House again in Committee on Clause 222.
238KC: Clause 222, page 154, line 30, after “on” insert “effectively”
The noble Earl said: I shall speak also to Amendments Nos. 238KDA, 238KF, 238KH, 238L and 238LE. One thing that makes people like me suspicious about what is to emerge from the Bill is the phraseology of Clause 222(2). To put it at its simplest, the activities that are described in the subsection are all about process; they are not about outcomes. That pertinent point was raised earlier by the noble Baroness, Lady Neuberger. It is as if all that matters is that someone observes the carrying on of health and social care commissioning and provision and obtains people’s views. What is the point of that activity? The point is to improve the quality of local services. Why do we not say that that is what LINks are there to do? Equally, why do we not say, in terms, that it is not enough for the contract with the host to specify that the activities mentioned are carried on; the contract needs to have as its aim that those activities should be undertaken effectively.
There is a very sterile and neutral feel about the wording in this part of the clause. Surprisingly, there is not even any mention of one of the main aims of patient and public involvement, which is to try to promote the interests of those people in the community whose voice is less often heard, or who, for one reason or another, are the victims of health inequalities. A good LINk will tackle social exclusion head-on and try to remedy it.
Perhaps I can illustrate that idea briefly. The Minister will be well aware that life expectancy varies depending on the area of the country where one lives, Manchester being the worst area for both men and women. If those with the shortest life expectancy do not have equal influence on services, the potential of those services to deal with these issues will be lost. A good example might be stop-smoking services, which need to be offered at the times of day and in the locations when those of working age in manual groups, which have higher rates of smoking, may access them easily. If they are involved in the design of services, those kinds of issues could be raised. Similarly, smoking in pregnancy is more than four times higher in social class 5 than in social class 1. The involvement of women from deprived areas in designing antenatal services could improve the success of those services. We know that the rate of perinatal mortality is twice as high among mothers living in the most deprived areas. It is essential for these groups to be involved in services so that they are designed effectively. There are any number of other examples, not least—it is fresh in my mind—the need to involve black and ethnic-minority patients in the design of psychiatric services.
I hope the Minister will accept that that is a real issue. If LINks are able to make reports and recommendations to those with the appropriate power to change things in the health service or social care, then there should not be an artificial restriction on to whom they can report. The wording does not make it entirely clear and I would be grateful if the Minister could confirm that the persons responsible for commissioning, providing, managing or scrutinising local care services could include, for example, the Healthcare Commission and CSCI.
What are we to understand by the definition of “care services” in Clause 222(5)? We see here that,
“‘care services’ means—
(a) services provided as part of the health service in England”.
That might seem perfectly all right until we remember that not everything that a patients’ forum is currently able to report on relates to health services as commonly understood. For example, concerns may be expressed about car-parking charges, waiting areas for hospital visitors or transport arrangements. These are matters that contribute to the patient experience in the broad sense but they are not directly to do with care. Can the Minister confirm that such matters will not be excluded from the purview of LINks? I beg to move.
I support the noble Earl, Lord Howe, in everything he has said. I will also add a few words to what he said about Amendments Nos. 238KD and 238KE.
The clause states that it is to enable “people” to monitor the local health activities. Instead, we have inserted,
“members of the local involvement network”.
If we are moving to LINks, and it seems fairly clear that—with all the queries that we have—we are, then it is right that we should say so and say what we mean about membership of those LINks. I am enormously grateful to the involvement network, which is a network of hosts, for the information it has submitted. It suggested that we must move to a system where LINks are sufficiently flexible,
“to allow members to respond at least as quickly and effectively, in the interests of those seeking or receiving service, as the Forums can do now”.
About forums, it said that they,
“generally have developed small, trained and experienced teams made up of members”,
and other participants,
“who are able to respond and take action faster and with a different perspective than other scrutiny or regulatory bodies”.
It added that,
“they are often more effective at eliciting a response because they are more down-to-earth, can work more simply and directly, including with staff at all levels”,
“remain focused on what matters to patients and their families”.
That is exactly what we want LINks to be. The involvement network has suggested that we need to create “classes of membership” for LINks, and that might mean having a variety of memberships for groups and for individuals and at many different levels. Whatever it is, we need people to be members of that entity. The incredibly loose network that the Minister described before the Statement seems to be too loose to be bearable.
However the model works, there must be some sense in which LINks have members. Anna Coote, a former colleague at the King’s Fund who was on the group that looked at the new structure and who is now at the Healthcare Commission, suggested in her evidence to the Health Select Committee that the original idea was a “true network”—something very loose indeed—but that it was shifting somewhat. The Health Select Committee argued that the Department of Health was reluctant to talk about membership of a LINk, but we argue that if LINks are to do anything and gather views properly they will need members and some clarity of what kind of entity they are. It is essential, however loose they are or how many classes of membership there may be, that they know who their members are and who they can charge with taking on various functions, duties, activities or whatever it is they will be called.
In lending my support to these amendments, I will speak briefly to Amendment No. 238KL.
Before that, I should explain to my noble friend why I have added my name to a number of the amendments being debated today. My noble friend will remember that I was critical of the Government’s decision to abolish community health councils in 2002, feeling that they should be strengthened and reformed instead. Their successor, the patients’ forums—I prefer to say fora—are now to be abolished in turn instead of being strengthened, perhaps with their structure and functions revised in light of experience and developments in the National Health Service and other social institutions.
Just over a week ago, my noble friend Lord Layard wrote an article in the Guardian entitled, “No change for change’s sake”. I will quote a small part:
“Reorganisation is much less important than some think. In fact, many different organisational structures can be made to work equally well. What cannot work is constant reorganisation, where nobody understands what is happening, institutional memory is lost, and everybody worries about their future rather than the job in hand”.
Exactly. However, the Government have gone so far down the road to establish LINks, instead of patient participation fora, that our job today is to probe the Government’s arrangements for setting them up and ensuring that they work smoothly rather than seeking to attack the whole concept. In fact, the concept of LINks is admirable in many ways, particularly in that it covers the area of local authorities, rather than individual trusts. It also includes primary care and—better than anything—social services in its remit. It is potentially an extremely valuable reorganisation, although its remit could have been included in those of existing bodies. The Government have said that, by leaving some of the wording of the Bill non-specific, they will allow for flexibility in operation, but we feel that inserting certain words will make it easier for those setting up and working in LINks to carry out their tasks and to know what those tasks are.
