Clause 14 - Abolition of community health councils in england
Health and Social Care Bill
Public Bill Committees, 30 January 2001, 10:30 am
Dr Liam Fox (Woodspring, Conservative)
I beg to move amendment No. 241, in page 11, line 19, at end add—
`(8) This section may not be brought into force until the Secretary of State has issued a certificate stating that it is his opinion that the bodies established under sections 7 and 10 are fully functional and performing their duties effectively throughout England.'.
Mr John Maxton (Glasgow, Cathcart, Labour)
With this it will be convenient to debate the following: Clause stand part.
Amendment No. 97, in clause 15, page 11, line 21, after `abolish', insert `or reform'.
Clause 15 stand part.
Amendment No. 248, in clause 10, page 8, line 9, after `(1)', insert
`Before the commencement of section 14 of this Act,'.
Amendment No. 254, in clause 13, page 9, line 26, after `(1)', insert
`Before the commencement of section 14 of this Act,'.
New clause 1—Reform of community health councils—
`.—(1) The Secretary of State shall lay before Parliament within 12 months of the date of coming into force of this section regulations providing for reform of community health councils in England which will ensure that all parts of the health service are effectively covered by a community health council.
(2) Regulations under subsection (1) above shall be subject to affirmative resolution of both Houses of Parliament.'.
New clause 7—Community health councils—
`Following the provisions in this Act, Community Health Councils shall be reformed following consultation.'.
Dr Liam Fox (Woodspring, Conservative)
I shall speak briefly to the amendment, but I intend to speak mainly on clause 14 stand part.
The hon. Member for Sutton and Cheam (Mr. Burstow) has a touching naivety if he does not believe that Parliament is the last place where we are likely to find out the details of any part of Government policy; and the abolition of the community health councils could not be a better example. It is one of the most controversial parts of the Bill—if not the most controversial—and it will cause the most difficulty in the other place. If the Government do not change their view on this part of the Bill, they will have a great deal of trouble getting it through the other place, as a substantial number of Cross-Benchers oppose the measure.
We accept that the Government's proposals are likely to remain in place, and we are in no doubt that amendment No. 241 would simply buy time to ensure that any new mechanisms are up and running and properly in place before CHCs are abolished and before those whom they help are abandoned to the new system. Nothing could be worse than to abolish something that works before putting safeguards in place to ensure that people will not suffer as a result of the changes.
In this debate, we shall examine exactly what CHCs do, how they work, what they have done, what functions they fulfil and whether those functions will be fulfilled by the new bodies that the Government propose. CHCs have 700 permanent staff and 5,000 volunteer members. They were created by a Conservative Government under the National Health Act 1973. It must not be forgotten that they effectively offer free labour to the national health service worth about £8 million a year. Each year, CHCs assist about 30,000 people with complaints.
In his briefing notes, the Minister accepts how well CHCs work. They say:
``While some CHCs have done a very good job, their effectiveness and breadth of service across the country is patchy and too highly dependent on individual officers and members. Only in some parts of the country do patients receive a high level of support from their CHC when making a complaint about NHS services.''
That surely is the best possible argument for reform and standardisation. We should raise the standard of all CHCs to that of the best, which the Minister accepts are already doing a good job in representing community interests and patients. If that is possible under the current model, it requires us only to ensure that the best practices apply equally across the whole system, not to pull the entire system apart. Such vandalism, undertaken for reasons that we can only guess at, is completely unacceptable.
We move from an easy and coherent system to one where the functions will be divided up between the patient advocacy and liaison services, patients forums and local authority scrutiny committees. The ensuing fragmentation will mean that no individual body will oversee the whole of the patient's experience. That may well result in increased litigation costs due to patients failing to receive appropriate advice. Elderly patients, for example, have complex problems, which can span acute and community care services. With the separation of scrutiny and complaints work the broader patterns of local health service problems are less likely to emerge and the exchange of information will be enabled only through the creation of yet another new quango. Under the current system, patients know exactly where to go for advice and their complaints are dealt with in a single, transparent manner. Under the new system, they will—for the first time—have to shop around for their rights, and that can only lead to increased patient confusion.
I am sure that the point of order raised earlier by the hon. Member for Sutton and Cheam about the information supplied to the Committee reminded the CHCs of the manner in which they were treated as they were kept in the dark until the Prime Minister announced the plan to abolish them. To add insult to injury, there is the Government's—and the Prime Minister's—concept of consultation. Given that the Government refer to such Orwellian concepts as ``earned autonomy''—whereby bodies are free to do things, but only with the Government's approval—I suppose that consultation might mean something different to them than it does to the rest of us.
The Prime Minister said in the House that the CHCs had been consulted about their abolition, but clearly nothing could have been further from the truth. The CHCs were not consulted. We are all aware of the subsequent exchange of letters between the Prime Minister and my hon. Friend the Member for Eddisbury (Mr. O'Brien). The Prime Minister said:
``I am aware that there is bitter opposition—
that is to the abolition of the CHCs—
which is why the proposals are being consulted on.''—[Official Report, 15 November 2000; Vol. 356, c. 937.]
Even after the Prime Minister said that there was consultation, there was still no consultation on whether or not the CHCs should be abolished. During the debate on Second Reading, many Government Back Benchers were clear that there had been no consultation.
Dr Liam Fox (Woodspring, Conservative)
It is interesting that none of those who sought to raise such complaints were selected to serve on the Committee. That is another triumph for the Whip system, but one in the face for the proper scrutiny of legislation.
In reply to my hon. Friend the Member for Eddisbury, the Prime Minister said of the CHCs:
We consulted widely on the run up to the NHS plan.
I look forward to hearing from the Minister details of his meetings with the CHCs on their proposed abolition, when they were told that they might be consulted and when it was made clear that the decision had been taken to abolish them. At least, my hon. Friend received a reply from the Prime Minister, unlike the Association of Community Health Councils for England and Wales. It is unacceptable for the body being abolished to have written to the Prime Minister and to have received no reply.
The association disputes the Prime Minister's assertion that consultation took place. It states that the Under-Secretary of State had written to them to say that CHCs would be essential to ensure the representation of patients during the implementation of the national plan and in the new NHS. When the Under-Secretary wrote that letter on 26 June, either she knew that they were about to be abolished or Ministers were kept as much in the dark as the CHCs. Perhaps the Minister could give us the detail of who knew what and when.
When Richard Gordon QC told the CHCs that,
``in my opinion, the consultation process over the new NHS plan was . . . legally flawed.''
Ministers responded by stating:
``We do not accept that ACHCEW or CHCs had any legitimate expectation to be consulted in relation to the proposal that CHCs should be abolished in primary legislation to be introduced in Parliament in due course.''
According to the Government, the body that is being abolished has
``no legitimate expectation to be consulted.''
What sort of consultation process is that? It is an absolute disgrace and an affront to any concept of natural justice for Ministers to adopt such an attitude towards employees whose jobs they are about to remove. Had something similar occurred in any other sector of our business or industry, Ministers would have been up in arms about it. However, they think that it is all right to abolish an organisation that employs 700 people, and to say that those people have no legitimate right to expect to be consulted by the Government. That says everything about the arrogance with which the proposal was carried through.
We must consider the funding of the new system. The association claims that by 2004-05 the new bodies that will replace CHCs will cost about £114 million, compared with the current CHC budget of £23 million. In 2002-03, patient advocacy and liaison services will absorb £23 million, with an additional £10 million from the Department of Health. The patients forums are estimated to cost £45 million, which is 0.05 per cent. of hospital budgets. The association also estimates that adding health to local authority scrutiny will cost about £70,000 per authority, or £14 million in total. It has been calculated that health authorities will need to budget £4.2 million for the independent local advisory forums, and a further £4.2 million for specialist advocacy services. The Minister shakes his head. I hope then that he will give detailed financial estimates when he replies to the debate, as we need to know what the cost of the changes will be to the public purse. The £100.4 million for 2002-03 would rise to £114 million by 2004-05, as more primary care trusts are formed.
We are told that the role of patient advocacy liaison services will combine the meeting and greeting in hospital reception areas with steering patients towards the complaints system. The body will be set up under NHS auspices, with staff employed by NHS trusts, and will be a creature of the system. That may create a conflict of interest, as the complaints system will appear independent but its real independence will have diminished. Many patients would prefer to raise complaints and concerns away from trusts. In the current culture of the NHS there is increasing control from the centre, and there will be less and less confidence in the ability of trusts to deal independently and objectively with such complaints.
That said, there is no reason why an improved advocacy and liaison service, as proposed in this part of the Bill, could not co-exist with the current CHC set-up. If a patient advocacy and liaison service were added to the CHCs that work to the best possible level—those that the Minister says now operate well and effectively on their patients' behalf—that would seem to cover the reservations felt by the Government and other bodies. Therefore, why must there be such complexity of provisions?
