Health and Social Care Bill

Lord Harris of Haringey Excerpts

Thursday 15th December 2011 Lords Chamber

That sums up the case for it being an independent body and being seen to be an independent body. I beg to move.

[Lord Harris of Haringey]

My Lords, we have already debated to some extent the way in which HealthWatch England might operate. However, this group of amendments returns not just to that issue, but to a number of other important issues which go to the core of the extent to which HealthWatch England is genuinely going to be an effective organisation. I give Ministers and the Government the benefit of the doubt on this—that that is something that they want to see happen. Therefore, the way in which HealthWatch England is established, the way in which it functions and the powers that it has are going to be critical to whether or not this body will simply join the long list of organisations that have been set up over the years to represent patients’ interests and have then been dismembered after a short period, or in some cases a slightly longer period, because they are not seen to be effective. If the Government are genuine about putting patients at the heart of the new NHS, then they need to ensure that HealthWatch England and healthwatch organisations are effective.

My noble friend Lord Warner, slightly unusually, pulled his punches. He talked about it perhaps being a major mistake to host HealthWatch England within the CQC. I have to say there is a danger that this could be a disaster. It is a disaster because of the sustained attacks that the CQC is currently undergoing, which seem to emanate in some instances from Government and Ministers who clearly are not satisfied with the direction of travel. There are clearly concerns that this is an organisation which is being asked and expected to do far too much at the moment. To add this additional responsibility is not necessarily helpful.

I can understand that it is important that HealthWatch England relates effectively to the Care Quality Commission: that is one of the organisations it must relate closely to. But it must also relate closely to the NHS Commissioning Board. It must also relate properly, under certain circumstances, to Monitor. Simply saying that the relationship with the CQC is paramount does not necessarily make an enormous degree of sense.

My noble friend Lord Warner made a specific point. If the motivation for hosting HealthWatch England within some other national organisation is to save money—I understand that it may not be the prime motivation but it is a concern in all this—then there are plenty of other ways of achieving those savings in terms of back-office functions. Those functions can be provided by agency agreements; you can have organisations which are in the same building and able to share some of the physical facilities and so on. It does not necessarily require that the organisation sits as an integral sub-committee within or as part of the organisation concerned. You can do it in other ways; you can achieve those savings in other ways.

However, if you place HealthWatch England in the Care Quality Commission, or for that matter in the NHS Commissioning Board or any of the others, you are in danger of there being either a real or perceived conflict of interest. It may well be the case that HealthWatch England will, on occasions, be asking the Care Quality Commission to do certain things. It may well be the case that there will be, on occasions, circumstances in which HealthWatch England will be saying that the Care Quality Commission has failed to do certain things. That is not a happy situation; nor is it one that is likely to engender the trust of the public if they are seen as being part of the same organisation. That is the principle which underpins some of these amendments.

There is then the question of the extent to which HealthWatch England is seen as being a creature of either the CQC or Government. That then relates to how the ruling body of HealthWatch England—the committee, if it is a sub-committee of the CQC—is appointed. That is why one of the amendments to which I have my name, Amendment 307, specifically refers to the committee of HealthWatch England being,

“elected from local Healthwatch organisations”.

It is a principle of accountability; it is a principle of ownership; it is a principle of safeguarding that independent viewpoint and voice. That is why that is necessary and that is why Amendment 307 in this group is so important.

We also have a series of amendments, Amendments 308, 309, 312, 313, 315 and 316, which try to make sure that it is absolutely explicit that HealthWatch England's role is not just to provide information or advice but, on occasions, to make recommendations to the bodies concerned. It may be a recommendation to the CQC or to the other major national organisations. This group of amendments specifies that that is part of its functioning. It also makes it clear that there should be proper responses to those recommendations from the bodies to whom they are directed. Again, if the Government are serious about making HealthWatch England effective and about having a genuine and clear voice of the users of the NHS and social care services, surely placing in the Bill the power to make recommendations is central to that.