The main purpose of the amendments, as noble Lords have said, is exploratory. It is appropriate for me, as a government Back-Bencher, to join the cross-party group that has tabled these amendments given that many Labour Party members and supporters—not least on the Health Select Committee of another place—are very concerned and have misgivings about the Bill.
I want to talk a bit about Amendment No. 238KL. Its purpose is to expand how LINks are to obtain the views of the population in their areas. Clause 222, at page 154, line 36, talks about local authorities,
“obtaining the views of people”.
That is extremely non-specific. That means that they can just go into the street and ask the views of a selection of passers-by. The amendment inserts, instead of “obtaining”,
“supporting members of local involvement networks to obtain”,
this information, thus delineating more clearly how the LINk is to work. This is one of a series of amendments to clarify the structure and function of LINks.
I am in exactly the same position as the noble Lord, Lord Rea, on these amendments. Will the Minister give us examples of who may be the hosts for LINks and what happens if they suddenly move or go broke—especially if they are housed in a voluntary organisation?
I want to speak to these amendments to probe further a question which I remain unclear about, although I had hoped it to be clarified in the previous group of amendments. I was somewhat disappointed when the Minister gave us the impression that some of us, by probing these issues, might not be in favour of change. I think that change is often extremely positive but, to take change forward, we have to understand how we harness the energy of those involved in existing services and do not demoralise them. The management of change is around gathering people with you and taking you forward with their energy. If we are to take these changes forward, we have to conceptualise what this is about—and I am struggling to do that, particularly when I read in Clause 222 that the activities include,
“enabling people to monitor, and review, the commissioning and provision of local care services”.
The commissioning of local care services is a highly complex process. What kind of organisation will we have? I continue to use that phrase, “What kind of organisation?”, because I do not know the terminology with which to describe the matrix it appears that the LINks will be. I agree with these amendments—we have to have some sort of form and structure, some sort of membership and some sort of understanding of the host. I agree with my noble friend who asked who the hosts will be. I do not understand that and have very little idea of what their governance relationship is with the local authority or the primary healthcare trust—or, indeed, how those two relate to the LINks in terms of governance.
I am sorry if this is losing some thread in our discussion and the nature of the documents that have been sent out. I have tried to follow it, but, as the noble Baroness will know, I spend a lot of my time in governance and trying to sort out some of the difficulties of change that the Government have created, which have not been too easy. I ask these probing questions simply because I am keen that we do not again create an animal that is unmanageable and something that we will have to unpick. This is a crucial change for the future.
As “host” has been mentioned, can the Minister say whether it is appropriate now or at a later stage to consider why we need hosts, how they will work, how much money they will have and whether they will be voluntary organisations that do not get involved in the work that was going on? Those will be very important points to explore later and I very much agree with what the noble Lord, Lord Rea, said, because he put some of our concerns very effectively.
I add my support to this group of amendments, particularly Amendment No. 238KG, on,
“supporting members of local involvement networks to obtain”,
their experiences. I wish to add to my noble friend Lord Howe’s search for clarity on the purpose of LINks.
Perhaps I may use an example from my local authority in Kent. Three years ago it wanted to support the patient forums by establishing an independent focal point to allow patients and residents to report their experiences of the NHS. We have, like many local authorities, a 200-seat, 24-hour-a-day call centre. We were simply suggesting that people could phone in, because one of the problems of patient forums is—and one of the problems of LINks will be—the large amount of anecdotal evidence. What they need is a professional organisation to take widespread opinion, to analyse that and produce hard evidence of patient experiences. This seemed a good idea. We called it Kent Health Watch, but at the time it was opposed by the NHS health authority. However, such an idea would be immensely valuable. Amendment No. 238KG and the clause bring that out. Will the Minister support the establishment of that kind of patient information base, which is very important both for information and choice?
This has been a thorough debate on some complex issues. I much admire the noble Earl’s struggle with language. Sometimes we seem to exist in a virtual universe when we consider the language of parliamentary draftsmen. That is not unique to this Bill, but it is, perhaps, perplexing here. The noble Earl also did the House a service by emphasising how important it was for the LINks networks to be as wide as possible. The examples he gave, not least regarding the relationships of black and ethnic minorities with mental health services, were absolutely right. All I would say is that that is precisely why we have not listed organisations in the Bill or defined the scope and extent of a LINk, simply because we have made it clear in everything that we have written and sent out that the test of a LINk will be how far it reaches into the community.
I say to the noble Baroness, Lady Howarth, that I certainly did not mean to denigrate people who manage change and who have had successfully to manage a great deal of change in recent years. I understand why she pushed me on clarity and I will do my best to conceptualise this and to answer some of the question that arise.
Amendment No. 238KC seeks to insert “effectively” in relation to the means by which LINks arrangements can be delivered. What we mean by “effective” is, essentially, that LINks will be organisations with sufficient scope, as I have said, to bring in the widest and most effective range of influences for different purposes. Those influences may be very specific to an interest group made up, for example, of people clustered around the independent living agenda. The influences may be broad in relation to changes proposed whereby this alliance, this network, will have a collective view of the impact it will have or some of the changes that it wants to see. Some of those changes may run across interests and conditions but will affect a particular age group, such as the elderly or the young. So there will be, I am afraid, infinite variety. It is that sort of inference.
The test of effectiveness is that there will be governance arrangements which are clear about the relative role of the host. The LINk will take decisions on priorities and activities and the host will provide the necessary support for them to carry it out. In all the documentation we have put out, that distinction and the need to be clear about that is vital. There will be clear and responsible partnerships with stakeholders, such as overview and scrutiny committees. Local partnerships will establish the role in relation to commissioning, at what point the LINk organisation and in what form—a group, a small sub-committee—would have a role in looking at the commissioning of particular services, maybe specialist services. Those sorts of things can be determined as the structure evolves.
There are clear accountabilities in the system. Local authorities have a duty to make arrangements to establish a LINk. The host will be accountable for the delivery of the contract and provide appropriate support, advice and infrastructure. The LINk is accountable to the community. It will reflect the range of organisations and interest groups which have an interest in the whole range of services and working with them to obtain the voices, it will determine priorities for work programmes in accordance with the issues which matter to local people.
