Health and Social Care Bill

Lord Patel Excerpts

Thursday 8th March 2012 Lords Chamber

Moved by

[Lord Patel]

223A: Clause 180, page 176, line 16, at end insert—
“( ) After Section 158 (Duty to consult Board in relation to regulations about patient information) insert the following new Section—
“Representation of Patients’ InterestsHealthwatch England
(1) There shall be a body corporate known as Healthwatch England.
(2) The primary duty of Healthwatch England shall be to represent the interests of patients and users of national health services and social care services (hereafter known as “patients and users”) in relation to providers, regulators and the Secretary of State.
(3) Healthwatch England shall be independent of any provider of national health or social care services or of any regulator of health or social care or of any other body established by this Act or otherwise.
(4) Healthwatch England shall have the following functions—
(a) to establish a local healthwatch organisation for each local authority area;(b) to provide each local healthwatch organisation with such resources as may be agreed by Healthwatch England;(c) to provide local healthwatch organisations with advice on, and assistance in relation to, their functions and on such other matters that Healthwatch England may determine; and(d) to provide relevant persons with information and advice on—(i) the views of people who use health and social care services and of other members of the public on their needs for, and experiences of, health and social care services; and(ii) the views of local healthwatch organisations and of 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.(5) Relevant persons referred to in subsection (4)(d) are—
(a) the Secretary of State;(b) the National Health Service Commissioning Board;(c) the Care Quality Commission;(d) Monitor; and(e) English local authorities.(6) A person provided with advice under subsection (4)(d) must inform Healthwatch England in writing of his or her response or proposed response to the advice.
(7) Healthwatch England shall in addition have powers of investigation as prescribed in subsections (8) and (9) and powers to require disclosure of information as prescribed in subsection (6).
(8) Healthwatch England may investigate—
(a) a complaint made by or on behalf of a patient or user or a local healthwatch organisation which appears to the Board to raise one or more issues of general relevance; or(b) any matter which appears to the Board of Healthwatch UK to be or be related to a problem which affects or may affect patients or users generally or patients or users of a particular description.(9) For the purposes of subsection (8) a complaint raises an issue of general relevance if it raises—
(a) a novel issue which affects or may affect patients or users in general or patients or users of a particular description, or(b) any other issue which has or may have an important effect on patients or users generally or patients or users of a particular description.(10) Healthwatch England may by notice require a person within subsection (11) to supply it with such information as is specified or described in the notice within a reasonable period as is so specified and the information so specified or described must be information that Healthwatch England requires for the purpose of exercising its function.
(11) The persons referred to in subsection (6) are—
(a) any provider of health or social care services licensed by the Care Quality Commission and Monitor under the provisions of this Act;(b) the National Health Service Commissioning Board;(c) Monitor;(d) Care Quality Commission; and(e) any other person specified or of a description specified by the Secretary of State. (12) If a person within subsection (11) fails to comply with a notice under subsection (10) the person must, if so required, give notice to Healthwatch England of the reason for the failure and if that reason for failure is not acceptable to the Board of Healthwatch England then the Board of Healthwatch England may take steps to publish the notice and the reasons for failure provided or to seek enforcement of the said notice through the courts.
(13) Healthwatch England must publish details of arrangements it makes under this section, including details of payments of remuneration or other amounts.
(14) In performing functions under this section, Healthwatch England must have regard to such aspects of Government policy as the Secretary of State may direct.
(15) As soon as possible after the end of each financial year, Healthwatch England must publish a report on the way in which it has exercised its functions during the year.
(16) Healthwatch England must—
(a) lay before Parliament a copy of each report made under subsection (15); and(b) send a copy of each such report to the Secretary of State.(17) Healthwatch England may publish other reports at such times, and on such matters relating to health or social care, as it deems appropriate.
(18) Before publishing a report under subsection (15) or (17), Healthwatch England must, so far as practicable, exclude any matter which relates to the private affairs of an individual, the publication of which, in its opinion, would or might seriously and prejudicially affect that individual’s interests.
(19) In this section “financial year” means—
(a) the period beginning with the date on which Healthwatch England is appointed and ending with the following 31 March, and(b) each successive period of 12 months ending with 31 March.”.”