Amendment 314, to which I have also put my name, essentially requires HealthWatch England to provide the CQC with information and advice on the views of patients and the public, and of local healthwatch organisations. It is not a question of it being a discretionary responsibility but a clear responsibility—it “must” rather than it “may”. I know that, in this Committee or in your Lordships’ House more generally, we sometimes get into esoteric discussions about the relative force of “must”, “shall”, “may”, and so on and so forth. I am quite clear that must is stronger than may. That is to avoid a situation where the national body fails to take into account the views and opinions being expressed locally. It is saying that this is an obligation on the organisation to reflect that. Again, if you want to see an independent voice for patients at national level, it must be clear that that body is obligated to put forward the views of patients, the public and local healthwatch organisations.

Amendment 317 also goes to the heart of the relationship between HealthWatch England and local healthwatch organisations. It is a very simple expectation, which I am surprised was not included in the Bill already. HealthWatch England must send a copy of any report it produces to all local healthwatch organisations. This is about the way in which local healthwatch organisations relate to their national body. I speak as someone who ran a national body for patients for a number of years. I know that we would have had an extremely difficult time with our member community health councils had we been making advice and recommendations at a national level without keeping the local organisations, on whose advice those recommendations were based, fully informed of what we were saying and doing. The Bill sets out some of the people who should receive the reports produced by HealthWatch England, but fails to mention local healthwatch organisations. It is a simple change. I am sure it was a mere error in drafting and that the Minister will be able to accept Amendment 317 without wasting time at Report on the issue.

Amendment 318 relates to the relationship between the Secretary of State and HealthWatch England. Clearly, there is a nagging concern in the Department of Health that HealthWatch England may not do all that the Government are hoping, which it certainly will not be able to do unless they make some of the changes being suggested in this group of amendments. However, the Secretary of State has taken upon himself the power to give directions to HealthWatch England. Personally, I do not have a problem with that. I accept that Secretaries of State like to have that in respect of all sorts of organisations. However, before making those directions, which the Secretary of State should not make lightly, Amendment 318 provides that the Secretary of State,

“shall consult local Healthwatch organisations”.

If the Secretary of State were to give a direction on the basis that it was failing to discharge its functions, that should be in the light of the knowledge that local healthwatch organisations, to which HealthWatch England should be responsible and is, in part at least, servicing and supporting, have been properly consulted.

I think that the amendments are entirely modest, sensible and ones that the Government can accept without further problem. They are integral to ensuring that HealthWatch England is the proper voice of the users, patients and those who depend on the NHS.

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[Baroness Northover]

My Lords, this has been another excellent debate. We have returned to the topic of HealthWatch, which we also discussed on 22 November. I listened very carefully to the views expressed in that debate. It seemed that there was a consensus, as there has been again today, about the need to have the patient voice very much at the heart of the NHS. There was agreement then, as I think there is today, that the Bill moves us forward in making sure that the patient voice is at the heart of the NHS. I thank the noble Lord, Lord Warner, for his comments in this regard.

However, I fully recognise that there are significant concerns about the way in which the Government are taking forward these proposals. When we discussed this previously, I made a commitment to continue discussing these issues. We have had subsequent meetings, which some noble Lords have attended; I thank them for their input. I found those meetings extremely constructive. I also attended the meeting between the noble Earl, Lord Howe, and the national association.

Our previous debate focused on the independence of HealthWatch England, which will be a statutory committee of the CQC. I understand that this risks, as the noble Lord, Lord Harris, said, dangerously compromising the independence that I talked about as being so important. Let me be clear why we are proposing this arrangement. There is a reason why, at present, there is no national statutory organisation to champion the patient voice. The last body, to which noble Lords made reference—the Commission for Patient and Public Involvement in Health—was abolished for being ineffective and lacking influence as well as being too expensive and too centralising. To quote from the Health Select Committee’s 2007 report into Patient and Public Involvement in the NHS:

“The evidence we received was overwhelmingly critical of the Commission”.

The noble Lord, Lord Warner, said that the Government should set up an authoritative, stand-alone body, and others have made similar points. This is, however, precisely the point. While I respect the view of the noble Lord, the Government have not been convinced that it would be possible to have such an authoritative stand-alone body in the form that they suggest. The previous Government’s attempt to do this with the commission did not work out well, as noble Lords know. The abolition of the commission was announced five months after it started work. It limped on for a further three years, chewing up £100 million and was universally criticised.

