the architecture as it has never been before.

Finally, if HealthWatch England thinks that the CQC is not fulfilling its statutory duties and functions, the Bill already provides for HealthWatch England to write to the Secretary of State to offer advice and information. I have already dealt with that in respect of her hon. Friend the Member for Islington South and Finsbury. It is in a unique place to be a critical friend when it comes to challenge around the performance of those tasks. There is a route by which concerns about the CQC can be directly raised with the Secretary of State, who has the necessary powers in extremis to deal with that. With those reassurances, I hope that Members will allow this clause to stand part of the Bill.

Clause 167

Emily Thornberry (Labour, Islington South and Finsbury)

The clause provides for the establishment of local healthwatch organisations. In general terms, it is welcomed. I thank the Minister—not this Minister, but the other one, the right hon. Member for Chelmsford—for the reassurance he gave the Committee that there will not be a hiatus between the end of LINks and the establishment of local healthwatch organisations. We do not oppose the clause, but there are concerns about the operation of local healthwatch organisations, which I will come to in the debate on schedule 13.

Schedule 13

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I beg to move amendment 423, page 312, line 22, leave out paragraph (b).

Mike Hancock (Liberal Democrat, Portsmouth South)

With this it will be convenient to discuss Government amendment 424.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

The amendments secure provision for auditing requirements for local healthwatch organisations which are appropriate for locally funded organisations. The National Audit Office brought the matter to our attention and supports our amendments to remove the Comptroller and Auditor General’s role in auditing local healthwatch organisations’ accounts.

The amendments will ensure that local healthwatch organisations are required to have their accounts audited. They enable the Secretary of State to direct local healthwatch organisations that their accounts will be audited in accordance with such requirements as are specified in the direction. When no direction is issued, local healthwatch organisations must arrange for their accounts to be audited in the manner that they consider appropriate.

We feel that those requirements accurately reflect the autonomy that local healthwatch organisations will enjoy to manage their own affairs and the flexibility that they will have to make appropriate local arrangements. With that, I hope that the amendments will be supported.

Emily Thornberry (Labour, Islington South and Finsbury)

I beg to move amendment 357, page 312, line 32, at end add—

The schedule is the bones of the local healthwatch organisations—and that, unfortunately, does not say a lot. It is one of the schedules that the Minister, the right hon. Member for Chelmsford, said that he used to see when we were in government and that he used to complain about, but I am sure that that is not right. It is difficult, when looking at this schedule, to understand properly what local healthwatch organisations will be like. It essentially gives provision for the Government to introduce, at some future stage, a whole lot of regulations. Earlier this morning, there was talk about the great benefit of putting things into the Bill as opposed to there being regulations at a later stage. This amendment attempts to help with that.

There is a sub-clause to proposed new schedule 16A, “Procedures” (8), to allow local healthwatch organisations to adopt and publish procedures for making decisions about the exercise of their functions—in other words, to have a constitution that everyone knows about—and to review such procedures from time to time, to ensure that they remain effective and efficient for the purposes of carrying out their functions. The healthwatch organisations shall publish and adopt procedures for selecting authorised persons to exercise the local healthwatch rights of entry.

One of the great powers that the local healthwatch organisations will have is the power to insist on going into local provision—for example, turning up at an old people’s home and saying, “We want to come in; we hear terrible stories about this place”. But it needs to be done in a way that has regard to the safety, privacy and dignity of patients and service users.

It is also important to find out who should be allowed in and who is not going to be allowed in and in what circumstances. Those procedures need to be published by the local healthwatch so that it is in some way accountable to the local community that it is seeking to serve. Again, local healthwatch will review such procedures from time to time to ensure that they work.

The amendment’s new subsection (2) relates to the procedure to be followed by the local healthwatch in determining the circumstances in which it intends to exercise rights of entry. When will it enter local provision and when will it not? There should be some form of accountability to the local public, and local healthwatch should meet in public. Papers should be published in advance so that people know what they are going to be discussing and they can be involved. The local healthwatch should publish an annual report on how it has been carrying out its functions over the preceding 12 months, including an assessment of how effectively and efficiently it has carried out those functions and of the changes to health care and social care services that have resulted.

We are offering some flesh to Government Committee members in terms of what local healthwatch ought to look like. On the face of it, it seems unlikely that they will vote against such an amendment. It is perfectly sensible and is offered in good faith.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I have no doubt that this is one of those amendments that attempts to improve the Bill, rather than undermine it. However, the amendment as currently drafted is not necessary, not least because the main thrust of the hon. Lady’s arguments seem to be about issues to do with requests and rights of entry to properties; she made that point at some length. It is worth drawing the Committee’s attention to a clause that we will reach soon, clause 171. It deals with the issues around rights of entry. For ease of reference, I should say that it is also covered on page 154 of the explanatory notes. I think that clause sets out a framework by which those matters and those questions can be properly answered.

But the amendment relates to clause 168. It sets out a number of new functions that the hon. Lady has described. That will affect local healthwatch organisations. Clause 168 amends the Local Government and Public Involvement in Health Act 2007 to include additional functions, building on those carried forward from the local involvement networks in section 221 of the 2007 Act. Section 221 sets out a duty for local authorities to make contractual arrangements to ensure that certain activities can be carried out. Currently, those activities are carried out by local involvement networks.

Clause 167 provides for the establishment of local healthwatch. Schedule 13 then makes provision for local healthwatch organisations, such as status, membership, general powers, exercise of functions and accounts. The schedule reflects the degree of flexibility that we have in mind for those organisations.

For hon. Members to add a detailed list of procedures is too prescriptive for these organisations. It would be unhelpful to them as they evolve and develop. Local healthwatch organisations need to decide locally how they will be transparent to local people. Earlier, we discussed the Government amendment that will ensure that they meet in public and that all their papers are public, too.

In response to our consultation “Liberating the NHS”, National Voices has said:

“There needs to be an integrated service at local level that provides all the support and guidance that people are likely to need, including complaints advocacy and support to individuals on choice, under the banner of ‘HealthWatch’. But it needs to be a local commissioning decision how this integrated service is best obtained—whether this be from one or more organisations.”.

The British Heart Foundation went on to suggest that

“the commissioning of HealthWatch services should be based on local needs assessment and on an understanding of the aspirations and priorities of local people.”.

The Government have a strong commitment to localism and greater transparency, which are central to the approach that we are taking to public service reform, so clear information must be made easily available so that people can make informed choices and compare and contrast the performance of different organisations. Demanding over-prescriptive inputs really is not the answer.

It might also be worth underscoring a point that I think the hon. Lady referred to. A statutory requirement is placed on local bodies to publish a constitution. That is a much better way of codifying, clarifying and setting out for the public the way in which those organisations will discharge their functions.

Some hon. Members have voiced their concern that there were too many regulating powers in schedule 13. My right hon. Friend the Minister of State has quite rightly made the point that, over the last 13 years at least, we have seen a progressive use of clauses that simply allow regulations to be made, without there being any detail in the Bill. This Bill reverses that trend significantly. In effect, it creates the second part of the NHS constitution because it ensures clarity about how various organisations within the context of that constitution discharge their function. So it is a very helpful guide that has not previously existed because such issues have all been down to individual regulations.

There is only one regulation-making power—in paragraph (2) of new schedule 16A to the 2006 Act, inserted by schedule 13. Paragraph (7) of schedule 13 enables the Secretary of State to determine matters such as the form in which local healthwatch must keep account. It must prepare annual accounts. This is not an issue about regulation-making powers, so I hope that my hon. Friends and the hon. Lady have been reassured that the amendment is not necessary, and that the provisions are sufficient to achieve the goal that we all share—an effective local healthwatch. I resist the amendment.

Debbie Abrahams (Labour, Oldham East and Saddleworth)

I want to comment on the hon. Member for Stafford’s comment that, currently, LINks organisations are very variable in their standards. The amendment is trying to ensure that we strengthen and have a minimum standard. If we are saying that it is up to the local healthwatch to provide their own constitutions, that allows for some flexibility. The amendment ensures that key standards are included within the terms of reference.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Again, the missing piece of the equation with LINks was that there was no national body to bring together good practice, to disseminate that good practice and to provide support and guidance to these organisations. That is one of the strengths that we bring through our legislation.

Emily Thornberry (Labour, Islington South and Finsbury)

The Minister says that we should not be overly prescriptive, but the amendment’s provisions on procedures are hardly that. They do not say how local HealthWatch should exercise its rights of entry; they say that it should publicise what it does and when it is going to exercise its rights of entry. They do not say what a constitution ought to be, but that it should simply publish its constitution.

The amendment is far from being prescriptive; it is simply trying to ensure that there is some consistency and openness in the operation and procedures of local healthwatch. That is the reason for the amendment, but I hear what the Minister says and he hears what I say. I will not be pushing the amendment to the vote. I beg to ask leave to withdraw the amendment.

Emily Thornberry (Labour, Islington South and Finsbury)

I wish to say more on schedule 13 stand part. Amendment 357 aimed to introduce procedures—

Simon Burns (Conservative, Chelmsford)

On a point of order, Mr Hancock. May I seek your guidance? Have we completed discussions and dealing with the amendment? Are we now on a stand part debate, or are you amalgamating that into the amendment?

Mike Hancock (Liberal Democrat, Portsmouth South)

No. The amendment debate is over, because the amendment was withdrawn.

Emily Thornberry (Labour, Islington South and Finsbury)

It is slightly confusing because when the Minister responded to my criticisms in relation to amendment 357, he expanded slightly outside its precise remit. Doing so made perfect sense, but I can see that there is confusion as a result.

I return to my central criticism that the schedule is not sufficiently specific. If we accept the provision, we pass legislation that enables the establishment of local healthwatch organisations. How do the Government envisage such organisations? How many staff will they have? How will funding work in different populations and areas? Dudley, for example, which is a metropolitan borough, has 306,000 people. How will a population such as that be served by a local healthwatch? What will be a sufficiently large—or small—organisation? My own borough of Islington has a population of 191,000—it is a metropolitan, inner-city borough. Again, what will be the staffing and funding levels?

If the provision is accepted, we will establish local healthwatch organisations in good faith, anticipating that the Government will do the right thing on regulation, and that local authorities will do the right thing when they establish the organisations. It is so important to get that right. Many leaps are to be made in good faith and we hope that everything will be all right—perhaps it will, but perhaps it will not.

How many people do the Government anticipate will be employed in Chelmsford, which is a non-metropolitan district with a population of 167,000? What will be a sufficient size for a local healthwatch? It is fair to raise such questions, because we are in the dock when it comes to establishing local healthwatch, which will be an important part of the architecture and an important part of ensuring that local patients’ voices are heard.

Jeremy Lefroy (Conservative, Stafford)

I have a couple of points on healthwatch. I welcome the establishment of the organisations, but I bring a little experience from Mid Staffordshire to bear. I realise that this is not part of the Bill and will come forward in regulations, but to whom, precisely, will healthwatch be open? As a local councillor, I have learned that we restrict the pool of people from whom we can draw the volunteers who serve in organisations such as healthwatch. County council meetings, for example, are held during the day, so people who are in employment find it extremely difficult to take part, to become members or to stand for election.