We sought at the outset to establish a means of informing ourselves and local authorities on what will work best, and that was the point of the early adopter projects. They are not pilots; they are early adopter projects, attempting to show how different models of activity may work, how people can be engaged in different ways, how LINks can be governed, and, in short how they can be as effective as possible. We have just completed nine regional events at which we asked all stakeholders interested in LINks for their views on how the arrangements should be set up. The responses indicate that people were really keen for options to be set out in guidance on how best to deliver LINks’ functions and structures, how best to engage, how to reach the seldom-heard groups, how to make model policies on areas such as codes of conduct. No one has asked for that to be put in legislation. They have asked for help and guidance on how to formulate it. It seems to me that that is the responsibility of Government.
We have consulted many voluntary and community organisations and there is a huge range of experience among them for obtaining responses and voices. The model contract specification was drawn up with their input to make sure that it set out the key features, which may well have been things that LINks are not as well as things that LINks should be.
On contracting, local authorities are very accustomed to contracting local service providers and performance-managing those contracts. We explored the great variety of innovative arrangements at an early stage of this Bill. Local authorities are increasingly confident about new types of arrangements. By giving them a clear duty to make the arrangements necessary to establish the support LINks, we have chosen the right organisation to fulfil the role.
I return to the notion of effectiveness. No, I will not return to the notion of effectiveness; I shall go on with the logic of what I was saying.
I turn to Amendments Nos. 238KG, KE and KG. They seek to articulate the notion of members of LINks. My noble friend asked how one obtains the views of people and I would say to him that there is a huge range of options. I take the point he is making. I am not sure that I agree with him but I listened hard to what he said. The point is that there is an enormous range of experience on how to obtain voices, not just through existing organisations, which are often membership-based and therefore have responsibility to reflect their members’ views, but also through the new range of technologies which make it very easy indeed—not least e-gov with its direct relationship with local government—for people to text or e-mail what they feel about things. So we have ways of doing this which we did not have before. The example given by the noble Lord, Lord Bruce-Lockhart, in relation to this was very interesting and I would like to think about what he said.
This batch of amendments is generally about giving identity to LINKs; giving members individual or collective identity or responsibility. I come back to where I started on the previous amendment, to the need to allow for flexibility and self-design; the need people themselves to say that this is the sort of organisation they want and that it is what will work for them. Obviously there will be participants in LINks who want to take on a more active role than others, who want to form the steering committee, and they will be enabled to come forward. The host’s first task is to identify who in the local area is active, involved and committed and who among those committed organisations, as they come forward, might be willing to take on some of these responsibilities. It will be an open but negotiated process. We have not prescribed whether there should be a board or a steering committee but it is very unlikely that there would not be.
In terms of membership, the noble Baroness, Lady Neuberger, asked why certain people could not be members. The involvement network has come up with some interesting ideas but it would be difficult to put classes of membership in the Bill. A company limited by guarantee or a charity could be members. There is nothing to stop it being a membership organisation but this should be for local people to decide. I know it is not easy. We are wrestling with a bit of a miasma but that is in the nature of what we are trying to achieve.
The noble Baroness, Lady Masham, asked who the hosts are and what they do. Hosts are organisations made up of the same sort of people who supported the patients’ forums. They can be voluntary organisations or social enterprises. The acid test is: do they know the field? Will they be able to be inclusive, to know who is able to or wants to make a contribution? Are they organisations that understand health and care matters? They could be an organisation in the field or a care provider, or a voluntary organisation dealing with health. They could also be a citizens’ advice bureau. We will have to see what comes forward and what capacity they offer the local authority. This is the test the local authority will impose. Can they do what we want? Are they sufficiently familiar, confident, trustworthy, open and capable to host and provide the infrastructure for this new organisation? We have not said what organisations should come forward for that reason. What happens if they go bust? There will be a rigorous process in awarding a contract but if they go bust, it will have to be retendered.
Let me say something about commissioning. PCTs and local authorities have a duty to seek the views of local people, especially in commissioning decisions. LINks will be an ideal resource for commissioners to enable easy access to people who are interested and knowledgeable about that process. I think we have a natural synergy there.
I have dealt with the hosts; let me come back to the notion of people. We do not think it is right that people should be identified in the legislation as having specific power or responsibilities. The intention of the legislation is to define the LINk’s functions rather than how it should be managed or governed. As I have said, there will be different ways of doing that.
Amendment No. 238KF seeks to require that the activity of a LINk to monitor and review the commissioning and provision of services is for the purpose of securing and maintaining improvements to those services. I think the purpose is a good one. I can see the argument but I want to take this away and think about it, because getting something in the Bill about securing and maintaining improvements could be helpful. I have to consider how it could be applied to all of LINks’ powers rather than just one so there will be some implications to be teased out.
Amendment No. 238L seeks to ensure that the list of LINks’ activities given in Clause 222(2) includes that the LINks can make their reports and recommendations to the bodies responsible for services. As it is currently drafted, subsection (2)(d) states that LINks can make,
“reports and recommendations … to persons responsible for … services”.
It is not necessary to amend that to read “persons or bodies” because, in the legal context, “persons” includes a body of persons and therefore applies to institutions that are responsible for services.
The noble Earl asked whether LINks would be able to make reports—require responses, as it were—to the Healthcare Commission or CSCI. No; LINks will be able to make reports to regulators but they are not included in this list because they will not be under a duty to respond, as commissioners will be. There is a distinction. LINks reports are to be sent to local organisations that commission care services, not to national bodies, to emphasise the local LINk rather than the national commissioning body.
I turn to Amendments Nos. 238KD and 238KH. I absolutely agree that it would be important for LINks to promote involvement opportunities to encompass the views of the entire population, as I said, including those who are hard to reach. The activities for a LINk listed under Clause 222(2) already include promoting people’s involvement and obtaining views. The most reassuring thing that I can say to noble Lords is that we will be setting out in guidance the importance of doing that and collecting best practice about how it is already done.
I will have to write to noble Lords about Amendment No. 238LE; I do not have the answers to hand.
Finally, the noble Earl, Lord Howe, asked whether LINks will be able to consider transport or access to services. Yes, LINks will be able to hear many views on matters relating to healthcare; it will not be confined to the delivery of health services per se. It will cover all the things that make a difference to the way in which people access and perceive their health services.
I am sorry; I seem to have spoken for quite a long time. I hope that I have given some of the answers that noble Lords were looking for.
I do not think that they will be confusing. We are at the stage at which they look confusing because we do not have these animals operating in front of us. Once the host is contracted and the functions of the LINks networks are described, people will have a clear idea that across their local area there will be a network or alliance of people who know and care about health and who are expert in it; it will be their job to give the community’s views on health services. That can be described in a fairly straightforward way. I agree that some of the organograms that we have had defy that. I am sure that when you state what the objectives are, people will understand.
