New Clause

National Health Service Reform and Health Care Professions Bill – in the House of Commons at 4:26 pm on 22 May 2002.

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Votes in this debate

Lords amendment: No. 6, before clause 16, to insert the following new clause—Establishment of Patients' Councils

Photo of Hazel Blears Hazel Blears Parliamentary Under-Secretary (Department of Health) 4:45, 22 May 2002

I beg to move, That this House
disagrees with the Lords in the said amendment.

Photo of Sylvia Heal Sylvia Heal Deputy Speaker

With this it will be convenient to take Lords amendments Nos. 7 to 16 and the Government motions to disagree thereto, and Government amendments (a) to (d), (o) to (q), (e) to (l), (r), (m) and (n) in lieu.

Photo of Hazel Blears Hazel Blears Parliamentary Under-Secretary (Department of Health)

I should like to express my sincere apologies to all hon. Members for the late tabling of some of these amendments, as that lateness may have caused hon. Members some concern. I have certainly done my best, by issuing covering memorandums and by writing directly to Opposition Members, to try to set out not just the terms of the amendments, but their effect so as to try to minimise any awkwardness that may have been caused. The amendments have been tabled in a genuine attempt to try to engage the widest possible range of stakeholders in producing a proposal that I can put before the House this afternoon. I should like to express my genuine apologies for any difficulty that the amendments' late tabling may have caused.

At last we are coming to the end of a rather tortuous journey to strengthen patient and public involvement in health. From the NHS plan, published in July 2000, to the Health and Social Care Act 2001, and now in the Bill, we have reached a position on patient and public involvement that is as good as it gets. I genuinely believe that we will have a robust, independent and vigorous system of public and patient involvement. I and my ministerial colleagues, as well as previous Ministers—and our officials, too—have been in discussion with many stakeholders during the last year and a half to ensure that we develop the best possible set of arrangements.

The points made during parliamentary scrutiny and arising from the involvement of stakeholders have been extremely constructive. Although we have not agreed with all of the views expressed, it is fair to say that they have all played their part in helping to fine-tune the system. Patients councils were one of the turning points in our preparations.

The amendments to provide for patients councils that the other place voted to include in the Bill are not welcomed by the Government, as patients councils are, in our view, flawed organisations for reasons we have rehearsed in the House and in the other place. One of the primary reasons why they are not welcome is that they would involve the introduction of 150 new bodies, adding an entirely new layer to the system of public and patient involvement.

The other fundamental reason why we oppose introducing patients councils is that they would involve a system in which a body purports to speak on behalf of the public. That is fundamentally opposed to the whole system that we have tried to establish, which enables the public to speak for themselves. That is a key difference in the kind of facilities that we want to put in place.

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon

I am still recovering from the last few sentences, but I want to ask the Minister whether she has worked out how many enhanced PCT patients forums her proposals will produce? Will not there be twice as many as there would be patients councils based on overview and scrutiny committee areas? Although the proposed forums will be in addition to PCT patients forums, does she accept the argument that increasing PCT patients forums is at least as bureaucratic and will result in smaller organisations than introducing a more limited number of larger, local authority patients councils, based on overview and scrutiny committees, or something of that sort?

Photo of Hazel Blears Hazel Blears Parliamentary Under-Secretary (Department of Health)

I understand the point that the hon. Gentleman seeks to make, but I do not accept it. We propose to enhance existing organisations, whereas patients councils would introduce a whole new layer of separate organisations in the system. I am keen to ensure that we do not recreate a hierarchy of organisations that operate with increasing exclusivity and in which people see themselves as delegates of other people. The whole thrust of the patient and public involvement mechanisms is to enable people to express their own views and for them to have support in doing so, rather than having a delegate system whereby other people purport to speak for them. Hon. Members may have difficulty with that distinction—it may be complex—but it is crucial to the new approach in the new national health service that we have a system that is not about an exclusive delegate democracy but about liberating local people so that they can speak for themselves.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

Which body will run "casualty watch"?

Photo of Hazel Blears Hazel Blears Parliamentary Under-Secretary (Department of Health)

As I explain the full implications of the amendments, the hon. Gentleman will see that we propose—in amendment (r), I think—to introduce a new power, or rather a function—which could be a power or a duty—for the Commission for Patient and Public Involvement in Health to consider reports from patients forums and to assess emerging trends that may give rise to issues of national concern that should be taken up by patients forums generally. That would not be limited exclusively to "casualty watch". The forums might want to consider other issues that span the spectrum of their concerns; for example, they might want to undertake a review of a national service framework.

Our proposals are stronger than those envisaged by the hon. Gentleman; they are not simply limited to "casualty watch". It might be perfectly legitimate for patients forums to look into accident and emergency waiting times. They could report to the commission to ensure that we had a national overview. They might be even more creative and look into other issues.

Photo of Ms Linda Perham Ms Linda Perham Labour, Ilford North

As regards the point made by Dr. Harris, will my hon. Friend explain why the proposals in respect of the duties of patients councils and the patients forums of the primary care trusts would not create a hierarchy of PCTs?

Photo of Hazel Blears Hazel Blears Parliamentary Under-Secretary (Department of Health)

I am grateful to my hon. Friend for that question. She will be aware that I and my ministerial colleagues have expressed concern about the creation of a hierarchy of patients forums. I am keen to ensure that one forum is not seen as better than another. I want to try to ensure that the forums are able to attract local people of high calibre. I want patients forums for acute trusts and mental health trusts to be just as attractive as those for the PCTs. We want to ensure that the system is rooted in patients forums—that people see them as the driver in the system. There are genuine reasons for PCT patients forums to have a wider role, because PCTs do not merely provide primary care but also commission secondary services. Instead of seeing the system as a hierarchy—where one patients forum is better than another—I should prefer the PCT patients forums to be seen as having a broader remit. They should be seen not as reporting upwards in a hierarchy of organisations, but as having extended responsibilities.

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon

I realise that the hon. Lady wants to make progress, and I shall be welcoming her proposals for other aspects of the measure, but this matter is important. One of the points that she made about patients councils is that she does not want people to feel that they are representing other people—or acting as delegates—and she wants people to feel free to speak out. I have not really understood that point. However, in order to create the super-patients forum—the PCT patients forum to which she referred—the amendments provide that at least one member of that forum should come from one of the other patients forums in the area. Does not that recreate what she considers a problem in the proposals for patients councils, although we would consider it a strength?

Photo of Hazel Blears Hazel Blears Parliamentary Under-Secretary (Department of Health)

When I go through the amendments, I shall explain the extended membership of the PCT patients forums. That is not about people representing others—it is a way of making connections and ensuring that people can share their ideas, knowledge and experience. It may help the hon. Gentleman if I explain that I said that the system should not involve people speaking on behalf of other people because there will be complex issues on which the public will hold a range of views. I do not want one organisation to weigh up that range of views and to come down firmly on one side and to promote only that point of view. Where there is a diverse range of views on a complex health service issue in a community, we need to have mechanisms that allow all of those views to be expressed, to be ventilated and to be weighed by those who are making decisions. Firm decisions should not be set in stone at an early stage before all the relevant views have been expressed. I appreciate that these matters are complex but I do not think that it is beyond our understanding to develop new ways of working.

We have said that much of the purpose of patients councils fits with our view of a strong and comprehensive public and patient involvement system. I think that the way forward is clear, and that is to try to ensure that the system that we have proposed builds on the strengths of patients councils but does not weaken the overall structure of embedding those powers in patients forums.

I shall explain the effects of amendments (a) to (d), (o) to (q), (e) to (l) and (r). The overall effect of what we are doing is to give to PCT patients forums the functions that we previously envisaged for the local offices of the Commission for Patient and Public Involvement in Health. I genuinely think that that makes for a stronger local connection.

The commission will appoint staff to support and work with every PCT forum in England. The staff of the forum will support the members of the PCT forum on a day-to-day basis. That will ensure that there is a robust process in place for the work priorities of the staff to be fully informed by the priorities of local people. There will be real accountability to those communities.

It will be the job of the forum to promote the involvement of the local community in local decision- making processes. In particular, it will be its job to go out and find out the views of those disadvantaged and marginalised groups that traditionally have not had a say in shaping the development of health services.

It will also be the job of the forum to promote the views of people in its area to local decision makers, and in particular to a local overview and scrutiny committee. I believe that this arrangement will root and ground the commission's staff in local neighbourhoods.

In addition—this is where we have picked up some of the key strengths of the patients councils concept—the staff of the PCT forums will be able both to provide and to commission independent advocacy support. During various stages of the Bill's consideration many Members have talked about incorporating the duty to represent the views of local people, and the provision of independent complaint and advocacy support would make sense. We genuinely picked up on that idea.

It will also be the responsibility of PCT patients forums to act as a sort of one-stop shop for local people, by providing advice and information to them about how they can get involved locally, what consultations are taking place and how they can make a complaint. The forums will also be responsible locally for keeping an eye on the arrangements that other NHS bodies have in place to fulfil their duty to involve the public and to make arrangements to consult them about changes to services.

We have amended the composition of PCT patients forums. They will now include members of local community groups that represent the views of the public on issues that affect their health. For example, if a local environmental group was concerned with a particular issue that could affect the health of local people, it would be welcome to be involved. It is important to note that we are trying to expand the remit not only of the NHS in terms of the service that clinicians and the NHS has traditionally provided, but to try to make key links with the wider determinants of health—the environment, jobs, education and safe streets. All those things significantly influence health.

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon

I stress that I welcome the fact that the Minister wants to include on one of these consultative bodies—which she wants to be PCT patients forums—people from other groups. However, she has just referred to them as representatives from other groups. I do not see a problem with that save that I wish they were to be democratically accountable. That is the only difference between us. However, she has talked earlier about rejecting the patients councils idea because she wants people to speak for themselves and not to feel that they are delegates of organisations. Has the hon. Lady sold the pass—I welcome it if she has—by recognising that it is reasonable for that representation to take place?

Photo of Hazel Blears Hazel Blears Parliamentary Under-Secretary (Department of Health)

No, I have not sold the pass on this one. What I have said is that there are organisations and groups out there who will want to feed people's views into the patients forum who will then put those views forward to other people. That is a perfectly legitimate position to be in.