It is therefore vital, when the regulations are introduced and implemented locally, that great care is taken to ensure that people who are in full-time employment, women—or indeed men—who stay at home with young children, and the disabled can be part of the body. We all have a great interest in healthwatch, but such people are likely to have an even greater one. From my experience, locally, members of LINks—or their predecessors—are greatly committed to the health service, but often the membership does not reflect the widest range of people.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Before we adjourned my hon. Friend the Member for Stafford was speaking about the lessons we should learn from the way in which local involvement networks have operated when considering the future of healthwatch. One of the points that I take from his and other contributions is the importance we attach to ensuring that the seldom heard and hard-to-reach groups and, bearing in mind the comments of Mind, Rethink and others, people with mental health problems are properly engaged and involved in healthwatch. HealthWatch England will provide guidance about sharing best practice across the network of local healthwatches up and down England,

We were asked a number of questions about the funding mechanisms for allocating resources. Just as LINks do now, local healthwatch organisations will receive their funding via local authorities which, in turn, will receive their funding via the formula grant mechanism, so resources will be available for local authorities to discharge their duties to commission these services. The vision for local healthwatch is clear: it is to build on existing structures and experience and to make sure that we share the best practice. All of that has to be done and be firmly grounded in local determination—an approach that is backed by many of the stakeholders who felt that some of the previous iterations of public and patient involvement over the past decade or so were top-down and heavy-handed and have not enabled the patient voice to be articulated as strongly as we want. That is why central Government will not decide every last detail of the way these boards work.

The curious thing about amendment 357, which we discussed this morning, was how it highlighted the dichotomy in the Opposition’s approach to the Bill. On the one hand, they are worried about the Secretary of State appointing the chair of HealthWatch England, but on the other hand they seem to want to prescribe in minute detail the membership and operation of local healthwatch. That seems strange. I hope that the hon. Member for Islington South and Finsbury will feel that we have had a good debate on these issues and that I have reassured her enough that she will not press her amendment to a vote.

Mike Hancock (Liberal Democrat, Portsmouth South)

There is no amendment.

Clause 168

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I beg to move amendment 425, in clause 168, page 140, line 38, at end insert—

I apologise for the slight confusion just now. The amendment will ensure that local healthwatch organisations can make known to HealthWatch England the views of local people, as well as reports and recommendations. It will help HealthWatch England to fulfil its role as the national consumer champion for health and social care by ensuring that matters that are important to the public, patients and other users of care services can be brought to its attention.

Emily Thornberry (Labour, Islington South and Finsbury)

I beg to move amendment 349, in clause 168, page 141, leave out lines 2 to 4.

Mike Hancock (Liberal Democrat, Portsmouth South)

With this it will be convenient to discuss the following:

Amendment 352, in clause 170, page 142, line 22, after ‘Independent’, insert ‘advice, information and’.

Amendment 353, in clause 170, page 142, line 22, at end insert—

Government amendments 426 to 433.

Emily Thornberry (Labour, Islington South and Finsbury)

Amendments 349, 352 and 353 are designed to probe the various functions of local healthwatch organisations by offering further discretion to local authorities.

The problem is that local healthwatch members are being asked to do a number of jobs at the same time, many of which are contradictory. As part of local healthwatch boards, they will have commissioning responsibilities, but they will also have the jobs of providing provide information and advice on choices in local health and social care services; providing advocacy and a complaints service; and playing a role in policing local services—they will be doing it all. They will commission, say, social care in a local area, provide information on that care and police the care that they commissioned and provided advice on; and if anything goes wrong, they will also provide advocacy and complaints services in relation to the social care that they commissioned and provided advice on. It may be that they commission a service, advise someone to go to it, police it but fail in that policing, and thus generating a complaint for which they then provide the advocacy service.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I am grateful to the hon. Lady for giving way while she is developing her argument, but I want to make it absolutely clear that local healthwatch bodies will not commission services for the public, in the sense of a social service. They may well commission an advocacy service that they have a function to provide, but they would not be commissioning direct services for the public of the sort she describes.

Emily Thornberry (Labour, Islington South and Finsbury)

Not as healthwatch, they will not, but as part of the health and well-being board, as we understand it, they will have a role in the commissioning of services and ensuring that services come together properly.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Again, the hon. Lady’s point is not entirely correct. The health and well-being board will do the joint strategic needs assessment and the joint health and well-being strategy, but the commissioning responsibility will remain with the local authority as the commissioner.

Emily Thornberry (Labour, Islington South and Finsbury)

I do not want open up an argument about local accountability that we will definitely be coming to soon. However, there are times when one sits back and listens to Ministers seeming to claim all kinds of powers for health and well-being boards, but one is then disappointed to look at the Bill and see that it is an empty promise.

What is the role of people on the health and well-being board? What are they doing there? What job are they fulfilling? Whatever job the health and well-being board is supposed to be doing—it may be very little—they will be doing that, and they will be providing advice and information, providing advocacy and complaints services, and playing a policing role. I am sure the Minister understands that, even if we take out the commissioning role, the very fact that local healthwatch give information on the service, police it, and provide advocacy services creates a conflict. They are doing everything.

I cannot think of a parallel. I was thinking about it in terms of a magistrates court and all the different roles people play there. Local healthwatch would be the magistrates, the police, the prosecution counsel and the defence counsel. Local healthwatch seems to do everything—that is all I am saying. It seems contradictory to me, but if the Minister feels that it can be dealt with and that local healthwatch can do all these different things at the same time, I still come back to the question how they will be able to fulfil all of those functions.

Local healthwatch bodies will need a number of different skills to perform all their functions; presumably, they will need a number of members of staff who have those skills, and therefore a substantial budget, yet it is unclear what budget local authorities will provide, if any. There certainly does not seem to be a budget that is ring-fenced. Given the appalling cuts to which the Government are subjecting local government, it is unlikely that there will be available the substantial budget that local healthwatches will need to fulfil the myriad tasks the legislation gives them.

For that reason, we tabled these probing amendments. We want the Minister to tell us how local healthwatches can do all those different jobs, with presumably very little funding and perhaps very little support. We want reassurance from him that local healthwatches are not being set up to fail, because there is concern that that is exactly what will happen.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I hope that I can reassure the hon. Lady and others who might have concerns about the policy intention and the effect of the Bill. Our clear purpose is to amplify the voice of patients and carers in the system. They have a chair at the local authority table and on the health and well-being board for that very reason—to make that their voice is heard loud and clear at key points when discussions are taking place and decisions are being made on the local population’s future and current strategic needs for health and social care. In the framing and setting of priorities in the strategy that comes from that joint strategic needs assessment, again, we want to ensure that voice has real leverage, purchase and impact at the most important time. Like the JSNA, that strategy will be an important document because of the clauses of the Bill that place into law, for the first time, the requirement that commissioners “must have regard to” it. We know that that is more than just words; it leads to legal interpretations. Looking at those two pieces of work will require a degree of rigour and evidence of rigour, so healthwatch will have a very important role locally.

The Opposition amendments in the group relate to the functions proposed in clause 168(3) to be given to local healthwatch organisations to provide

“advice and information about access to local care services and the choices that may be made with respect to aspects of those services”.

Amendment 349 would remove that function from clause 168. Amendment 353 would relocate that aspect of clause 168(3) to clause 170, which deals with the independent advocacy services, which the hon. Lady touched on, but with the added provision that the local authority would

“make such arrangements as it considers appropriate”.

Amendment 352 would change the title of the clause to, “Independent advice, information and advocacy services”. Therefore, those amendments would transfer responsibility for the relevant advice and information functions from the local healthwatch to the local authority.

Clause 168 amends the Local Government and Public Involvement in Health Act 2007 to include those additional functions, which local healthwatch organisations will have to carry out. We want it them clear on the face of the Bill as responsibilities of local healthwatch, not matters for the local authority to subcontract to local healthwatch organisations. That includes the provision of information and advice to the public about accessing health and social care services and about choices in aspects of local care services. Providing information and advice is important if we are to ensure that the public and patients are given the information to help them to make the informed decisions we want them to be increasingly able to make.

Emily Thornberry (Labour, Islington South and Finsbury)

The hon. Gentleman and I are in agreement on a number of issues. It is certainly important that people be given information, particularly about social care, and especially when they are self-funders. Far too often at our advice surgeries, we come across people who are self-funders and simply do not know where to go to find long-term care, so we must have a good source of information. However, there is a question in that.

As I understand it, the Government have changed their position on independent advocacy services in response to the consultation. They have allowed local authorities to respond to local needs and decide to take on the responsibility of advocacy services. In those circumstances, is there not the same argument in relation to information, so that information could be taken from healthwatch and put into local authorities? I do not suggest that one is preferable; I just want to understand the Government’s thinking.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

The first point is that there is nothing in the current statutory and legal framework to preclude local government from commissioning other information and advice providers; it still has its powers to provide grants to citizens advice bureaux and many other organisations. That does not change. In that sense, transferring the responsibility from local healthwatch to the local authority merely transfers to local authorities something that they already have the power to do. We want to make it clear in the Bill that local healthwatch can do such things. The Government consider that to be an appropriate function for local healthwatch, not the local authority.

Local healthwatch organisations will be the local consumer voice. They will have the knowledge about local provision of health and social care services, and that will be important in helping people to find out more about the services. On the question of contradictory roles or roles that might stretch their skills and capabilities, HealthWatch England will provide leadership and advice to local healthwatch. It will make sure that there is appropriate support. That could include a framework for skills and training for local healthwatch, if that is deemed necessary. There is ample opportunity through the new arrangements that we are making at a national level to support the necessary development of skills.

We want local healthwatch to be instantly recognisable as a reliable source of information and expertise on health and social care while allowing for those functions to be carried out by local healthwatch. The amendment would not make it a requirement; that would lead to confusion for service users and members of the public who will not be able to rely on advice and information services being offered by their local healthwatches.

Clause 168 sets out a function of providing advice and information about access to local care services and about choices that may be made with respect to aspects of those services. That will be a local healthwatch function. In providing that each local authority must make such arrangements only as it considers appropriate, amendment 353, in effect—I appreciate that it is a probing amendment—would dilute the current requirement. I hope that I have been able to offer the hon. Lady some reassurance and that she will not press the amendment.

Government amendments 426 to 433 are minor drafting or technical amendments relating to clause 170, to which we will come in due course. It relates to the provisions of independence advocacy that the hon. Lady mentioned just now. Clause 170 inserts new section 223A into the 2007 Act, which imposes a duty on local authorities to commission independent advocacy services, as they consider appropriate, for complaints relating to the provision of health services. A local authority may commission these services with a third party or arrange for advocacy to be provided by a local healthwatch.

Amendment 426 is a minor drafting correction. The current subsection (4) of new section 223A provides that a local authority may make arrangements, as it considers appropriate, in addition to arranging independent advocacy services, for the provision of assistance to individuals in connection with complaints about the provision of NHS services. The amendment simply moves subsection (4) to a better place. Amendment 429 is consequent to amendment 426 and is also a minor drafting amendment. It removes what was previously subsection (4), consequent on the contents of subsection (4) being moved.

Amendment 427 closes a potential loophole that would have allowed third parties commissioned by local authorities to arrange to provide independent advocacy services, to arrange for the provision of those services from a local healthwatch. Amendment 428 ensures that arrangements for local healthwatch to provide new section 223A services are treated as made under section 221(1) and that the service provision is treated as an activity specified in section 221(2).

Amendment 430 closes a gap in new section 223A. In arranging for the provision of services, the local authority needs only to have regard to the principle of independence in relation to the provision of services under the arrangements—for example, where the arrangements are between a local authority and a provider. The amendment will also ensure that the duty on the local authority applies in relation to the provision of services in pursuance of arrangements under new section 223A, where the local authority arranges for a person to commission the provision of services from another person.

Amendment 431 is another technical amendment. New section 223A(6) will enable a local authority to make payments to any person providing services under new section 223A, but as drafted it does not provide a power to make payments to a person who arranges the provision of those services. In certain cases, a local authority may wish to make arrangements under new section 223A for a person to commission services, and we do not want to prevent local authorities making such payments.