I am sure that Members of the Committee are most grateful to the Minister for having covered the amendments in such detail. This is a mixed bag of amendments so I suppose that it is not surprising that we should take comfort from some parts of the Minister’s answer and less comfort from other parts.
I was encouraged by what she said about Amendment No. 238KF, and I thank her for agreeing to take the idea away. I was sorry, however, that she confirmed my suspicions that a LINk would be unable to make reports and recommendations to national bodies. In some circumstances, a LINk might feel justified in reporting to that level. These are matters to which we can no doubt return if we wish at a later stage of the Bill. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendments Nos. 238KCA to 238L not moved.]
238LZA: Clause 222, page 154, line 43, at end insert—
“( ) enabling people to monitor and review the provision of care services and local care services for persons moving their place of ordinary residence into the area.”
The noble Lord said: Never mind the opacity of parliamentary draftsmanship; the numbering of amendments that I have come back to from three weeks away in the States is mind-boggling enough. Noble Lords will see that Amendment No. 238LZA is grouped with Amendment No. 245B, which adds a new clause to Part 16, which deals with miscellaneous provisions. Both are probing amendments. Although they relate to distinct parts of the Bill, they are closely connected and, with the Committee’s agreement, I will speak to them together.
Hundreds—potentially thousands—of disabled people are being prevented from moving home or moving from residential care to independent living each year because of bureaucratic delays and disputes about who should pay for their care. The root cause of these problems is the definition of someone’s place of ordinary residence. This is a means by which local authorities and primary care trusts determine which authority has responsibility for personal support for disabled people who live in their area. Local authorities are responsible for assessing the needs of and providing social care to people who are ordinary residents within their area. However, it is quite common for one local authority to place someone in registered accommodation within another local authority’s area. Under these out-of-area placements, it is the placing local authority that pays for the personal support costs. If the individual then decides to move into more independent accommodation, their place of ordinary residence is deemed to have changed to where their new accommodation is. The local authority—where the new accommodation is located—should then take responsibility for their assessment and for funding personal support. However, there is no legal definition of ordinary residence and the guidance is unclear. The Department of Health said that it would update the guidance in 2004 but has not so far done so. Some local authorities are using this confusion to delay or avoid paying the costs of the care of those for whom they should be responsible.
Situations in which disputes about ordinary residence arise include the following: first, when someone is funded as an out-of-area placement in a care home that ceases to be registered as a care home; secondly, when someone funded out of area leaves a residential college but wishes to stay in the vicinity of the college; thirdly, when someone receiving support to live in the community wishes to move to another authority area, perhaps just a mile or two away; and, fourthly, when someone who is assessed by a local authority moves to a home in another area on a self-funding basis and within a few weeks or months approaches the original authority for help with funding. I have been personally made aware of another complication in my role as chairman of RNIB, in respect of which I of course declare an interest. RNIB’s Rushton School, which is now located near Coventry, receives numbers of children who are placed out of area from divers regions of the country. Their educational and social care costs are met by the placing authority but for some reason Coventry PCT is expected to pick up the bill for the healthcare costs of all the children from around the country. These situations have major implications for local authorities. The current system creates clear winners and losers. Some local authorities have very few residential care facilities and therefore make a lot of out-of-area placements. Others are well served by residential care facilities and therefore receive a lot of out-of-area placements.
There are perverse financial incentives for placing authorities to encourage disabled people living in registered care homes to move into the local community, or to encourage homes to de-register so that they no longer retain financial responsibility for their clients’ personal support costs. Those authorities in which large numbers of people have been placed face a significant increase in the numbers of disabled people needing support, with consequent budgetary implications. It is therefore essential that arrangements are put in place to ensure that these funding inequalities are resolved. Giving LINks the task of monitoring and reviewing provision in this area would help to give a voice to those stuck in the middle of these inter-authority disputes, many of whom are among those least able to make their voices heard. This is the purpose of Amendment No. 238LZA.
Amendment No. 245B seeks to put in place a mechanism for arriving at a more systematic approach to resolving these problems. The Voluntary Organisations Disability Group, in a recent report entitled No Place Like Home, urges the Department of Health to take three urgent steps. First, to establish and enforce the principle that a person should receive appropriate social care and support from the authority where they are currently living or wish to live, regardless of circumstances. This would not deal with the Rushton problem, to which I referred, where the issue is one of disproportionate costs falling on a single authority because it happens to have within its boundaries a facility with a significant out-of-area—for example, national or regional—catchment. Perhaps a better way of putting it might be to say that it is a fundamental principle that the ability to change one’s place of ordinary residence should not be contingent on health or social care needs.
Secondly, guidance to social services and PCTs should be updated to ensure that they implement this principle in a person-centred way that removes barriers to choice and independence. Thirdly, a framework should be put in place for the transfer of funds between authorities so that the issue of ordinary residence can no longer be used as a basis for refusing to provide care and support.
I hope the Minister will be able to give us some indication of the Government’s approach to these matters, and how they propose to disentangle the intricacies to which they give rise. It cannot be doubted that there is a range of knotty problems overdue for solution here. If the Minister does not have an immediate answer, perhaps she would agree that it could be beneficial to meet with local authorities and the other bodies involved in providing social care and health services, with a view to finding a way forward that commands general assent. I beg to move.
I support the noble Lord, Lord Low, very strongly in all that he has said on these amendments. In doing so I declare a non-financial interest as president of the National Society for Epilepsy, a charity that regularly finds itself entangled in exactly the kind of sterile and time-consuming arguments to which the noble Lord has so correctly referred. I hope that the Minister will be sympathetic to the issue and will do all she can to expedite a satisfactory outcome.
I also support all the words of the noble Lord, Lord Low. I declare an interest as a former trustee of Jewish Care, where precisely these issues came up time and again. I very much hope that the noble Baroness will be able to do as much as she possibly can to resolve this issue, which has been going on, to my knowledge, for the past 30 years or more.
I support the noble Lord, Lord Low, and congratulate him on his ingenuity in bringing this extraordinarily long-standing difficulty to the House through this amendment. I doubt whether the noble Lord thinks that the Minister can solve this, but if she could move it forward in any way, she would help the lives of thousands of people.
