Health and Care Bill — House of Lords, 2022-01-18
Topic: Health
Jonathan Toby Harris (Labour, Centre-left): My Lords, I refer to my health interests as declared in the register; in particular, I chair the General Dental Council, but I should make it clear that I am not speaking on its behalf in Committee Almost exactly 35 years ago, I became director of the Association of Community Health Councils for England and Wales, which was then the national statutory body representing the interests of the patients and the public in the NHS. Since then, both local and national representation of patients has gone through a series of iterations—indeed, the number of occasions on which I have been sitting on the opposite side of the Chamber from the noble Earl, Lord Howe, talking about patient representation seems too many to recount. After community health councils, we went through a series of iterations of which local Healthwatch is the latest version. I admit that when we had the debate which my noble friend Lord Hunt began by referring to, I was extremely dubious about whether local Healthwatch would be able to flourish and the national body be effective. I have to say that my worst fears have not been founded, but it has to be recognised that the way in which it was structured, in particular the late changes introduced by the Government during that legislation, made it much more difficult for Healthwatch, both at local and at national level, to be as effective as it might be The context of this debate is the centrality of patients and service users in delivery. Every time the NHS is reorganised, whether it was the reorganisation of the noble Lord, Lord Lansley, or the reorganisations we have every three years or so, there is always a grand White Paper which says, "Patients will be at the centre of this new structure", but it is never quite like that. In the new arrangements being brought forward, the Government need to make sure that the local patient voice is represented and articulated and that, at national level, those voices can be aggregated and put forward. That is why this group of amendments is so important. We have just had a debate which ended up revolving around how many separate interests should be represented on the various bodies that we are creating. I can see the problems if we add and add, and how difficult that is going to be. However, what I hope the Government will take away from the consideration of this amendment and look at before Report is how they can make the patient representative structure within the future arrangements better and more effective. I think that a number of things could be done The first is about the budgets. The budgets for local Healthwatch go through a complicated, notional process. It is very difficult to define why the allocations are what they are. It would be far better if it was clear what the expectations were to run a local Healthwatch and to deliver what is needed The second thing that can be done concerns the degrees of independence: from the local authority, health providers and health commissioners, at the local level, and from the CQC at the national level. The noble Lord, Lord Patel, talked about the problems of Healthwatch England being a sub-committee of the CQC. I understand that the relationship has actually worked quite well, but that is probably because of the good will of all concerned. It might be that, in the future, Healthwatch England has serious criticisms of the regulator. How can it do that, as a sub-committee of that body? Whether formally or informally, you can see the difficulties.