Amendment 432 will make a minor drafting change to new section 223A, to ensure that duplicate payments cannot be made. Amendment 433 will close a gap in the legislation, conferring regulation-making powers in relation to the duties of service providers to allow entry by LINks, which will be replaced by local healthwatches. As drafted, an authorised representative must be carrying out a viewing or observation for the purposes of undertaking activities specified in section 221(2), under the arrangements in section 221(1). The amendment extends that by also providing for the viewing or observation to be carried out for the purposes of undertaking such activities in pursuance of the section 221(1) arrangements.

I hope that I have clearly set out all those amendments for hon. Members and for the record. I end by saying that the hon. Member for Islington South and Finsbury will have noted the unprecedented transfer, made by the Government, of resources for social care from the NHS to local government, and the support that that provides the NHS.

Mike Hancock (Liberal Democrat, Portsmouth South)

I missed part of that, Mr Burstow; I wonder whether you could repeat it without your cribsheet. [Laughter.]

Emily Thornberry (Labour, Islington South and Finsbury)

In response to the last point that the Minister made—gratuitously—I should say that I am sure that he is aware that the Local Government Group and the Association of Directors of Adult Social Services believe that there will be a £4 billion shortfall in the funding for social care. Our concerns are cumulative, continue and grow in relation to the next clause. I beg to ask leave to withdraw the amendment.

Clause 169

Emily Thornberry (Labour, Islington South and Finsbury)

I beg to move amendment 350, in clause 169, page 141, line 38, at end insert—

Mike Hancock (Liberal Democrat, Portsmouth South)

With this it will be convenient to discuss amendment 351, in clause 169, page 141, line 39, at end insert ‘and insert—

Emily Thornberry (Labour, Islington South and Finsbury)

I begin by apologising to the Committee for the amendments, but they are consistent with the Bill. I have to say that making the amendment refer to “A must consider” as opposed to “local authority” is unnecessarily obscure, but we need it for consistency.

It is a huge shame and a great missed opportunity that proposals should be being put forward for establishing local healthwatches without there first having been a proper evaluation of LINks. What emerged from LINks was that a host often did not provide a proper understanding of community needs. I am sure that Members are aware of the written evidence submitted by the Patients Association. The eighth bullet point of point 6 states:

“We are concerned that there is an expectation there will be a free transfer from personnel in LINks to local HealthWatch. But we hear from patients phoning our Helpline that the local LINks are not working and that the service they are providing is substandard.”

It goes on to comment on the transfer of personnel in those circumstances. The Patients Association believes that LINks are not working. Some LINks work, but some definitely do not. Before establishing anything new, we should have found out why some worked and others did not.

Having listened to evidence and the people who come to see me, I think that one of the reasons is that when local authorities give support to LINks, they establish a host organisation that then organises the committees and gives secretarial and administrative support, but may not be entirely sympathetic to the way in which the LINk wishes to work. It may be too inward-looking and may not properly understand the importance of engaging the whole community. Sometimes they are only interested in one particular part of the community, either geographically, racially, socially, culturally or whatever. That has been one reason why LINks have not worked. It is important, therefore, that local authorities listen to the local community in relation to how they are going to establish LINks. That is what the amendments seek to do.

Without a clear understanding of respective roles, local authorities could commission hosts to provide levels of support that do not match the aspirations of LINks. This is where the system can break down at the very start, as LINks want support that hosts cannot provide because their contract does not allow it. There is also the point that the focus of LINks was often on one area of the borough at the expense of another, and they can be dominated by a narrow set of interests, as I have already said.

The amendments seek to ensure that the local healthwatch consults widely on what its priorities should be and what the needs of the communities are, so that it is in the best position to put in place the appropriate resources right from the start. That is the purpose of the amendments. They attempt to strengthen local healthwatch, because it is in the interests of all of us that patient voice should be heard loudly, clearly, fairly and proportionately at a local level.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Let us start by dealing with the very fair point about the evaluation of LINks and how the Government intend to proceed; that will help the Committee as it considers the role of HealthWatch and how the Government are intending to develop that role. We are planning—as we are with the GP commissioning consortia—to establish a network of pathfinders to explore and to learn by doing under the current structures.

Just as we are working with colleagues in local government to encourage and support the establishment of health and well-being boards, so, too, are we planning a similar approach with HealthWatch. That, along with links to a number of action learning sets that will be established as part of the evaluation of the pathfinder activity, will be used to explore more fully the lessons learned during the pathfinder period and from the LINks around the country.

It is also worth noting—I suspect that this is the source of some of the points that the hon. Lady made—that the Centre for Public Scrutiny, the Patients Association and the Local Government Association are carrying out the very evaluation that she suggests is necessary. I understand that they will report their findings in May. Of course, we wait avidly to see what they find and how that will inform the practical guidance and support that HealthWatch England will be able to supply to healthwatch as it develops.

Emily Thornberry (Labour, Islington South and Finsbury)

May I make the obvious point? We have three groups looking into LINks and how successful they have been. We have another inquiry looking into what happened in Mid Staffordshire. We need to learn from all that, and yet the Government continue to force through legislation relating to national HealthWatch and local healthwatch without the benefit of learning from the experiences of people up and down the country. Does not the Minister understand that it is time to stop, listen and come back with better legislation?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

On the contrary, we are listening, responding and, where necessary, making sure that the Bill is improved. That has been the nature of the process since July when we published the White Paper. We consulted. We had 6,000 responses. We listened. We understood the concerns and have addressed them in the Command Paper and the Bill. There has been a process of ensuring that the Bill is fit for purpose and actually delivers the devolution of power in the NHS that the Government believe is essential to liberate front-line staff to deliver the best possible outcomes for patients. That is something that the current system will never be capable of doing, because of constraints and impositions from the centre.

On local authority duties, clause 169 amends the Local Government and Public Involvement in Health Act 2007 to allow the local authority to set up a contract with the local healthwatch organisation directly, or with a host if it wants, to carry out the functions as set out in section 221 of the 2007 Act, which includes the new functions added by clause 168.

Amendment 350 seeks to place a requirement on the local authority to consult persons as it considers appropriate before it prepares its report on its findings on whether local healthwatch arrangements are performing effectively and delivering value for money. As part of its functions, the local authority will assess and prepare a report about the performance and value for money of those arrangements.

Such information is important to the public purse and to the local healthwatch organisations, which will have a separate duty to operate effectively, efficiently and economically. The amendments are unnecessary, and, in reference to proposed new subsection (7C), if the authority has considered particular information and consulted particular people, we would expect it to say so in its report.

Amendment 351 seeks to add a requirement on local authorities to consult with persons and representatives of persons whom it considers able to provide advice about arrangements. That would happen before it enters into a contract with local healthwatch or a host organisation. It is curious, because the hon. Lady is saying that we should evaluate, delay and wait for the inquiry, and this morning’s exchanges made it clear that we are open to and intend to consider the findings and recommendations of the Francis inquiry.

Of course, we will also look carefully and closely at findings of the work that the Local Government Association is doing. Indeed, we are working closely with it on many aspects of the implementation of the measures in the Bill. The hon. Lady’s proposals are too prescriptive. They are matters that should be decided on locally by elected local councils; they are not for Members to prescribe in the House. Our approach is to encourage local authorities to consult, and it is good practice to do so. Local authorities must decide how it would work for them.

If the amendments are not withdrawn, I invite my hon. Friends to oppose them, but I hope that the hon. Lady feels able to withdraw them.

Emily Thornberry (Labour, Islington South and Finsbury)

I will have more to say in the clause stand part debate, but I beg to ask leave to withdraw the amendment.

Emily Thornberry (Labour, Islington South and Finsbury)

I want to raise some other concerns about clause 169 that have not fallen within the scope of the amendments. The first is under the category of the relationship between local healthwatches and local authorities. What if there is a conflict of interest or a disagreement? What would the local authority do?

The local healthwatch could be, for example, an assertive, aggressive, argumentative and difficult organisation that is giving the authority a really hard time, particularly in the commissioning of social care. It could be in the local paper every week, criticising the local authority and having a go at the leader of the council and so on. The local healthwatch, however, is dependent on the local authority for its very funding and existence. One hopes that the local authority, in all good will, will continue to fund it properly and to give it support, but there would be a temptation not to do that.

What would happen in those circumstances? What if a local healthwatch was doing its job in an aggressive, but nevertheless proper, way? If it does not have sufficient independence from the local authority, how can it fulfil its function? The local healthwatch has a particular concern with social care, and it therefore has a job in scrutinising what local authorities do in the commissioning of social care. That is an important question, which requires a clear answer from the Government.

Nicky Morgan (Conservative, Loughborough)

I understand the hon. Lady’s point, and I am sure we are all aware of good local authorities and bad ones. Does she not think, however, that if there was an aggressive and effective local healthwatch that felt its funding was threatened, the first thing it would do would be to go to the press? Any sensible local authority would not have a battle in the public domain about funding.

Do the hon. Lady’s comments not also suggest that she has little confidence in the ability of local authorities and councillors to stand up to decent scrutiny? Is that not rather insulting to all those hard-working local authorities and councillors across the country that are perfectly capable of dealing with effective scrutiny committees and defending their policies if necessary?

Emily Thornberry (Labour, Islington South and Finsbury)

Given the appalling level of cuts that local authorities are facing, many different organisations will face the wall very quickly; I suspect the first in line might well be those that are giving the local authority the hardest time. I do not want that to be the situation, and in an ideal world it would not happen, but we are all living in the real world, at least on this side of the Committee.

Dan Byles (Conservative, North Warwickshire)

Is the hon. Lady confirming that it is Labour party policy at the local level to make cuts based on political decisions, rather than try to make effective savings?

Mike Hancock (Liberal Democrat, Portsmouth South)

That is going way beyond the scope of the Bill, and I would not want the hon. Lady to respond to it.

Emily Thornberry (Labour, Islington South and Finsbury)

I am not tempted to respond. I do not think that I could respond in language appropriate to the confines of this room, but I would be happy to talk to the hon. Gentleman about it afterwards.

One very serious question that needs a serious answer is: what happens where there is a conflict between local authorities and local healthwatch, because we are dealing with people? The second question is this: there is provision for one member of local healthwatch to sit on the health and well-being board, is that sufficient? It seems to be prescriptive that only one person from local healthwatch will be sitting on a health and well-being board. Is that really necessary?

I would like to read into the record further evidence from the Patients Association:

“Local authorities will be responsible for the performance of Local Healthwatch as the commissioners of this service. It will be the local authority’s responsibility to performance manage Local Healthwatch. There will be no nationally driven performance management of Local Healthwatch. How will consistent standards between Local Healthwatch be monitored?”

If that is right—perhaps the Minister could confirm that it is—the organisation responsible for performance management of local healthwatch will be the local authority. How can we ensure that there is consistency of standards across the country? Or will it be national Healthwatch that will monitor the performance of local healthwatch? That would be odd because national Healthwatch would be monitoring the performance, regulating it and ensuring there is best practice across country, but it would be paid for by another body. Being able to pay the piper is the source of much power. It is another example of tension between those two bodies. We want local healthwatch to succeed, rather than fail, but this seems to be a hole down which a local healthwatch could fall.

Local healthwatches need to represent all the views and experiences in their area, and they need to be able to gather views from across the population. There needs to be a range of ways in which people can get involved. Some LINks seem to have failed to create the community-focused approach we envisaged for their work. There is always a danger of capture by special interest and single issue groups. How can we ensure that there will be more genuine participation in the new local healthwatches? Will the Department of Health or local authorities provide guidance on how the views of the vulnerable and the hard-to-reach are expressed through healthwatch, because that seems to be an important area?

We do not just want to have the articulate, the motivated and the confident to be taking over these groups, nor do we want a subgroup of the area that feels particularly hard done by taking over, when there is a range of views that should be reflected by local healthwatch. How can we ensure that does not happen with this new organisation? Could the Minister offer us any guarantees? How will the views of the most vulnerable be fed into the system? Those are our concerns on local healthwatch and its relationship with local authorities. We want to have some reassurance from the Minister about how it will happen.

