Health and Social Care — House of Lords, 2016-12-15
Topic: Health
Jonathan Toby Harris (Labour, Centre-left): My Lords, I am enormously grateful to all noble Lords who have contributed to today’s debate. I am particularly grateful to the noble Baroness, Lady Chisholm, for standing in at short notice and speaking from the Front Bench, and to my noble friend Lord Tunnicliffe, who at even shorter notice has stood in for our Front Bench, who are also away for reasons of illness and other matters This has been an interesting debate, and lots of important points have been made. I particularly welcome the point made by the noble Lord, Lord Lansley, that shared decision-making in terms of the individual should happen anyway, irrespective of the structures in place. He outlined—and I do not dispute it—that when he was Secretary of State the Government’s objectives in creating Healthwatch were good, and the intention was to improve the system. It is just a question of how well it has worked subsequently. He asked a very valid question about why the Labour Government abolished community health councils. That is a question that I certainly asked at the time. I am sure that, had he been in his place, my noble friend Lord Hunt of Kings Heath, who was the Minister at the time, may well have wanted to comment on those matters. The fact that the arrangements that were then put in place were felt not to be working only a few years later suggests that perhaps the model was not absolutely right My noble friend Lady Pitkeathley, along with a number of other contributors, talked about the whole point of the involvement of patients being that it challenges the existing power structures and orthodoxy, which therefore produces a backlash. She also made the point, which I agree with, that in the Bill that ultimately became the Health and Social Care Act, the creation of Healthwatch was potentially a ray of hope in terms of how things would progress The noble Baroness, Lady Brinton, quite rightly reminded us of the role of the voluntary sector and the way in which users can shape the different patient pathways that are available. That too is something that often gets neglected. The noble Baroness, Lady Masham of Ilton, talked very pointedly about the lack of local knowledge about Healthwatch and its role, as well as the suspicion that is growing about the STP process—which could be extremely important, because it is intended to be transformational—in terms of the lack of openness and transparency. It is an important process, which is why it was so vital that health service users and social care service users were fully involved in the process My noble friend Lady Warwick of Undercliffe talked about how the role of local Healthwatch could be critical and said that it was one of the few organisations that really has an overview across the health and social care divide. She highlighted the concerns about the changed relationship between Healthwatch England and the CQC. She also reminded us, very importantly, of the potential role of housing associations. The noble Earl, Lord Listowel, talked about the value of senior people listening to service users. That is the essence of most of the models that have existed over the years—senior people directly hearing the voices that are there. The noble Baroness, Lady Watkins, also made that point when she talked about challenging the orthodoxy. She made interesting points about how users should influence and shape things I was very amused by one element of the speech made by the noble Baroness, Lady Walmsley, because she said it was not the Liberal Democrats who had said that the structure should work through local authorities. In that case, I am beginning to wonder whose idea it was. The noble Lord, Lord Lansley, speaking 10 years ago about the previous system, said that LINks may "struggle to be credible as long as they are funded through local government". Just a few years later, he felt impelled by something or someone—we now know it was not the Liberal Democrats—to say that the new system should be funded through local government, with the consequences that I have described The noble Baroness, Lady Chisholm, in her reply, tried to reassure me about the relationship between Healthwatch England and the CQC, and reiterated what I already see as the accountability lines which render independence slightly more difficult. She then told us that the CQC would in future be deciding the funding of Healthwatch England, which seems to put even more into question the way in which that independence would operate. She also talked about local councils’ accountability for how much they allocate to Healthwatch England. This is very important, but the sanction Healthwatch England has available—which I think we have discussed before in your Lordships’ House—is that it can send a letter to the council lead saying it is not good enough. As a former council leader, I know what response I always gave to letters saying that something that my local authority was doing was simply not good enough In conclusion, I am grateful to all noble Lords who contributed to the debate. There is a great warmth around the House about what could be achieved by Healthwatch, both locally and nationally, and the message going back to the Department of Health must be that it is important to build on the Healthwatch network. If it really wants to get this right, and deliver what all your Lordships have said they want to happen, then it needs to resource local Healthwatch organisations properly through a freestanding Healthwatch England. I suspect we might then well find that we have a system which genuinely delivers a user voice and influence into the centre of health and social care in this country.