When I was a director of social services, well over 20 years ago, this was a central problem. It is not the wish of the local authorities to continue, but they have a responsibility to make their money go as far as it can. The regulations are not clear. If there was clarity it would make an enormous difference. I declare an interest as the chair of Grooms-Shaftesbury. It was very involved in the Voluntary Organisations Disability Group’s report, which the noble Lord, Lord Low, outlined with such clarity that I do not need to go into further detail. The Minister could almost make her name—if she has not already—if she could take this forward.
In making my name, I should say that it is Baroness Morgan speaking; my noble friend Lady Andrews is taking her seat for a moment. I congratulate the noble Lord, Lord Low, on his ingenuity in bringing forward this amendment in this way and, perhaps more so, on speaking so eloquently and with great knowledge and depth of understanding about what is an extremely important issue, as he always does when he brings these issues to the attention of the House. I particularly congratulate the noble Lord on highlighting a potentially very positive role for the new LINks in a future where they could be responsible for championing this key issue.
I understand that Amendment No. 238LZA—these are amazing titles for amendments—seeks to ensure that LINks have an overview if, for example, a local authority wants to move someone to a care home outside the area, or indeed if someone wants to move from one local authority area to another. They should have the right to social mobility.
I can confirm that the activities of a LINk, as they are described in paragraphs (a), (b), (c) and (d) of Clause 222(2), apply to care commissioned and provided to people moving their place of ordinary residence into the area. The definition of local care services given in Clause 222(5) relates to care services provided in the authority’s area and care services provided in any place for people from that area. Therefore, anyone living even temporarily within a given local authority area should be able to share their experiences of care services with the LINk for that area, even if the services they receive are from outside that area. Any healthcare commissioned by the PCT will fall under the remit of the corresponding LINk, even if it is provided in, for example, a prison. I know we are going to talk about that later.
Turning to Amendment No. 245B, I understand that this amendment is a means to secure social mobility, or to raise the issue of it. Local authorities should be under a duty to co-operate in, for example, the sharing of needs assessments to facilitate and speed up payments if people move from area to area. I thank noble Lords for highlighting these issues around the question of mobility for disabled people and local authorities’ responsibilities in this area. I agree that these are extremely complex and important issues and that they merit more detailed examination. I shall be pleased to take away the points raised by noble Lords today and will ask the Department of Health to discuss them with key organisations, as the noble Lord, Lord Low, has suggested. I know, for example, that the Voluntary Organisations Disability Group is particularly keen to meet to discuss these matters. I shall recommend that such a meeting takes place and shall be happy to bring pressure to bear in that regard or at least, for noble Lords who are discussing the issue here today, to press for significant progress to have been made before Report. With that in mind, I hope that the noble Lord will consider withdrawing his amendment.
Before the Minister sits down, perhaps I may ask her one question. If a LINk in a local area is so persuasive about certain provisions that need to be made that, in its wisdom, the local authority decides that more of its finances should go in that direction rather than in the direction that I would heartily support—as I support the amendment of my noble friend Lord Low—would that mean that, with so many different priorities in each area, the situation would get worse rather than better?
The objective in agreeing to take away and consider these amendments is to promote an outcome that will result not in further complexity or in things getting worse but in a situation where local LINks—the matter before us now—will be able to champion the needs of the people in their area, particularly disabled people who want mobility. That is what we are talking about here. The noble Lord, Lord Low, has highlighted the complexity involved. We have to look at that carefully and come back with some practical, simple and straightforward suggestions.
I am extremely grateful to the noble Baroness for her very positive response to the points that I raised and to those endorsed by other noble Lords who have spoken, for whose support I am also grateful. I thank the Minister for making it clear to me who was responding to the debate, although, having sufficiently made her name already, that was hardly necessary.
The noble Baroness is absolutely right that, essentially, I was drawing attention to the complexity of these issues, and no one would expect an instant solution this evening. I am most grateful that the Minister has recognised and taken full delivery of their importance, that she has undertaken to look at them with the department to see whether they can be unravelled and that she has agreed to meet the voluntary organisations, disability groups and others involved to see whether, as I suggested, a way forward can be found. For all that, I am most grateful to her and I happily beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
238LA: Clause 222, page 155, line 4, after “consult” insert “members of Patients’ Forums and”
The noble Baroness said: I shall speak also to the other amendments in this group. The most distressing thing in all the discussions about the establishment of LINks has been that patients’ forums have not been consulted or involved in the change. They were not part of the original group that Harry Cayton set up and they have been sidelined. Even the doctor-patient partnerships, which are moving towards LINks, have not been listened to adequately over their concern that the pace of the change is too rapid.
In private meetings, the Minister has assured me that the Government are very grateful for all that patients’ forum members have done. I suggest that it would be a concrete sign of that recognition if those members, or at least some of them, were consulted when the regulations for the new LINks system are drawn up.
In Amendment No. 238LB, we suggest changing the wording to “such other persons” to be consulted about the regulations, because “such other” can include those who know how all this might work. It might, for example, include present patients’ forums, as well as special interest groups, the national association for patients’ forums and the local involvement network hosts. If that wide group is not consulted, huge doubt must remain as to whether full account has been taken of the implications of LINks and what they are to be asked to do. Our general concern about the lack of clarity of purpose, rather than about the process, has not yet been put to rest, and that is why we have put forward these amendments. I beg to move.
I shall address the issue of the regulations because it involves a slightly narrower interpretation than that made by the noble Baroness. I shall then say a few words about how we want the expertise and commitment to continue working. I understand the noble Baroness’s concerns and I hope that I can reassure her.
The power to make regulations set out in subsections (3) and (4) already requires the Secretary of State to consult such persons as he considers necessary. However, it is important to state that there is no intention of using these regulations in the near future. The power to make regulations has been taken simply to ensure that LINks activities can be kept up to date in the future. For example, if health and social care services change—perhaps with the announcement of major reforms—we want to ensure that LINks have enough flexibility so that the effectiveness of their activities is not restricted. We said that forums are now ill-suited to meet the changes because there needs to be a wider, more inclusive network, but what we have learnt from patients’ forums is very valuable and we certainly do not intend to lose that knowledge.
The regulation-making powers are unlikely to be used soon, and patients’ forums will no longer exist if and when regulations are made to add to the powers of LINks. Amendments Nos. 238VB and 238VC seek a similar end when regulations are made detailing the duties of service providers to respond to requests for information made by LINks. Again, the Secretary of State must consult the members of patients’ forums.