By placing all these responsibilities with the PCT patients forum, we have shifted the power base of the new system for patient and public involvement to local communities. To do that, we will remove the middle layer of our original proposals: local offices of the national commission. We recognise, however, that there needs to be a way for forums to come together across an agreed area, which is a key concern raised by many Members. We have strengthened the provisions in the Bill to say that forums must work together in prescribed circumstances. Those circumstances will be set out in regulation, and I hope that that will meet the concerns of many Members about the integration. 5 pm

Photo of Helen Jones Helen Jones Labour, Warrington North

I welcome what my hon. Friend is saying about the representation of community groups. Will she assure me, however, that the regulations will ensure that, in places such as Warrington, deprived areas get representation on these bodies, as well as the better-off areas? Will she assure me that there will not be a repeat of what we have seen in the Warrington PCT, on which my constituency has hardly any representatives?

Photo of Hazel Blears Hazel Blears Parliamentary Under-Secretary (Department of Health)

My hon. Friend makes an extremely important point. She has made a significant contribution over recent weeks, expressing her concern about what has happened in her local PCT. For that reason, we propose that members of patients forums should be appointed by the Commission for Patient and Public Involvement in Health rather than by the Appointments Commission. We want to ensure not only that people respond to an advertisement but that we seek out people from communities who, traditionally, have not put themselves forward. That is easier said than done. In many cases, people will need encouragement, support, training, advice and back-up to come forward and feel that they can be part of the patients forum. That is a very different and much more proactive approach—not simply issuing an advertisement, waiting for people to apply and allowing a very self-selecting group to come forward to be part of our public involvement, but going out to deprived, marginalised, excluded communities that, traditionally, have not been part of running our services and making those decisions. My hon. Friend makes a key point about the way in which these mechanisms will operate differently in the future.

We are also amending the provisions that apply to both primary care trust and NHS trust patients forums. We are making it explicit in the Bill that patients forums will not only have a role in monitoring and reviewing the services that a trust provides but that they will also be able to identify gaps in service provision and make reports and recommendations about those to trusts. Trusts will have to publish forum recommendations in their annual patients prospectus, together with the action that they will take as a result, further ensuring that forums have real influence.

What was said to me, at many of the events that I attended with local people, was that all the structures in the world could be as perfect as we could make them, but unless there was real evidence that the decision makers in the health service took notice of what local people said and acted on it, they would quickly fall into disrepute, and rightly so. Therefore, making sure that a patients forum's recommendations are published in the prospectus and acted on by the trust will be a key mechanism in saying to local people, "It was worth while coming forward to get involved in your patients forum, because something has happened as a result of your activity. It was not simply a talking shop; action has been taken."

Many local people have also said to me that, although they do not expect 100 per cent. of things to be changed, they do expect significant changes to take place.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

Was the Minister dismissing the valuable work done by community health councils by suggesting that they were just talking shops?

Photo of Hazel Blears Hazel Blears Parliamentary Under-Secretary (Department of Health)

The hon. Gentleman knows well that, in various discussions of these matters, on Second Reading and in Committee, I have put on record three, four, five or half a dozen times my tribute to many community health councils that have done an excellent job in representing people. The hon. Gentleman also knows—and many members of his party have agreed with me—that their performance has, in some cases, been patchy and inconsistent, and that people's ability to get involved has varied dramatically up and down the country. He knows fine well that the situation is more complex than he seeks to portray it, and that standards have varied dramatically.

We have also made explicit the breadth of the powers for forums to be able to refer matters. Concerns have been expressed, but the forums will be able to refer matters not just to overview and scrutiny committees, as previous amendments to the Bill provided for, but to the commission and, indeed, to any other person or body that the forums deem appropriate. They will be able to make their representations and concerns public.

We have transferred some of the functions envisaged for the Commission for Patient and Public Involvement in Health that would have been carried out by its local offices to the PCT patients forums. We have also strengthened the functions that the commission will carry out at a national level. On top of its job of setting and monitoring quality standards for all patients forums and providers of independent complaints advocacy, it will also be able to make recommendations to them about how they can improve their performance. The commission will have a performance management role, and that is key to ensuring consistency right across the country and high quality in the activities of complaints services and patients forums. We are dealing with the key issue of inconsistency.

Photo of Laura Moffatt Laura Moffatt Labour, Crawley

Does my hon. Friend agree that the proposals are genuinely about going out and involving people in decision making in the NHS? As a nurse, I very much welcome the fact that people will be involved. Does she also agree that some of the opposition to the proposals is merely about maintaining a cosy and comfortable atmosphere for the NHS watchdog? Implementing the proposals will not be easy—no one ever said that it would be—but it must be worth trying to involve people who were not previously involved in the NHS.

Photo of Hazel Blears Hazel Blears Parliamentary Under-Secretary (Department of Health)

I thank my hon. Friend for that contribution. She is right. Change and new ways of working are never easy. One of the most difficult things has been to try to get people to visualise what a new system might look like. When something exists, people can see, touch and feel it. It is hard to get people to understand something that is not yet in place. One of the problems is that people feel that the proposed system will be complex but, once the provisions are established, people will get used to working with them. They will see that that they are integrated at the right stages of the NHS. However, I do not pretend that the system will be revolutionised overnight; it is a matter of building on our proposals over the next few years.

The right for the commission to have a performance management role will ensure that the public, wherever they are, and the NHS can be assured of consistently high standards in the patients forums and from the providers of independent complaints and advocacy services.

We have listened to parliamentarians and to stakeholders and, in particular, to the Association of Community Health Councils for England and Wales and to community health councils, which were on our transition advisory board and helped us with transition to the new system. They have referred to the often-cited need for a "casualty watch" exercise. As I said earlier, rather than limiting the activities to "casualty watch" per se, the commission should have the right to undertake national reviews of patient experience data on issues that appear to it to be of national concern. That might include the waits in accident and emergency departments or a wider range of issues.

Photo of Andrew Murrison Andrew Murrison Conservative, Westbury

The Minister says that the Government have listened to interested bodies about the future of community health councils. However, I have a list of about 20 organisations that are very much against the abolition of the CHCs. The bodies that have written to voice their concerns include the Manic Depression Fellowship, Mencap, the National Association of Citizens Advice Bureaux and the National Council for Voluntary Organisations. I could go on. How much has she listened to outside organisations?

Photo of Hazel Blears Hazel Blears Parliamentary Under-Secretary (Department of Health)

The hon. Gentleman will be aware from previous debates that all sides of the argument have prayed in aid other organisations to support their case. However, I draw his attention to the view of the Long-term Medical Conditions Alliance, which has 115 patients organisations in its membership. On 8 April, it wrote to Members of the other place when the Bill was being considered there and said:

"The argument over Patients' Councils seemed to our members to be a political one; the proposals as currently set forth appear to be perfectly adequate".

It consulted one of its groups that held an event in the local community and it reported that members were

"alive with awareness about the possibilities offered by the new strategy, eager to participate, but prevented from doing so by what seem . . . to be esoteric arguments about detail".

It went on to say:

"We do not see the need for more committees, which we see as likely to lead to the strangling of genuine citizen involvement and the promotion of bureaucracy at the expense of the voice of individual users of the NHS."

The hon. Gentleman is correct—there is a range of views on these issues—but the Long-term Medical Conditions Alliance expressed the view, on behalf of its members, that it wanted to be able to get on with the new issues at stake. We have listened, and I hope that the hon. Gentleman will accept that.

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon

I accept the Minister's point that there are different views. However, she will be aware that in January this year the Long-term Medical Conditions Alliance welcomed the local network of the Commission for Patient and Public Involvement in Health, which she has just announced an interest in abolishing. It also welcomed the separation of advocacy services from commissioning, for which there is an argument, but from which she is announcing a retreat. She should accept that certain organisations, even those that were among her initial supporters, will not welcome her proposals.

Photo of Hazel Blears Hazel Blears Parliamentary Under-Secretary (Department of Health)

The hon. Gentleman has been following the development of these issues closely and with great interest, and he will be aware that a wide range of organisations welcomed the functions of the commission in taking a proactive role to draw in views from communities that traditionally have not been represented and in promoting the involvement of local people. Certainly, the Long-term Medical Conditions Alliance, together with a wide range of organisations, welcomes the functions of the commission. Those functions remain very much at the forefront of our proposals but will be exercised by the PCT patients forum, and thus in a way that is more connected to local communities. We are not doing away with the functions of the commission, but embedding and grounding them much more in local structures. I hope that the hon. Gentleman is reassured by that.

Photo of James Purnell James Purnell Labour, Stalybridge and Hyde

Does the Minister agree that the real test of the system will be what patients and people who work in the NHS think of it once it is in place, which we shall not know for a while? Will she tell us the views of the Chairman of the Select Committee on Health, whom no hon. Member would accuse of being a stooge of the Government, about the reforms?

Photo of Hazel Blears Hazel Blears Parliamentary Under-Secretary (Department of Health)

Certainly, I will. The Chairman of the Health Committee, my hon. Friend Mr. Hinchliffe, expressed concerns during our previous consideration of these matters. He said:

"We are inches apart, but those inches are extremely important."—[Hansard, 15 January 2002; Vol. 378, c. 207.]

Today, unfortunately, we are thousands of miles apart, because my hon. Friend is delayed in a long-arranged previous commitment in Russia. However, he was able to have a discussion with me before he went on his journey. I was keen to involve him in working up these new proposals, because he made some important points during previous debates.

In a letter to me, my hon. Friend said:

"Unfortunately, as you are aware I have a long standing commitment . . . I felt it might be helpful to outline my views on the amendments you are bringing forward."

He continues:

"You will recall that I raised specific concerns about the fragmentation of the separate Patients Forums and the inability to ensure an overview of the local health economy. I felt very strongly that a unifying structure of lay people at the level of local health economy should be written in the Bill."

He goes on to say:

"I therefore genuinely welcome the fact that your new amendment"— the one that I referred to—

"places on the face of the Bill the requirement that all Patients Forums in an area should come together regularly to share ideas, views and experiences."

We are now providing that patients forums must, in prescribed circumstances, co-operate in jointly exercising their functions, which will give us that overview. He continues:

"Obviously, I have not had the opportunity to consider fully the implications of your amendments, but I am satisfied that you have moved very significantly in the direction I and others felt necessary."