The objectivity and independence of local authority scrutiny also concerns us. As care trusts become more common, conflicts of interest will inevitably arise when councillors are increasingly called on to scrutinise services for which their local authority has joint responsibility for funding and provision. Such councillors will not be independent of the services that they scrutinise. Many will be of the same political persuasion as the non-executive directors, and even the chairman, of the local trust. Either there will be a temptation for a lack of effective scrutiny for party political reasons—we all understand that it happens—or the system could be used as a political football in way in which it is not used at present.
Although local authorities may accept the extension of local scrutiny powers, that does not necessarily mean that they also welcome the abolition of CHCs. Croydon borough council and the Greater London Assembly, for example, have passed motions criticising the abolition of CHCs, and judging from the tone of the debate on Second Reading, they were in tune with Government Back Benchers.
Patients forums will monitor services provided by trusts, with a substantial part of their membership coming from voluntary groups. We are told that their work in examining how services are currently functioning will be supported by the independent local advisory forums, which will monitor the development of services.
So far, the Government have been unable to confirm that the lone member of a patients forum to be appointed to a hospital trust board will be selected by the relevant patients forums. Perhaps they will now confirm that. They have also sought to reassure Labour Back Benchers by portraying the patients forums as mini-CHCs in some of their internal party briefing. That is a ludicrous argument. If patients forums are mini-CHCs, why are CHCs being abolished?
We know that there is considerable disquiet on the Government Back Benches. We have all seen the letter from the Prime Minister's agent, congratulating the CHCs and stating that the Prime Minister
``agrees with every word''
of a congratulatory early-day motion, and that he
``would certainly like to add his congratulations to the work the CHCs have done over the last 25 years and wishes them every success in the future.''
The sheer cynicism of that was best summed up in a letter from the South Durham and Weardale CHC, which states:
``The truth of the matter is, there has been no consultation either before, or since the NHS plan was drafted or published. We are concerned that the Government have announced the intention to abolish the CHCs as a cynical attempt to silence any negative publicity during the winter and in the lead up to the General Election, as they know they are most vulnerable in regard to the NHS. What better way to deflect attention away from any shortcomings than by silencing the only independent monitor that the public has for the NHS?''
That quote did not come from me, but from one of the CHCs. Labour Members should remember that many CHC members and staff are Labour activists. They have no party-political reason to criticise the Government, and they are genuinely worried that the measure is a mechanism for silencing dissent. If the Government are willing to silence and axe even their most prominent colleagues in order to keep the show on the road, the CHCs should not be surprised if they are treated in the same way.
Mr Philip Hammond (Runnymede & Weybridge, Conservative)
Does my hon. Friend agree that one of the greatest concerns of those who oppose the abolition of CHCs is that, under the Government's proposed scheme, it is not clear which institution will perform the important independent whistle-blowing role currently performed by CHCs? Is there not a suspicion that the Government are seeking to abolish that role altogether?
Dr Liam Fox (Woodspring, Conservative)
Yes. The current Secretary of State has an amazing ability to say one thing and mean something entirely different. That is what I meant when I referred to the Orwellian nature of the Government's proposals and language. Only the current Secretary of State could describe the Bill as a decentralising measure, when it gives him unparalleled powers of hiring and firing within the NHS. In the extreme cases that we will deal with later, the legislation gives the Government the power to tell patients that information about them is not theirs but belongs to the state, should the state wish to use it in any way that the Secretary of State deems fit.
The measure is not decentralising, but the Secretary of State describes it as such. It does not surprise me, given the mindset that that implies, that the Government want to abolish the concept of whistle-blowing or independent scrutiny. I share the suspicions of my hon. Friend that the measure will make access to the complaints and scrutiny procedure more complex and difficult for patients. It will ensure that there is less chance of any further body bringing embarrassing information to light in the way that CHCs have so successfully done in recent years.
Ministers' attempts to avoid questioning have been an unfortunate feature of the whole sorry episode. When a seminar was held by the Association of Community Health Councils of England and Wales on 4 December, the junior Minister wrote in advance that she would be attending the seminar, but that she would be unable to answer questions about the Government's proposals to abolish CHCs. Never have I known such a naked abdication of responsibility by a Minister in charge of a Government proposal—telling those involved that she would be unable to discuss the proposal at a conference that they were attending. What hope do we have of holding the Government to account, when Ministers refuse to answer questions on matters for which they have prime responsibility? It is an outrage.
As the hon. Member for Sutton and Cheam mentioned in his point of order, the Department has arranged a meeting in Fulham that is taking place as we speak. Those who might most want to listen to our deliberations, and who have most to lose from the Government's proposals, have been taken off to another part of the city. No doubt they will be briefed by the Secretary of State, as this Committee has not so far been briefed, and will already know the details of the proposal. However, they will not be able to listen to what is being said in Parliament. That is typical of the way in which the Government do business.
The Secretary of State recently promised national guidelines on the proposed new structures, but as yet we have seen no sign of them. There is a strong suspicion that the Government are making up the entire process as they go along, never having thought in advance about what would happen if they abolished CHCs, and with little idea even now of how to implement the plan. We all accept that there is a strong case for reform of CHCs, to make them more effective. Their work could be more standardised, the appointment system could be reformed and resourcing could be improved. However those are not arguments for abolition and the Government have yet to make a case for that.
The question of patient information and confidentiality has still not been considered either on Second Reading or, so far, in Committee. The CHCs have expressed concern because of the volume of confidential information about patients that they hold. There are large numbers of such records, which may be handed over to hospital trusts whose staff may be the subjects of many of the files. We must hear from the Minister today exactly how such conflicts will be prevented. What mechanism will ensure that information that patients gave in confidence, often about trusts or staff, will not be relayed to the very people about whom they complained? We must know in detail what will happen to the records and a failsafe mechanism must be introduced.
Under the Bill, the Secretary of State will, as I mentioned just now, take powers over the control of patient information and will be able to make any information public if he deems that to be in the public interest. There will be potential for patient records from the CHCs to be put in the public domain at the whim of the Secretary of State. The system was not set up to do that. It would be contrary to every assurance that patients were given when they provided the information. They would have been told that it would be treated sensitively and in confidence. The Government need to sort this matter out, because it is one of the most appalling flaws in the procedure.
In the past, community health councils, or at least those at the top of the scale, have done a wonderful job. They have represented the entire public, not just patients, in the NHS. We have all seen the Casualty Watch documents that they produce, which are extremely useful in pointing out flaws in policy and identifying where service is poorest. That effectiveness has proved to be one of the nails in their coffin. The Secretary of State in particular detests Casualty Watch because it points out what is happening in the real NHS, as opposed to the one that he likes to describe in the House of Commons.
The CHC supported the victims of Harold Shipman in Hyde. The Northallerton CHC played a key role in suggesting that the counselling help line for victims of Richard Neale should be funded by the Northallerton NHS trust and health authority. The Sheffield CHC has demanded that the Commissioner for Public Appointments investigate the appointment of the new chairman of Sheffield Teaching Hospitals NHS trust, which was not publicly advertised, and for which only two candidates were interviewed. The junior Minister has not replied to the CHC's letters of concern.
Members of Barking, Dagenham and Havering CHC made an unannounced visit to the Corbet ward of St. George's hospital in Hornchurch, where they found staff shortages so severe that elderly patients were being put to bed at 4 pm. They found that seven of the 16 qualified nursing staff were off work owing to sickness. All those revelations are at risk of going by the board because of the new mechanisms being established by the Government. Indeed, there is a strong suspicion that they are being put in place in order to make sure that such matters are not brought to light in the way that they have been to the embarrassment of this and previous Governments.
A number of distinguished people have served on CHCs. It will be interesting to hear the views of the noble Lord Hunt—one of the first secretaries appointed to the CHCs in 1975—as he turns executioner for the organisations that he once championed. It will be interesting to listen to his reasoning.
We have a different approach to the subject in Scotland and Wales, which we will come to subsequently. Neither the Scottish Executive nor the Welsh Assembly has introduced plans to abolish CHCs. They seem to be at odds with the Government, viewing CHCs as something useful and their independence as something to be encouraged. Now that we are to get a two-tier service in terms of nursing care in the United Kingdom—courtesy of the Government's devolution proposals—it is not surprising that we are to get a second-rate advocacy service in respect of independence and autonomy in England.
A number of Labour Members have made vocal their criticisms of the Bill. One example is as follows:
``Does my right hon. Friend accept that community health councils do good work in our national health service? Does he also accept that those councils genuinely represent the patients and their families—the consumer? As he is engaged in some necessary, far-reaching reforms . . . could he delay deciding his approach to CHCs until he has advanced his other reforms?''