[Lord Harris of Haringey]

Bandying around figures—“it chewed up £100 million”—gives a completely misleading impression. Could she tell us what proportion of that £100 million was the administrative cost of the commission, as opposed to the provision of patient and public involvement forums in every part of the country? The figure of £100 million is totally misleading.

[Baroness Northover]

I suggest that the noble Lord talks to his noble friend Lady Pitkeathley about some of the details.

[Lord Harris of Haringey]

I suggest that if you use a figure like £100 million, which was not the figure used by the noble Baroness, Lady Pitkeathley, you need to explain that that includes the running of the public and patient involvement forums. It is not the cost of the administration of the national body itself.

[Baroness Northover]

The organisation used up £100 million. There were criticisms from the local organisations that they were not getting the money they needed, so there was widespread criticism. There was criticism at a national level within the NHS and, in particular and importantly, the local organisations did not feel that it was acting in the way they needed it to, or feeding through to them the resources they needed to do what they felt was appropriate.

[Lord Harris of Haringey]

One of the failings of the commission was that it did not have a relationship with local public and patient involvement. The purpose of the amendment which talks about direct election would be to obviate that problem and provide a constraint in terms of whether or not there were going to be overly centralised administrative costs, because the body itself would be accountable to the local bodies that would be the recipient of most of them. My concern and my frank irritation with the commission—which I had no part in at the time—was the suggestion that all the £100 million was somehow used by the central administration. That was not the case.

One of the failings of the commission was that it was not accountable and did not have a proper direct relationship with local public and patient involvement. That was a fault both of the way it was constructed in terms of the legislation, for which the Labour Government of the time must take responsibility, and of the way in which the commission chose to work, with the support of the Department of Health at that stage.

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[Lord Harris of Haringey]

The noble Baroness made a very important point just now. She said explicitly that HealthWatch England could and should be a campaigning organisation, although it would be a sub-committee of the CQC. This is irrespective of the debate about where it is located. I think that the principle of creating a national patient organisation as a campaigning organisation on behalf of patients is extremely important. I am very grateful to the noble Baroness for making that commitment on behalf of the Government.

[Baroness Northover]

HealthWatch England will represent the voice of the patients. It will publish on that; it will advise on that; to take up a point raised under one of the earlier amendments, it will no doubt make recommendations within the areas of its advice. It has the obligation to make those recommendations to various organisations within the NHS. Various organisations, including the CQC, have the responsibility to respond to that. All those obligations will flag up problems, so I do not see that I have made a startling admission. I would have thought that the noble Lord, Lord Harris, would know that transparency—publishing information—was the best way forward.

However, I agree with many noble Lords that this has been rather a patchy area. We have to try to give greater strength to these organisations both locally and nationally. Much of that is not based on their structures, because all sorts of structures have been tried, but we are trying to take them further forward.

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[Baroness Northover]

I am sure that it could. If it felt that it was not managing to persuade the CQC or some other part of the NHS to do what it considered to be in the best interests of patients, then I am sure it would go to greater lengths to ensure that it got its message across. It is very important that we have a louder patient voice within the NHS, and this is one means of seeking to achieve that.

I return to some of the amendments that noble Lords have flagged up. This is a very important debate. I think we agree on where we wish to head and what we are seeking to achieve, but I hear noble Lords’ concerns about whether this is the right way of going about it. Noble Lords talk about an independent organisation and so on but that route was tried. This is another route for trying to make sure that there is a body close to an organisation which itself must have a major role in driving up quality. The synergies there are very important.

The question was raised of how local healthwatch is going to influence HealthWatch England. I heard what the noble Lord, Lord Harris, said about elections to HealthWatch England from local healthwatch. Clearly, as my noble friend Lady Cumberlege said, a great deal will depend on who is on these organisations nationally and locally, and it will be necessary to ensure that they are as strong as possible. The Secretary of State will determine how the membership is comprised through regulations and we will be discussing with a wide range of stakeholders the contents of those regulations. I can confirm that we will discuss the suggestions put forward by noble Lords. We had from the noble Lord, Lord Harris, an emphasis on election and a concern about that route from the noble Baroness, Lady Pitkeathley. Both noble Lords might wish to feed in to how those regulations are taken forward so that we can best comprise HealthWatch England and local healthwatch.