I am extremely grateful to my hon. Friend for setting out those concerns, because I have been keen to try to maximise the degree of consensus that we can achieve. 5.15 pm

To summarise, every NHS trust and PCT will have a patient advocacy and liaison service, ensuring that concerns are dealt with before they become a serious problem, and a patients forum, ensuring that the local public have a vehicle to express their views about matters relating to health. The forum will also monitor and review services. Every PCT patients forum will have staff to commission or provide independent support to help individuals make a complaint.

Photo of Paul Truswell Paul Truswell Labour, Pudsey

Leeds has one community health council. Under the new structure, we will have seven patients forums, which will be responsible for undertaking the vast range of crucial functions that my hon. Friend sets out. Will they receive a commensurate increase in staff and support from the commission?

Photo of Hazel Blears Hazel Blears Parliamentary Under-Secretary (Department of Health)

My hon. Friend is right to raise the issue of resources, which has been mentioned in all my meetings with local people. I have acknowledged and put on the record that the new system will be more expensive and will need to receive greater resources. Public consultation does not come cheap. If we are serious about involving patients, the public and the community in shaping health services, then we have to do it properly. It cannot be a superficial sham.

There are bids for additional resources to enable us to have a rigorous, strong and independent system. I need to ensure that all the elements are properly resourced so that we do not involve patients and the public without providing the necessary back-up and support that they need to make the system work. We should be open and honest about that. Real involvement requires hard work by all organisations, including the NHS, and we need to ensure that the system works.

Photo of Patrick Hall Patrick Hall Labour, Bedford

Broadly speaking, the Government amendments are welcome. Will the new system allow agreement to take place at a local level to allow a PCT patients forum to act as the lead on behalf of other PCT patients forums in a geographical area, such as Bedfordshire or Leeds, which my hon. Friend Mr. Truswell mentioned? That would avoid the expensive duplication which would defeat the object of the new system.

Photo of Hazel Blears Hazel Blears Parliamentary Under-Secretary (Department of Health)

My hon. Friend has made several welcome and thoughtful contributions on such matters before, and I know that he is conscious of the detail. Many lead arrangements are in place for PCTs to commission services, so the idea of having lead organisations is already well established within the NHS. I would not want to do anything to provide a rigid blueprint framework to determine how people must operate. For patient involvement to work well, people have to agree on the system and feel as though they own it at a local level. I want the proposed regulations that will set out guidance for organisations to be flexible enough to accommodate the arrangement that my hon. Friend outlines.

My hon. Friend is probably aware that a number of pilot patient forums exist which are beginning to test out some of the new models. One such model in Tyneside has brought together the various elements in the system. They are sharing resources because they obviously get better value by bringing some activities together. However, that has to be based on local agreement. We do not want to impose a framework from the centre. What we are trying to achieve is in tune with shifting the balance of power. We will set the framework, but it is up to local people how they want to operate it. It is for them to decide how they get maximum input in driving up the standards of local health services. My hon. Friend makes an important point.

Every PCT forum will have staff who will commission or provide independent support to help individuals make a complaint. They will work to empower the local population to express their views about health issues, and will provide the one-stop shop service by giving advice and information about public involvement, the complaints process and how people can participate.

Photo of Hazel Blears Hazel Blears Parliamentary Under-Secretary (Department of Health)

I will just make a little progress.

Nationally, the Commission for Patient and Public Involvement in Health will set quality standards for the work of patients forums and the independent complaints and advocacy service. It will also performance manage them in relation to those standards. The commission will submit reports to the Secretary of State on how the whole public and patient involvement system is working and advise him about it. It will make reports as it sees fit to other national bodies such as Commission for Health Improvement, the National Care Standards Commission and the National Patient Safety Agency on issues that in its opinion give rise to concern about the safety or welfare of patients, and that have not been or are not being dealt with properly. It will review patient data in patients forums' annual reports and follow that up with reports as appropriate to the Secretary of State and others.

The overall effect of the changes that we are making today is to make the system simpler to understand, less bureaucratic and consequently more effective. As a result, it will be easier for patients and the public to navigate themselves around the system, and easier for them to get involved. We must not forget that what underpins all our patient and public involvement provisions is empowerment. All patients have the right to have their concerns addressed and to be properly supported in making complaints. All patients and all members of the public have the right to be supported in expressing their views about health issues, to be listened to and to have their views acted upon.

That will be undermined by adopting patients councils. Councils and what goes with them would have the effect of perpetuating what we most want to change about the existing system—the idea of an organisation that only represents the interests of patients and the public, without encouraging the wider population to get involved; an organisation that consequently has to take a decision about the relative importance of the many and varied views of members of the local population; in other words, an organisation that decides for people what is in their best interests.

I genuinely believe that local people can make those decisions, provided they are given support. The changes that we propose will, with the original provisions, create a system that is truly accessible to everyone, that is radical and far-reaching, and that will make a positive difference to the services the NHS provides and to patients' and the public's experience of the NHS.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

The purpose of the debate is to enable the Government to persuade the House to disagree with the amendments made in another place that put patients councils on the face of the Bill, in defiance of the Government's wishes. A debate on this subject without Mr. Hinchliffe—the father of the amendments, which were rejected by this House—being present seems rather like a production of "Hamlet" without the gravediggers. It is extraordinary that the poor man has been banished to Siberia because of the debate. I suspect that the Government Whips Office had known for some time about the hon. Gentleman's diary engagements when—conveniently, from the Government's point of view—the debate was scheduled for a day on which he was many thousands of miles away. The Minister shakes her head, but if she consults her Whips Office, she might find that there is far more truth in what I have just said than she believes.

The Minister alluded to the long history of this subject, and we have trodden a long road to get to where we are today. The proposals emanate from a desire, expressed in the Health and Social Care Act 2001, to abolish community health councils. When that legislation was passing through Parliament, the Conservatives said that that decision was wrong and not in the interests of patients, local communities or the NHS. CHCs were clearly defined, easily understood and well recognised by local communities. They were transparent, independent and able to consider and ask the awkward questions, as both Conservative and Labour Governments discovered.

Photo of Tom Harris Tom Harris Labour, Glasgow Cathcart

The Conservative party has been curiously reticent about revealing any details of its health policy. Can we now assume that the reinstatement of community health councils will be a centrepiece of its health policy if and when it ever gets round to telling us what it is?

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

The hon. Gentleman rightly said that, in health as in other areas, we are in the middle of a review, which any Opposition party is perfectly entitled to undertake. Indeed, the hon. Gentleman's party undertook them on at least four occasions between 1979 and 1997. In due course, I shall give him my view of the abolition of CHCs and the way forward, but he must be patient.

As I was saying, CHCs were a one-stop shop that performed a vital and valuable service for the local community in dealing with patients' problems and general health provision. They also made controversial decisions about the provision of health care, whether closing down a ward in a hospital or the hospital itself, as they had a power of veto and could formally object to the Secretary of State; Ministers could then look at decisions that CHCs considered were not in the public interest. Many people say that some CHCs did not work as well as others and that the provision of the service was patchy. If a system provides an invaluable service in principle, but has certain flaws, those flaws should be identified so that improvements can be made; we should strengthen the system, rather than destroying it altogether. The Minister was a distinguished chair of Salford CHC in the 1990s and I suspect that she was fully supportive of the role of CHCs and thought that they did a tremendous job in looking after the interests of the local community and individuals. I wonder how many of the Government proposals that we are considering today are motivated by a desire to remove a thorn in their side: they do not like criticism, especially if it comes from an independent source and gains credence among members of the public. The Government motion and amendments are a mistake. Personally, I would have preferred a strengthening and improvement of the CHC system to deal with perceived weaknesses, rather than the wholesale removal and replacement of the system.

The initial replacement was to my mind—and presumably to the Government's, as they have now backtracked dramatically—a ridiculous miasma of proposals, which included things like patient advocacy and liaison services and other bodies. The system would have been fragmented, and there was little confidence that it would be independent. To be fair to the Government, they have bowed to sustained criticism of their proposals and have taken a different direction.

Photo of Laura Moffatt Laura Moffatt Labour, Crawley

The hon. Gentleman and his party often talk about reform and how crucial it is to the NHS. Yet, in one of the most important parts of the NHS—the watchdog organisation—they propose little or no reform. How then can the hon. Gentleman pretend that his party's view reflects that of the general public?

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health) 5:30, 22 May 2002

I know that the hon. Lady was trying desperately in her earlier intervention to impress her Whip; of course, this is the season of the run-up to reshuffles. Unfortunately, she has not been listening. I said that my preferred choice was to pick up the weaknesses in the CHC system and legislate to improve, enhance and strengthen it to make it more effective where perceived weaknesses existed, instead of abolishing it wholesale. As the hon. Lady will notice if she reads tomorrow's Hansard, that is the view that I expressed. I am afraid that her intervention bore little relation to what I was saying.

Let me return to the point that I was making before I ill-advisedly gave way. The Government have had to alter their position on the patients forums proposals in tabling their amendments. The battle on CHCs is over and they are not going to change their mind about them. Another place decided on the patients council option instead of seeking to restore the community health councils. As a realist, I accept that we must now move forward because of those actions. As the hon. Member for Wakefield made clear in speaking to his amendments in this place and in expressing his views in the Select Committee on Health and other arenas, the patients councils are for a number of reasons preferable to the Government's broad proposal.

Patients councils not only offer a range of features that were present in community health councils, but represent a move forward in terms of adjusting to some of the concerns that have been expressed. I believe for a number of reasons that they are more attractive than what the Government are offering, as they are an attempt to oversee the health service from the perspective of the patients and to consider a wider spectrum of activity than would a body based solely on specific trusts.

I accept that we will move away from some of those areas as a result of the Government's amendments, but I believe that patients councils will be able to monitor the complete patient journey between trusts. They can also play an advocacy role over a sustained period. In relation to Alder Hey, patients benefited from the work of CHCs in that regard. Campaigning work such as "casualty watch" and other work that is still done by community health councils would be within the remit of patients councils, which could continue working in line with developments in the past 27 years by acting as a watchdog and advocate for patients.

It is also important to consider that patients councils would not be working in isolation within their trusts and that there would be greater interrelation between the trusts and on the progress of patient issues. The restoration of the one-stop shop and the removal of the maze brought into the system by the patients forums are also important, as the patients councils would be more easily understood by patients and members of the public in local communities. That is a preferable way forward.