That is exactly what we propose in amendment No. 241. Another Government Back Bencher said:
``There is grave concern that such services will be fragmented among a range of providers and that the patient's voice element will be dissipated rather than co-ordinated.''
The hon. Member for Wakefield (Mr. Hinchliffe), who chairs the Health Committee, stated:
``My concern is that the proposal places patient advocates within trusts and they will not be seen to be independent in a way that patients need them to be.''—[Official Report, 21 November 2000; Vol. 357, c. 158.]
All those statements are from supporters of the Government, who have grave concerns about the proposals.
The Secretary of State has gone to great lengths to cite support from patients' bodies for the new structure. He stated that the College of Health
``welcomed the new statutory duty for public involvement and consultation by health authorities, primary care trusts and NHS trusts. We also welcome the creation of patient forums as statutory bodies.''—[Official Report, 10 January 2001; Vol. 360, c. 1081.]
Mr Philip Hammond (Runnymede & Weybridge, Conservative)
Is my hon. Friend aware that on Second Reading a number of Labour Members who spoke against the abolition of CHCs made it clear that they had personal and direct relevant experience of them? Is it not extraordinary, therefore, that the Government have chosen to pack the Committee with Members who did not speak on Second Reading to the extent that, with the exception of the Minister, not a single Labour Member spoke on Second Reading?
Dr Liam Fox (Woodspring, Conservative)
I see that my Whip is not present and I am treading on dangerous ground. I was in the Whip's Office and that I know how the membership of Standing Committees is decided. The more controversial the legislation, and the less sure the Government are of their ground, the less likely it is that independent opinion from their Back Benches will be represented. When a Committee is made up of those who did not speak in the Second Reading—missing those who discussed their reservations about Government policy—I would bet my bottom dollar that the Government know they are on weak ground intellectually.
Dr Doug Naysmith (Bristol North West, Labour/Co-operative)
Is the hon. Gentleman aware that there are Labour Members present with experience of serving on CHCs? I have served on two, including one in his constituency. Perhaps he could explain why the Organisation of South-West Community Health Councils, including the one that serves his area, has chosen not to oppose the proposals and instead agreed to work with the Government to introduce more effective measures?
Dr Liam Fox (Woodspring, Conservative)
Individual CHCs are answerable for their views. I hope that the hon. Gentleman is not trying to take a specific example and extrapolate it to the general, because it is clear that the vast majority of CHCs are against abolition. Is the hon. Gentleman suggesting that that example is typical of the attitude of CHCs?
Dr Doug Naysmith (Bristol North West, Labour/Co-operative)
The 14 CHCs in the south-west do not oppose the Bill.
Dr Liam Fox (Woodspring, Conservative)
That does not alter the point; the hon. Gentleman is well aware that that is not the view of the vast majority of CHCs or of the association, all of whom are against—
Dr Liam Fox (Woodspring, Conservative)
Before I give way to the hon. Member for West Bromwich, West (Mr. Bailey), I shall finish what I was saying about the misrepresentation of support for CHCs. The Secretary of State went to great lengths to say that the College of Health supported his proposals. However, the college also stated:
``The College of Health regrets the lack of discussion with public and patient groups prior to the decision to abolish Community Health Councils announced in the NHS Plan. CHCs have important statutory rights and duties to represent the views and needs of their local populations and to be consulted on proposed changes in the provision of care by health authorities and trusts. We are concerned that under the new arrangements proposed, these important statutory rights should be strengthened and not weakened to the detriment of patient and public empowerment.
While welcoming the introduction of Patient Advocacy and Liaison Services (PALS) to trusts and acknowledging the important role they should have in helping patients sort out problems before they become complaints, we have strong reservations about the extent to which they will be seen as truly independent by patients who have a complaint about the trust, if the trusts employ and direct the work of the advocates. We are also concerned that PALS based in hospitals may be badly placed to help the majority of patients whose problems are to do with community or primary health care or with failure to access the services they need or relate to lack of co-ordination between primary and secondary and with social services.''
The other main concern expressed by the College of Health was that abolishing CHCs would risk fragmentation at local level.
Dr Liam Fox (Woodspring, Conservative)
I have said that I would give way; the hon. Gentleman must contain himself.
The college's other main concern was:
``we risk fragmentation at local level and, importantly, the loss of a good mechanism for monitoring and identifying national trends and patterns in both good and bad practice through the sharing of local knowledge and experience.''
I quote those comments at length because the Secretary of State used the college's words in defence of his proposals.
Dr Liam Fox (Woodspring, Conservative)
I have made it clear that I will give way in a moment.
The Secretary of State prayed that organisation in support of his policy. That shows that there is no end to the Government's twisting of words to pretend that organisations that clearly have major doubts about the proposals are in favour. I look forward to the next fantasy.
Mr Adrian Bailey (West Bromwich West, Labour/Co-operative)
I am grateful to the hon. Gentleman for ultimately giving way. I wish to be associated with the comments made by my hon. Friend the Member for Bristol, North-West (Dr. Naysmith); I would have got in first, but his timing was better than mine. First, I declare a non-pecuniary interest in that my wife is a member of a community health council. I, too, served for seven years on a CHC. I ask the hon. Member for Woodspring (Dr. Fox) to withdraw the accusations that he made about the membership of the Committee.
Dr Liam Fox (Woodspring, Conservative)
I am confused by that intervention. I am not sure what the hon. Gentleman wants me to withdraw. Does he want me to withdraw the comment that CHCs provide different qualities of support, or does he disagree with the fact that CHCs are against the Government's proposals? Is he trying to pretend to the Committee that CHCs welcome their abolition? Will the hon. Gentleman clarify what offends him?
Mr Adrian Bailey (West Bromwich West, Labour/Co-operative)
The hon. Gentleman went on for such a long time that he has probably forgotten what he was saying when I first asked him to give way. He was making accusations about the management and staffing of the Committee.
Dr Liam Fox (Woodspring, Conservative)
When the hon. Gentleman has been here a while, he will understand that the staffing of the Committee is not the same as the membership of the Committee.
Dr Liam Fox (Woodspring, Conservative)
There is no doubt that the hon. Member for West Bromwich, West will be rewarded, as naked ambition and toadying are now qualities much to be recommended in the Labour party. The function of scrutiny of legislation has been entirely abandoned by Labour. The concept that Members are here to hold the Executive to account and to question what is going on has been completely forgotten.
Dr Doug Naysmith (Bristol North West, Labour/Co-operative)
I sat through the whole debate on Second Reading.
Dr Doug Naysmith (Bristol North West, Labour/Co-operative)
I was not called to speak. Two or three other Labour Members sat through the whole debate and were not called.
Dr Liam Fox (Woodspring, Conservative)
I am sure that the hon. Gentleman is right, but that does not change my view that the majority of Labour Members who spoke in that debate, no doubt randomly chosen by the Speaker, were hugely against the Government's proposals.
Mr John Maxton (Glasgow, Cathcart, Labour)
Order. The membership of the Committee has nothing to do with the debate, so I would be grateful if hon. Members returned to the amendment.
Dr Liam Fox (Woodspring, Conservative)
I am grateful to get back to the debate on the amendment, as I look forward to the Minister's reply to my specific points. I raised the issue of membership only so that those who read the report of our proceedings understand that the Committee does not represent the views of many Labour Members.
Mr Ian Stewart (Eccles, Labour)
On a point of order, Mr. Maxton. Clearly, the hon. Member for Woodspring does not read the reports of our proceedings. The matter was dealt with at our first sitting. I raised a point of order about whether it was appropriate for the Opposition to second-guess what was in the minds of Ministers, or for them to suggest that qualification for serving on a Committee was related to attendance at a previous debate. The hon. Gentleman does not know why people could not be at a certain debate.
Mr John Maxton (Glasgow, Cathcart, Labour)
I have already ruled that the debate on membership of the Committee should now cease, so we should get on with debating the amendment.
Mr Simon Burns (West Chelmsford, Conservative)
On a point of order, Mr. Maxton. Are we allowed to drink anything other than water?
Mr John Maxton (Glasgow, Cathcart, Labour)
Members of the Committee are not allowed to, I am afraid.
Mr Simon Burns (West Chelmsford, Conservative)
Further to that point of order, Mr. Maxton. What would you do if an hon. Member were drinking coffee?
Mr John Maxton (Glasgow, Cathcart, Labour)
I was not aware that someone was drinking coffee. If someone is, he should remove it.
Dr Liam Fox (Woodspring, Conservative)
If I may, I will return to the abolition of CHCs. I recognise that a raw nerve has been touched.
We have six tests to apply. There has been no consultation, and costing has not been carried out properly. The abolition will lead to fragmentation of services, loss of staff and increased costing, so is it workable? We do not sufficiently understand the accountability and independence of future mechanisms. The new proposals fail all such measures.