We are particularly concerned about a number of problems. I welcome what the Minister says about pathfinder local healthwatches. That is the sort of evidence-based policy making that we approve of so much—one of the reasons why we should not be pushing the Bill through as quickly as we are. Given that we are, that is perhaps one way of patching things up. I am pleased about that, but I hope that when we look at the performance of local pathfinder healthwatches, the questions that have been asked this afternoon will set the standard against which local pathfinders are measured.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Again, I suspect that the Committee shares the intention to ensure that the successors to LINks, local healthwatches, are effective bodies that provide a much stronger patient voice in the places that matter and in decisions about the health and social care provision in communities.

With regard to the hon. Lady’s questions, I shall start with the one about conflicts of interest, which is important to deal with. We have made clear in the Bill the duties of local authorities to establish healthwatches, the nature of their relationship and the safeguards to ensure that authorities do not overreach themselves and start to bully a healthwatch; that is the fear she described. It intrigues me because one group of amendments that we may consider in due course poses an interesting challenge.

A concern is that for example, a local authority might become so fed up with being constantly challenged by its healthwatch that it seeks to have it dissolved. We have provided an important safeguard against that in the Bill. A local authority, having established a healthwatch, will not be able to have it dissolved it unless it agreed with HealthWatch England that that was the right thing to do and approached the Secretary of State to do so. That will provide a check and balance in the system and a view from HealthWatch England, and will secure the independent status of local healthwatches, which is important for their ability at the local level.

Emily Thornberry (Labour, Islington South and Finsbury)

Again, that sounds fine and dandy on the face of it. The difficulty is that although the local healthwatch might continue to exist and not be dissolved by a local authority disgruntled by its behaviour, the authority could starve it of funds or move its support elsewhere. As I understand it, there will be nothing that the national HealthWatch can do about that, and if I am wrong, I would be grateful for a reassurance. If there is a bad relationship between a local authority and a local healthwatch, will there be any way in which the national HealthWatch or anyone else can step in to ensure that the local healthwatch does not shrivel?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Let me try to ensure that we get that problem properly cleared up. People outside the Committee might have a legitimate concern about how the Government’s intention that local healthwatches be an independent and critical friend of the system can be secured. Local authorities will need to make funds available and will have a statutory duty to make arrangements to ensure that the activities mentioned in section 221 of the 2007 Act are carried out in their area, meaning that they have to provide any necessary funding. The legislation will also require a local authority to make arrangements to ensure that the local healthwatch carries on with its activities.

We have also had discussions about the need to publish accounts—I have moved amendments to deal with that—and the need for transparency in understanding how resources are to be used. I am not convinced about the underlying case for a ring fence, as that can also become a constraint when it comes to the level of resources needed to provide a service. I hope that I have given the necessary reassurances about the statutory basis on which the provisions rest.

Emily Thornberry (Labour, Islington South and Finsbury)

May I say how impressed I am with the Government? The Minister was able to say with a straight face both this morning and now that a ring fence might constrain a local authority, as if in the current climate a ring fence would mean that local authorities would not be able to spend more than the Government intend. Given the terrible cuts that the Government are imposing on authorities, that simply will not be the case.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

As the Government tackles the debt legacy we inherited it is undoubtedly the case that local authorities are having to deal with and make very difficult decisions, forced upon them by the fact that £1 in every £4 we currently spend in the public sector is borrowed. [ Interruption. ] I will move on very swiftly, Mr Hancock, to make other points more pertinent to the clause.

Let us deal with the issue of membership and representation. The Secretary of State has a power to make regulations on membership if it is necessary to increase representation. The hon. Lady expressed her concern about there being only one member of the local healthwatch on the health and well-being board. It is important to stress again that in the Bill we provide the de minimis requirements for the membership of health and well-being boards. We do not want to be overly prescriptive in terms of all sorts of organisations that it might be good to have involved. It is very important that, in framing their governance arrangements, democratically elected local authorities that are accountable to their populations make and account for those choices correctly. They should make those choices, rather than MPs who sometimes miss things while adding longer and longer lists to the requirements. The current plans will allow the local authority to decide who and how many take part in the arrangements.

In terms of conflict between local authorities and local healthwatch, I think there will be a creative tension, but we are not trying to transfer—if you like—hon. Members’ experience of the adversarial system that we have in this place. We are trying to create a collaborative, consensual process that makes sure that the patient’s voice is heard, respected, understood and acted upon. That is what the Bill is all about. It is simply not possible for local authorities to starve these organisations of funds, as I have already set out, and of course HealthWatch England will be able to advise on the building of effective relationships with local authorities, should that become necessary. That is what these pathfinders are all about; making sure that we learn through experience and that that experience is disseminated throughout the system to get the very best of healthwatch into the system.

Clause 170

Clause 171

Emily Thornberry (Labour, Islington South and Finsbury)

I beg to move amendment 355, in clause 171, page 144, line 29, at end add—

This clause relates to requests, rights of entry and referrals, and amendment 355 seeks a commitment from the coalition Government on their intention to place all commissioners and providers of publicly funded NHS and social care services under duties to respond to requests for information and to comply with rights of entry.

Paul Burstow rose—

Emily Thornberry (Labour, Islington South and Finsbury)

A “yes” will do.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I may be a little longer, but I hope to get to that point very quickly. Section 226 of the Local Government and Public Involvement in Health Act 2007 relates to referrals of social care matters to health overview and scrutiny committees by local involvement networks, which are to be replaced by healthwatch organisations. The amendment would enable the referral of such matters to the local authority, where an overview and scrutiny committee is not operated locally.

We agree that it is appropriate to ensure that social care matters can be referred in such local authority areas. However, the amendment is unnecessary because proposed new schedule 16A(4) to the 2007 Act provides a general power for local healthwatch organisations, under which they

“may do anything which appears to it to be necessary or expedient for the purpose of, or in connection with, the exercise of its functions.”

That would include referral of social care matters to the local authority. In the light of that and with an indication that it is certainly our intention that, as now, such access should be available, I hope that the hon. Lady will feel able to withdraw the amendment.

Emily Thornberry (Labour, Islington South and Finsbury)

I beg to ask leave to withdraw the amendment.

Clause 172

Emily Thornberry (Labour, Islington South and Finsbury)

I tabled amendment 356, which would have replaced “and” with “or”, but in the light of what the Minister said about dissolution of local healthwatch, the importance of there being some form of protection for those bodies and the assistance they may get from HealthWatch England, I have a better understanding of why we have the “and” instead of the “or”—or whichever way round it is—and I will not move the amendment.

Clause 173

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I beg to move amendment 434, in clause 173, page 146, line 7, at end insert—

The amendment amends section 227 of the 2007 Act to clarify reporting responsibilities for hosts. A host organisation is a body that a local authority currently contracts with for the purpose of ensuring that local involvement networks’ functions are carried out. The Bill allows a local authority to decide whether to keep the existing host arrangements or contract directly with a local healthwatch organisation. If a local authority decided to continue the existing host arrangements, amendment 434 will ensure that the arrangements do not need to require the host to prepare annual reports on the provision by local healthwatch of independent advocacy services or other services under section 223A of the Local Government and Public Involvement in Health Act 2007. That is because arrangements for the provision of such services by local healthwatch would be separate to any arrangements under section 221 with the host to arrange for the local healthwatch to carry out its functions. The amendment makes it clear in the Bill that it is local healthwatch that discharges the function, not the host.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I beg to move amendment 435, in clause 173, page 146, line 16, after ‘(4)’ insert ‘—

Mike Hancock (Liberal Democrat, Portsmouth South)

With this it will be convenient to discuss Government amendment 436.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

To ensure accountability and transparency, local healthwatch organisations will have to produce annual reports each financial year. Those reports will be sent to certain bodies, including HealthWatch England. The amendments clarify the requirements relating to the annual reports of local healthwatch organisations and are minor and technical. For those reasons, I hope that the Committee will support the amendments.

Clause 174

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I beg to move amendment 437, in clause 174, page 147, line 1, at end insert—

The amendment is minor, but technical and drafted in the spirit of good, legislative housekeeping. It removes the relevant section 228 from the 2007 Act, which made provision for transitional arrangements for local involvement networks. Clearly, that is no longer necessary—those transitional arrangements have been and gone. The amendment is simply a tidying-up provision that removes something that is no longer necessary.

Clause 175

Emily Thornberry (Labour, Islington South and Finsbury)

I beg to move amendment 358, in clause 175, page 147, leave out lines 8 to 10.

The clause is important because of the substantial worries about what the Government are doing with overview and scrutiny, which, in some ways, are illustrated by the two amendments to the clause that we have tabled. Some of the arguments are complex and I hope that I can do them justice—I will do my best. We have a problem with the principle and whether overview and scrutiny will be able to refer anything other than changes to designated services to the Secretary of State for Health.

The amendment would exclude

“omit ‘an overview and scrutiny committee of’, for ‘the committee’”.

In many ways, overview and scrutiny committees are highly successful vehicles, which gain a great deal of praise. I have received some agreed wording about the importance of overview and scrutiny, which essentially says that they are very far from being broke and certainly do not need to be fixed. It states that the

“Centre for Public Scrutiny and the Local Government Group support the retention of the current arrangements—independent health scrutiny committees that can determine the service changes they engage with and can make evidence-based referrals independently from executive and authorities.”

Our concern is that the Bill will throw overview and scrutiny committees up into the air and allow local authorities to reorganise them. That is a walk into the dark that is simply unnecessary. The provisions of the clause are consistent with what I understand to be in the Localism Bill, under which all overview and scrutiny bodies are reorganised except, rather bizarrely, health overview and scrutiny committees—that Bill specifically excludes them. We have found ourselves in the odd position where the trust and confidence that the Department of Health has in health overview and scrutiny committees is much greater than the trust and confidence that the Department for Communities and Local Government has in health overview and scrutiny committees.

I do not want to draw obvious and unnecessarily—

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Petty?

Emily Thornberry (Labour, Islington South and Finsbury)

Very far from petty. Very important, in fact. I will spell it out. The Department of Health may not be terribly happy with keeping overview and scrutiny as currently organised because it is powerful. It is a way in which local communities are able to stop service reconfiguration in its tracks and send it off to the Secretary of State. The Department for Communities and Local Government has some respect for that and has specifically excluded it from the Localism Bill, but an attempt is now made in the Health and Social Care Bill to exclude the part of the Localism Bill that excludes it. There is an attempt to patch this up, but clearly in the two Bills we see clearly a disagreement going on between the Department for Communities and Local Government and the Department of Health. Perhaps those in local government have been able to lobby the Department for Communities and Local Government effectively so that the powers of overview and scrutiny committees are kept in the Localism Bill, but the Department of Health wants to chop its head off.

Concerns such as those may be some of the reasons why the Liberal Democrats are, according to the Evening Standard, in rebellion from the “top to the bottom” of the party over the Bill. [Interruption.] I am simply referring to what is in the papers right now and to what will be happening this weekend. The Minister has to answer those questions, because in the run-up to the Bill’s passage through Parliament, he has been travelling up and down the country and saying in all the local papers that one of its purposes is to bring democracy to the heart of the NHS, but clause 175 conflicts with that. Much of my criticism has centred on the fact that, despite the promises, we are not getting an increase in democracy as the Minister has promised. The clause is much worse: not only are we not getting an increase in democracy, but it removes some of the best powers that local authorities have. That is our concern. Far from fulfilling the promises that the Secretary of State has made to his own Back Benchers that the legislation will increase local democracy, the clause shows that some of local authorities’ most important powers are being taken away. It is important to have a clear answer from the Minister about what is happening.