Regardless of what the Minister says and of some of the amendments that have been tabled, the Government are proposing to introduce complex organisational bodies. In the early days, they will also be seen to be complex by patients and local communities. Whether that perception will disappear if they survive the legislation remains to be seen. With patients councils, as with CHCs, people would have a greater understanding of where they needed to go if they had individual health problems or problems with the provision of service in their area. The councils would, however, have to be properly financed.

The Government's statistics show that the funding of CHCs costs between £20 million and £30 million. I understand from the projections relating to the Government's proposals that the funding of the patients forum system will be considerably more—given their complexity and the sheer numbers involved—than the funding required for CHCs. I listened with interest when the Minister said earlier that she was determined that the forums would be properly resourced to ensure their success. That commitment is a slightly diluted version of one that would ensure proper funding to provide the resources necessary to operate effectively. I should be grateful if the Minister would return to the question of funding and give the House an assurance on that issue.

Photo of Gwyneth Dunwoody Gwyneth Dunwoody Labour, Crewe and Nantwich

Is the hon. Gentleman suggesting that, unlike other members of his party, he would be happy to see an expansion in the amount of money available for the NHS budget and for this particular service? If so, it is a welcome conversion.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

I am grateful to the formidable hon. Lady. I will be cautious in crossing swords with her; I do not wish to make the mistake made by many of her own Ministers.

What I meant was that, in the context of CHCs versus patients forums, it is extraordinary that, in making a commitment fully to fund the forums, the Government are prepared to spend so much extra money when we already have a system in place that works.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

If the hon. Lady will wait, I will tell her that I do not criticise extra money for the health service. What concerns me about the extra money that has been made available is that there are no systems in place to ensure that it will achieve what it is meant to achieve—the improved, enhanced provision of health care. It worries me that, if we do not have structures in the health service to ensure that we get value for money and enhanced patient care, that money will be frittered away and the patients of this country will become even more disillusioned and discontented.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

No, I will not.

So that we do not continue to talk about money, which is slightly off the subject, I shall conclude by saying that the Government's proposals are ham-fisted, and that they will not work as the Minister suggests. The proposal for reformed and improved CHCs was the best way forward, but that is not to be. The proposals of the hon. Member for Wakefield for patients councils that were incorporated into the Bill in another place represent the better way forward. I question the motives behind the Government's proposals, because they are a way of trying to stifle any criticism and proper inquiry into problems in the health service in local communities. For that reason, I ask my right hon. and hon. Friends to join me in opposing the Government's proposals to reverse the decisions made in another place.

Photo of Ms Linda Perham Ms Linda Perham Labour, Ilford North

I speak as secretary of the all-party group on community health councils, as someone who has been a CHC member for four years, and as one of the 26 Members who voted on 15 January for the amendment on patients councils tabled by my hon. Friend Mr. Hinchliffe. As hon. Members know, this debate is taking place on a day when my hon. Friend has a long-standing commitment, of his choice, abroad.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

Has the hon. Lady spoken to the Whips Office?

Photo of Ms Linda Perham Ms Linda Perham Labour, Ilford North

The hon. Gentleman may go in for conspiracy theories: indeed, everyone in this place is more willing to believe in a conspiracy than in the true version of events.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

Has the hon. Lady discussed this matter with the hon. Member for Wakefield? If not, I recommend that she does so.

Photo of Ms Linda Perham Ms Linda Perham Labour, Ilford North

I have had many discussions with my hon. Friend, and I am coming to those.

Photo of Ms Linda Perham Ms Linda Perham Labour, Ilford North

I intend to continue with my speech.

My hon. Friend's contribution on these matters will be missed by many inside and outside the House. The Minister and others have acknowledged that my hon. Friend has done more than anyone else to draw attention to the shortcomings, if I may use that word, of the Government's original proposals for patient and public involvement in the health service. In consultation with the Association of Community Health Councils for England and Wales, my hon. Friend has made constructive suggestions for a way forward.

I spoke to my hon. Friend at length on Monday night before he left the country, as well as to the Minister. As Members have heard from the Minister, my hon. Friend has written to her welcoming the amendment to include in the Bill the requirement that all patients forums in an area should come together regularly to share ideas, views and experiences. Members will recall that, in his speech on 15 January, my hon. Friend asked for

"a unifying structure of lay people at the level of the local health economy, offering an overview of that economy".—[Hansard, 15 January 2002; Vol. 378, c. 208.]

Because that provision was lacking in the Bill, my hon. Friend tabled and voted for an amendment, which was also supported by myself and 24 colleagues.

I know that my hon. Friend has been grateful to the Minister for her co-operation in seeking to resolve the problems from the time when these matters were last before the House until a few days ago, but that he is not entirely happy about what is proposed today. Obviously, he would prefer the Government to support the introduction of his model for patients councils. It is almost two years since one line in chapter 10 of the NHS plan baldly stated that CHCs were to be abolished, and I have never had a satisfactory and rational explanation of why CHCs could not have been reformed and strengthened to play the central role in other reforms, most of which are warmly welcomed. [Interruption.] I am glad that Members are listening closely.

During the passage of the Health and Social Care Bill, an earlier version of my hon. Friend's amendment on patients councils was accepted by the Government but subsequently withdrawn. As Mr. Burns said, it has taken the other place, together with a well co-ordinated and competently argued campaign by ACHCEW and a range of other stakeholders, to bring us to the point where we may finally have a resolution.

I regret that so much time and effort has had to be expended when it has always been clear that a compromise would add value to the proposals as well as resolving the ongoing controversy. However, I recognise that the Minister has been very helpful and proactive in working on alternatives that seem capable of achieving much of what patients councils would deliver. I wish that the dialogue had started much sooner, perhaps even before her time as a Minister, but I have only praise for her tireless work in seeking a resolution of our differences, particularly in the past week or so with my hon. Friend the Member for Wakefield and latterly myself.

There are some positives to take from this experience. It should be the good news story that we could have had earlier. The Minister and the Government are showing that they know that even though they did not get it wrong, they certainly did not get it all right. They have listened, and we have before us a compromise that I hope can lead to consensus. In this policy area, we ought to be able to reach agreement. 5.45 pm

I hope that CHCs and their national association will feel better after today. Theirs has been a long and stressful road that has taken a heavy toll. Although they and some patients and members of the public are not getting exactly what they wanted, they can claim a moral victory in the light of the Government's proposal, which includes a strong, independent, community-led and integrated watchdog for PCT patients forums. However, I hope that we can come up with a more user-friendly name, such as the "community health service".

I hope that the Minister will join me and the rest of the House in paying tribute to CHC voluntary members and staff, who have continued to serve their communities well during a time of much uncertainty and instability. I pay particular tribute to my own Redbridge CHC, of which I used to be a member. I hope that the Minister and other colleagues will also join me in congratulating the Association of Community Health Councils for England and Wales, its director, Peter Walsh, and its supporters, on conducting its campaign with such rigor and integrity. There can be no denying that the proposal before us is a great improvement on past attempts. That is due in no small part to ACHCEW's well informed and well argued briefings, and the excellent work—as has been widely acknowledged—carried out on behalf of NHS users by CHCs for almost a generation.

I heartily welcome the genuine attempts by all concerned to secure greater public involvement in health services. This Government are rightly investing huge sums in those services, thereby reflecting our constituents' continuing commitment to the national health service.

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon

All of us—perhaps excluding the Minister—are sick of repeatedly discussing this issue, but it is important to recognise that we have made progress, and I want to make a constructive contribution.

We have yet to reach consensus, but if we build on the excellent speech from Linda Perham we might find a starting point. Mr. Hinchliffe said that, although the two sides of the argument are inches apart, those inches are very important. If I might modernise his terminology—a risky procedure—perhaps they are now only centimetres apart, although the distance remains very important. Perhaps we can explore that issue.

I thank the Government for agreeing to change the programme motion. I do not understand how such matters are dealt with, but it was appropriate to extend the original offer, thereby enabling us to explore these issues properly. It is unfortunate that we cannot discuss a sheaf of amendments line by line in a Committee; perhaps we should do so outside this Chamber, so that we can resolve some of the confusion. I am confident that we can do that, because the Minister has always been willing to discuss this issue. If the amendments give rise to specific questions, we can discuss them.

In his usual style, Mr. Burns explained some of the reasons why the Government's entire strategy is flawed—a view with which we agree. It is not worth my repeating the points that I made on Second Reading, in Committee and on Report. My predecessor in this role, my hon. Friend Nick Harvey, made the same points. Originally, he worked closely with the hon. Member for Wakefield to try to save community health councils and the other important elements that need to be saved.

I have never understood why the Government felt it necessary to abolish CHCs. Perhaps they did so on the basis of patchy performance, but such reasoning would threaten the roles of many Front Benchers.

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon

We should all watch out, and particularly members of the Cabinet. If patchy performance were a basis for abolition, we would have even more of a dictatorship, and even less Cabinet government.

I do not accept that it was ever reasonable to abolish community health councils, but the Government want to change the way in which things are done and we have to meet them part of the way. I accepted on Report, a little before the hon. Member for West Chelmsford, that we must move on to consider a way of reaching agreement.

As the Minister knows, the arithmetic is such that in the House of Lords, where the Government do not have a majority, there was a strong turnout of both main Opposition parties and Cross Benchers against the Government's proposals. Unless we can reach full agreement, I fear that that will continue. Despite the progress that we have made, I cannot say that my party will necessarily change its position. I do not believe that there is huge enthusiasm for the Government's proposals on the Labour Benches, although they are welcomed by some hon. Members, who are more than capable of speaking for themselves. There is still some way to go, but we have a useful platform.

Photo of Tom Harris Tom Harris Labour, Glasgow Cathcart

For the purposes of clarity, it would be wise to point out that, in Committee, the Lords voted for the abolition of community health councils, with a Government majority of 27. That was not made clear by the Conservative spokesman.

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon

That is an intervention for the Conservative Front Bench. Some time ago, my party accepted that we should fight on for patients councils—the amendment tabled by the hon. Member for Wakefield has had our support throughout. We want to fight now for what patients councils provide; otherwise, we will just go round in circles. We cannot hold out time and again for the identical amendment in the House of Lords. I stress that unless we are satisfied on specific issues, there will continue to be opposition—it does not matter how strong; it will still be voting opposition—to the position that we have reached.