The group to be abolished has given sterling service to the NHS. Many people may become unemployed who have been extremely loyal to the task, for remuneration that has not been fantastic. The Government have failed to make the case for the changes, and have failed to consult about them in advance. We suspect that the changes are being made up as they go along, and that information is being given to those outside before it is given to the Committee.
The Minister has a great task, as he has to reassure the Committee, and through it those who pay attention to our deliberations, that the Government are not simply trying to gag the NHS and to ensure that patients are less able to get headlines that the Government hate into newspapers. We are losing a valuable resource, which even the Minister tells us works well in many parts of the country.
Our argument should be about raising standards to the best. Sadly, it has become about an entirely different Government agenda: one of putting the political process first and putting politics before patients.
Ms Kali Mountford (Colne Valley, Labour)
I did not intend to take too much of the Committee's time today, given that under the new programming rules time is of the essence and that the last speech was rather long, but I want to touch on a couple of the points raised. I do not recognise the picture of CHCs that has just been painted. I have had a quite different experience, and most Members will bring their own experiences. My experience of CHCs dates from when I was a councillor in Sheffield and the area health authority proposed to abolish one of the accident and emergency departments in the local hospitals. The proposal caused an outcry in the community and my own local authority opposed the proposal. I am sad to say that we felt that the CHC at that time did not serve the interests of the hospital patients—which most concerns me. Of course the CHCs have a role in consultation, but surely patients too have a role, as do their feelings about the service that they receive.
Unfortunately, I have had two recent experiences of a CHC in my area. One arose from my own medical disaster, as a result of which I met other patients; the second concerns the proposed reconfiguration of hospital services. On the latter point, one would have expected the CHC to take a major role. The local community decided to develop something called ``Save our services'' because it felt that the CHC was not taking the expected lead role. The ``Save our services'' organisation was very successful and, as a result of its lobbying, quite a lot of changes were made to the original plans for the reconfiguration of the local hospital services. I am saying not that the CHC did nothing, but that it did not seem to be sufficiently well-equipped to deal with the problem that it faced. Many people were disappointed. Members of the ``Save our services'' organisation who were approached by the CHC, which said that it felt that its role was not being supported, telephoned me to say that they were very disappointed.
Dr Peter Brand (Isle of Wight, Liberal Democrat)
Is the hon. Lady suggesting that whatever replaces the CHC should be absolutely populist and always support popular campaigns to save a national health service provision, however suitable, modern and relevant it is to today's world? If she is saying that, she is treading an extremely dangerous line.
Ms Kali Mountford (Colne Valley, Labour)
I do not think that I came anywhere near saying such a thing. However, consultation with patients and the community is essential. If we change anything, the people for whom we are changing it—mainly the patients—must have confidence in what is happening. That brings me to my other point, which concerns my own experience. When an accident in surgery happened to me, I was alarmed to find that the process for dealing with my complaint about it was extremely difficult. I have been in hospital several times recently—it is unusual to have the experience of being a Member of Parliament on a ward—and people were approaching me all the time. I was alarmed to find that no one knew how to access the service of the CHCs, and that hardly anyone had heard of them. That is a major flaw in the present process.
Regarding confidentiality, of course I would like to know what would happen to my own records. However, the CHC—inadvertently, I hope—gave information about me to another organisation, and even to another patient about whom information was then given to me. I have, therefore, experienced some terrible flaws in the CHCs and must deal with the problems that I have experienced personally and look at how the damage that is being done, to other patients and to myself, can be repaired. I have not felt well served, as a patient or as a representative of the community, by what has happened so far, and I have been lobbying since 1997 to change the structure of CHCs.
Ms Kali Mountford (Colne Valley, Labour)
I will do so when I have finished this point. Opposition Members are entitled to argue that reform could be an option, but experience tells me that whatever reform takes place, CHCs are too distant from patients and not closely enough tied to the places in which patients experience problems: that is, GPs' surgeries and hospitals.
Dr Liam Fox (Woodspring, Conservative)
The hon. Lady has mentioned the important subject of patient access and knowledge of where in the system to go for redress. Under the Bill, to whom should a patient complain after encountering a problem with a GP, the ambulance service and the acute trust during a single episode of illness?
Ms Kali Mountford (Colne Valley, Labour)
The hon. Gentleman will be surprised to learn that patients in hospital expect some service there. I have now represented several patients who have had unhappy experiences, and in all cases their first port of call was the place about which they were complaining. That may surprise some Opposition Members, but most people with a complaint about a service will go back to where they received it.
Mr Paul Burstow (Sutton & Cheam, Liberal Democrat)
The hon. Lady is developing an important point about the operation of CHCs, and about how we could deal with some of the problems. However, the Government are reviewing NHS complaints procedures. Does she agree that it would be better to design the architecture for the new system once the new complaints procedures have been revealed?
Ms Kali Mountford (Colne Valley, Labour)
I completely understand the hon. Gentleman's point, but it does not detract from the main thrust of my argument, which is that people feel that CHCs have not always represented them well. Whatever new procedures are set up, my experience gives me no confidence that CHCs would be any better. Whatever the structure in which complaints are dealt with, access to the structure is important. I strongly believe that access needs to be where patients most expect it, which is where the service is provided.
Dr. Brand rose—
Dr. Fox rose—
Ms Kali Mountford (Colne Valley, Labour)
I have a choice; I shall take the hon. Member for Isle of Wight (Dr. Brand) first.
Dr Peter Brand (Isle of Wight, Liberal Democrat)
The hon. Lady is developing an important line of argument. It is important for people to receive support while they are in hospital or during an episode of primary care. Of course, most hospital trusts and all primary care practices have internal complaints procedures and internal liaison procedures. However, although in an ideal world those would be enough, does the hon. Lady recognise that in the real world something outside that arrangement is needed to support the patient when, for example, a multiplicity of organisations is involved? She has described something that is essential, and I am sad that she has had such poor experience in her area. Perhaps the Sheffield councillors on CHCs who advise hospital trusts should have done a better job.
Ms Kali Mountford (Colne Valley, Labour)
I take the hon. Gentleman's point, although patient advocacy can be dealt with separately within an organisation. I do not think that it is impossible, as the hon. Gentleman seemed to suggest, to make distinctions within an organisation between the people and services about whom complaints have been made and the person who deals with the complaint.
Dr Liam Fox (Woodspring, Conservative)
I entirely sympathise with the point that the hon. Lady is trying to make about single-point access to a system. Nevertheless, does she accept that whereas a patient encountering a problem with primary care, the ambulance service and the acute trust can, in the current system, make a complaint at a single access point, namely the CHC, under the proposed system patients will have to make three separate complaints at different points of access? That will not empower the patient; it will fragment the process of complaint and redress.
Ms Kali Mountford (Colne Valley, Labour)
The hon. Gentleman seems to have missed my point completely. I find that patients are not doing anything at present. Once they have made an approach to one of the organisations—for example, a hospital's patient advocacy unit—I would expect them to be advised as to whether they need to make further approaches. At least they would have made the first approach. I find that patients are making no approach to get advice at all. Often, they just suffer in silence from the bad service that they have received.
We should be able to use the information that is gathered. When I asked whether there was any information that would help me in my own case, whether there were other patients who had experienced something similar, and whether there was a case for a certain doctor to go back and be retrained in the technique that was used in my surgery, I was told that no such information was held. We need that sort of information. In my experience as a representative, a councillor, a Member of Parliament and member of the community and, above all, as a patient, the organisation is far too cumbersome, remote and distant from patients. It needs vital reform. If that means creating something completely new, I am all for it.
Mr Paul Burstow (Sutton & Cheam, Liberal Democrat)
I shall start by picking up on some of the points raised by the hon. Member for Colne Valley (Kali Mountford). We should be debating the reform of CHCs, not their abolition. Some of the amendments provide hon. Members with an opportunity to allow that debate to proceed as an alternative to throwing the baby out with the bath water.
I suspect that some of the hon. Lady's criticisms, drawn from her experience, will find an echo in all parts of the House. The performance of the complaints procedure could accurately be described as patchy. Equally, it has been acknowledged by the Government that the CHCs have done a very good job. I want to return to that point, and develop our view in asking some questions about how the matter will proceed.
The hon. Lady made a case for reform—she used the word herself in her conclusion—not abolition. The clause contains a proposal to remove the structure and substitute a new set of structures. I want to analyse some of those new structures to see whether they will allow effective scrutiny of our health service.