We shortly intend to make regulations on how service providers should respond to LINks, unlike the regulation-making power in Clause 222. We intend to draw up draft regulations and, in the next few months, will begin a full three-month consultation on the various powers, such as the power to review or to request information. It is absolutely our intention that that consultation should involve important stakeholders from many sectors. Many people who are interested in how LINks will work will have valuable opinions, and we do not wish to make patients’ forums a statutory consultee because we do not think that the consultation should be limited to that group. It would seem unwise to retain them as statutory consultees once they were abolished, but they obviously contain important expertise.
The transition to the new system will be evolutionary. It is a new system and that is part of the argument for the way that things are being done. It is a new system rather than an amendment of the old system. As we say in the document on making effective LINks, there is no reason at all why forum members, as part of LINks, cannot continue to build on the often positive relationships that they have formed with specific NHS trusts, which, in many instances, have been valued on both sides. Specifically, LINks members will be able to form specialist sub-groups focusing on areas that include hospital trusts, mental health trusts and so on, as well as focusing on LINk-wide commissioning issues at PCT or local authority levels. That will build on best practice.
I firmly believe that many people who have built up relationships and trust with those organisations will want, and need, to continue to be involved. Therefore, not only will they be consulted in respect of what the noble Baroness raised in her amendment but they will have a role in making LINks, and the flexibility in the system, work according to the good sense and interest of the institutions. I very much hope that patients’ forums will take that message in the spirit in which it is meant. We need the expertise and commitment to continue, and I very much hope that it will.
While I quite understand why the Minister does not necessarily want the present system of patient forums to be among the statutory consultees, will she assure the Committee that, where regulations are being consulted on in the next few months, she would expect patient forums to be consulted, even though they need not be statutory consultees?
I thank the Minister for that assurance, which is helpful. If that is the case, it will give members of patient forums considerable reassurance. I also thank her for the rest of her clarification, but we are not yet entirely on the same page here. There is still extreme concern among your Lordships about the transitional arrangements and how they will all work. Nevertheless, as the Minister has given me some assurance, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendment No. 238LB not moved.]
238LC: Clause 222, page 155, line 4, at end insert—
“(4A) The Secretary of State shall make payments to each local authority that are, in the opinion of the Secretary of State, sufficient to cover the costs incurred by that local authority in making contractual arrangements specified under subsection (1).
(4B) Nothing in this section shall prevent a local authority making contractual arrangements under subsection (1) so as to ensure that the activities specified in subsection (2) are carried on to a greater extent than would be the case if the arrangements were to cost no more than the payments made available under subsection (4A).”
The noble Earl said: I shall speak also to Amendment No. 238N. It was perhaps inevitable that, at some stage in these proceedings, we should come to the vexed subject of money. Through this amendment, I want to raise a number of questions for the Minister about the resourcing of LINks.
We understand that funding is to be made available to local authorities by the Department of Health to enable the host organisations to support LINks and their activities. If, as I imagine, that funding is not to be ring-fenced—though the Minister may correct me—the obvious question arises about whether the activities undertaken in a local authority area in the name of patient and public involvement will be adequate in any given case. If it is open to local authorities to apply money intended to support that involvement to other activities altogether, we have the prospect—or, at any rate, the possibility—of LINks being supported on a mere shoestring and, therefore, not being able to do their job properly.
We will be debating the role of the Commission for Patient and Public Involvement in Health in later amendments, but one signal advantage of the commission is that the money that it distributes to forum support organisations cannot be used for purposes other than those for which forums were established. Under the arrangements in the Bill, however, there is no guarantee at all that money intended to support the activities listed in Clause 222 will actually reach the front line. It would be possible for a local authority to say that it was delivering the activities in the Bill when, in reality, those activities were so minimal that they were hardly worth the name of patient and public involvement. What steps could be taken, in those circumstances, to ensure that such involvement in health and social care is delivered properly? The answer is not clear from the Bill.
Another aspect to this issue is that, if LINks are going to assume different forms and guises in different localities, it is axiomatic that the level of activity that they undertake is going to vary from area to area. That will not only be because the activities themselves naturally give rise to a different burden of work in different parts of the country; it will also reflect the size and composition of the LINks, which may be large and diverse in one area and thin and perhaps weak in another. The amount of money directed toward PPI in any given area has to be based on a reasonably objective and dispassionate assessment of what that area needs in order for the job of PPI to be done properly and effectively. This is not to advocate the conscious overfunding of LINks that may be a bit thin and weak. My point is that the budget for the host contract has to be arrived at on the basis of what is, and what might be, needed to deliver desired outcomes.
How is that aim to be achieved? Again, the Bill is extremely vague and uninformative. What considerations will underpin the process whereby a local authority judges that funding of a host for a given year should, let us say, go up? If it reaches such a judgment, what factors will the Department of Health look to if it is to persuade the Treasury that additional funding should be provided? Whatever process is employed here needs to be transparent and fair, not least as between different parts of the country.
I would be grateful if the Minister could shed some illumination on those issues. Also, what total amount of funding has been earmarked by the Department of Health for patient and public involvement in 2008-09 and any subsequent years? Is it less or more than the amount currently granted to the Commission for Patient and Public Involvement in Health, and how has the budgeted amount been arrived at? Does she believe that more funds will find their way to host organisations than currently goes to forum support organisations and, if she does, how much more money will there be?
I hope that the Minister will be able to give us at least a measure of reassurance that there will indeed be a budget comparable in size to the present one and that the effect of all these changes is that we will see worthwhile amounts of money released to the front line, as adumbrated in her letter to noble Lords of 9 July. I beg to move.
While I support everything that the noble Earl, Lord Howe, has said, I will speak specifically to Amendment No. 238SA, which would insert a new clause about the employment duty for LINks. The reason for the amendment is that some 10 or so days ago the noble Earl and I went to see the Minister in another place, Ann Keen. It was a new innovation to be asked to see the Minister together, rather than our separate parties being seen separately. At that meeting, we raised the issue of employment—who decides whether a LINk will be able to employ people and at what point. As yet, I have not been fully satisfied on that point.
In discussion with Ministers, we have been assured time and again that a LINk will ultimately be able to employ people, even though the contracts may be held elsewhere. We have also been told that that will not be the case yet, because at the moment the host will do that at the setting-up stage. I would like the Minister to assure us that LINks will be able to employ people—she might already have said that—and perhaps when this will be so. Indeed, will contracts have to be held elsewhere, by the host, say, rather than by the LINk itself? That would be a considerable clarification, along with reassurance that there will be adequate money available to do it all.