The hon. Member for Wakefield has been described as a grave-digger. Today, in his absence, he is more like the spectre at the feast. I accept, of course, the Government's assurances that the debate was not timed to coincide with the hon. Gentleman's absence. We had a helpful contribution from the hon. Member for Ilford, North, who I know has been working with the hon. Gentleman in negotiating with the Government. There is not much value in asking whether he went of his own accord; I am sure that he did.

The hon. Member for Wakefield did not write to me to express his views before he left, although I know that it was a last-minute decision. The letter that he did write has not been published, and the hon. Member for Ilford, North hinted that the hon. Member for Wakefield did not agree completely with the Government's proposals. I probably share that lack of agreement.

Photo of Ms Linda Perham Ms Linda Perham Labour, Ilford North

I said that my hon. Friend the Member for Wakefield was not entirely happy, as we would clearly have preferred the patients council model. However, the Minister has read out my hon. Friend's letter, and hon. Members can judge what he means from what the Minister said.

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon

I accept that the Minister read from the letter. I do not suggest that she misread the hon. Gentleman's words, but I do not see why it should be a problem for the letter to be seen in its entirety and context. Although my party will make its own decision, it is useful to be informed by someone who has been involved in negotiation of the issues.

Let us consider some of the specific issues. Many of the functions proposed in the patients council model are delivered by the series of Government amendments. I put that on the record. When we are trying to persuade the Government to change their view, it is not helpful to hector them for doing so. We welcome the Government's proposals. That is how the two Houses work well, and how pressure from the Government's side works best. Even if it does exclude the Opposition parties, such negotiations bring progress to the public forum. There are, however, a number of objectives that have not yet been delivered by the amendments. I hope that in her response, the Minister will indicate that there may be some flexibility.

The Association of Community Health Councils for England and Wales, to which I pay tribute, has been up as late as all of us, dealing with the late amendments from the Minister. It is a remarkable feat of her office to have delivered vaguely competent amendments in such a short time, given that negotiations were still taking place on Tuesday. In a briefing sent to hon. Members on 17 May, the Association of Community Health Councils set out why it liked the patients council option. There are various criteria on which the association based its case for patients councils.

One criterion was integration and simplification. It is not clear that that criterion has been met fully, but the abolition of the local networks of the Commission for Patient and Public Involvement in Health helps to meet some of those concerns.

Another criterion was less bureaucracy than currently exists. I accept that there are arguments on both sides, but it is not clear that the proposed system is less bureaucratic because of the imbalances created by different types of patients forum of different sizes. The Association of Community Health Councils wanted a one-stop shop. The primary care trust patients forum provides almost all the aspects of the one-stop shop. Again, I put on record my gratitude for the progress made in the Government's amendments on that point.

A further factor was local credibility and accountability. To a certain extent, that relies on paid staff within the organisation. The theory of local networks and volunteer-run patients forums did not have that credibility, let alone the accountability. The fact that there will be staff for the PCTPFs—I agree with the hon. Member for Ilford, North that we need a better word, and as the Minister has had plenty of practice at coming up with new words I am sure that we will make progress in that respect—will provide more credibility.

The Association of Community Health Councils argued for a powerful, independent voice for local people. I am not convinced that the forum, as the Minister envisages it, delivers that, and I still fail to understand her distinction between the patients forum and the community health council or patients council model, in terms of allowing people to speak, rather than being spoken for. I have never understood what the hon. Lady meant by that.

What people want locally is for their view—their agreed view, if necessary—to be transmitted. The outcome is more likely to be a talking shop if people simply give their view, and no agreement is reached about the way forward by whatever body. I am sceptical about what the Minister said, particularly as she then said that there will be representatives—not people from, but representatives—of local health interest groups on the PCT patients forums. That is welcome, but it is inconsistent with her approach. I question whether it is a legitimate basis for her opposition to the patients council approach.

Another part of the case for patients councils is the need for an overview of health issues and services. That depends on whether the area governed by the primary care trust patients forum is large enough to provide an overview; otherwise it will merely provide a bottom view of a part of it. There is a major concern that when the Government think about PCTs, they are thinking about London, and not, as Mr. Hall said, about shire counties and the size of PCTs there.

Photo of Bob Spink Bob Spink Conservative, Castle Point

Does the hon. Gentleman agree that under the current proposals, which lack overall integration, there would be no body to examine the impact of health issues on a local community?

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon

There is the oversight and scrutiny committee of local authorities, which the Government introduced, but that does not represent the patient voice directly. That is why the patients council used as its base in terms of the local health economy, to quote the phrase coined by the hon. Member for Wakefield, the oversight and scrutiny committees of local authorities. That was a much better way of tackling the problem. In shire counties, there would be a county-sized overview and scrutiny committee, and a patients council or larger patients forum, which would benefit from the economies of scale, but would have the critical mass of expertise and be able to take a proper overview.

I shall be more specific. In Oxfordshire, there are a multitude of PCTs, so there will be four, five or six—who knows?—primary care trust patients forums with an interest in Oxfordshire, whereas at present there is one community health council that does a very good job, not just because of the people who serve on it, but because it is big enough to take an overview, with the one large acute trust in the county. It would be bizarre if there were five PCT patients forums with a wide remit and one acute trust patients forum that was subservient to them. That sounds like five chiefs and one Indian. It would be top-heavy and overly bureaucratic. It would be better to have a structure based at county level, which is where the overview and scrutiny committees work. That works well in London, for example, where PCTs are larger and often coterminous with local authorities.

The Minister should perhaps consider a scheme to allow the merging of PCT patients forums where that is supported locally. They could have a duty to consult on mergers, which would offer local people the structure that they want and would fit well with local authority scrutiny. The Minister knows that we supported the Government's proposals in the Local Government Act 2000, which provided for that function, but setting up multitudes of non-coterminous PCT patients forums is not joined-up government. If the Minister can make some concession on that important point, I might find more to commend in the amendments.

There are currently about 180 CHCs and some 150 overview and scrutiny committees. The functions performed by CHCs include oversight and the reporting of concerns, and they have the resources, the secretariat and the research capability to perform the necessary investigations. Placing those functions with local authority overview and scrutiny committees would maintain the critical mass necessary for effective performance. Placing those functions with 300 or so PCT patients forums will multiply bureaucracy and increase costs. The Government claim that resources will be provided, but the House has an interest in ensuring that whatever resources are finally decided—we can argue about quantum—are spent as efficiently as possible. That could be achieved most efficiently through patients councils, or larger patients forums, operating at local authority level. The area covered should certainly be bigger than the chunks of shire counties that patients forums will cover in my area and others.

I have several detailed points to raise on the amendments, but I know that other hon. Members wish to speak. I hope that the Minister will accept interventions when she winds up the debate. I cannot at the moment support the Government's motion to disagree, but I recognise that we have made some progress. It would be wrong to fail to recognise that the provisions have improved in terms of function, but the structure is not yet right and some issues remain on resources. I hope that the Minister will express a willingness to negotiate both in the Chamber and outside on some of the specific points that I have made.

Photo of Richard Taylor Richard Taylor Independent, Wyre Forest 6:00, 22 May 2002

I am amazed and delighted that some of my first impressions of the Government are beginning to be proved wrong. As we sat through the tedious hours in Committee, I felt that the Government were a juggernaut that was not for turning. Today, however, we have evidence that the Government have taken notice of many of the concerns expressed about the abolition of CHCs.

The first concern was the loss of the one-stop shop, but that does seem to have been addressed. Just this week, I have had complaints from a man who would have had to go to at least two separate PCTs; now, he should be able to go to a one-stop shop. I am also very pleased that the Minister has said that the forums will not be only talking shops, but will have opportunities to make changes.

My second concern—the independence of patients forums—is more difficult to address. There was no doubt about the independence of CHCs, but I remain to be convinced about the independence of patients forums. The Prime Minister recently wrote that PCTS were

"run by patients, doctors and nurses."

They are certainly run by doctors and nurses, but I remain to be convinced that the patient input is effective. I have not been convinced by the independence or the effectiveness of some of the non-executive directors whom I have seen in action.

The non-executive directors are appointed by the NHS Appointments Commission. Several issues were raised at a recent public meeting of the Health Committee that called into question the independence of the commission. I do not wish to cast aspersions on individuals—the problem is the system that has been set up. For example, the chief executive of the commission was the chief executive of the previous similar body and the chairman has been well steeped in the functions of the NHS as a chairman of trusts. The first act of the commission was to appoint 28 strategic health authority chairs, 26 of whom already chaired, or were non-executive directors of, trusts or health authorities and had been appointed by the Secretary of State.

I am waiting to see what effect the appointment of patients forum members by the Commission for Patient and Public Involvement in Health will have. I am pleased to hear that it will be able to seek members from potentially disadvantaged groups, but I was puzzled to hear recently that patients forums will elect a member to sit on PCTs and the NHS Appointments Commission will have the power to vet—and, presumably, veto—those elections. I hope that the Minister will deny that.

I was encouraged to see that the amendments would open the door to patients forum membership for people from health-related voluntary groups. That was one of the strengths of CHCs. My fear about patients councils is that they would add an extra tier, so I fully approve of strengthening an existing tier instead. On balance, I will support the Government, because they have widened and strengthened the scope and functions of PCT patients forums. However, as other hon. Members have pointed out, we need a better name for the forums. That would be a help, but their independence will be largely in the hands of their members—if they are given enough freedom.

Photo of Tony Baldry Tony Baldry Chair, International Development Committee, Chair, International Development Committee

Like almost everyone who has spoken in this debate, I am at something of a loss to explain why CHCs have been abolished. Dr. Harris and I have both had experience of the Oxfordshire CHC. For many years it was led by John Power, the leader of the Labour group on Oxford city council. It was a constructive and critical CHC, irrespective of which party was in office. I still do not understand why it was felt necessary to abolish CHCs.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

Does my hon. Friend think that the abolition might have had anything to do with "casualty watch", which showed how poor the situation was in accident and emergency departments?

Photo of Tony Baldry Tony Baldry Chair, International Development Committee, Chair, International Development Committee

I genuinely do not know, but we have never been given a coherent explanation for the abolition. If I was looking for bits of the machinery of government that caused concern, CHCs—especially the Oxfordshire CHC—would not have been high on my list. As Ministers and everybody else would have hoped, Oxfordshire CHC was an effective voice for patients and the community as a whole. It was critical and constructive, and it engaged in the debate.