Will the Minister tell the Committee who, in the new set-up that the Bill will establish, will be responsible for undertaking such work as Casualty Watch? At the moment, CHCs, locally and perhaps regionally, take periodic snapshots of the performance of accident and emergency departments, recording the length of waits on trolleys, the age profile of the patients and the nature of the condition that they are waiting to have treated. That is invaluable, independently gathered information, which gives an insight into how that sector is performing. I hope that the Minister will tell us how such surveys will be conducted in future. Can he tell us why, at the end of last year, there were delays in finalising the funding settlement for CHCs at a national level? That appears to have delayed, if not put off altogether, the nationwide Casualty Watch, which usually takes place in January or February.
Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)
I am worried that my response may be rather lengthy. Patients forums will be able to, and will, carry out activities such as Casualty Watch. I do not know why the nationwide Casualty Watch did not take place, but I have no reason to believe that it had anything to do with the funding of CHCs.
Mr Paul Burstow (Sutton & Cheam, Liberal Democrat)
Perhaps we can return to that, but it is certainly my understanding that there were delays in finalising the funding settlement for the Association of Community Health Councils for England and Wales, which made it much more difficult for it to plan sensibly for a Casualty Watch exercise in the coming period.
Dr Liam Fox (Woodspring, Conservative)
Does the hon. Gentleman share my suspicion that this measure is not about increased scrutiny, but about decreased scrutiny, as a body under the auspices of a trust is less likely to be willing to criticise that trust? Under the new arrangements, local government will provide the care, so will be less willing to criticise its own provision of care. Does not that undermine objective criticism of services?
Mr Paul Burstow (Sutton & Cheam, Liberal Democrat)
What struck me as I read the NHS plan, the explanatory notes and the briefing paper is that the Government have managed to create a feeling of anti-synergy--the sum of the parts of this new structure will be worth less than the whole, and will reduce and diminish because they do not connect one with another. They do not enable the picture and patterns of individual complaints to be discerned. As a result, we will not benefit from synergy: we will lose synergy in this new system. CHCs may well have their flaws, but at least they integrate the various aspects of individual complaints and have an overview of the system as a whole. At their best, that is what they should and can do, and that is why we need reform.
Ms Lorna Fitzsimons (Rochdale, Labour)
The hon. Gentleman is worried about trusts ``getting away with it.'' Surely the easiest way for them to get away with it is under the current system, because patients have nowhere to go and do not go anywhere, so complaints do not get heard.
Mr Paul Burstow (Sutton & Cheam, Liberal Democrat)
The hon. Lady will have to excuse me, but we are debating the Government's proposal to abolish CHCs. We are discussing what the Government propose to put in their place and whether that will be better than the current system and better than instigating reform. Twenty years have been invested in CHCs: they have 20 years of experience. One of the arguments advanced for abolishing CHCs is that the variability of their performance depends on their individual members and officers. The Government's argument that a CHC's effectiveness is down to the performance of the individuals in it surely begs the question whether any new organisation would be any better. All the organisations will need to use human beings to carry out their tasks, and their performance will vary. Human beings are fallible, and that is particularly relevant, given the report that we shall hear about later.
Mr Paul Burstow (Sutton & Cheam, Liberal Democrat)
I am happy to take an intervention, but I have barely started and do not want to delay the Committee unnecessarily.
Ms Lorna Fitzsimons (Rochdale, Labour)
Does the hon. Gentleman accept the main point made by my hon. Friend the Member for Colne Valley? CHCs, as currently constituted, do not deal with the problem caused when there is no one in situ--as with the patient advocacy and liaison services--and someone needs help there and then, especially if there is a problem with the consultant and a patient feels that he has not been properly understood and represented.
Mr Paul Burstow (Sutton & Cheam, Liberal Democrat)
The key words are ``as currently constituted''. I shall address that point later as I deal with the amendments. The theme of this debate about abolition is ``if it ain't broke don't fix it''. We believe that the Government have failed to carry the argument for abolition of the community health councils. They have failed to persuade patients and professional organisations of their case--certainly according to the evidence we have had from representations. On Second Reading, some Labour Members also expressed concerns and are yet to be persuaded. This area of concern is one of the reasons why the Liberal Democrats voted against the Bill.
The proposals for patient empowerment and the abolition of CHCs were important for us. Our central opposition to the clause is based on the fact that it will result in the fragmentation of the work currently undertaken by CHCs, which will be divided among a number of bodies that have no clear linkage and no co-ordination. Patients come into the NHS at different stages and follow different care pathways. It is crucial to test any new system of patient representation and advocacy to ensure that it is able to cut across the boundaries of the different agencies and providers of care that come into contact with patients. It has to be patient-centred, which is a key part of what we understand to be the Government's aim for the NHS as a whole. The fundamental weakness of the Government's plans is that they are provider-centred.
The structures are based around providers rather than around patients.
We learned from the briefing material provided by the Minister last week that the Government accept that some CHCs are doing ``a very good job.'' However, Ministers go on to say that CHCs are very dependent on the individual officers and members. Where is the evidence that the replacement system will be free of the failings that the Government have identified in the CHCs? Performance and overview committees, patients forums, the patient advocacy and liaison services and the independent local advisory forums will all depend on members and officers who are perhaps equally as fallible as those currently involved in CHCs. It is striking how easy it is to construe from the explanatory notes, the briefing paper and ministerial statements that these proposals have been developed on the hoof, and are being re-written time and again. Indeed, the role of PALS is being re-written almost daily.
We learn from the explanatory notes that the overview and scrutiny committees and the patients forums, which will constitute the successors to CHCs, are the core of these new arrangements. They will have the statutory backing that the Bill provides. At best, however, those two bodies will have no more power—possibly less—than the CHCs that they are intended to replace. I accept entirely that some of those powers may not have been exercised as hon. Members would have wished, but the powers in the National Health Service Act 1977 are there to be used. At worst, the two bodies will represent a dilution of those powers by splitting up the inspection and scrutiny functions.
The scrutiny role will be left without the insight and intelligence that inspection brings. Furthermore, separating handling of complaints from scrutiny denies the overview function the ability to identify common problems and trends thrown up by complaints. Under the Bill, there is no obligation on patients forums to work with local authorities in exercising their overview function, and some aspects are not covered by any legislation. We are told in the explanatory notes:
``The new arrangements are to be supplemented by two new non-statutory arrangements, Patient Advocacy and Liaison Services (PALS) and Independent Local Advisory Forums''.
However, the briefing notes that the Minister rightly circulated to the Committee state that the Government see the advisory forums as providing an arena for patients to have their say about the whole local health economy. That is an important role, but the advisory forums will gather the views and experiences of all patients in their areas. If that important role is as the Secretary of State and Ministers have said in their briefing paper, why is it not dealt with as a specific measure in the Bill? Why is there shortly to be a dramatic expansion in the areas that health authorities cover? Health authorities in London are being reconfigured, so these new advisory bodies will be very remote when it comes to dealing with and drawing together the everyday experiences of patients.
All the matters that these area advisory groups and the patient advocacy and liaison services cover are discretionary and at the behest of the Secretary of State. They are not covered in the Bill. As with the advisory forums, the powers are not covered in the statutory provisions that are before us. Their role, as mentioned by the hon. Member for Rochdale (Mrs. Lorna Fitzsimons), appears to be more akin to that of a customer care manager, or even a concierge. The explanatory notes talk specifically about them being
``Situated in or near main reception areas of hospitals and act as a welcoming point for patients and carers.''
I am sure that that is a valuable role, and that the descriptions given in the briefing notes show an important augmentation of the existing system to address concerns. However, what about accident and emergency departments, where people have experiences of poor service? What about on the wards themselves? I think the most revealing phrase of all in the briefing notes is the heading on page 5:
``Guiding the patient through the system''.
In my view, CHCs provide a readily identifiable independent one-stop service for patients. That is clearly not the opinion of everyone in the Committee, but it is the experience of many people, to judge by the evidence that I have seen. More could be done to ensure that people are aware of CHCs. We will have a confused and confusing set of arrangements in their place, so a guide will certainly be necessary.
I asked the hon. Member for Colne Valley about my concern that the Government are putting the cart before the horse, as they are reviewing the NHS complaints procedures, and the results have yet to be published. Before we have had the benefit of seeing the complaints procedures, we are designing an infrastructure around which they will operate. It would seem more sensible to design the complaints system and then to decide on the independent elements designed to work with it.
The issues of costs has been explored at some length. I hope that the Minister will be able to tell the Committee how much extra will be pumped into the system. More specifically, I hope that he will confirm that about one twentieth of patient care budgets will be diverted to pay for patients forums. That may not seem a large proportion of those budgets, but every penny for patient care should go to patient care, not be siphoned off to fund new bodies. If the Government are committed to making the changes work, new resources should be committed to make them work effectively.