[Lord Harris of Haringey]

Can the Minister indicate the timetable for consultation on the content of those regulations? Those of us who wish to see an election process in the Bill will need to know sooner rather than later whether that is the way in which the Government’s thinking is going. When is that consultation going to take place and when is it likely to conclude?

[Baroness Northover]

In the meeting that I was in yesterday with NALM this was an issue. The noble Lord, Lord Harris, is probably aware of that. No? That was one of the issues—perhaps the noble Lord, Lord Warner, referred to it—that did come up. The consultation will be early next year. Given that we are almost in next year, that is pretty soon.

The noble Lord, Lord Harris, wanted to make sure that HealthWatch England’s annual report was shared with local healthwatch. While we do not feel that that is a matter for the Bill, the annual report must be published. It is important that that information is made widely available. I am sure that the noble Lord’s suggestion will be noted by HealthWatch England and local healthwatch as the information between the two must go back and forth, in both directions.

[Lord Harris of Haringey]

The Bill does not refer just to the annual report. It refers to all reports.

[Baroness Northover]

It is clearly important that the information goes back and forth between the local and national organisations.

If HealthWatch England were significantly failing in its duties, the Secretary of State has powers to intervene. An amendment addressed whether the Secretary of State should consult local healthwatch. This was on the assumption that HealthWatch England was in effect failing local healthwatch. While the Secretary of State should not be bound into a rigid consultation—something else entirely could be in question here—we would fully expect him to seek the views of others where appropriate in coming to a decision to intervene. I hope that that will reassure noble Lords.

My noble friend Lady Jolly talked about local healthwatch needing to look widely at all groups of patients, including those with rare diseases and so on. She is right. We will be coming on to other amendments where we look at this a bit more. LINks and its predecessors recognise that they have not had as wide a coverage as they would like or been as representative of their communities as they would need to be. This concerns us. The noble Baroness, Lady Pitkeathley, referred to it briefly in relation to whether local healthwatch should elect to HealthWatch England. We are seeking to learn from this. We want to try to make sure that local healthwatch has as broad a spread as possible. It is worth bearing in mind that it has a place on the board of the health and well-being boards and so there will be information feeding back to local healthwatch from the others on the health and well-being boards and from local healthwatch into the health and well-being boards. We will come on to local healthwatch in relation to local authorities, but there is synergy there too.

While I feel that the Bill provides safeguards for the independence of HealthWatch England within CQC, I would like to repeat my commitment that we are prepared to listen to further views. It is very clear that we are all trying to head in the same direction. There is a variety of views about how best to do this. We would welcome noble Lords’ continued input as we take this further forward. In the mean time, I thank noble Lords for flagging up these issues. I hope that the noble Lord will withdraw his amendment.

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Therefore, I am seeking that a similar principle should apply to the role of local authorities, who are sometimes commissioners and even providers of social care themselves, as funders of local healthwatch. Greater transparency in decisions made about local healthwatch by a local authority is part of the solution, as it would make bias and undue influence much more difficult as a rationale. All the decisions would have to be explicit and aligned with the statutory functions of both organisations. This is not to reduce the autonomy of local authorities but merely to improve the transparency with which they exercise that autonomy. I hope the Minister will consider these amendments carefully.

[Lord Harris of Haringey]

My Lords, I will speak to the seven amendments in my name in this group, Amendments 319, 321, 322, 323, 325, 326 and 327. The noble Lord, Lord Rix, described this group as something of a Christmas stocking; I have to say that even my seven amendments do not have a common theme. They are on a variety of topics, ranging from some that simply correct what I assume are drafting errors in the Bill to others that raise rather more fundamental issues along the lines of the amendment of the noble Baroness, Lady Cumberlege.

Amendment 327 deals with what is, I think, a drafting error. Unless I have misinterpreted the interlaying Acts that are being subsequently amended, the Bill leaves a reference to primary care trusts in the base Act. Presumably the assumption is that the commissioning groups will take on those functions and should be expected to respond to the local issues raised by local healthwatch organisations. I am sure that is simply a drafting arrangement.