The most important thing about community health councils, however, was that people could find them. We in the Westminster hothouse may sometimes forget how long it takes for our constituents to adapt to change—and the NHS has experienced an enormous amount of change recently. I suspect that if we asked people in the high streets of our constituencies "What do you know about primary care trusts?" we would find that few had caught up with the change, or would know who was involved in the trusts. Our Oxfordshire health authority has been replaced by five primary care trusts; I suspect that few of my constituents could name the trust currently covering their area.

Photo of Stephen Hesford Stephen Hesford Labour, Wirral West

Does the hon. Gentleman realise that community health councils were introduced in 1974, while PCTs have existed, broadly, since April this year? He is not really comparing like with like. My experience is the reverse of his: I found that even after nearly 30 years people did not know where their community health council was, and most of those I bumped into did not even know what community health councils were.

Photo of Tony Baldry Tony Baldry Chair, International Development Committee, Chair, International Development Committee

Perhaps the Oxfordshire CHC was a star, but I suspect that many people in Oxfordshire knew about it. We experienced a number of dramas over the years. There were concerns about the future of hospitals such as the John Radcliffe and the Horton general hospital in my constituency. When public meetings were needed, people were content for the CHC to organise them, knowing that it was objective and independent and would not be party political or partisan. CHCs dealt in the politics of the possible, carrying out effectively the job with which Parliament had entrusted them.

As I have said, a lot of change is taking place in the NHS and it is sometimes difficult for our constituents to keep up with it. For each primary care trust there will be a patients forum. I must tell the Minister that I do not think that my constituents, or indeed many other people, are desperately gripped by the debate about whether there should be a patients forum or a patients council. I will support those on my Front Bench because I think that the other place has made some good points, but I believe that what people out there really want is stability.

My postbag today contained a newsletter from the primary care network, whose line was simply "Give NHS managers space, time and freedom to deliver". Inside was an article by Dr. Stoate, in which he said that PCTs must be allowed space in which to establish their own priorities.

People do want stability. If there is to be a patients forum for each primary care trust, people must at least know what the trusts are. As I said earlier, Oxfordshire now has five PCTs, one of which—Cherwell Vale—is based in Banbury. When it was set up, with the agreement of all, it included a chunk of Northamptonshire. The reason was simple: as Banbury is a market town, a day's cart ride has historically been involved. That is how it came to be a market town.

For centuries, those in many villages and small towns in the constituency of my hon. Friend Mr. Boswell have considered Banbury to be their natural market focus. Consequently, general practices in south Northamptonshire have traditionally sent patients to Horton general hospital in my constituency. Indeed, 30 per cent. of the hospital's work comes from Northamptonshire.

Photo of Tim Boswell Tim Boswell Shadow Spokesperson (Business, Innovation and Skills), Shadow Spokesperson (Work and Pensions) 6:15, 22 May 2002

Will my hon. Friend accept a declaration of interest? I have lived in my constituency, in the far south-west of Northamptonshire, for more than 30 years. Throughout that period I have not only used Horton general as my local hospital, but used a general practice in Banbury. I have crossed the border for primary as well as secondary services.

Photo of Tony Baldry Tony Baldry Chair, International Development Committee, Chair, International Development Committee

My hon. Friend—who has lived in, worked in and represented his constituency for many years—makes an effective point.

The primary care trusts that the forums will represent "went live" on 1 April 2001, but only began active life on 1 April this year with the demise of the Oxfordshire health authority. They were shadowing the authority for a year. As I have said, Cherwell Vale primary care trust stretches into Northamptonshire. Members can imagine my amazement on seeing a letter from the chief executive of the Northamptonshire strategic health authority. Incidentally, if few people know which PCT represents them, I suspect that almost no one—and this goes for many Members of Parliament—understands what strategic health authorities do.

One thing strategic health authorities clearly want to do is reorganise PCTs. On 10 April, less than a fortnight after Cherwell Vale went live, David Sissling, chief executive of the Northamptonshire strategic health authority, wrote to the chief executive of the Thames Valley health authority saying:

"We recently discussed a possible adjustment to the boundaries of Cherwell Vale PCT and Daventry and South Northamptonshire PCTs. This would enable an alignment with the boundaries of Northamptonshire and Oxfordshire and of course the new health authorities.

I have discussed the proposal with a"— listen to the next word—

"limited number of colleagues including the Chief Executive of Daventry and South Northamptonshire PCT. On the basis of these discussions I can formally confirm our strong support for a reconfiguration."

No one in the PCT was consulted. No patients or general practitioners were consulted. Members of Parliament were not even given the courtesy, then or since, of being told about the possible configuration of PCTs, just 10 days after they had come into being.

Photo of David Cameron David Cameron Conservative, Witney

Many of my constituents, particularly those living around Chipping Norton, use Horton general. It will concern them greatly that if the hospital does not have the support of PCTs and patients in south Northamptonshire, it may not be as viable as it is today. It currently gives my constituents a very good service, often much better than that provided by the very strapped John Radcliffe hospital in Oxford.

Photo of Alan Haselhurst Alan Haselhurst Deputy Speaker and Chairman of Ways and Means

Order. Before the hon. Gentleman follows that line too far, let me say that the debate seems to be straying somewhat from the main point of the amendment.

Photo of Tony Baldry Tony Baldry Chair, International Development Committee, Chair, International Development Committee

We are focusing on patients forums, Mr. Deputy Speaker. Important questions are who will be on those forums, and what geographical areas they will represent. People in south Northamptonshire need to know which forum to go to, and they can know that only if they know which is their PCT. As I have said, they need some stability. For instance, people living in Chipping Norton, in the constituency of my hon. Friend Mr. Cameron, need to know which PCT represents them.

One of the most important concerns of the forums, however, will be the viability and vitality of their local general hospitals. The only logical reason for the Northamptonshire strategic health authority to want to take patients away from the Cherwell Vale PCT is that it wants to refer them to hospitals in Northamptonshire—which will undermine the viability and vitality of Horton general.

At present, Oxfordshire has five primary care trusts; each one will, under the Government's proposals, have a patients forum. They came into being after considerable consultation between general practitioners, everyone involved in the national health service and all the stakeholders. Doubtless they had to have ministerial approval. It was agreed that there would be five of them. They have chief executives, boards and chairman—all the paraphernalia of a primary care trust. The Government are asking us to vote tonight for a patients forum for each of those PCTs.

Similarly, as soon as the primary care trusts took up their effective duties on 1 April, the chief executive of the Thames Valley strategic health authority tried to bludgeon the five to become three. Not surprisingly, the smallest of these, the North East Oxfordshire primary care trust, based in Bicester in my constituency, is somewhat concerned. The chairmen of at least two of the primary care trusts said:

"We 'went live' 1st April 2001, i.e. 13 months ago, and are all now engaging fully and constructively with patient groups, local agencies and health professionals, including our GPs. We are certain that to close down our 5 trusts in order to create 3 new ones will very significantly disrupt and damage the ever improving quality of provision for our patients."

That was written by the chairmen of the North East Oxfordshire and the Cherwell Vale primary care trusts.

It is irrelevant to my constituents whether they have patients forums or patients councils. They want stability; people working in the NHS want stability; GPs want stability. The Government have set boundaries for primary care trusts—let us keep to them, at least until 2005, for heaven's sake. At least let there be natural evolution. The Government should not set up primary care trusts on 1 April 2002 and seek to change the boundaries radically, without consulting anyone, by 10 April. What kind of precedent is that for patient or consumer involvement? Ministers talk about involving the wider community. If the national health service does not even have the courtesy to involve Members of Parliament, what hope is there of involving the wider community?

The Government will win the vote tonight because they will dragoon all their members into their Division Lobby, except for those who have been expelled to Siberia for the occasion. However, this debate is irrelevant if Ministers cannot accept and understand that, above all, the NHS needs some stability for the next two or three years so that everyone involved can understand what is happening. Simply rewriting the geographical boundaries will benefit no one. I hope that the Minister will intervene with the chief executives of the various strategic health authorities who seem to have nothing better to do than try to rewrite the boundaries of primary care trusts.

Photo of Andrew Murrison Andrew Murrison Conservative, Westbury

In an earlier intervention on the Minister, I referred to a number of organisations that objected to the abolition of community health councils. I cited a number of charities, and the Minister responded with the name of an organisation which, unlike the ones to which I had referred, could hardly be said to be a household name.

I see from the list that someone has helpfully passed me that a number of establishment bodies have complained that to shut down CHCs would be a retrograde step. These include the British Medical Association and the General Medical Council. Interestingly, however, that view is also held by the Socialist Health Association, Health Action for Homeless People and the Co-operative party, while the Greater London Assembly has objected unanimously. There seems to be a pretty uniform view that the Government are about to make a retrograde move. It is a great shame that they have not listened.

Dr. Taylor said that he was heartened that the Government had been listening since the Bill's Committee stage. My impression throughout the Committee stage and subsequently is that the Government have been extremely recalcitrant with regard to all the helpful suggestions that have been offered to them. That is a great shame.

Brian McGinnis of Mencap said very tellingly that the CHC network has been a nuisance to the Government, but that that has been one of its strengths at times. He said that the new patchwork of half-baked ideas, designed for difference rather than effectiveness, lacks any real credibility.

Photo of Paul Truswell Paul Truswell Labour, Pudsey

For some years, I was a member of a CHC. The crocodile tears that Conservative Members are splashing about are making me smile wryly. If the Conservative party is so wedded to the idea of CHCs' independence and critical role, why did a former Conservative Government remove from CHC observers to health bodies the right to participate in their proceedings? That right existed until a Conservative Government took it away. How does that square with all these crocodile tears?

Photo of Andrew Murrison Andrew Murrison Conservative, Westbury

The hon. Gentleman's knowledge of history is greater than mine. The important thing is our commitment to the general concept of community health councils.

The CHCs offer a fairly seamless guide to people passing through the journey of the national health service. We must remember that people do not simply go to their GP and then suddenly go to hospital—it is a journey. One of our chief concerns is that the new proposals will cut across that. No longer will people have that seamless recourse to a knowledgeable and well respected body if they want to raise an issue of concern in the national health service.