As I said, for the theme for our deliberations, we should take the adage, ``If it ain't broke, don't fix it.'' I do not have a misty-eyed view about the perfection of CHCs, and other hon. Members have made similar points.
Dr Peter Brand (Isle of Wight, Liberal Democrat)
Does my hon. Friend agree that it is rather sad that awful CHCs have not been tackled using existing powers? The Secretary of State has enormous input into decisions about who serves on CHCs, as do local councils. I have been concerned about the poor performance of CHCs from Labour areas.
Mr Paul Burstow (Sutton & Cheam, Liberal Democrat)
My hon. Friend is right. I hope that Ministers will have considered that, and will exercise their powers under the 1977 Act, which enable them to make changes to the composition and functions of CHCs. Reform is available through existing legislation. However, it may have been appropriate to add specific references to the new NHS bodies.
There is evidence of poor performance and a question about under-resourcing. In a way, the Government appear to acknowledge under-resourcing by accepting, at least in the briefing, that an additional £10 million will have to be invested in the first year of the new arrangements. Whether that figure is a gross underestimate of what will be needed in the long run is another question. Certainly, my CHC is struggling to do a decent job with the resources available. If we want decent patient empowerment, we must consider the resources available. I hope that the Minister will clearly explain what resources will be available to make the system work effectively.
I believe that the concerns about and criticisms of CHCs amount to a case for reform rather than abolition. There should be reforms to strengthen CHCs' capacity to support patients, and to broaden their scope to include primary care and the new care trusts. The hon. Members for Colne Valley and for Rochdale made points about powers to augment, but not to replace or supplant, the role of CHCs.
The amendments fall into two categories. Some use our preferred approach of reform rather than abolition, but the amendment moved by the hon. Member for Woodspring would put a delay mechanism in place that would require the Secretary of State to certify that the new arrangements functioned effectively before he abolished CHCs. We might have a long wait before the Secretary of State could provide such a certificate. As things stand, the Government's proposals are not fit for the purpose. The sum of the parts adds up to less than the whole. The result is not synergy, but the anti-synergy that I was talking about earlier. I hope that in considering the amendments, the Minister will step back and reflect on the comments, not necessarily of members of the Committee, but of all those who are concerned with patients' interests. Those views are what matter and the Government should listen to them more than to anything else.
Sir George Young (North West Hampshire, Conservative)
Of the large number of amendments before us, the one that most attracts me is amendment No. 241, which would provide for the clause to come into force—that is, for CHCs to be abolished—only when the Secretary of State was satisfied that the new bodies were functioning well. That is the right approach.
I hope that the Minister will concede that this proposal has not been a presentational triumph for the Government. For an Administration who pride themselves on the way in which they present initiatives and manage news, the episode has been a disaster. A group of people who were, I think, quite well disposed towards the Administration—those who work for and serve on CHCs—feel deeply bruised, if not betrayed, by the events of the past few months. It might be helpful if the Minister were to concede, in winding up the debate, that the matter has not been handled well, and that those who serve on CHCs have every reason to feel aggrieved at the way it has been presented. That might begin to heal some of the wounds.
I have no difficulty with the principle of examining the interface between the consumer, or patient, and the NHS. The existing system was introduced 25 years ago and it is reasonable for an Administration to examine it and decide whether it constitutes the best way of discharging the function in question. When we took office in 1979, we gave some attention to CHCs. In those days they were slightly different. They were more political—certainly in London. Some had been captured by the trade unions and some were very radical and campaigning. They have now matured a great deal and are more professional. However, in 1979 they caused the incoming Conservative Administration quite a lot of inconvenience and grief. None the less, we decided to leave them as they were, for several reasons.
We were making many changes to the NHS and there is a limit to the number of changes that can be made at one time. Some elements must be left stable while others are moved around. Attempting to move too much at once results in an unstable structure. In addition, one of the themes of our reforms and the name of the relevant White Paper was ``Patients First''. We wanted the patients' views as we proceeded with the reforms. If we had abolished or reformed the CHCs, we would have been denied the clear voice of the consumer. Among my regrets about the present process is that I should have liked the CHCs' views about the rest of the Bill—the care trusts, pharmaceutical changes and so on. However, because they have understandably been preoccupied with their own survival, they have had to take their eye off the ball. We have not received much briefing from CHCs on those aspects of the Bill, which I regret.
If we had decided in 1979 to abolish the CHCs, I hope that we would not have done so in the way chosen by the present Administration—slipping the idea out under cover of the NHS plan, having given some signals that CHCs would survive and were appreciated. I understand the argument for reform. There are tensions within the existing functions of CHCs. They have several different jobs to do, and it is difficult for one body to accomplish all of them. Indeed, Winchester CHC is not opposed to reform or to its replacement by other bodies, although it has reservations. However, if the argument against the present structure is that too much is being done by one body, the argument against the new structure is that it involves too many bodies. It is, as it were, the obverse of the problem. At present there is a one-stop-shop. People know where to go: to the CHC. Under the new structure I expect some patients or consumers to be confused about which of the variety of bodies that are to be established they should approach.
I was impressed by the argument put to me by Winchester CHC that if the Government proceed with the new structure, co-ordination will be needed to link the various elements. The new structure is over-prescriptive and centralised. The hon. Member for Sutton and Cheam and my hon. Friend the Member for Woodspring have described problems that could arise under the new system.
A patient in my constituency who had an accident at home and dialed 999 would be taken by ambulance to Andover hospital. That hospital has a small accident and emergency department looked after by local GPs. If the patient's condition turned out to be more serious than Andover hospital could cope with, he would be taken by ambulance to Winchester and, if it turned out to be even more serious, from Winchester to Southampton. At the moment, if something went wrong, the local CHC could track the episodes. One CHC would provide assistance in establishing what went wrong, and where. Under the new structure, as my hon. Friend said, it would be necessary to knock on several doors. It is not clear to me how the different elements of the process will be co-ordinated and linked for the benefit of the individual patient.
As the hon. Member for Sutton and Cheam said, the proposed model for the four types of replacement body is organisation-based: it is based on the trusts and other bodies. The present structure is patient-based: there is one body for patients to approach. I see some danger of fragmentation. The new bodies will perhaps be less effective, and may become isolated, without a co-ordinating body at local or regional level to bring them together. That was what struck me when I met my local CHC. I was interested to find that the British Medical Association is quite forthright on the matter. It states:
``CHCs should not be abolished until all the new systems replacing them are in place.''
That is what amendment No. 241 would provide. Even the research department of the House of Commons Library, which is usually very neutral, refers to clauses 7 to 15 as
``a panoply of measures designed to provide a new system of patient and public consultation''.
Other members of the Committee may have read in Public Finance a perceptive piece by Liz Kendall, entitled ``Community Test'', which I came across yesterday. She writes:
```Do you support abolishing your constituents' independent voice in the NHS?' could soon become the question Parliamentary candidates fear most during the election campaign.''
On the proposed patients forum she writes:
``The big surprise in the Health and Social Care Bill is that these forums will now have a statutory basis and a substantial degree of independence. This looks more like a political move designed to appease the CHC movement than a properly considered policy. While CHCs were right to feel angry and betrayed at the way their abolition was announced (a throwaway line at the end of Chapter 10 of the NHS Plan), replacing them with strong, independently minded Patients Forums will only be effective if they work constructively and are genuinely representative of the communities they serve.''
She continues:
``The Government's analysis of the problem is broadly accurate''—
which is a generous comment—
``but . . . good ideas have been marred by a lack of overall strategy and little or no thought to implementation. These issues are the real challenge for Labour's second term.''
Some Conservative Members will have views about that.
Dr Liam Fox (Woodspring, Conservative)
I should not allow that generous interpretation to go unchallenged. Even if we accepted such an analysis, Labour Members have argued that one of the reasons for abolition is that patients do not complain to CHCs because they do not know where to go, or because they feel that the process is too complex, so would it not be logical to ascertain whether the number of complaints under the new system has risen or fallen before deciding whether it is a better or worse system?
Sir George Young (North West Hampshire, Conservative)
I agree. The benefit of the amendment is that it would permit the retention of CHCs until it was possible to be satisfied that the replacements were working. If the Secretary of State were not satisfied, he would not issue the certificate, and CHCs would remain.
I wonder what is likely to happen next. As I said on Second Reading, the Bill is unlikely to hit the statute book if we have an election in April or May. The Bill will be on Report some time after 8 February, but even simple non-controversial Bills take seven or eight weeks to go through the other place. The clause may be opposed there, so the Minister may be confronted with the choice either to ditch clause 14 or to ditch the Bill. Will he abandon the other reforms, many of which cause us no difficulty, in order to keep clause 14? Or will he be persuaded by our arguments and by those that I hope will be made in the other place?