I have added my name to two of these amendments. If I may say so, I thought that the questions asked by the noble Earl, Lord Howe, were absolutely spot on. I want to probe a tiny bit further on the point about ring-fencing, which is important. If we had assurances on that, we would have rather more confidence in what is being proposed. What will be the basis of the funding? Do the Government intend that there will be a careful look at the residents of a particular area, and their needs, quite apart from the needs that are being spelt out as the LINks get under way? It would be important to know that.
Another thing that worries me slightly is what happens if there is a fallout between the host and the LINk and they do not agree about what is being done—the host may not much want to endorse it and might get a bit critical that what it hoped for is not being achieved. Those are the sort of things that I hope are being looked at and thought about. These will be opinionated groups with all sorts of different priorities, which will not necessarily be acceptable either to the host or to the local authority. There are some problems, which, presumably, the Government are thinking through.
I have three simple questions. First, what advantage does the host have in carrying out this duty? Secondly, will it be able to levy a management charge? Thirdly, if so, how will that be controlled by the local authority so that as much money as possible goes to the front line? I have totally forgotten what the next question was, so I apologise. No, I know. It is about power sharing. Clearly, if a host is going to undertake this, it might be doing so for financial gain or for influence. Will the guidance ensure that there is a wide diversity of interest, rather than a narrowness of interest held by a particular host?
None of the questions that noble Lords ask is simple. I am sorry that the noble Baroness remembered the other question, although the first one was actually worse.
Perhaps I may briefly go over the process. We think that giving local authorities the duty to establish LINks for procurement of hosts fits very well into the whole notion of devolution of power to local authorities in the Bill. It is right that this provision should be at local level and not delivered from a central body, which is exactly what we do not want to do.
I have to resist for predictable reasons the proposal to put in the Bill a requirement on the Secretary of State to ensure that sufficient funds are available to cover the costs of a local authority and its work to put in place contractual arrangements to enable the establishment of LINk activities. As noble Lords know, the intention is that the Secretary of State will make a grant to each local authority to enable it to procure a host organisation to support the LINk and to fund its activities.
Although the exact amount of these grants is still subject to the Comprehensive Spending Review—a mantra that is being echoed across all government departments—we have said that the total amount available for the new system of LINks should be equal to what is currently spent on patient forums. The noble Earl asked whether the amount of money will be comparable. The answer is yes. That will initially take the form of a three-year grant. It is not ring-fenced. There is nothing perverse in that. It is not ring-fenced because we have moved away from the ideology of ring-fencing. Indeed, the whole notion of local area agreements, to which we are moving in the Bill, is to have flexible pots that can enable services to support each other and draw on a much more coherent and explicit form of support.
The funding will be explicitly targeted to ensure the purpose of making arrangements to establish a LINk. This will be visible; it will be discrete; and I am sure that it will be observed. In making the grant, the Secretary of State will assess what levels of funding will be necessary to cover the costs of each local authority. Obviously, this must be grounded in local realities. I hope that the noble Earl is reassured when I say that we are working with local authority representatives as well as with the Local Government Association to determine realistic budgets that will cover costs associated with administering and monitoring contracts. That will vary according to the nature of the area. Size is clearly a factor. Birmingham will have a very different set of requirements from those of a unitary authority such as Thurrock.
The amendment of the noble Earl seems to present an irresistible argument, but I must resist it because, if I were to give in, it would be customary from here on to have a passage in every piece of legislation stating that funding would be sufficient. That then raises the question of who would be the statutory judge of whether the funds were sufficient. We are entering a minefield here. The Secretary of State will consider how much each local authority needs and will make a judgment as to the level of funds necessary, informed, as I have said, in these different ways about how the local authority can comply with its duty. The factors will be demographic—the nature of the population and the size of the area. I hope that that will meet the criterion of fairness, because it will certainly be a transparent process. We want LINks to work. We are not setting them up to fail. We want them to be as effective as possible.
Proposed new subsection (4B) aims to allow local authorities to spend more on making contractual arrangements than the allocation provided for by the Secretary of State. That is a very important suggestion. Equally, it is very important that arrangements for LINks should allow for the possibility of additional funds being available from whatever sources exist. There is nothing in the Bill to prevent local authorities from making additional funds available for LINk activities. If, for example, they wanted to add to funding for LINks from their own engagement activities, I could see that there would be an argument. In the Bill, local authorities are under a duty to involve, inform and consult local people. If we can get some synergy, there may well be some possibilities.
Amendment No. 238N is difficult to understand. It seems to take away a fundamental plank in the process of establishing a LINk; that is, the power for a local authority to make payments to a host. I am not sure whether I have missed something very important or subtle, but I cannot see any benefit in removing that provision because, as I have said, we think that it is vital that a host is created.
Amendment No. 238QA seeks to ensure that the arrangements that the local authority makes with the host provide that the LINk has the necessary staff, premises and so on. This is a logical amendment in relation to the earlier one. I do not believe that it is necessary because I think that the whole point of the contractual arrangement, which we set out in the model contract, is precisely to state the types of support that the host is expected to give the LINk. It could be minimal, it could involve staff, support and premises, but it will vary. Every contract must reflect local realities. We are issuing a model contract specification. It is not mandatory but it is a guide to help tailoring in local circumstances. The local authority will be under a legal duty to make contractual arrangements with a host to ensure that LINks activities can be undertaken. The safeguard is there.
On Amendment No. 238SA, the noble Baroness asked whether it will be possible for LINks to employ their own staff and decide such issues as pay and so on. I can certainly give her an assurance that it will be possible, as the provisions already allow for a LINk to be any sort of body, including one that can employ its own staff. I am thinking of companies limited by guarantee or charities with employment status.
A more difficult question is when. It is difficult to say, because in some instances the contract could be held by the host immediately, but it would be explicit from the start that the LINks would want to do the employment. It would be in the nature of the contract. There will be LINks organisations that will grow in confidence and that may feel a year or two into the scheme that it is right for them to take over the employment functions. The provision has to be as flexible as that. I cannot see a problem with that. I do not think that we would want to prescribe this. I shall look at the matter again and come back to the noble Baroness if I think that there are ambiguities.
The noble Baroness has just suggested that a LINk might be able to employ staff immediately. Is she suggesting that a LINk might become a company limited by guarantee or a charity with employment status at the very beginning of its existence? It is important for us to know that for the rest of our discussion about LINks.