[Lord Patel]

My Lords, Amendment 223A and those that follow, which relate to local healthwatch, are the key amendments that address public and patient involvement in the Bill. The Bill says a lot about how the patient will be centre stage in the whole reorganisation. Therefore, it is important that the patient’s voice be heard. How will we do that?

I say at the outset that my amendment is about the independence of HealthWatch England in statute and its ability to get the information about health services that it will need to do its job. Public involvement in health and social care in England has been in a turbulent state since 2003. Despite the genuine aspiration of the Government to establish an effective system of public involvement, they have failed. This is now the fourth, or even the fifth, attempt to do so.

In 2003, more than 500 patient forums were set up around the country, many with a tiny membership. They had an independent national body, which was distant and isolated from local patient forums. It failed because it was neither useful to nor respected by local forums. The abolition of patient forums led to Local Involvement Networks being established with no statutory national body. The name LINks made them invisible to the public. They were often isolated and struggled against the odds to develop successful systems to monitor services and influence commissioning. Nevertheless, after two or three years, many LINks have done well; they have established a good local reputation and had an important impact on the effectiveness of local services. However, they need a national body to support them, enable them to develop successfully and give a hand to those that are failing.

Recognising the problems and weaknesses of some LINks, the Government decided to abolish them and replace them with HealthWatch. The plan—to have a national body called HealthWatch England, working closely in a supportive relationship with local healthwatch—is very good. The intention is for HealthWatch England to be up and running by 1 October 2012 and local healthwatch by 1 April 2013. Ministers had a vision of a relationship between the local and the national that went in the right direction but needed some tuning to make it work for the benefit of the public. However, the plans that the Government now have for both HealthWatch England and local healthwatch may risk that vision being realised.

To succeed, HealthWatch needs strong input from people with practical experience of building a successful national HealthWatch England that works in tandem with local healthwatch. A national governance framework is required from the centre to enable local people to get on with the job. Supportive governance from the centre reduces local friction and speeds the process of local development. HealthWatch England should provide a national vehicle to drive standards in health and social care and identify areas of poor practice. It has a very special mission, which is quite different from that of the regulator, the CQC, of which the Government want HealthWatch England to be a committee.

HealthWatch England should be the voice of the people—the voice to which the Secretary of State must listen in making the CQC, Monitor and the Commissioning Board have a strong relationship. HealthWatch England is the voice of the abused patient, the forgotten person with dementia on the second floor of a nursing home, of the child with a learning disability who is getting poor care on a children’s ward and of the people waiting excessive periods for emergency care in an A&E department. When local healthwatch or a member of the public raises their voice because of a persistent local problem—as occurred in Mid-Staffordshire—HealthWatch England must hear it and respond immediately. To do this, independence is critical.

Embedding HealthWatch England in the CQC is a fundamental error. To call it a committee is a fundamental error. It diminishes the power and influence of HealthWatch England if it becomes a committee of the CQC. The only people who think that a committee is important are the people who sit on it. Having sat on many of them, I might agree. Most people think a committee is a talking shop. HealthWatch England must not be thought of across the country as a talking shop.

The CQC has a huge and important job to do and needs to be supported. I do not deny that. However, the way in which it deals with that job is seen to be highly bureaucratic. It has the wrong culture for a public body such as HealthWatch England. Members of the public will not wish to go through a CQC call centre or website to raise urgent issues. They will want to speak to an expert in HealthWatch England who will understand the problem and can act immediately. Combining the people-facing body of HealthWatch England with the regulator by making it a committee of the CQC, which is focused on data and regulation, will quickly suffocate it. That cannot be what the Government want to do.

It has been argued that locating HealthWatch England within the CQC puts it at the centre of regulation, where it can have real power and influence. However, it cannot have power and influence if it is a committee of the regulator. To have power and influence, it needs independence and the ability to challenge the regulator. HealthWatch England needs to be trusted by the public and to be seen as a big hitter. It must be seen to be able to hold the CQC, Monitor and the NHS Commissioning Board to account, and to have influence with every local authority in England. It must be seen to be independent, and not just called independent.