It would help if the Minister talked us through the timetable for the Bill's remaining stages--if not today, at some point in our proceedings. When will it be introduced in the other place? When will Report take place? I am sure that the Minister's propensity for producing amendments will be undiminished, and that we shall have to consider at least some Lords amendments. Will that happen in March or April? When will the Bill be enacted? If it comes to the crunch, will the Minister be prepared to abandon clause 14, and therefore keep CHCs, as the price for having the rest of the Bill?
Mr Simon Burns (West Chelmsford, Conservative)
Like my right hon. and hon. Friends and the hon. Member for Sutton and Cheam, who is the spokesman for the Liberal Democrat party, I have grave misgivings about clauses 14 and 15. I am attracted by amendments Nos. 241 and 97, because I believe that it is foolish to abolish community health councils and replace them with something diffuse and confusing. The case against CHCs has not been made.
The hon. Member for Colne Valley and others have said that the CHC system is not 100 per cent. perfect. Of course it is not; no organisation can be perfect. The hon. Lady gave us a powerful example of such problems, and I suspect that, during their time as Members of Parliament, most hon. Members have come across problems with CHCs, as they will have done with many other organisations. We have had problems in mid-Essex, but during my 14 years as a Member I have not had to deal with problems or complaints from constituents about the way in which the Mid Essex CHC has handled cases. As I said on Second Reading, two years ago I had to deal with complaints about the proposed ward closures in my local hospital, but never with complaints from individual patients.
I suspect that the reason behind the abolition of CHCs has more to do with control freakery, and that the Government are trying to stamp out anything that could embarrass them by highlighting problems in the health service rather than trying genuinely to improve the system. It would be extraordinary if the Government had discovered problems with CHCs only in the past year or two. I suspect that, until 1997, they thought that CHCs were probably the best thing since sliced bread. We certainly never heard Labour Members complaining about CHCs when they were in opposition; they frequently praised them for doing their job, which was to highlight problems.
Mr Simon Burns (West Chelmsford, Conservative)
I am grateful to the hon. Lady. My point is that during the period 1987 to 1997, when I was a Member of the House, Opposition Members were not heard to complain about the performance of their community health councils.
Mr David Jamieson (Government Whip (technically a Lords Commissioner, HM Treasury); Plymouth, Devonport, Labour)
She was not here.
Mr Simon Burns (West Chelmsford, Conservative)
I am explaining that point to the hon. Lady. Neither she nor the hon. Member for Eccles (Mr. Stewart) was here. That is the point. I am talking about those hon. Members who were in the House during that period. When they were in opposition, they were keen on community health councils and full of praise for them and the effective, dedicated work that they did. That effective and dedicated work has not changed in the last three years. What has changed is the Government. They do not like criticism. They do not like any organisation, however independent, to contradict the rose-tinted view of the Secretary of State and the message that he wants to get across to the country about what is going on in the health service.
Ms Lorna Fitzsimons (Rochdale, Labour)
Does the hon. Gentleman know that before I became a Member of Parliament, none of my family—and my sister is a solicitor and my brother a chemical engineer, so neither of them is lacking in intelligence—knew about the CHCs, although my father, sadly, passed away having spent a month in intensive care? Does the hon. Gentleman not see that it is outrageous that I had to become a Member of Parliament before my family had access to patient representation?
Mr Simon Burns (West Chelmsford, Conservative)
As my hon. Friend says, it does not depend on that.
It is interesting that two Labour Members have said in interventions that they were members of community health councils. It is surprising, though, because presumably they were members of those councils before their election to the House. I am surprised that we have not heard from them how inadequate and flawed those community health councils were when they served on them. The answer is that, as my hon. Friend said, none of the Labour Back Benchers who are present today spoke in the Second Reading debate, and none of them has views that contradict what the Government want to ram through the House, because they were handpicked by the Whip, so we shall not hear from them.
The important thing is that we have a system of patient representation that is independent and seen to be independent. My fear is that the current system, which is perceived as independent, will be replaced by bodies that will not command the confidence of the general public that they represent their best interests and will move forward the enhancement and improvement of health care in their local regions.
My own community health council has written to me on the subject, and powerfully reinforces that point. Mrs Norma O'Hara, chief officer at the Mid Essex Community Health Council, said:
``I remain very concerned that individuals, in particular, will not receive the independent support they presently receive from the CHC.''
She is also concerned that
``matters highlighted through complaints, through regular visiting by specialised CHC members and by attending a myriad of health meetings will be lost if the new system is put in place.''
She is absolutely right.
The experience and expertise that community health councils have built up since their establishment in the 1970s is second to none. That will be wiped away by a highly petty move by the Government to get rid of an organisation that is doing its job. If the Minister feels that areas within the existing system are flawed or need to be tightened up and improved, why not take that course rather than take away the whole system and bring in the cockeyed system that the Government propose?
Paragraph 2 of the helpful briefing on patient representation in the NHS that the Minister has sent us in the last two weeks says:
``While some CHCs have done a very good job, their effectiveness and breadth of services across the country is patchy and too highly dependent on individual officers and members.''
I ask the Minister, because that is a very broad-brush and generalised condemnation, what is the evidence to support that statement? It would be helpful to discover the basis of the Government briefings that seek to undermine the CHC system. I hope that the Government will listen to the debate and, more important, to Labour Back Benchers who have not been selected to serve on the Committee. I hope that the Government will think again at this late stage. If they are not prepared to do so, I hope that, in the other place, the two clauses will be treated with the contempt that they deserve and be rejected.
Dr Peter Brand (Isle of Wight, Liberal Democrat)
I should like to make some brief comments. Much has been said about the independence of CHCs, and the fear that whatever replaces them might not be so independent. It is right to worry about that, but I have another concern. CHCs are, on the whole, knowledgeable. They have a wealth of knowledge and experience of the NHS, and they understand it. That has been part of the maturing function that was described by the right hon. Member for North-West Hampshire (Sir G. Young).
I remember that, when CHCs were first set up, no doctor would talk to a CHC member. They were considered to be wild, outrageous people, interfering with the proper functioning of the profession. That has changed enormously. There is now co-operation, but not in the sense of collusion. There is an understanding on both sides that the public are represented through bodies such as CHCs, but those bodies have an obligation to understand the technical pressures and the constraints on medical provision.
The medical profession and the CHCs have evolved, in places where their relationship works, a responsible method of monitoring patient opinion and influencing the people who are charged professionally with delivering the service. In my CHC, we have reached the stage where local general practices have invited CHCs to set up an inspection regime for them. That is right. Inspection is one of the roles that the Minister could have given to CHCs.
I was sorry to hear the hon. Member for Colne Valley describe her experiences, but I was somewhat alarmed that one of her criticisms of CHCs was that they do not always represent popular campaigns. It is CHCs' role to find out what the public believe about a proposal to change the NHS, but it is also their role to evaluate that feedback and make reasonable comment. If the NHS were run purely by campaign—as politicians, we have too often been guilty of that—nothing would ever have changed. We would still be taking out tonsils on the kitchen table, and accident and emergency departments would be present in every village. That is what people would like, but it is not medically responsible.
Ms Kali Mountford (Colne Valley, Labour)
I should like to clarify that at no point did I say that CHCs, or any other body, should simply take up populist campaigns. However, I felt that they were not responsive enough, and that they did not listen to the public. The service is, after all, aimed at the public.
Dr Peter Brand (Isle of Wight, Liberal Democrat)
I am not sure whether that is much of a clarification. Clearly, CHCs should listen to the public. In fact, they should take the lead in public consultation, but that is not the same as—to use the hon. Lady's term—responding. One listens, evaluates and then takes a position. That is the same as our role in Parliament. We do not respond to every pressure group that wants to keep a particular hospital or accident and emergency department open. Hopefully, we receive briefings on the underlying reasons for changing the configuration. We can then decide whether the change is sensible.
The proposals are a mixed bag. The PALS system is fine, and I think that all well run trusts already have such systems. They may not be called by the same name, but they have liaison officers, and have good relations between complaints officers in trusts and staff on wards, in accident and emergency and on reception desks. Such a system will give patients the right advice, but is appropriate only when patients or their carers agree with the process produced by the trust.
In 90 per cent. of cases, that will be the right way to handle such complaints and give support. However, a simple way to receive such support is essential when complaints cannot be resolved in-house. My hon. Friend the Member for Sutton and Cheam said that the Government recognised the problem in their response to the Select Committee on Health about complaints procedure. It seems sad that we are abolishing a route whereby we could handle specialist complaint procedure, without being specific about what we are putting in its place, and that we are doing so before the Government formally respond to the problem, as they should in the next few weeks.
Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)
We have had a good introduction to the important debate on this part of the Bill. I welcome the hon. Member for Woodspring to the Committee to lead for the Opposition. He is not usually far from any bandwagon, and he has not disappointed us this morning.