As well as the conflict caused by the reorganisation of overview and scrutiny and health committees, a further difficulty is the removal of the power of local authorities to refer anything other than designated services to the Secretary of State. That is addressed in the next amendment, which I will come to next.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

This is one of those debates where we are effectively debating the phantom Bill that the Opposition choose every so often to set up as an Aunt Sally that they can knock down, rather than addressing the Bill before us. This is definitely one of those areas where the rhetoric is intended to undermine rather than improve, strengthen or probe. That is understood, however, and it is taken in the spirit in which it is meant and, clearly, the spirit that was meant when the reference was made to the pleasant time that I expect to have with colleagues in Sheffield discussing this Government’s health reforms.

To be clear, clause 175 amends the scrutiny provisions in the National Health Service Act 2006 to enable scrutiny functions to be conferred on local authorities instead of individual committees within local authorities. It also inserts a regulation-making power that allows the Secretary of State to establish the circumstances in which the authority may refer a matter on which it must be consulted to the Secretary of State and others. That power also enables the Secretary of State to issue directions in relation to referrals and to confer powers on the NHS commissioning board to direct consortia. It also—this is an important point, which the hon. Lady perhaps conveniently glossed over—widens the scrutiny of regulation-making powers so that they apply in relation to any provider of NHS services, in other words extending the notion that wherever the NHS pound is spent, that provider will be subject to scrutiny by a local authority in the future. It would have been valuable to have had that when the previous Government introduced the independent treatment centres. Perhaps we would have been in a better position to look at some of the cherry-picking that took place as part of that measure, as well as the extra costs and waste of taxpayers’ money that was incurred as a consequence.

I am grateful for the opportunity to look at these issues, because they map out a critical difference in our approach. Amendment 358 would remove the flexibility for local authorities to choose how best to discharge their overview and scrutiny functions by enabling regulations to be made conferring such functions only on overview and scrutiny committees. I think that the hon. Lady and I have a shared desire to retain a clear separation between executive and scrutiny functions, which was a point made during the consultation on the White Paper, when we floated the possibility that the scrutiny role could be discharged by health and well-being boards. Local government and many others told us that they did not think that was a good idea, so we listened, understood, and changed it in the Command Paper, and that is now reflected in the Bill. We recognise that that original purpose was not to be achieved, but we are also clear that we do not want to create unnecessary, artificial barriers between different parts of the local authority scrutiny architecture. The amendment retains a top-down prescriptive requirement, which would act as a barrier to local authorities creating scrutiny arrangements shaped around their activities.

The phantom Bill cast before us today by the hon. Member for Islington South and Finsbury is not the real Bill that we should be debating. She raises the spectre of a difference of opinion between us and ministerial colleagues in the Department for Communities and Local Government taking the Localism Bill through. Let us be clear: the Localism Bill stipulates that in local authorities that operate executive arrangements, there must be a separate overview and scrutiny committee. We want that separation, but we also want to enable councils to develop health overview and scrutiny arrangements that can apply to any arrangements that the local authority chooses. They are democratic bodies which should be able to frame their own constitutions and governance arrangements and account to their electors for doing just that. We are clear that the clauses already prevent the executive functions themselves from scrutinising, while ensuring that the scrutiny function cannot be delegated to the health and well-being boards. Clause 175(2) ensures that we can give local authorities scrutiny functions, while ensuring, in combination with clause 180(4), that we achieve the necessary separation between scrutiny and the functions being scrutinised.

Emily Thornberry (Labour, Islington South and Finsbury)

Will the Minister have a stab at explaining why subsection (8) is drafted as it is? It states:

“In section 9F of the Local Government Act 2000”

—which is somewhat presumptuous—

“(overview and scrutiny committees) (as inserted by Schedule 2 to the Localism Act 2011)—

Is that not where the heart of the battle is going on? As things stand, we may have a situation where, if the Bill is passed, the Secretary of State would be able to establish regulations to manage how overview and scrutiny is developed in health. However, we could have, under the Localism Act 2011—if that comes into being—further regulations also being sent out about overview and scrutiny by the Secretary of State for Communities and Local Government. There may well be a conflict between the two of them. How would the Minister seek to resolve that problem?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

There is no such conflict. Government always act collectively and come to a view, which is presented clearly, cogently and powerfully. That is what we will do when it comes to dealing with such matters as we take the two Bills through the House.

Daniel Poulter (Conservative, Central Suffolk and North Ipswich)

Does my hon. Friend the Minister agree with this point? There has been a problem with overview and scrutiny committees in relation to local authorities and joined-up thinking, particularly on care of the elderly. When the overview and scrutiny committee in my local authority, for example, said that closing community hospitals was a bad idea, because we need to look after older people, have step-up care, step-down care, and respite care for cancer patients, the PCT was able to act independently against the interests of the wider community, and in fact against medical advice which the overview and scrutiny committee had taken on board. That is why things need to be changed, as the Bill is doing.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

My hon. Friend makes a good point, which shows why we need to make such changes.

In this part of the Bill, we have also balanced the separation, giving local authorities greater flexibility to shape the scrutiny function to meet local needs. This provides local authorities with greater certainty, so that they can design their scrutiny arrangements with the medium and long-term in mind. We have not done that in isolation. This is not a way of diluting the crucial role of scrutiny. We have done this in response to the consultation, where respondents recognised the importance of scrutiny, and at the same time asked for greater flexibility. The Association of Directors of Adult Social Services, for example, said:

“there needs to be local determination and flexibility to decide the best possible arrangements for scrutiny functions”.

Jessica Crowe, executive director of the Centre for Public Scrutiny, said in her response to the publication of the Command Paper:

“It is a tribute to the hard and constructive work of health overview and scrutiny committees everywhere that the government has recognised that their role should be not only maintained but extended.”

That is what we are doing with the Bill. We are making sure that it fits within the new architecture but is still clearly separate from the executive roles that are being established.

Emily Thornberry (Labour, Islington South and Finsbury)

As the Minister quotes the representative of the Centre for Public Scrutiny, may I cite the agreed wording between the Local Government Group and the Centre for Public Scrutiny? It states:

“The powers currently set out section 244 and associated regulations”—

that is the overview and scrutiny powers—

“are possibly the strongest expression of democratic accountability in public services. They allow for robust, independent scrutiny of health care and health issues by elected councillors. Councillors on health overview and scrutiny committees can make independent reports and recommendations. They are a strong model for democratic accountability in public services—they should be retained and not diluted.”

How strong an endorsement is that? Why are the Government meddling with that in the Bill?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

First, I do not believe that anything in the Bill or what we are attempting to do here diminishes or dilutes the scrutiny role. In fact, it extends the scope. That is what we are attempting to do here. I reject the premise that this is the pinnacle of democratic accountability when it comes to the reforms that we are making in the Bill. The changes in the relationship between the NHS and local government are brought about by the establishment of health and well-being boards and their new responsibilities to set joint strategic needs assessments and joint and health and well-being strategies. They are a further extension of democratic accountability, control and influence over the NHS that is very important.

Scrutiny is not about democratic control. It is about challenge and examination of what various other bodies that have specific responsibilities are taking forward. Early implementer health and well-being boards are very clear that their work is about increasing transparency and accountability to local people and communities, and effective scrutiny will be a key part of that.

Derek Twigg (Labour, Halton)

I understand what the Minister is saying. One of the challenges to the ability to scrutinise is the availability of information. The Minister or his colleague has made it clear that it is up to the consortia to hold public meetings and to decide what information they put in the public domain. Basically, the scrutiny board can call the consortia and other bodies to come before it, but it might not have all the information because the consortia can make spending decisions in private. There is a resolution before the Liberal party conference this weekend that no decisions about spending of NHS funds should be made in private by GP groups. Senior members of the coalition support that resolution. It is important when we are talking about transparency and accessibility that we consider the information that scrutiny boards can get hold of.

Mike Hancock (Liberal Democrat, Portsmouth South)

We need to be careful. I know that there is a great deal of interest in this. I am sure that the hon. Gentleman would like a walk-on part at the conference in Sheffield, which could be arranged, but it is not really at the heart of this legislation. We need to temper our comments according to what is in front of us today.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I will follow that instruction. If the hon. Lady would like to attend, I am sure an appropriate bill could be sent to her for the charge of the appropriate rate for registration at a late time to attend the conference. It is a curious moment, when a Liberal Democrat Minister is dealing with this part of the Bill, to wind up debating amendments to a Liberal Democrats conference motion. That says something about how things change. I look forward to debating those amendments that we come to in Sheffield later.

It is a nonsense that the intentions of the Bill, and the words on the face of it, undermine our scope. Local authorities could continue to have overview of scrutiny Committees in their current form if they see fit. They will have to discharge a scrutiny role. We are saying that it should be up to those authorities how they do it. I do not understand the notion that we should not be prepared to trust autonomous, democratically elected local authorities to make decisions about their own governance arrangements, which is what the Bill enables. It does not remove the requirement that they do these things, but simply gives them the scope to decide how best to do it.

Emily Thornberry (Labour, Islington South and Finsbury)

The whole point of overview and scrutiny committees is that they are at an arms’ length from local government. They are able to be in some ways independent. It is of enormous concern that local authorities will be able to look again at their overview and scrutiny committees generally, but the Localism Bill is not my concern here. My concern is the Health and Social Care Bill and the fact that local authorities may look again at overview and scrutiny committees and dilute them. That is not just the Opposition’s concern, but that of the Local Government Group and the Centre for Public Scrutiny.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

In response to the consultation, we have given local authorities this flexibility—it is something that many in local government said to us. Many outside this Committee will note the level of Opposition Members’ distrust of their colleagues in local government and their ability and willingness to have a very clear separation between executive and scrutiny functions. Government Members are very clear that scrutiny is an essential part of the role of local authorities, both of the services they deliver and of those that the NHS delivers.

To the question about local authorities not having all the information they need to exercise scrutiny, again, the straightforward answer is no. We are extending scrutiny regulation-making powers to enable the scrutiny function to require information and attendance. They will be able to say, “You must come and you must provide information.”

Derek Twigg (Labour, Halton)

On a point of order, Mr Hancock, is the Minister saying that no decision on spending by GP consortia will be taken in private?

Mike Hancock (Liberal Democrat, Portsmouth South)

That is not a point of order.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

The hon. Member’s question, which I am answering, was can a scrutiny committee ask—

Derek Twigg indicated dissent.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

That was the question the hon. Gentleman asked first, and I am answering it.

Derek Twigg (Labour, Halton)

The question was very simple. I said very clearly that the Bill accepts that GP consortia comes under the same scrutiny as other NHS bodies. The concern, expressed by members of the Minister’s own party, is that decisions on spending can be taken in private by the GP consortia and, therefore, the local authority and the scrutiny committee will not necessarily have all the information. If the hon. Gentleman is saying that no spending decisions will be taken in private by the GP consortia, I am happy for him to put that on the record.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I am saying that there is no information that a scrutiny Committee cannot ask of a GP commissioning consortia. That is the issue we are debating at the moment: scrutiny of health functions by local authorities. We have already debated, Mr Hancock, the fact that GP commissioning consortia are required to produce constitutions setting out how their governance arrangements will work, and that those constitutions will provide more clarity and transparency than the system we have inherited from the Labour Government. The measures are about making sure that we can extend scrutiny to any provider who provides NHS services, to make sure that there is a level playing field and that local authorities can exercise the scrutiny role in a way that works for them and their community, rather than just for the convenience of the Opposition.

Emily Thornberry (Labour, Islington South and Finsbury)

I do not think I need to say anything else. I shall press the amendment to a vote.

Emily Thornberry (Labour, Islington South and Finsbury)

I beg to move amendment 359, in clause 175, page 147, line 25, at end insert

‘, and in addition to any regulations relating to the referral of proposals for changes to services, the regulations may also provide for circumstances where referrals may be made either to the Board or the Secretary of State where local authorities or commissioning consortia are considered not to have had due regard to their duties to have regard to relevant health and well-being strategies when exercising their functions;’.