In the light of the answers that have been given, and the fact that this is a financial issue, perhaps I may ask the Minister a question. She said the organisation could be a charity. If these LINks become charities, will they have the same status as other charities in their area and therefore be able to raise funds externally? Will they therefore be in competition with all the other charities, although they are delivering what has previously been a statutory function for things like the lottery? If this has not been thought through, can it be thought through before it becomes an issue?
If they are a charity, they will have the freedom to do that. In terms of the impact it would have on the pattern of local provision, in the voluntary sector we are nearly always in the situation of competing against our best friends. That is part of the negotiation procedure. I will think about what the noble Baroness has said.
With regard to the noble Baroness’s other question, we see no reason why this should not happen straightaway. But given the embryonic nature of the organisations, it is more likely that they will want to wait until they have established their raison d’être, until their scope is determined and their priorities, agendas and working programmes set up. But we will have to wait and see.
The noble Baroness asked what would happen if hosts and LINks fall out. I cannot imagine that that would ever happen, but LINks will have the opportunity to put their views and concerns directly to the local authority. The contract has got to be deliverable; if LINks finds that its host organisation is doing something that disables it in some way, it would be right and proper for it to go to the local authority and say, “Look, this contract is not being managed in the way it should be”. That is part of the performance management built into the situation.
I have answered most of the questions. It is worth reiterating that this legislation is very permissive and we need to preserve in the arrangements for LINks the duty of the local authority to take a view as to what is necessary. We are talking about minimal levels of support, or it may be a sophisticated arrangement that will either be designed in or will emerge over time.
I have a note asking whether local authorities will be able to produce some grants to pay for the costs. This refers to management costs. We have already discussed this with the Local Government Association and we trust that local authorities will take a fairly mature view of it. We will come back to this point and will look at the legal implications of that.
The point is that the local authorities will not hold the money; they will make the contract with the host, which will hold the money. It is that which guarantees the independence of LINks. The first amendment we discussed about why a host is needed clearly established the notion of independence, so that the sort of situation the noble Baroness describes simply could not happen.
Once again, the Committee will be grateful to the noble Baroness for her reply. I am glad that work is currently going on with the Local Government Association on how a transparent and fair system of funding of LINks could be best established. That is good news. I am sorry that the noble Baroness could not go further and give the Committee some idea as to what levers might be pulled by Ministers or others to prevent a situation arising where the activities listed in Clause 222(2) are performed in only a minimal way as a result of inadequate funding in a given instance. Like the noble Baroness, I am no advocate of ring-fencing, but there are dangers when ring-fencing does not apply—the obvious one being that the activities in question are not safeguarded
Nevertheless, the noble Baroness has shed some useful light on this area. There are questions that remain open, the principal one being the quantum of money that will be directed to this area, which for obvious reasons she cannot be specific about at this juncture. But it was helpful to hear that it will be comparable to the sum currently directed towards patients’ forums and we can take comfort from that. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
238LD: Clause 222, page 155, line 4, at end insert—
“( ) For the avoidance of doubt, arrangements under this part apply to the provision of care services and local care services in prisons, secure training centres and young offender institutions.”
The noble Baroness said: In moving Amendment No. 238LD, I seek to see if LINks are going to operate in prisons and other penal establishments. The NHS now has responsibility for prison health. I quote from a statement made by my noble friend Lady Murphy:
“Prisons are like swamps providing the breeding grounds for the mosquitoes of disadvantage … the revolving prison gate feeds further public health problems back into localised communities. If we are serious about narrowing the health inequalities of our most disadvantaged communities, prisons are a very good place to start”.—[Official Report, 10/11/05; col. 802.]
Improving healthcare of prisoners can also have the positive effect of reducing and preventing reoffending—a key government target. Prisons have a cross-section of health issues and there is a vital need for good through-put in healthcare within prisons and good links with the communities they go out to if there are ongoing health problems. There must be suitable communication.
One of the most difficult problems in prisons is the dual diagnosis of mental health and addiction. There are also sometimes other problems, such as sickle cell disease. There is a huge drug and alcohol addiction problem in prisons. It must be treated within prisons and links with the communities are needed so that rehabilitation can continue. All adult prisons now have CARATS—counselling, assessment, referral, advice and through-care services. This is certainly an improvement, but health issues within prisons need more flexibility and working in co-operation with each other. Prisoners come into prisons very often and nearly always with no health records. Communication about their health needs improvement. Health facilities within prisons, such as the building of a treatment room, take a very long time to establish as the issue is surrounded by unnecessary red tape and bureaucracy. That frustrates prison staff when they know that there is money available.
The Minister has stated today that if LINks ever come into being, they will help with a wider range of needs. Will prisons and other penal establishments be included in these ranges? I beg to move.
I hope that I can reassure the noble Baroness and take this opportunity to put some points on the record with regard to the inclusion of prisons in the function of LINks. To make it absolutely clear: the function of LINks will be to gather the views and experiences of people in their area. It will be one of the roles of the host organisation to ensure that the views of all parts of the community are sought, and therefore LINks will certainly want to seek the views of prisoners and, for example, asylum seekers in detention centres on the health and social care services they receive or might receive. We want to encourage everyone in the community to become involved in LINks and ensure that a wide range of views are proactively gathered and fed in to those who commission and provide care services.
On the specific amendment before us, I can confirm for the record that a LINk as described in Clause 222(2)(a) to (d) applies to healthcare commissioned and provided to prisoners. The definition of “local care services” is given in Clause 222(5) and relates to care services provided in the authority’s area and those provided in “any place” for people from that area. Therefore, anyone living even temporarily within a given local authority area will fall under the remit of the LINk and should be able to share their experiences of the care services they have received with the LINk for that area, even if the services they receive are from outside it. Any healthcare commissioned by the PCT will fall under the remit of a LINk, even if it is provided in a prison.
I hope, with that clear point on the record, that the noble Baroness will feel able to withdraw her amendment.
I thank the Minister for that encouraging answer. She will be aware that in prisons there has been an increase in infectious conditions such as drug-resistant tuberculosis, which is a very worrying development. There is therefore a need for these health issues to be considered within the community, and I am glad that she said that. However, she did not mention the vast number of people who visit prisons, such as prisoners’ families, prison visitors and so on. They are often left out, and they have problems such as timing their visits, travelling long distances and places to wait in when it is raining. There are many issues. But the Minister has been encouraging and therefore I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendment No. 238LE not moved.]
Clause 222 agreed to.