Government confirms that NHS Bill will privatise patient representation

On Friday, when Parliament was not sitting, the Government published 68 amendments to the Health and Social Care Bill changing the status of local HealthWatch organisations (the local bodies that are intended to protect patient interests in the new Tory/LibDem vision of the Health Service), as I predicted a few weeks ago.

The amendments are very complex and difficult to follow – they amend amendments to Part 14 of the Local Government and Public Involvement in Health Act 2007.  And they are scheduled to be debated next week during the House of Lords Report Stage consideration of the NHS Bill.

That means that these amendments – slipped out without proper warning or explanation (a normal courtesy of writing to those Peers with an interest in a particular matter doesn’t yet seem to have happened in this case) – will not receive proper Parliamentary scrutiny.  They have never been considered by the House of Commons (and, if passed in the Lords, will now only be taken there as part of the truncated Consideration of Lords Amendments procedures).  In the House of Lords, they have not been subjected to detailed scrutiny at Committee Stage and will essentially have to be debated on a take it or leave it basis when they are eventually reached probably some time late on Thursday.  That will be the only opportunity for any  discussion on what these amendments mean.

So what are these amendments about?

The biggest change is to remove Clause 181 and Schedule 15 of the Bill.  These established local HealthWatch organisations as statutory bodies with a defined local membership (appointed in accordance with regulations) that could employ staff, would meet in public etc.

Instead, local authorities will be expected to make “arrangements” with a body that “a person might reasonably consider … acts for the benefit of the community in England”. And these bodies will then be able to sub-contract the patient representation work further.

The role of the national body, HealthWatch England (which the Government still want to be a sub-committee of the heavily-criticised Care Quality Commission) to advise local HealthWatch organisations is also being diluted with their power to give “advice” being changed in another amendment to a weaker role of giving “general advice”.

Presumably as a sop to people like me who had complained that there was nothing to require local authorities to provide an adequate local HealthWatch organisation (or even to spend the money allocated for local HealthWatch for that purpose), there is an amendment that gives HealthWatch England the power to give a local authority “written notice of its opinion” that the services expected of a local HealthWatch organisation are not being provided properly.  This gives HealthWatch England the power to write a letter, but that is all.  There is not even a requirement for a recalcitrant local authority even to respond to the letter.  I am sure they will be quaking at the prospect!

The Government acknowledges that there may also be a conflict of interest between a local HealthWatch organisation and the local authority that is responsible for setting it up and funding it (for example, if a local HealthWatch criticises the quality of the social care provision provided by a local authority).  They are therefore putting forward an amendment saying that local authorities “must have regard to any  … guidance on managing conflicts” that the Secretary of State may issue.  Again, not much of a safeguard.

The amendments also seem to envisage that a local authority may get different contractors to provide the various functions of local HealthWatch organisations, so one contractor may “gather information” and “make recommendations”, another may be responsible for “monitoring” services with the power to “enter and view” them, a third might provide advocacy services and a fourth might be responsible for “influencing commissioning”.  This is hardly a recipe for an effective structure.

And there is another strange amendment which suggests the possibility of imposing a requirement that  in any area “Local HealthWatch contractors (taken together) are representative of people who live in the local authority’s area”.  This acknowledges that there are likely to be several sub-contractors providing patient representation services in an area, but also opens up the possibility that the sub-contractor providing one service may not be representative provided the other subcontractors compensate for the first’s unrepresentativeness.

Without these amendments, there would at least have been some clarity as to what a local HealthWatch organisation might look like – even though they would be hampered, possibly shackled and potentially starved of funds by being subservient to the local council in their area whose social care provision they would be monitoring.  However, with these amendments local HealthWatch organisations are likely to be fragmented and will lose the authority they would have had by being statutory bodies.  What is more by deleting the schedule that would have specified membership arrangements and governance they will now be shadowy and unaccountable structures.

The net effect of these amendments will be to make it more likely than not that the new local HealthWatch organisations will be ineffective and that there will be no proper and coherent structure of patient representation at local level.

One can only speculate as to why these amendments have been brought forward in this way at this time.

One possibility is that some obscure unit in the Cabinet Office charged with dismantling the public sector suddenly realised that there was a bit of the Health and Social Care Bill that did not facilitate privatisation and instructed the Department of Health to change it.

Another is that Department of Health Ministers have realised that the changes they are making to the NHS are so unpopular and are likely to have such a damaging effect on patients that they simply cannot risk having an effective mechanism for patients’ interests to be represented.

I don’t know which is the real reason, but it is difficult to conceive of any other rational explanation.

14 thoughts on “Government confirms that NHS Bill will privatise patient representation”

  1. What do the Tory spin doctors say about this?
    What does Shirley Williams say about it?
    What does the Daily Mail/Sun say about it?
    This lot are a joke for open honest democracy. They say one thing and do another.
    This listening administration is deaf.
    The NHS needs evolutionary change not revolutionary change.
    The NHS needs efficiencies not deficiencies.
    Of all the worlds health service systems our NHS is the best, most cost effective.