The Liberal Democrats might be knocked from the top to the bottom in the revolt over NHS reforms because of the first part of the removal of the power of overview and scrutiny; they certainly will be when people learn about this. I would like the Minister’s clear confirmation that my understanding is right. Will the legislation result in overview and scrutiny committees no longer being able to refer to the Secretary of State any changes of services that are not designated services? If he wishes to reassure me, I have little else to say.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

indicated dissent.

Emily Thornberry (Labour, Islington South and Finsbury)

He does not, so I will go on. I appreciate that the mention of such things tends to result in a red mist descending in front of the eyes of some hon. Members.

To give an example, in my area of Islington, my local PCT, in its wisdom, decided to close the Finsbury health centre. My overview and scrutiny committee referred the matter to the Secretary of State after a great deal of to-ing and fro-ing, and attempts to deal with the matter locally. My PCT decided to consult not on the basis of whether the health centre should be closed, but on how it should be closed and where the various services should go. I have much sympathy with arguments that PCTs should be more democratically accountable, because that is the sort of issue that really gets people’s goats. If the provision were about ensuring that PCTs were more democratically accountable, the Government would find support from many Opposition Members.

This is the difficulty: if there was an attempt to close the Whittington hospital’s A and E department—given that it may not be a designated service—is it right that the overview and scrutiny committee would not be able to refer that to the Secretary of State? It is of great importance and we need to know it. As I have said, the power that local authorities have to do that is one of the strongest models for democratic accountability in public services. It should be retained and it should not be diluted. If it is the case that only changes to designated services will be referred to the Secretary of State, we need to know that. In response to the White Paper, it seemed fairly clear that that was the Government’s intention. Can we hear one way or the other what the situation is? It is of great importance to us all, not only in our Front Bench roles, but as constituency MPs.

Section 244 of the National Health Service Act 2006 also relates the duties of NHS bodies to consult relevant overview and scrutiny committees about proposals for substantial variations to services, known as service reconfiguration. Section 244 gives relevant overview and scrutiny committees the power to refer proposals for substantial variations to services to the Secretary of State for determination. Since 2003, those referral powers have been available for many service reconfigurations. It must be said that there have been few actual referrals. The local authorities have used their powers wisely and carefully.

The Independent Reconfiguration Panel has advised the Secretary of State about referrals from health and scrutiny committees. It praised the quality of the referrals that it has received in its report “Learning from the Reviews.” It has not been so complimentary about the NHS consultation process. So there we have another example. The Independent Reconfiguration Panel is telling us that local authorities are exercising those powers well. So why, why is the Bill taking away that power from local government? It would be interesting to know what the Secretary of State for Communities and Local Government thought about that, although we will not. We were hearing about his potential conflict on overview and scrutiny earlier. What the panel found suggests that health scrutiny committees can be the vehicle for building consensus around constructive change. Removing independence, resources and support from health scrutiny risks losing a crucial check and balance on the system, leaving communities with a weaker voice in service reconfiguration.

There has already been a great deal of debate on service reconfiguration issues during earlier debates. We are sure that there is concern on both sides of the Committee on how local services can best be protected under the Bill and how proposed changes can be quality assured in the way that they can be if local authority overview and scrutiny boards are given a proper role. We are concerned that the regulations made under clause 175(3) could restrict councillors’ referral powers to very a narrow band of designated services, meaning that the vast majority of services could be changed with very little democratic accountability.

Currently, overview and scrutiny committees decide which variations are substantial variations about which they wish to be consulted, that are subject to the referral power, even though that power is not often exercised. Restricting referral powers to designated services would mean that decisions about which service changes councillors could consider and refer would be taken out of local control. That would amount to a dilution of local democratic accountability.

There is also a concern that the regulations might also require decisions to refer to be taken by full council meetings. That risks breaching the principles of Wednesbury reasonableness. It would mean that councillors who had not scrutinised the issues or heard the full range of evidence, could determine the outcome. It would be impractical for a full council to seek to overcome that difficulty by carrying out reviews of service changes, of the kind currently undertaken by health scrutiny committees. Requiring votes at full council would also risk adding bureaucracy and delay to the process of reconfiguration. If the Minister can reassure us that regulations will not be introduced to ensure that the full council refers to the Secretary of State, we would like to hear that reassurance. I am sure that many people in Sheffield would want to hear that too.

The Centre for Public Scrutiny and the Local Government Group support the retention of the current arrangements and have helped me on the work that I have done on these amendments. They believe that independent health scrutiny committees can determine the service changes that they engage with and can make evidence-based referrals independent of executives and authorities. For consistency, they believe that health scrutiny committees should also be able to refer to the NHS commissioning board when they believe that commissioning plans do not have sufficient regard to health and well-being strategies. Will that be part of the regulations, too?

“Equity and excellence” set out an intention to remove independent health scrutiny powers by vesting them in health and well-being boards. After reflecting on the outcomes of the consultation, the coalition recognised that that would be wrong. The was welcomed. The Bill retains separate health scrutiny powers for local authorities. The willingness to listen and to change, as I have said, has been welcomed, especially by the Centre for Public Scrutiny and the Local Government Group, which have campaigned on behalf of councils against locating scrutiny powers with the health and well-being boards. Given that those powers have been retained, why undermine them? Why allow something that works well, that ain’t broke, to be fixed in a way that effectively takes away a great deal of the power? That is our genuine concern. We hope the Minister will be able to answer it, but we fear that he may not.

Clause 175 as drafted risks the loss of independent health scrutiny—which the coalition has already recognised would be wrong—by vesting the health scrutiny powers in local authorities themselves, rather than overview and scrutiny. As I have already argued, there is no guarantee that they will be fully independent.

Those are the difficulties and concerns. This is not a ghost concern, and it is not the Opposition arguing about a Bill that is, in some ways, a fantasy Bill. We are looking at the clauses, and we are not alone in our concerns. We want to have particular reassurance about whether or not non-designated services can be referred to the Secretary of State by overview and scrutiny. If not, why not?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

This is a curious place to have the debate that the hon. Lady wants to have, because the amendment does not provide the scope for it and the intention to explore the issue of designation is not covered by these clauses. It is curious to revisit the issue at this point in the Bill.

I suggest that I deal first with the amendment and what it does and then address one or two of the hon. Lady’s points.

Emily Thornberry rose—

Paul Burstow (Liberal Democrat, Sutton and Cheam)

If I could just develop my point, the hon. Lady might not need to intervene.

I am again pleased to hear what the hon. Lady has said about the value of introducing the joint health and well-being strategy. She recognises that it is a valuable development. Although we can agree that such changes, which include the role of the health and well-being boards, are all very important, what we are also trying to do with the Bill is to ensure that the arrangements are proportionate.

Amendment 359 would enable regulations to provide for circumstances in which referrals may be made to the NHS commissioning board or the Secretary of State if the referrer feels the commissioning consortia or the local authority have not had regard to its joint health and well-being strategy. I entirely understand the policy intention that there must be some recourse when it is felt that the local commissioners have not had due regard to the locally developed joint health and well-being strategy. That is what the amendment is about, which is why we have made provision in the Bill to enable the health and well-being boards to write to the NHS commissioning board if they are of the view that the consortia plans have not taken proper account of joint health and well-being strategies.

We are introducing a strong framework with clear incentives and a more robust basis for local integrated working than has been the case thus far. We do not want to undermine real and productive relationships by returning to the days of process set by Whitehall that looked to central Government to resolve matters that would have been much better resolved by local debate, local scrutiny and local decisions. These arrangements will make that more likely to happen.

Although the hon. Lady may want this to become a debate on designation, this clause and this amendment are not the place to do that. If I were to give lengthy answers to her questions, I would be straying well outside the scope of the clause. I will give one piece of information to ensure that the hon. Lady feels that I have responded a little to her questions, notwithstanding the points that I have made about their being outwith the amendment.

How are local authorities involved in changes to NHS services? First, they will use the health and well-being board to discuss changes. Secondly, the local authority will use its scrutiny function to discuss changes. Thirdly, for service changes that are substantial or designated, the scrutiny function of the local authority can start a process of appeal. There are a number of aspects to that scrutiny function and it will be referred to the local council for a full vote.

As a former member of a local authority, I have dealt on a number of occasions over the years with other quasi-judicial roles that local authorities have. For example, in discharging planning functions, it is perfectly possible, without any threat of legal challenge, for a local authority to consider a planning application, for that matter to be referred to the full council by elected members and for it to be reconsidered and debated there without any concern about the matter that the hon. Lady described. I think that would equally be the case when it comes to a local authority, which, after all, is a body corporate that delegates functions to committees and other bodies. It will be able to do just that when it comes to this new responsibility that we are giving to the full council.

If the vote agrees to continue with the appeal, it is then referred to the NHS commissioning board. If the local authority disagrees with the commissioning board, it may then refer to the Independent Reconfiguration Panel and to the Secretary of State. The Secretary of State will ask for advice from the Independent Reconfiguration Panel. Acting on the advice, the Secretary of State can reject the appeal, ask for the proposer of the change to reconsult and, in some circumstances, stop the service change.

Undesignated services are obviously not subject to the third stage that I have just described. Every local authority must be consulted by Monitor—a very important point—on their designation guidance and by the relevant commissioners in applying that guidance once it is in place and is used to designate services. We will come back to the details. I do not propose to provide the detailed response to that debate, which we will properly have when we get to the relevant clauses.

Emily Thornberry (Labour, Islington South and Finsbury)

I want to make sure that I heard the Minister correctly. Is it the case that only designated services can be referred to the Secretary of State by overview and scrutiny? It is a simple question. Does the fact that the hon. Gentleman may not have been able to answer it directly, mean that I can assume that only designated services will be referred to the Secretary of State? Let me put it another way. Can the hon. Gentleman confirm that because he has not answered the question, we can infer that only designated services will be referred to the Secretary of State by overview and scrutiny?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Let me try one final time to answer. We have clauses later in the Bill that will provide a better place for this to be examined in detail. The question is about the referral of designated services. It is for local determination as to which services are applied to for designation.

Emily Thornberry (Labour, Islington South and Finsbury)

We know that.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I am just making sure that it is clear and on the record so that there is the clarity that the hon. Lady seeks. It is right that those services which are not designated should have more flexibility to reconfigure. We have debated that already. They will, of course, still be subject to section 242 duties to consult the public on changes to services, and overview and scrutiny committees will of course be able to conduct their scrutiny of such reconfiguration decisions. So the answer is yes, only designated, through regulations; but local authorities’ role in which services are designated is also very important. These are a series of interlocking clauses that provide a change in the nature of the scrutiny but actually strengthen it, because decisions about designation are ones that local authorities have a direct say over as well.

Emily Thornberry (Labour, Islington South and Finsbury)

I want to put the amendment to a vote and for it to be made perfectly clear that, as far as we are concerned, this is a vote on whether overview and scrutiny committees should be allowed to refer non-designated, threatened services to the Secretary of State. Anyone voting against the amendment is voting for non-designated services to no longer have that protection of being able to be referred to the Secretary of State, and that includes A and E departments in London.

Mike Hancock (Liberal Democrat, Portsmouth South)

I am not altogether sure that that is what the amendment says. The amendment before us is quite clear.

Mike Hancock (Liberal Democrat, Portsmouth South)

May I say on behalf of the Committee, Mr Burstow, that it may be appropriate for you to write to the Committee, clarifying your answer to that last point, so that it is clear on the record for people inside and outside the House that we know exactly what the issue was. There could be some easy misinterpretation of that answer.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

On a point of order, Mr Hancock. I am, of course, happy to do that and to make clear the reasoning behind why we felt that this matter would not be debated under this amendment.