There was a wider consultation on the future of community health councils in Wales, which subsequently opted to keep its CHCs. We could learn something from that.

I was interested to learn that Bath and District community health council, to which I pay tribute for all its hard work, cost £119,000 in the last financial year. Its chief officer thinks that patient advocacy and liaison services alone will cost about £750,000. There is a big difference. The Health Service Journal reckoned around the time of Second Reading that the new structures would come to about 10 times the current cost of community health councils. It is important to bear that in mind. Subsequent Government amendments could conceivably lead to greater costs.

Functions are far more important than institutions, however. I was interested to see the comments of my community health council on the recent revelation that the Royal United hospital in Bath will end the year with a deficit of £17 million, and that there is evidence of fiddled waiting lists. My CHC reacted in a timely and effective manner in contributing to that debate. I am left struggling to work out how the new bodies that the Government intend to replace CHCs would cope with the crisis facing the Royal United hospital in Bath.

I was pleased to read the agenda for the Bath and District community health council meeting of 14 May, held in Bath. It contains a raft of useful things that that body has done. It includes a review of the emergency unit and a "casualty watch" 2002, which took place earlier this week. It comments on detailed plans for the new emergency unit at the Royal United hospital and on transport into Bath for medical attention. That is a tribute to the many and varied things that my local community health council does, and its work is replicated across the country.

One of my concerns about the proposals is the impact that they are likely to have on staff. It seems to me that there is some confusion about who staff will work for and to whom they will be accountable. If I understood the Minister correctly, she suggested that the staff of PCT patients forums would be farmed out from the CPPIH, yet ACHCEW thinks that staff will answer to the PCTs. I would be grateful to the Minister if she could clarify that because, if ACHCEW and I are confused, I suspect that the general public will be as well. I am genuinely concerned that, if the staff who participate in the new bodies do not know to whom they are accountable and where they fit in the organisation, there is a real risk that they will become disheartened and dispirited.

I am also concerned that the remit of PCT patients forums is being widened to include issues that broadly affect health. I would be the first to admit that, in general, many things impact on health and that issues such as housing, transport and so on have a very definite impact on people's lives and, indeed, health, but I would caution the Government that, by widening the remit in that way, they are perhaps diluting the forums' focus on the NHS. Of course the resources will have to be increased if the remit is widened, and the Minister has said nothing about that so far.

The Minister talked about representatives from various interest groups that could conceivably have a view on health-related issues. I am confused about that notion because she appeared to suggest that representatives would not be the way ahead in the new order of things. I disagree with her on that point, but I would be grateful to her if she could clarify it. If she is referring to representatives, who will choose them? Will they be appointed? If so, who could dismiss them?

Photo of David Wilshire David Wilshire Conservative, Spelthorne 6:30, 22 May 2002

One of the great advantages of being an Opposition Whip rather than a Government Whip is that one is not quite tied to the same vows of silence. I am conscious of the fact that I have not heard all the debate, but I do not wish to go over any ground, other than to say that I note the time is 6.32 pm and it would be fair to say that the Government willingly agreed to our request to change the guillotine arrangements so that there would be a guillotine part way through our proceedings. I should like to put on record our appreciation for that.

A subsequent request for further time came not from Her Majesty's official Opposition but from the Liberal Democrats. [Hon. Members: "Where are they?"] They wanted an extra hour. The Government offered us two hours to discuss this business, and I am sure that you will notice, Mr. Deputy Speaker, that we have indeed said all we wish to say. We have had our opportunity to disagree. We do not like what is going on, and I doubt whether we will be satisfied by the Minister's reply. However, I must make the point that the Liberal Democrats demanded an extra hour, but none of them can even bother to be here to hear the Minister's response.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

Does my hon. Friend agree that the effect of changing the guillotine arrangements in that way was that we were unable to debate three groups of amendments that would have been discussed earlier, as a result of the Liberal Democrats' activities? [Interruption.] I see that one Liberal Democrat Member is now arriving in his place.

Photo of David Wilshire David Wilshire Conservative, Spelthorne

That very Member—Dr. Harris—is the one who demanded the extra time because he had so much to say, and so many of his hon. Friends wanted to say it, but I have made my point, and I do not wish to stray into the issues that were debated when I was not present in the Chamber. However, I am most grateful to the Government for agreeing to our request, and I ask the House to note what else has happened.

Photo of Hazel Blears Hazel Blears Parliamentary Under-Secretary (Department of Health)

This has been an interesting and wide- ranging debate. It is fair to say that all hon. Members involved in it probably know far more about patient and public involvement than they could ever had anticipated when we first embarked on this journey almost two years ago, and I hope that we have all extended our knowledge and understanding during that period.

Mr. Burns said at the outset of his contribution that the decision to abolish CHCs was wrong, and he set out why he thought that was the case. I would simply remind him that the decision to abolish CHCs was approved in the other place by a majority of 27 and that Lords amendment No. 6 deals with patients councils, and therefore we are discussing the fact that the Government disagree with that amendment. The issue of whether to retain CHCs is in fact behind us.

The hon. Gentleman expressed a kind of nostalgia about CHCs and said that they had a power of veto over hospital closures. I need hardly remind him that that power of veto, or power of referral, has now been transferred to democratically elected local government, and I would hope that that very important step forward would command the support of the whole House. Such crucial local decisions should be taken not by non-elected bodies but by ones that are locally accountable and democratic. I am sure that overview and scrutiny committees will carry out their tasks in a very discerning and appropriate way in future. That is real progress.

The hon. Gentleman also expressed concern about whether the new system will be able to address issues such as the terrible events that occurred at Alder Hey hospital. Hon. Members have also mentioned the dreadful trauma caused by the events at Bristol. I should like to remind the House that Professor Kennedy made the absolutely crucial point during the Bristol inquiry that patients and the public need to be on the inside of the system of patient and public involvement, not on the outside reacting to events when things have already gone wrong.

People should be inside the system and able to shape and influence the decisions that are taken. It is crucial to this debate to say that patients councils would perpetuate the system whereby people are on the outside, observing. Patients forums are fundamentally different; they are about patients and the public being on the inside of the system and able to exercise real power and influence.

The Conservative party is going through what the hon. Member for West Chelmsford described as a fundamental review of its policies on health and everything else. Obviously, there has been huge change in the NHS recently, which is the very reason why the system of public and patient involvement needs to change as well. If the hon. Gentleman is undertaking a review, he needs to be a little more creative and imaginative in looking to the future, not back at what has gone on for the past 27 years with CHCs. The shape of the system will be very different in future, and its values will be different as well. I urge him to keep up with the pace of change in our system.

The hon. Gentleman raised the issue of funding. My hon. Friend Mrs. Dunwoody welcomed his commitment to extra funding for the NHS. It is a great pity that the hon. Gentleman did not see fit to vote for it in the recent Budget debate. Nevertheless, I have acknowledged that more resources will be needed to ensure that the system works properly and that we do not get consultation and involvement on the cheap, so we will need to invest extra resources.

The hon. Gentleman also raised the important issue of value for money. At long last, performance management of patient and public involvement will be part of the new system, so we will be able to find out what we get for our money. In future, the people whom we have asked to pay a little extra for the NHS—I am delighted to say that the vast majority of the community are happy to do that—will be able to see exactly where the money is spent, what they get for it and how well the system of patient and public involvement is working across the country, instead of having perhaps a bit of a hit-and-miss system.

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon

On taxpayers' money being spent on a locally accountable health service, there is a strong argument for local democratic accountability in running the health service. Will the Minister make an announcement on the funding available to resource the model that she now proposes? Many of us think that it will cost a lot of money. If that money comes from the same announced resources, it will be spread more thinly, simply because of the multitude of organisations that she now seeks to beef up as PCT patients forums.

Photo of Hazel Blears Hazel Blears Parliamentary Under-Secretary (Department of Health)

I have in fact put it on the record in this debate and in Committee that the system will be more expensive. I am not in a position to make an announcement about specific allocation decisions, because they will be made as we decide where it is appropriate to put the massive extra investment that Labour is making in the national health service. The announcement of those allocations will be made at the appropriate time. However, we value a robust, independent and vigorous system of patient involvement, and clearly its implementation will cost more than the existing system. That is evidence of our commitment to investment.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

Although I accept the Minister's statement that she cannot tell us about funding allocations for the bodies, has her Department made any assessment of their probable costs and, if so, can she share those figures with us?

Photo of Hazel Blears Hazel Blears Parliamentary Under-Secretary (Department of Health)

I have already acknowledged that the proposed system will cost more. At present, CHCs receive about £23 million; we allocated an extra £10 million to fund the patient advocacy and liaison services. The staffing of the patients forums will require additional resources, but I am not in a position to go into further detail. We could make hugely ambitious proposals for public and patient involvement, but we need to be sensible when making decisions, because investment is crying out to be made in other parts of the health service. Getting the balance right will be fundamental as we go through the next few months.

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon

I recognise that the Minister is committed to putting more resources into the new system than the old one, which included PALS. I also recognise the need to ensure that the money is well spent and that there is a crying need for it actually to be spent on services. However, if she cannot give us an undertaking about money, can she give us some indication of the possible staff numbers in PCT patients forums? We know about the staffing levels of CHCs—at least in our own areas—but if there were to be only 0.7 of a person per PCT forum that would significantly obstruct us in reaching agreement with her as regards the proposed structure.

Photo of Hazel Blears Hazel Blears Parliamentary Under-Secretary (Department of Health)

I have already said that there will be staffing both for the PCT patients forums and to facilitate the co-ordination of other patients forums. I am certainly not in a position to say whether that would be one person or one and a half, two, three or four people, but the staffing support will be adequate to enable the forums to carry out their functions. That is the key part of the equation. It would be wrong to give bodies responsibilities without the resources to discharge them. No sensible Government would ever do that.

Photo of Tom Harris Tom Harris Labour, Glasgow Cathcart

Does my hon. Friend share my surprise that the Conservatives are demanding accurate figures for the funding of the new bodies, yet will not commit themselves to the shape of the NHS—or even to support it?

Photo of Hazel Blears Hazel Blears Parliamentary Under-Secretary (Department of Health)

My hon. Friend goes to the heart of the matter. Our proposals are evidence of our commitment both to reform the system—this measure is a major reform—but also to the investment that makes reform work. The Opposition are unwilling to provide extra funds for the national health service as a whole. They have a reactionary approach to the whole subject. They are not looking forward—they have no creativity or imagination—and that is very disappointing indeed.