Amendment 323 would slightly tighten the wording on how independent advocacy is organised and says that the provision should be appropriate to the needs of those for whom that provision is being made available. I am sure that the Government will have no problem with that. It makes sure that advocacy arrangements recognise the very different nature of the problems and the client groups who will raise them.

Amendment 321 puts into the Bill a requirement that arrangements be made to enable members of local healthwatch organisations to have indemnity cover against the risk that a claim may arise from their duties. I am doing the Government a favour by highlighting this at this stage. I certainly recall, from the time of my involvement in community health councils, and in another sector prior to that—the work of electricity consultative groups for a completely different government department—that the same issue arose. I refer to the indemnity or protection that is there for people who are carrying out public duties if they are involved in an accident and a claim is made against them for it. What we will have—I am sure it will be in the Minister’s brief—is some vague statement about Treasury indemnity.

The problem for individuals in this position is that it is not clear what such indemnity will cover and how they will be able to access it if, for example, they are involved in an accident or an incident during their work as a member of a local healthwatch organisation. I would advise—I am trying, as ever, to be helpful to the Government—that this should be sorted out now rather than waiting to get into a tangle about it. I remember spending many happy years, when I was Director of the Association of Community Health Councils, trying to get a definition that would satisfy local CHC members that they were protected. Otherwise, the answer goes back that you should claim on your own insurance policies; yet those insurance policies often exclude people who are carrying out work—even voluntary work—or similar duties. Acting on behalf of a local healthwatch organisation will almost certainly be excluded by the individual members’ insurance policies. My experience on CHCs and in other organisations is that this is a constant pressure and a constant concern. There should be something explicit in the Bill to provide a degree of reassurance to people who are undertaking these activities on behalf of their communities.

Amendment 319 relates to the membership of local healthwatch organisations and is put forward today as a probing amendment. I hope the noble Baroness will give us details of how it is envisaged that local healthwatch members will emerge in that role. The question of how legitimate local healthwatch organisations will be—how representative they will be—depends critically on the precise arrangements by which people end up as members of the organisations. The previous Government’s proposals in respect of LINks, which I never fully understood, left it in a state of limbo and people were, essentially, self-appointed as members of LINks. There must be a degree of transparency and clarity in the process by which people end up as members of local healthwatch organisations. The proposal here is that there should be some system of election. Often, although this was not exclusively the case, the most effective members of local community health councils were those who were elected by local voluntary organisations in the areas concerned. They were often the people with the most detailed, personal knowledge of the services they were monitoring. They often had a constituency they could draw back into for information and support for the work they were doing. Above all, they had the added legitimacy of having been chosen for that role by other local voluntary organisations.

I am not suggesting that as a model that should necessarily be adopted. What I am saying is that the clarity it gave those individuals was very helpful. Other members were appointed directly by the local councils for the area. Again, that gave clarity about who they were representing and what their legitimacy was. Some were appointed by regional health authorities, though this changed every time the health service was reorganised, which was every two or three years. That is something that does not change, even now, and I am sure we will be back here in two or three years unpicking whatever finally emerges from the sausage machine of legislation that we are processing now.

It is going to be critical to have a clear process by which local healthwatch organisation members are appointed. It is also important that they have legitimacy. Otherwise the organisations to which they relate will say, “You are not representative. You are self-selecting” or “You do not represent the communities you purport to represent”. Clarity about the appointments process is important. Some system of election would be valuable, but it would be helpful if the noble Baroness could tell us today exactly what is envisaged. We certainly need to know that before we proceed further with the Bill.

The orange in the Christmas stocking is the relationship between the local authorities and local healthwatch organisations. I have tabled Amendment 322, which refers to local healthwatch organisations not being subservient to the body that is responsible for their establishment. That goes to the core of the issues raised by the noble Baroness, Lady Cumberlege, about the extent to which local healthwatch organisations can be effectively under the control of local authorities.