Derek Twigg (Labour, Halton)

Further to that point of order, Mr Hancock. I am not 100% clear about what you were saying. We do not have clarity as to why non-designated services are not included.

Mike Hancock (Liberal Democrat, Portsmouth South)

That is the question to which the Committee and those outside Parliament would be interested to know the answer. It would be appropriate if we were written to on that point, so that it is clear.

Emily Thornberry (Labour, Islington South and Finsbury)

On a point of order, Mr Hancock. Given that the clause relates to the scrutiny function of local authorities, what is going to appear within the regulations and whether designated services or anything other than designated services will be able to be referred are things that are entirely within the remit of the clause. It is for that reason that we need to have complete clarity—

Mike Hancock (Liberal Democrat, Portsmouth South)

That is a debate for clause stand part.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I beg to move amendment 438, in clause 175, page 148, line 31, at end insert—

This is a transitional provision, which is necessary as we are contingent in part on the progress of the Localism Bill. The amendment will ensure that local authorities have flexibility in how they discharge their overview and scrutiny functions should we need to commence our provisions ahead of the commencement of the relevant provisions in the Localism Bill. Should those provisions be commenced before the commencement of our provisions, this transitional provision will not be necessary and the flexibility will be granted to local authorities through the amendments that clause 175 will make to the Localism Bill when it is enacted. For those reasons, I urge hon. Members to accept the amendment.

Mike Hancock (Liberal Democrat, Portsmouth South)

With this it will be convenient to discuss Government new clause 4—Amendments consequential on section 175.

Emily Thornberry (Labour, Islington South and Finsbury)

I believe that we have had such a complete debate that, tempting as it is, it would probably be wrong to go over it again.

Clause 176

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I beg to move amendment 439, in clause 176, page 149, line 9, leave out

and insert

Mike Hancock (Liberal Democrat, Portsmouth South)

With this it will be convenient to discuss Government amendments 440 to 442.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

These minor and technical amendments will ensure that the representatives of the relevant GP consortia are required to be included in the health and well-being board, and that the amendments to the provisions on the preparation of the joint strategic needs assessment correctly refer to consortia.

As members of the Committee will know, commissioning consortia will set out their geographical area in their constitution. Any consortium that has a geographical area that overlaps with or is within the local authority area will have a duty to send a representative to the health and well-being board, and jointly prepare the joint strategic needs assessment and joint health and well-being strategy through the health and well-being board. The amendment makes it clear that references to consortia in the relevant provisions mean those whose area overlaps with or is within the local authority.

As such, I hope that all the members of the Committee can see that that will ensure greater clarity and consistency with previous clauses and the engagement of all relevant commissioning consortia in the work of local health and well-being boards, and that they will therefore support the amendments.

Emily Thornberry (Labour, Islington South and Finsbury)

I make the simple point that the necessity to attempt to tidy up the Bill arises from the fundamental problem that GP consortia do not need to be coterminous with local authority areas. The difficulty is trying to ensure that strategic needs assessments are made in a way that makes sense in an area with a patchwork of GP consortia.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

In briefly responding, I make the simple point that that is already the case with primary care trusts, many of which are bigger than a local authority or cover many local authorities, and in other circumstances the overlap is different. The problem is being inflated and exaggerated, as is so often the case with proposals made by the Opposition.

Emily Thornberry (Labour, Islington South and Finsbury)

I beg to move amendment 360, in clause 176, page 149, line 25, leave out from ‘consortium’ to end of line 26 and insert

Mike Hancock (Liberal Democrat, Portsmouth South)

With this it will be convenient to discuss amendment 366, in clause 176, page 149, line 25, leave out from ‘consortium’ to end of line 26 and insert

Emily Thornberry (Labour, Islington South and Finsbury)

If we look at the clause, a fair caricature of what it is doing might be taking out “PCT” and putting in “partner commissioning consortia” instead. Essentially, it is updating the current joint strategic needs assessments, so that they are done by the local authorities and doctors, as opposed to by the PCT. I hope that that is a fair summary of the purport of the clause.

Nevertheless, the clause provides an opportunity to ensure greater accountability and more involvement by more bodies—bodies as diverse as the Optical Confederation, which contacted me, stating that it would wish to be one of the bodies consulted under the clause before a joint strategic needs assessment. That is why, in some ways, amendments 360 and 366, which come in at the same point, in effect make the same point: if we are putting together a joint strategic needs assessment, let us ensure that we do not only have the local authority and doctors discussing it, but a much wider group, so that we learn from everyone, including the opticians. We would have a proper joint strategic needs assessment, which was a distillation of the communal wisdom of an area.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

The lead amendment would place a requirement on local authorities and commissioning consortia to consult with district councils as well as any other relevant persons, groups or representatives in the preparation of a joint strategic needs assessment. The amendment is unnecessary as section 116 of the Local Government and Public Involvement in Health Act 2007, amended by the clause, will require partner commissioning consortia and the relevant local authority—if a county council—to consult each relevant district council. The provision retains the current duty of local authorities and primary care trusts and recognises the important role of district councils in offering local insight and expertise.

We recognise the concern of the hon. Lady and of some district councils, but hope it is addressed by the reading across of existing provisions in the previous legislation. Moreover, consortia and the commissioning board will also be expected to consult the public as part of their obligations under section 242 of the National Health Service Act 2006 when planning for the provision of services. Local councils and consortia should have the flexibility to consult any person they think appropriate, as they do under the Bill. Decisions on whom to consult, beyond the statutory minimum, are best made locally and should be for local health and well-being boards.

Nicky Morgan (Conservative, Loughborough)

I entirely agree with what the Minister said about decisions on who to consult being up to local authorities, but I wanted to reflect some of the concerns expressed by various charities, including Rethink, which wanted confirmation that “any person” could include the local healthwatch organisation, as well as anyone else the authorities see fit to consult.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I am grateful to my hon. Friend for asking that. I can give her, Rethink and the other charities that posed the question the assurance that the provision does do just that. In addition, the local healthwatch, as a member of the health and well-being board, will be able to influence and recommend who else should be consulted about and included in the work around joint strategic needs assessments. The clause puts in place a double lock by providing for the local healthwatch to be consulted directly and for it to be able to ensure that the local authority and the consortia discharge their consulting role in a wider way.

Amendment 366 would require local authorities and commissioning consortia to consult the public and interested groups in line with the Cabinet Office code of practice on consultations when preparing the JSNA. We want local authorities and consortia to consult their populations when undertaking JSNAs as appropriate, and that should be a local choice. Local authorities and primary care trusts can already consult relevant organisations and people as part of the preparation of the JSNA. As I mentioned, local authorities and consortia already have a duty to consult district councils, and that will continue. Requiring them to undertake a formal, 12-week consultation would be unnecessary, and we would prefer to leave how commissioners properly consult and engage with the people they serve to local determination.

This will be the first extension of the Cabinet Office code to a local authority, and it will not apply to any other aspect of their obligations to consult their public. Moreover, the code will not bind local authorities, as it sets out the Government’s general policy on formal, public, written consultation exercises. Other public sector organisations are free to use the code, and local authorities could, of course, avail themselves of it if they chose to, but it does not apply to local government exercises unless they adopt it.

The amendments tabled by the hon. Member for Islington South and Finsbury would require local authorities to consult particular persons when preparing JSNAs and to follow the code. That would create an anomaly and go beyond the current obligations on local authorities. As an aside, we note that her colleagues on the Public Bill Committee on the Localism Bill have not tabled similar amendments to extend the code to other areas on which local authorities are expected to consult.

For all those reasons, we believe the amendments are unnecessary. I hope that I have been able to reassure the hon. Lady about district involvement. As she rightly said, clause 176 replaces PCTs with consortia, and it also strengthens the JSNA requirement. This is the important difference: whereas, at the moment, none of these bodies have to have regard in law for JSNAs, once the Bill becomes an Act they will have to. That is an important strengthening for the future and of the relationship we wish to build between consortia and local government.

Emily Thornberry (Labour, Islington South and Finsbury)

I beg to ask leave to withdraw the amendment.

Kevin Barron (Labour, Rother Valley)

The Minister will be pleased to know that I am unable to be in Sheffield on Saturday afternoon, but my season ticket is available for Rotherham United versus Bury at the Sheffield Don Valley stadium. If he would like to borrow it, he might find more friends there than in conference.

The Minister says that the clause is about replacing PCTs with consortia, but it also extends the JSNA. Subsection (3)(c) says

“after ‘a need’ insert ‘or to be likely to be a need’.”

That is better described in the explanatory notes, which say that the amendments in the clause

“also widen the scope of the joint strategic needs assessment to require it to cover both the current and future needs of the local population, and not only current needs.”

What is that likely to bring in? I presume that that is pointing to population health as opposed to health needs, but could he give us a brief description of how the assessments we have at the moment will be widened?

Debbie Abrahams (Labour, Oldham East and Saddleworth)

The Minister will not be surprised that my comments will relate to the importance of ensuring that there is an explicit reference to assessing comprehensive health inequalities, which I have raised a number of times in Committee.

The Bill has a particular weakness, because although it refers to the importance of health inequalities, and they are addressed under clause 3, the matter has not been well dealt with in relation to the mandate for the Secretary of State, the duties for consortia and so on. If we are committed to reducing health inequalities, there must be a more explicit reference in the Bill. We must have a comprehensive assessment that looks at not only the individual, but wider economic determinants. My concern links to a reference from the Faculty of Public Health, so other people regard the matter as a particular weakness, too. I hope the Minister will consider that and consider whether a designated person should be responsible for such assessment.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I shall start with the hon. Lady’s remarks on explicitly referring to health inequality within the discharge of the duty to produce a JSNA. It is important to keep in mind the simple fact that when particular organisations carry out any function that the Bill designates to them, such organisations must also have regard to the duties that are placed on them. They must exercise such regard through every function that they undertake. When discharging their function to produce a JSNA, they therefore have to demonstrate that they are also taking into account health inequalities. In addition, we intend to review and revisit the guidance on JSNAs, and we want to co-produce that with colleagues in local government and more widely. We also want to ensure that such a review addresses the point made by the right hon. Member for Rother Valley about public health issues.

To answer the right hon. Gentleman’s question, we want to ensure that demographic trends are being understood and taken into account. Understanding such trends are a key part of determining how services might change over time to meet the changing needs of a population as a result of its ethnic mix, its socio-economic mix, and its age profile. We do not just want to get a snapshot of all those things in the here and now and then fix services on that basis. We need to be thinking into the future, too, as we are trying to ensure is clear in the Bill.

Debbie Abrahams (Labour, Oldham East and Saddleworth)

Again, I stress that these points were made through the Faculty of Public Health and arise from my experience. Why is there a problem with making the importance of health inequalities more explicit throughout the Bill? How will the matter be dealt with at the different stages? If it is not dealt with, there is a danger that health inequalities will not have the profile that is needed.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

We will make absolutely certain that the guidance that supports the provision draws the attention of the parties that will produce JSNAs to the duty around health inequalities. It is a key part of the Bill, and this is the first time that a health Bill has contained an explicit reference to such inequalities—that has not existed in any previous NHS legislation. The duty must be exercised in any function that is discharged under the measures in the Bill, so it is a key part of the architecture. I am sure that hon. Members are right to keep raising the matter, and we are right to keep reassuring them. I am more than happy to have further conversations with the faculty about its particular concern, if it wishes.

The key point is that when producing JSNAs, consortia must take account of the relevant needs of the population, so they will have to take into account the health inequalities that exist. The strategy will set out how they will reduce such inequalities, and we would expect a joint health and well-being strategy to do that.