Being independent and being seen to be independent requires HealthWatch England to be run by a board that has public trust and confidence, meets in public and speaks to the public, not a board—as the CQC is—that does not even allow questions to be put by the public. It would be absurd for England’s leading public involvement body to be the statutory committee of a board that does not even recognise the need to be open and accountable to the public. HealthWatch England must have its own board, which must meet in publicly accessible places to discuss issues of national importance in healthcare. It must be seen as a body that people will want to connect to by attending its meetings, raising issues with it, watching it live on the internet and engaging with it. It must be what might be called a living organisation, not an obscure committee of some other big national regulator.

The CQC seems very anxious about having members of the HealthWatch England committee elected directly from local healthwatch. Why is it so worried about a little democracy? The recent consultation on the regulation of HealthWatch England was silent on independence and elusive on elections. It considered the possibility of election to HealthWatch England, but not directly to the HealthWatch England committee as it sees it. It would have to be through some intermediate mechanism just in case a rogue representative was elected to the committee who might challenge the CQC, I suppose. HealthWatch England cannot be seen to be a part of the CQC and to operate in its shadow, fearing direct public involvement. As a regulator, the CQC may have to keep a distance. To ensure objectivity as the people’s voice, HealthWatch England must invite the people in and be disappointed if they do not turn up. If they do not show up, HealthWatch England will have failed in its job as a public and patient representative. Direct election from local healthwatch organisations to HealthWatch England would ensure that HealthWatch is a national and local organisation that people can trust.

--- Later in debate ---

[Baroness Northover]

In response to the noble and learned Baroness, if I was in any way discourteous, I apologise but I hope that I gave the opportunity at the end for anybody who had further questions please to put them to me.

[Lord Patel]

My Lords, I thank the noble Baroness for her response. I think that the conversation, or lack of it, was unfortunate because not only did it not allow people to put their questions at the correct time, it probably interrupted the noble Baroness’s flow of speech and thoughts. Having said that, I am flattered by her compliments on what I had to say. However, she did not address the fundamental point when I speak for those who are concerned about public and patient involvement. She has said that the statute provides that HealthWatch England will be a committee. That is quite different from a statute which provides that HealthWatch England will be independent. Again, there is a vast difference. Also, in terms of its functions, there is nothing in the statute that says that HealthWatch England will have the power to ask for or demand information in the interests of patients and the public in order to demonstrate that the quality of care provided is not adequate. Although the statute recognises that HealthWatch England will have strong relationships with Monitor, the Commissioning Board and so on, it will not have the power in statute to demand that independently. It has the power in statute to work through the CQC to ask for that. That is what concerns people outside. Indeed, while listening to the debate I was getting e-mails saying, “This is not what we asked for and it is not what we want. This does not give us confidence that we will have the necessary authority to respond”.

The one lone voice in the wilderness, although it might have been loud, came from the noble Baroness, Lady Murphy. She suggested that this is ideal because of one very good chief executive in mid-Sussex. I wish we could clone her. For every one that is successful there will be 10 failures, and it is those failures which a good, powerful and independent HealthWatch England would be able to address when a local healthwatch organisation fails because the chief executive is not being supportive.

There are many issues here. If we are serious about giving the public and patients a strong voice, the Government must recognise that they need strong support and that they need it for a long time. Although I have not been associated with patient and public organisations in England, I have been involved with them on three different occasions. In fact, I set up one of them. I should say to the Minister that I thought I did a brilliant job. I gave it all the powers one could possibly give in terms of setting standards, inspecting hospitals, writing reports and criticising every service. It worked well, but it fell down because its strong support was withdrawn. It is important to recognise that if we are serious about giving patients and the public a strong voice, we need to give them status. We should not treat them like juveniles who do not understand the issues. They should be treated with the respect they deserve and be given strong support.

Unless the Minister is about to tell me that suddenly she is hearing a different message and that we can have a further conversation and another opportunity to look at this, I am afraid that, for those outside who are concerned about this, I will have to seek the opinion of the House.