I know that we will be assured that local healthwatch organisations will be independent and have all this additional legitimacy because they will know that local authorities have provided them with support, and that that is why the proposed structure is being adopted. However, that model will not necessarily work. I speak as someone who was leader of a local authority for 12 years and I know how decisions are made. In particular, I know how decisions are made at times of financial stringency. Unless the resources for these local organisations are guaranteed in some way, they will be vulnerable—not necessarily because they are saying unhelpful things but simply because the local healthwatch organisation will not be seen as a core activity of the local authority at a time of stringent finances and resources. That is why this issue needs to be addressed head on.

There is a problem of potential conflict of interest. Local authorities are responsible for providing certain types of social care. They are responsible for commissioning and providing that care. They will have a responsibility with others through the local health and well-being boards. There is a danger that local healthwatch organisations will be seen as being conflicted because they are subordinate to the local authorities in their area.

There are two simple ways for the Government to solve this problem, both of which I know they are not currently minded to consider. One model is a separate structure that provides the funding and resourcing for local healthwatch organisations; and that would flow back to HealthWatch England. The other model is to ring-fence the resources that are passed through to local authorities for this purpose. I know that Her Majesty’s Treasury is always against ring-fencing and, indeed, the Local Government Association, of which I have the honour to be a vice-president, always argues against the ring-fencing of resources because it is always better for local authorities to make their own determinations. However, this is not about determining local needs. This is about providing something for the local community on behalf of another government department.

The Department of Health has, no doubt, fought a valiant battle with the Treasury to secure the resources for HealthWatch and the Treasury is passing that money through the Department for Communities and Local Government down to local authorities. There is no ring-fencing. The reality is that local authorities will not be able to say to the Treasury at the next comprehensive spending round how those resources have been used. They will not even be able to demonstrate that those resources have been used for the purposes for which they were given, and they will lose the battle for the continuation of that funding. If there is a ring-fenced structure, you will ensure that the resources are there for local healthwatch organisations. There may then be a question about how effectively those local organisations operate, but at least the resources will be clear and the local authority will be accountable for how it has used that money explicitly, rather than for whether or not it has used the money for that or for other purposes.

Unless that issue is addressed, there will be not only perceptions of conflicts of interest but the problem that local healthwatch organisations may, in time, be starved of resources. This is not an idle concern. We have all received the correspondence from LINks, talking about the budget cuts that they have faced in the current financial year. We can expect that to continue. If the Government are serious about having vibrant and effective local healthwatch organisations, they have also to solve the resourcing question and the perceived conflict of interest between the local authority and local healthwatch organisations.

We heard much in our earlier debates about the synergies and wonderful effects that talking in corridors would have within the CQC. I thought at one point that the noble Baroness was going to talk about talking in the toilets about decisions and how you infuse ideas from one organisation to another if they are co-located. That will not be the case with local authorities and local healthwatch. You will not get that same connection. The mere fact of being in the same organisation will not matter because they will not be physically located with the people who are making the decisions about social care; they will probably be in an outward-facing office, meeting the public. It will be an outpost of the local authority. There will not be that informal interchange which we were told would be so valuable if Healthwatch England was placed within CQC. The issue is how you make these organisations effective. That will require independent resources and it will require that the question of conflict of interest is dealt with.

[Viscount Tenby]

My Lords, very briefly, I support the amendment in the name of my noble friend Lord Rix. He has clearly outlined the rationale behind the amendment; accordingly, I do not intend to keep the House long—sighs of relief all round, I should think—although, like my noble friend, I should declare an interest. Until last Wednesday, I was chairman of a residential home for those with learning disabilities.

I think we are aware that the complaints process against the NHS can be extremely complex and challenging for those involved. That nearly always coincides with a period of some personal distress. Indeed, the very inclusion of Clause 182 indicates that the Government, to their great credit, are aware of that factor. However, there is a danger that the provision is not sufficiently explicit. My noble friend has highlighted the potential for advocacy support to stop before a conclusion has been reached. I share his concern, and add that the amendment safeguards against the freedom given to a local authority to define what it deems to be “appropriate arrangements” for the provision of independent advocacy services.

The critical point is that, at a time when local authority budgets are particularly stretched, to expect them to provide additional resources for advocacy support could result in the needs of people being sacrificed in favour of councils balancing their books. We all understand that that goes on. In other words, the level of advocacy support offered might be dictated by available funds and, accordingly, “appropriate arrangements” might be taken as being what is appropriate for the council to offer.