Debbie Abrahams (Labour, Oldham East and Saddleworth)

What about having a designated person responsible for assessment?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

With regard to a designated person being responsible for producing the joint strategic needs assessment, we have made the organisational responsibilities clear in the Bill. Given the thrust of the Government’s intention not to be over-prescriptive in autonomous organisations’ governance arrangements, it would be odd to prescribe in the Bill a specific person as responsible, but it is a clear function and duty for them to discharge. With that, I hope that the clause can be approved.

Clause 177

Grahame Morris (Labour, Easington)

I beg to move amendment 220, in clause 177, page 150, line 19, at end insert—

Mike Hancock (Liberal Democrat, Portsmouth South)

With this it will be convenient to discuss amendment 221, in clause 178, page 151, line 16, at end insert—

Grahame Morris (Labour, Easington)

The clause would impose a duty on local authorities and commissioning consortia to produce a joint health and well-being strategy to meet the needs identified in the joint strategic needs assessment. There will be a duty on consortia, the local authority and the NHS commissioning board to have regard to the joint strategic needs assessment and the joint health and well-being strategy when carrying out their commissioning functions.

The amendments would extend the duty to ensure that those strategies take account of some of the most important determinants of health. My hon. Friend the Member for Oldham East and Saddleworth just referred to health inequalities. In a similar vein, the amendments intend to be helpful and strengthen the provisions.

Amendment 220 is designed to ensure that, in preparing local health and well-being strategies, health and social care needs are considered alongside local housing needs. It would give regard to local assessment of housing needs. To reassure coalition Members, I should say that the amendments would not divert resources in a particular direction. They would give an opportunity to address health inequalities by identifying that particular need. It would also ensure that local partners could make this key determinant of health a priority when joint health and well-being strategies are being put in place.

Amendment 221 would ensure that a housing representative sits on the health and well-being boards. That person might be a director of housing or a chief executive of a housing association, in the cases where stock has already been transferred. Boards are expected to put in place a health and well-being strategy for their local area and to work in an integrated manner. To achieve that, a housing representative should be on the local board, alongside people representing social services, children’s services and other representative board members set out in the legislation, because housing is a key determinant of health.

Steve Brine (Conservative, Winchester)

I do not doubt the hon. Gentleman’s motives, and he is making his point well. In my area, the city council owns stock and there are at least two—on the edge, three—other housing association providers. Does the hon. Gentleman propose that only the council’s housing representative should sit on the board, or would there be four individuals?

Grahame Morris (Labour, Easington)

Without getting into an argument about numbers, I should say that it would be sensible to have a representative. I do not think it would be problematic. In my area, we have a large arm’s-length management organisation in respect of local authority housing stock. There could be a consensus on the representative among the providers, as long as we had somebody there with the expert knowledge to contribute.

The Committee should also be aware that any assessment of housing needs will be removed by the Localism Bill. The Minister might want to address that point later. My understanding is that that would mean there would be no local needs assessment to guide and inform what is decided and prioritised in local housing strategies. It is interesting that the National Housing Federation suggested that that contradicts the approach taken by this Bill—a point made eloquently by my hon. Friend the Member for Islington South and Finsbury. Needs assessment remains important for integrating services and prioritising the appropriate measures.

By accepting the amendment, we could ensure not only that housing need informs local health and well-being strategies, but that there is some sort of assessment of local housing needs in the first place. I appreciate that housing need varies from area to area. For example, in my own constituency—a traditional coal mining area—we have a particular need for special-purpose accommodation because of a large and growing elderly population, many of whom have disabilities. Clearly, that has implications for health provision.

Each area has its unique problems. In areas such as Dudley or the London borough of Islington, where the populations are younger, there may be demand for more family accommodation. The amendment would not be prescriptive; it would be left to local determination to assess housing need and take appropriate action.

The amendment might be the only way to get the assessment of local housing need on to the statute book, because, to the best of my knowledge, the Localism Bill does not currently legislate for that, although I stand to be corrected. The Department of Health team may be unaware of the issue, and the amendments offer a vital opportunity to address the problem.

Such an assessment would benefit integration, cost-effectiveness and savings, and give more credibility to local health and well-being strategies. It may sit uncomfortably with the Government to enforce the membership of housing representatives on the health and well-being boards, but it could be of invaluable benefit for determining health needs. It would make sure that the relevant people were at the table to make vital decisions and have input into formulating strategy.

If the Government are serious about integration, as the Bill implies, the amendment should help them to realise that aim. Proper integration across health and social care cannot be fully achieved without considering the role of housing and support. Indeed, National Housing Federation research shows that currently only 20 PCTs are scoring well on the “collaborative working” indicator, which is not good enough. As the new health service comes into focus, this picture must be improved. The amendment offers a mechanism for doing so.

Both sides of the Committee agree that there should be better integrated and co-ordinated services, so I would like to share some relevant facts and figures, which the National Housing Federation has provided. Housing-related support services—funded through the Supporting People programme, as Members will realise—save the NHS around £315 million each year, according to Government figures. Some 42% of social housing households have a resident who is disabled or has a limiting long-term illness, compared with a national rate of 17%. One community-based falls prevention scheme—which might even have been the one in my own area—reduced the rate of falls among older people by 55%.

Housing problems are frequently cited as a reason for a person’s being admitted or readmitted to in-patient mental health care. The need to find appropriate accommodation and a lack of appropriate move-on housing are major reasons for delays in discharging people from hospital back into the community. In an average homelessness project in England, an estimated 43% of clients are likely to have mental health needs and 59% may have multiple needs.

I point out to Government Members that the Government will be looking for local authorities to deliver cost-effective and value-for-money solutions to health challenges. For Opposition Members, putting housing needs at the top of the agenda would help to deliver more efficient health services, so I hope the Minister will look kindly at the amendment.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I am more than happy to confirm that when it comes to the representations that the National Housing Federation is making about the essential contribution that housing makes to good health, the hon. Gentleman is absolutely right. We do not disagree with that contention in any way. Our difference is over how we give effect to recognising that that is the case.

The difficulty with the amendment, as was pointed out by my hon. Friend the Member for Winchester, is that, given the large amount of housing provided by registered social landlords, and in some cases because of stock transfers, it would be challenging at the very least to decide who should sit on the health and well-being board. That is why prescribing membership in the way that the amendment seeks to is not the answer.

Daniel Poulter (Conservative, Central Suffolk and North Ipswich)

Does my hon. Friend agree that there is a big problem, and not just in the social rented sector? The worst housing is often in the private rented sector. It is particularly difficult to find any representation from that sector, so finding a coherent representation on housing would be difficult.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

It is also why, in an earlier debate, we referred to and gave reassurances about the obligations on local authorities to consult with districts when discharging those responsibilities. They have environmental health responsibilities that will be relevant to concerns about housing in the private sector.

Grahame Morris (Labour, Easington)

Just because a problem is difficult, it does not mean that we should not try to address it. In my area, we set up a taskforce with various key working groups, housing being one of them, and there is ample evidence that it was not difficult for the private and public sector to work together and have a representative. It is perfectly possible to do that, and it clearly identifies the issue on the agenda.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

We have great trust in the wit, wisdom and ability of health and well-being boards and local authorities to make judgments about who would be the most appropriate additional members of a health and well-being board. We have set out the de minimis requirements in the Bill, not the de maximis position that everyone must be on the board. The danger with adding extra members to the board in the provision is that it narrows the local authority’s scope to make rational choices about who should sit around that table, contributing to these very important roles.

On the point about making sure that housing is properly taken into consideration in joint strategic needs assessments and therefore informs joint health and well-being strategies, the current guidance says that all factors impacting on the health and well-being of residents in an area should be considered. We intend that to continue. It rightly addresses the fact that there are many factors that affect public health needs and the social care needs of that population. The amendments would not give local authorities, through health and well-being boards, the necessary flexibility to deal with their local circumstances. That is why we resist them; it is not because we have a disagreement about the importance of housing. We do not. There is simply a need to ensure the right level of flexibility in approaching the issues at a local level.

Grahame Morris (Labour, Easington)

I think we have covered the ground. The amendment was an attempt to be helpful; I regret that the Minister cannot accept it. I beg to ask leave to withdraw the amendment.

Emily Thornberry (Labour, Islington South and Finsbury)

I beg to move amendment 367, in clause 177, page 150, line 23, leave out ‘may’ and insert ‘must’.

My weasel word detector picked up this “may”. It is completely unnecessary; it should be “must”. We all know that if we want to make a big difference to health care, we have to integrate health care and social care services. It is completely unnecessary to use “may”, which is far too weak a word. We should have “must” instead.

Nicky Morgan (Conservative, Loughborough)

I want to put on record the fact that I have also been contacted about the amendment by several organisations. I have tried to amend various bits of legislation in my life before I came to the House, and this is sort of proposal I would always put forward. I am sure that the Minister will give us a full explanation of the current wording. Parliamentary draftsmen take their jobs extremely seriously and there are definitely rules and guidelines on why they tend to use such words. Mind and other charities want an explanation. The change could run right the way through the Bill. I am sure that there is a good reason why it does not, and I look forward to my hon. Friend’s explanation.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Let me try to reassure the Committee and give an explanation, as I have been invited to do. The amendment would require local authorities and commissioning consortia to include a statement in the joint health and well-being strategy of their view on how health-related service commissioning could be more closely integrated with other health and social care commissioning in their area. Currently, local authorities and their consortia partners may include such a statement in their strategy, but are not forced to do so.

The intention behind the wording was not to be weaselly, but simply to follow parliamentary drafting conventions. The intention was to give local commissioners the flexibility to decide whether such a statement was helpful for their locality, rather than forcing them to include it. It reflects more broadly our approach of allowing them to shape the joint health and well-being strategy to reflect local challenges and priorities. The respondents to the consultation were generally very supportive of the flexible approach that we proposed, and we found no appetite for a more prescriptive approach driven from the centre.

Emily Thornberry (Labour, Islington South and Finsbury)

The Minister tells us that it will be up to local authorities to decide whether it is more appropriate for their locality to have better integration of health and social care. Has he any particular locality in mind that may benefit from there not being more integration between health and social care?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I am sure every locality will benefit from the integration of health and social care where that integration is appropriate. That is exactly what the Bill sets out to achieve with the new responsibilities that we are giving to the National Institute for Health and Clinical Excellence by extending its remit to social care. That is set out in the clauses that give the NHS commissioning board a duty to promote the integration of services and use of the National Health Service Act 2006 flexibilities on commissioning, and in the clause that we are considering, in respect of the health and well-being board. Integration is very much hardwired into the architecture of the Bill and is part of what we want health and social care commissioners actively to consider as part of their work on joint health and well-being strategies.

For local integrated working to be effective, there needs to be a minimum of central duties, especially unbalanced central duties, and the maximum space for local commissioners to build relationships based on trust and mutual respect. That is what we have learned from the fact that the existing flexibilities, which have sat in statute for many a year, have not been as extensively used as I am sure the previous Government hoped. We intend the clauses to make sure that there is much clearer focus on that, and much better working relationships in the system at a local level.

We will talk a great deal more about integration under later clauses, especially when we deal with amendments tabled by the hon. Member for Islington South and Finsbury to clause 179. However, I hope that I have been able to reassure her that we continue to listen, and that we want to make sure that the Bill achieves our intention of having greater integration of services and commissioning.

Emily Thornberry (Labour, Islington South and Finsbury)

The Minister says that the integration of health and social care is hardwired into the Bill. That is another one of his well honed and florid phrases that sounds great, but the provision is not hardwiring. It is as soft as it can be. It states:

“The responsible local authority and each of its partner commissioning consortia may include in the strategy a statement of their views on how arrangements for the provision of health-related services in the area of the local authority could be more closely integrated with arrangements for the provision of health services and social care services in that area.”

If that is hardwiring the integration of social care and health care, I am a monkey’s uncle. I want to press the amendment to a Division.

The rest of the debate is in Hansard.