My hon. Friend Linda Perham made an excellent contribution and I was grateful for her support for the detailed amendments that we propose. I am pleased that she feels we have made significant progress in establishing a strong, independent and community-led system of public and patient involvement. She expressed a willingness to move towards those principles—as we are trying to do; we are talking about functions rather than rigid structures to which people should conform. I am grateful to my hon. Friend for her contribution, and for the time and effort that she has put in to try to reach a position that reflects the views not only of hon. Members but of the many stakeholders in the public and patient involvement system.

Dr. Harris said that my hon. Friend Mr. Hinchliffe and I were centimetres rather than inches apart. I am grateful for the hon. Gentleman's acknowledgement of the progress made by the amendments. He accepts that the decision to abolish CHCs has been taken both in this place and in the other place and that we should now move on to try to provide a robust system for future patient and public involvement.

I am sorry that before my hon. Friend the Member for Wakefield left for Russia he did not write to the hon. Gentleman, but I have noted the hon. Gentleman's concerns and the fact that my hon. Friend welcomed our amendments.

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon 6:45, 22 May 2002

We shall make our own decision about the proposals—as will Mr. Hinchliffe when he reads the report of the proceedings—but as some of the amendments were not tabled before he left, he would not have fully known the Government's position. We do not know whether the entire letter was read out and we still do not know whether he thinks that more progress could be made. I am not trying to be awkward, but, in his absence, we cannot be persuaded that the concerns that we share with him have yet been met in their entirety.

Photo of Hazel Blears Hazel Blears Parliamentary Under-Secretary (Department of Health)

I do not have the Moscow telephone number of my hon. Friend the Member for Wakefield—if I did, I would pass it to the hon. Gentleman. I assure him that my hon. Friend was aware of the principles and intentions behind all our amendments.

The hon. Gentleman read out a briefing from ACHCEW when he expressed his concerns. I urge him to take into account the fact that there are other views. ACHCEW has provided some constructive contributions, but one of the main reasons why we want to broaden the system of patient and public involvement is to incorporate the views of a range of patients organisations, carers groups and people in the community who are not part of the existing CHC framework. In many cases, they have been denied the opportunity to get involved because once the CHC world was consulted, the health service judged that it had fulfilled its duty. I ask the hon. Gentleman not to think that the views of ACHCEW express those of all patients and the public on important and crucial issues.

Recently, I attended an event organised by a support group for patients with bowel cancer. During the past three months, it had involved almost 1,000 people in various events; they had come together to share their experiences and to talk to clinicians about how standards could be driven up. That would not happen in a traditional, CHC framework. It is crucial that we involve people more creatively and imaginatively, so I urge the hon. Gentleman to look beyond the world of CHCs in coming to a view on the issues.

Photo of Clive Efford Clive Efford Labour, Eltham

My hon. Friend referred to the involvement of local people in the formulation of health policy and decisions. Will that inform the process for choosing members of the local forums?

Photo of Hazel Blears Hazel Blears Parliamentary Under-Secretary (Department of Health)

As I explained earlier, the members of the forums will be appointed by the Commission for Patient and Public Involvement in Health, part of whose remit will be to seek out people rather than simply waiting for them to make an application—as is sometimes the case, when we end up with a self-selected and fairly limited group. The commission will actually go out and find people who, in the past, had no say in the health service and will give them support, guidance and training to enable them to come forward. I very much hope that a much more representative group of people than ever before will be shaping decisions. Crucially, involvement will not be confined to the people in the organisation—they will be charged with finding out the views of the public. The members of the forum will not simply put their own view—they will have to ensure that they draw in the views of a wider section of the community.

The hon. Member for Oxford, West and Abingdon and other Members expressed some concern about the name "primary care trust patients forums" and asked whether we could come up with something snappier. I have had my fingers slightly burned in coming up with names for organisations. I hesitate to say that we should call PCT patients forums "local voices". Perhaps we shall not go back down that path. However, I hear what is being said to me and perhaps we can consider the matter.

The hon. Gentleman made an important point about the different configuration of different communities—urban communities, rural areas and places with small market towns, which will be different throughout the country. Therefore, there may be a need for PCT patients forums to come together so that we avoid duplication. I draw the hon. Gentleman's attention to regulations that will be made under clause 18(2). Paragraph (f) provides for regulations to be made which govern

"the discharge of any function of a Patients' Forum by a committee of the Forum or by a joint committee appointed with another Forum".

There is legislative provision there to meet the flexibility that not only the hon. Gentleman but my hon. Friend Mr. Hall wants. My hon. Friend made a similar point.

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon

Clearly there are not yet regulations to read. Is the hon. Lady saying that there will be regulations that will allow, for example, the five PCT patients forums in Oxfordshire to group together to form one unit in the county as a PCT patients forum, which will have the staff and carry out all the functions, or will there still have to be five duplicated and different forums, that will come together for occasional issues?

Photo of Hazel Blears Hazel Blears Parliamentary Under-Secretary (Department of Health)

Far be it from me to take a centralist approach and to impose that on local communities. The regulations will be the subject of consultation. I am sure that the hon. Gentleman will want to make his views and those of his community known in the consultation process.

Photo of Hazel Blears Hazel Blears Parliamentary Under-Secretary (Department of Health)

No. I think that I have responded adequately to the hon. Gentleman.

Dr. Taylor welcomed the changes that the Government are putting forward. I am delighted that his faith in the political process has been slightly restored since consideration of the Bill in Committee. I can reassure him that the forums will not merely be talking shops. They will be taking action. The hon. Gentleman expressed some concern about the election of a patients forum member as a non-executive member of the trust, and whether the NHS Appointments Commission would have a power of veto over that appointment.

The patients forum will put forward the person it wants to be on the NHS trust. That person will have to meet the criteria set by the appointments committee and will have the same status as all other members of the trust. It is vital that that person is not seen as a second-class member of the trust board, and that there is parity of esteem and influence within the board to ensure that their issues are taken on board.

There is a precedent in that at present the NHS Appointments Commission appoints a person—he or she is usually from the education sector—to trust boards, but it is the education sector that nominates that person to go forward. I hope that that reassures the hon. Gentleman. I am delighted to have his support for the Government amendments.

Tony Baldry expressed the view that people knew where to find community health councils. Some of my hon. Friends expressed concern about the proportion of people who knew that. Some polling was done in the past. I do not pray it in aid and say that CHCs were bad because people did not know about them. However, extremely few local people knew what CHCs did, where they were and how they could get in touch with them. Less than 10 per cent. knew that. There is not the view that CHCs are well known and representative bodies.

The hon. Gentleman said that there had been a great deal of change in the NHS. That is exactly why the system of patient and public involvement needs to change, too, so that it can align with the changes that have taken place. He talked about dramas at the hospital in his area with which the CHC has been involved. There will be dramas about hospital configurations, but that is a tiny part of the entire system of the NHS. We are trying to get to a system that involves people who have diabetes, cancer and kidney disease, young people and children—the entire range of services.

In the past, everything has been about a drama and a crisis as a result of a configuration. That is one important aspect, but it does not reflect the entire range of concerns that people have about how the health service works for them. I genuinely believe that our new system will draw in many more views and issues than simply the sharp point about reconfiguration.

The hon. Gentleman raised an important issue about how decisions that change the way in which primary care trusts operate would be subject to public consultation. The general duty on the NHS, under section 11 of the Health and Social Care Act 2001, is that the trusts must consult—every part of the NHS must consult—where there will be an effect on the operational services. If it is a purely administrative matter that does not affect the way in which services are delivered, that can go ahead. Where the issue affects any of the services to be provided to the hon. Gentleman and his constituents, it needs to be the subject of proper and detailed consultation. That is a strong power in our provisions.

Dr. Murrison again raised the issue of the abolition of CHCs, which is unfortunately not the subject raised by the amendments. However, I welcomed his statement that functions are far more important than structures. That was real recognition. Perhaps he is keeping up a little faster than the hon. Member for West Chelmsford with a new approach. I am delighted about that.

The hon. Member for Westbury raised some concern about staffing. There will be staff employed by the Commission for Patient and Public Involvement in Health who work with PCT patients forums, supporting all of the forums in an area, commissioning and providing independent complaints and advocacy services and, crucially, promoting public involvement in the whole of the health service and those wider issues that determine health in local communities. The staff will be a key part of the system, but they will be grounded and rooted in PCT patients forums close to their communities. I can confirm that the commission will be appointing members of the patients forums.

I believe that we have had an extremely wide-ranging debate on these issues. I like to think that after going over this ground perhaps half a dozen times, I may even have persuaded Opposition Members that the NHS is changing dramatically. Therefore, public and patient involvement needs to change too. We have recognised the fact that to get change we must have investment. We must ensure that our services improve and that we give local people the tools to get on with the job. We must give them guidance, back-up, education, training and support. We have active, articulate citizens who are able to take their rightful place in being involved in the NHS. We are proposing real and radical change. Perhaps these changes are a little too radical for Opposition Members, but we are committed to real change, real reform and massive investment, which we had the courage to vote for and take forward. I commend the amendments to the House.

Question put, That this House disagrees with the Lords in the said amendment:—

The House divided: Ayes 303, Noes 179.

Division number 252 National Health Service Reform and Health Care Professions Bill — New Clause

Aye: 303 MPs

No: 179 MPs

Aye: A-Z by last name

Tellers

No: A-Z by last name

Tellers

Question accordingly agreed to.

Lords amendment disagreed to.

Lords amendments Nos. 7 to 16 disagreed to.

Government amendments (a) to (d), (o) to (q), (e) to (l), (r), (m) and (n) agreed to in lieu of Lords amendments Nos. 6 to 16.

Committee appointed to draw up Reasons to be assigned to the Lords for disagreeing to their amendments Nos. 2 and 4: Mr. Simon Burns, Jim Fitzpatrick, Dr. Evan Harris, Mr. John Hutton and Ms Claire Ward; Mr. John Hutton to be the Chairman of the Committee; Three to be the quorum of the Committee.—[Jim Fitzpatrick.]

To withdraw immediately.

Reasons for disagreeing to Lords amendments Nos. 2 to 4 reported and agreed to; to be communicated to the Lords.