That detracts from what I assume is the object of making advocacy support available: to benefit the individual. The ability for people—often in mourning and in some distress—to seek justice should surely seek precedence over what is convenient to the local authority. By explicitly removing any upper limit on the length and type of advocacy, the amendment sends a strong message to councils that the individual must be the priority in this situation. It removes the excuse that a council might have not to provide the adequate level of advocacy support required by those who need it; and instead gives the individual the power to challenge any decision they feel is unjust on the basis that their advocacy needs are greater than the support proposed.

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[Baroness Northover]

My Lords, again, we have had a very impressive and wide-ranging debate. It links in with the earlier debate on this area, as well as with our discussion the other day.

The noble Lord, Lord Low, made a very strong point when he talked about the need for confidentiality. I hope I can reassure him that HealthWatch England will be subject to the provisions of the Data Protection Act and other applicable law. However, these are complex matters, involving a number of interlocking pieces of legislation and other issues. As a result, I hope that the noble Lord will allow me to write to him with full details of how we see these provisions working. However, I hope that he will be reassured about the overarching effect of the Data Protection Act. He made some very telling and important points.

Our aim is for local healthwatch organisations to become an integral part of the commissioning of local health and social care services. They will build on the strengths of the existing Local Involvement Networks and, we hope, address their weaknesses. I have listened to the concerns that various noble Lords have expressed about independence, given local healthwatch organisations’ contractual relationships with local authorities. I hope I can reassure noble Lords that local healthwatch organisations will be very firmly in the lead in determining their own work programmes and local priorities. Local authorities, for example, cannot arbitrarily veto a local healthwatch organisation’s work plan or stop a local healthwatch organisation providing feedback or recommendations to HealthWatch England, nor can they suppress local healthwatch organisations’ reports with which they disagree. I am sorry that the noble Lord, Lord Warner, is not in his place, as no doubt he would be hopping up and down challenging me on these matters. It is extremely important that local healthwatch organisations are effective in this way: we have made the provision that we have. Nor can local authorities starve local healthwatch organisations of funds, as the noble Lord, Lord Harris, implies. Local healthwatch organisations must have sufficient resources to fulfil their statutory functions. Those are laid down and they have to deliver on that.

[Lord Harris of Haringey]

I—

[Baroness Northover]

Oh! Here we are.

[Lord Harris of Haringey]

I thank the noble Baroness for giving way. The problem with not ring-fencing funds and simply relying on the statutory requirement is that there are many ways of interpreting a statutory obligation. For example, there is an obligation on local healthwatch organisations to provide information to the public. You can provide information at various levels. At one extreme, this could be leaflets to every household, or it could be telephone helplines. It could be all sorts of things—or it could simply be to say that the information manual has been placed in the local library. If the local healthwatch organisation does that, it has fulfilled its statutory obligation in providing information to the community. I am assuming that Ministers do not want that to be the scale of the provision, but simply saying that you have met your statutory obligation is not a sufficient safeguard to provide £60 million-worth of services, if that is the sum of money being made available to local healthwatch organisations.

[Baroness Northover]

The noble Lord, Lord Harris, made exactly this point at the meeting that we had the other day with my noble friend Lord Howe, who I thought countered his points extremely effectively. However, I realise that is now almost 6 pm and I know that noble friends have other appointments; maybe we would otherwise carry on until Christmas. We take on board what the noble Lord, Lord Harris, has said. I am sure that he takes on board the counterpoints from my noble friend Lord Howe, but we will continue to discuss how best to ensure that local healthwatch organisations are effective in the way that we need them to be.

Some of the amendments of my noble friend Lady Cumberlege would increase the role of the Secretary of State in relation to local healthwatch organisations. Though we understand the intent behind the amendments, we do not feel that that is quite the way to go. Nevertheless, we acknowledge the need to keep the issue of local healthwatch organisations’ independence under review and we are working closely with stakeholders to look at how best we can support that independence at local level.