  2. Toby – thanks for this – to be honest like many people I remain flummoxed by much of these changes – and I am glad that people like you are keeping an eye on the detail. I do think that one of the problems with Healthwatch is that DH model is unconvincing to start with – I detail some of this on my blog. However, I don’t think that we have come up with a credible local alternative yet. I do think that some key principles should apply – which may slightly contradict some of your points.

    First – the more local the better – frankly, the further away healthwatch is from government the better. I would rather fight a local battle with a local authority than with any national government particularly one like this which is happy to break manifesto pledges and create new policy after election. This also applies to national bodies like CQC – who are ultimately accountable to government not local people.

    Second – I think it is only right that funding that local authorities receive is not ring fenced – they need to decide how best to balance resources to meet local need. Again, I don’t want central government dictating what we can and cannot spend local funding on. Again – this government with its use of financial levers to penalise councils for raising tax or to force them to keep unnecessary bin services is an example of why local autonomy is so important.

    Third – I do think that local authorities should be free to design (and be accountable for their actions) systems that enhance local democratic accountability. Local authorities need to be able to build on existing assets such as Citizens Advice Bureau, Health Champions and local advocacy Organisations – and not feel obliged to create yet another organisation which relies on central government patronage.

  3. The only immediate point I would make in reply is that the NHS is supposed to be a national service and the local arrangements for patients to be represented should be similarly resourced rather than have to compete with unrelated local priorities. The money for local HealthWatch organisations is coming from the Department of Health for that purpose – does it really make sense for it to be used for other purposes?

  4. Thanks Toby – the problem is that health and wellbeing is about more than the NHS. Under this legislation local authorities are responsible for commissioning a function that also keeps and eye on/advocates for social care and public health – best wishes Mark

  5. The health and well-being function is not about a lot more than “keeping an eye” on these issues. It should be leading, shaping and coordinating the provision – along with other agencies. HealthWatch will be the body – in theory at least – that is supposed to monitor this provision on behalf of patients and that’s why there is a potential conflict of interest. Having said that, however, I would have less worry about HealthWatch being organised via local authorities if the level of resources was guaranteed and there was some clear template about what a local HealthWatch organisation should look like.

  6. What concerns us it the demise of public scrutiny of decisions : be it commissioning or reconfiguring.
    Under the banner of “Don’t lets waste a crisis” the NHS is ploughing ahead with mergers and reconfigurations and handing billions of Pounds of commissioning to shadowy unaccountable organisations with the potential for huge conflicts of interest ; corruption and short term financial pressures dictating without any democratic feedback and control.
    Who is championing Public Overviewand Scrutiny?

  7. We must not forget than when power is devloved to Local Level, so also is the responsibil;ity for failure. This can be seen clearly with Foundation Hospitals which, when they fail, has nothing to do with the DOH; it’s incompetant Local managers. The failed attempt to remove responsibility for the NHS from the Secretary of State was the ultimate attempt at insultaing the DOH from blame.
    Local anarchy seems to be the new mantra.

  8. Sadly I am not surprised by any of this. I am a long time time user of the NHS (i have arthritis and diabetes mellitus amongst other things) and for the most part whatever Party has been in power it has made little difference to the good quality of the service my family and I have received. But I am really concerned by what the Government seems to be doing. And I am very annoyed that for a brief glimpse of the good times the LibDems have sold their integrity. Hopefully it will condemn them to another 50 years of obscurity.

  9. I have been an Orthopaedic Consultant now for in excess of 25yrs. I am sure the evicos of patients and the public are very important but will you take any notice of them. I have in my time been MAC chairman , Specialty Regional Advisor, Surgical Tutor and LNC chairman but I have always felt frustrated as any such position lacked teeth there always seems to be an established agenda which we are not going to influence. We are encouraged to get involved but the process of multiple meetings at the expense of clinical practice and the ultimate ineffectuality discourages involvement. When I was a Senior Registrar I was critical of my Bosses being intolerant of Administrators, but I am afraid I find myself becoming the same in that Doctors are not having any influence on the way the show is run. It worries me because it makes the Doctor become a Technician working shifts and not a Professional and caring person who is interested in continuity of care for his/her patients and that is what it is all about.

  10. The Privatisation of patient representation has been a fait accompli by some LINk ‘Hosts’ for a number of years now, with the connivance of their Local Authority Pay-Chiefs. You pointed this out in one of your speeches in the Lords, Toby.
    Reports suggest that those Volunteers who tried to resist those moves have been vilified, subjected to kangaroo courts and threatened with legal action. Meanwhile elected Councilors and Directors of … have chosen to stand by mute, and may well award the LHW contracts to these ‘Hosts’.
    That seems logical, since those Hosts have already shown that they can shut out, and shut up, any voices from the populace that don’t praise the LHWs and glorify in their new subservience to those anti-democratic regimes.

Leave a Reply

Your email address will not be published. Required fields are marked *