My noble friend made a range of proposals which were extremely interesting and we will take those back, along with other noble Lords’ suggestions. We are keen that local healthwatch organisations have the flexibility to work with and for their local communities. I am aware of the concern expressed by a number of stakeholders that the Bill does not contain sufficient flexibility. I can confirm that we also want to make sure that the process of getting local healthwatch organisations started is as efficient as possible. We want to assist in that and again we discussed this with stakeholders yesterday. We would not want to see local healthwatch’s ability to get on with its valuable role slowed down.

My noble friend suggested that local healthwatch organisations should have a stronger role in relation to CCGs’ commissioning plans. I sympathise with the sentiment behind this amendment and with other proposals to try to make sure that the voice of the patient is heard. However, this would place a further statutory function on local healthwatch organisations, and it might be unnecessarily prescriptive. There are, of course, arrangements in place in the Bill for local healthwatch organisations to feed their concerns to HealthWatch England, and HealthWatch England can also provide the NHS Commissioning Board with information and advice on the views of local healthwatch organisations on the standard of healthcare. Were a local healthwatch organisation to have concerns that a clinical commissioning group had not taken proper account of its views in commissioning plans, they could be raised by this route. However, this is an important issue, and I will take it away to consider it further.

[Lord Harris of Haringey]

Will the Minister clarify whether she is seriously suggesting that rather than having a route going direct from a local healthwatch organisation to a clinical commissioning group, it is better to have a route that goes from the local healthwatch organisations to HealthWatch England—I do not know whether we would include CQC in that process—then through the national Commissioning Board and then back down to—

[Baroness Northover]

I did not put that clearly enough. Local healthwatch organisations will be feeding into clinical commissioning groups. That is already apparent. They have all sorts of ways, not least through the health and well-being boards, to make sure that the needs of the community are clearly expressed so that commissioning is as appropriate as possible. Where that is not being properly listened to, and therefore serious issues need to be addressed, there are other ways of ensuring that actions can be taken.

However, all these groups need to be talking to each other. I hope very much that they will. One of the reasons for local healthwatch organisations to have the association with local authorities is that local authorities have responsibility for so many areas that also affect the health of the population. They will have new responsibilities in public health as well. All this needs to link up to make sure that the quality of health is improved. This is part of that arrangement. We are looking at it locally and nationally. However, I will take back the suggestions that my noble friend Lady Cumberlege made. We want to make sure that this system works effectively without being overly prescriptive.

I agree that indemnity is a fundamental issue. It is one to which the Government have given significant consideration. We have concluded that it is most appropriate for it to feature in local contractual arrangements rather than in primary legislation that may lack flexibility.

The noble Lord, Lord Harris, is right that the system by which people serve on local healthwatch organisations needs to be transparent—all this needs to be transparent. I heard what he said in that regard, and I will feed it into the discussions that are going on at the moment.

On some matters it is probably best, if I need to follow up, that I do so in writing, as I am acutely aware that my noble friend Lord Howe and the noble Baroness, Lady Thornton, have another engagement this evening, and we must release them.

I turn to NHS complaints advocacy. Clause 182 has the effect of transferring a duty to commission independent advocacy services for NHS complaints from the Secretary of State to local authorities. The principle behind advocacy will remain unchanged: it is the provision of appropriate support to people who wish to make a complaint about the NHS to enable them to make their own decisions. We propose that commissioning of advocacy shifts from the Secretary of State to local authorities to best meet local needs.

I note the wonderful Amendment 324, tabled by the noble Lords, Lord Rix and Lord Wigley, which seeks to ensure that advocacy will be provided without limits on the length or type of support. I commend them for their ambition but it would not be appropriate to put that limit in the Bill. I am sure they understand that but we take what they say about the importance of advocacy and commend them for their strong advocacy of advocacy.

I realise that all these areas are of great concern to noble Lords. This may be just one part of the Bill but in many ways it is the heart of the Bill, which is about patients and how best you ensure that patients’ experience translates into an improvement in quality in practice. Other noble Lords have grappled with this before. The previous Government did and Governments before that. We are trying to take this further forward, both in terms of the national and local arrangements. We hear what people say in response to the proposals but I hope that in the mean time the noble Lord will not press his amendment.