Although the debate has been important and will continue to be, I feel disappointed by it so far. There has been a tendency to seize on the issue as one on which the Government have been criticised, so people have piled in to do that rather than to tackle the fundamental and serious question of what form of scrutiny and patient representation is needed to build a patient-centred national health service. Much of the debate has been complacent and lacking urgency about what needs to be done. It has proceeded on the premise that the situation is are pretty much okay from patients' point of view, and that tweaking with a few bad spots here or there will adequately deal with the problem. I do not believe that that is the situation, and it is not the vision set out in the NHS plan. That is why the Government propose a more fundamental change.
The clause is about the abolition of community health councils. It is essential that Committee members understand that the conclusion that CHCs are being abolished as a consequence of the decision to create a better and more powerful system of scrutiny and patient representation. It is not and never has been a primary objective of the Government. We did not start with the idea of getting rid of CHCs and then wonder what to put in their place, but by asking what was needed, from first principles, to build an effective system fit for the 21st century. We must change how the NHS operates, as well as protecting and enhancing the interests of individual patients. The change will be a comprehensive overhaul of the involvement of patients and the public in the running of the NHS. In key areas—for example, the oversight and scrutiny committees and patients forums—we are providing the necessary powers in the Bill, but in others we do not need new legislation to make the proposals work. As hon. Members have done, it is important to put the clause in the context of all the changes that we are making.
There is a need to strengthen support for patients, carers and their families. In the front line of that are the patient advocacy and liaison services. When we consulted on the NHS plan last summer, people said time and again that they needed someone to help sort out situations that had gone wrong. They wanted someone on the spot who could tackle an individual problem as it arose. We might like to think that the system already provided such assistance. The hon. Member for Isle of Wight said that that was often the case in trusts, but the overwhelming message from our public consultation was that patients did not feel that way. Through leaflets, radio phone-in programmes and meetings that Ministers attended, we were repeatedly told that something was going wrong, and that there was a need for someone to whom people could turn.
The advocacy and liaison services will be essential to sort out problems on the spot. We believe that they should be part of the trust, should have direct access to the chief executive, should be able to facilitate the swift resolution of problems and identify patterns of problems that emerge within trusts so that management can deal with them. There have been concerns about the independence and effectiveness of PALS, and we are building some safeguards into the process, but I will come to them later.
Mr Ian Stewart (Eccles, Labour)
Will my hon. Friend the Minister comment on the accountability of PALS and advocates?
Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)
PALS will be part of the trust, reporting to the chief executive and sorting out problems as they occur. We expect the new independent patients forums to scrutinise the work of PALS and to assure themselves that they are working for patients as they were designed to do. As a safeguard, we will provide powers in amendments today so that, if necessary, a patients forum can recommend that the PALS be taken out of a trust and run independently. I honestly do not believe that that is likely to happen on many occasions, but it is built into the Bill as a safeguard against the danger that a trust management would browbeat or neuter the work of PALS and stop them from being effective on behalf of patients.
PALS will help patients going through hospitals and primary care, so on occasions serious and formal complaints will need to be addressed. We are reviewing the complaints system. There will be new proposals, and Ministers have not yet received the evaluation of the existing complaints procedure, but we think that we need a more independent system. Although we do not have the exact shape of the new system, we are confident that patients will require independent advocacy—someone to hold their hand. We are confident about going ahead with the proposals because it is difficult to conceive a complaint system in which there is no need for independent advocacy on behalf of the patients.
As part of the pattern for provision, an independent patient advocacy will be commissioned in each area of the country. We accept that there is a critical issue—it is managerial, not legislative—about ensuring that the signposting to the PALS in each hospital or primary care trust leads directly to the advocacy service. As we have heard, that is often lacking in the current system, so that some people do not find their way to CHCs.
Mr Paul Burstow (Sutton & Cheam, Liberal Democrat)
The Minister said that the tasks of PALS would include discerning the patterns that complaints produce and reporting them to their chief executives. What powers and duties will be placed on PALS, should they come to the view that their chief executive and trust are not responding to their concerns? To whom to do they report, and will they be protected for doing so?
Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)
There is obviously extensive provision. The hon. Gentleman will know that the Government introduced legislation to protect individual members of staff, whatever their position—whether they are part of an advocacy and liaison service or in any part of the health service—who, having properly tried to raise their worries about how things were being managed, felt it necessary to become a whistleblower. That is a fundamental protection.
We shall certainly discuss it, but we shall need a good flow of information between the different parts of the system as they are being put together. I am not persuaded that we need to legislate for it, but it will be necessary for the patients forum and PALS to work closely together because the forum will be overseeing and scrutinising the work of PALS. A member of the trust board will have been elected from the patients forum. That person will be another friendly member of the trust board, although he or she will be there as a trust board member and not simply as a patients' representative.
Mr Paul Burstow (Sutton & Cheam, Liberal Democrat)
The Minister referred to the appointment of a patients forum member to the trust board. However, neither the explanatory notes or the briefing paper discuss the problems that a patients' representative will have given his duty as a corporate member of the trust board. How will those difficulties be overcome so that the patients' representative can act for the patients?
Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)
A representative will be elected by the patients forum but, on balance, we believe that it will be better for him to be a full corporate board member. It guarantees patients a route through the system that does not exist now.
PALS and the independent advocacy service are the key organisations for the patient. Other elements in the system, such as the advisory forums for health authorities, are important in ensuring that patients and local communities have a voice. However, for individuals trying to find their way through the system, PALS and the independent advocacy service are the two critical elements. It is all about the experience of individuals.
We want to strengthen the patient's voice within the NHS. That is why we want to establish a patients forum for every trust and primary care trust. Subject to today's discussions, they will be statutory bodies independent of trusts. As I said, each forum will appoint one of its members to be a non-executive member of the local trust board. The patients forum will consider and comment on every aspect of trust care from the patients' perspective. They will also have the right to make inspections wherever NHS patients go—hospitals, doctors' surgeries, nursing homes and the private sector—and they will be able to make recommendations direct to the trust board, ensuring that patients' views are heard where it matters most.
Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)
If I may, I shall finish the point; it may help because I am reflecting on points raised in the debate.
We are convinced that we need to focus on the main organisational unit of the health service. I see from the amendments that that is the difference between the Liberal Democrats and the Government. However, an organisation at a greater remove would not be able to bring the patients' perspective to bear sufficiently sharply or effectively. If the experience of the patient is to change, real changes must be made to the operation of the organisation; it has to be brought to bear directly on the board and its chief executive, executive directors and medical directors that change is required. Establishing a patients forum is the first building block to in our attempt to strengthen the patient's voice in the NHS.
Dr Peter Brand (Isle of Wight, Liberal Democrat)
I wanted to ask a more detailed question. The Minister spoke about the Bill's provisions applying in those areas of trusts where patients have access. Will inspections be made of mortuaries, chapels of rest, kitchens, laboratories, laundries or—not far from him locally—sterilising departments?
Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)
The hon. Gentleman makes a fair point. The strict interpretation of the expression ``anywhere that patients go'' might be used to exclude—
Mr John Maxton (Glasgow, Cathcart, Labour)
Order. I hate to interrupt the Minister, but there are amendments on exactly that point later in the Bill, and it might be better to deal with it then.
Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)
I am grateful to you. We shall clarify the point later.
Mr Desmond Swayne (New Forest West, Conservative)
Earlier, the Minister was asked about the future of Casualty Watch and similar publications. My understanding was that he thought that patients forums would be the proper place for them. Would he go further and make a stronger commitment? Will he make it his business to ensure that such publications find new publishers within the patients forums?
Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)
My difficulty is that the fear that Secretaries of State or Ministers would tell patients forums what to do persuaded us—as a reassurance—to make them independent statutory bodies, and that precludes me from instructing them to do anything of the sort. It is our expectation, however, that patients forums will undertake specific or general monitoring activity. That is important as an allegation has been made—and repeated this morning—that the aim of the exercise has been to remove from the system of scrutiny in the NHS any organisation or body that could play that role. That is not the case. Patients forums will be as able to carry out that role, as CHCs have in the past.
Mr Paul Burstow (Sutton & Cheam, Liberal Democrat)
I am grateful to the Minister for giving way so often on the details of the provision. In response to the hon. Member for New Forest, West (Mr. Swayne), he said that the Government's concern was to establish the bodies on a statutory basis so that there was no doubt that they could not be told what to do by the Government. Why have the Government chosen not to establish the area advisory committees on a statutory basis?
Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)
We believe that the powers of direction that require health authorities to set them up will be adequate. We shall debate that later, but in terms of safeguarding the independent patients'voice in the system, which has been the main focus of debate and concern, establishing the patients forum on a statutory basis was the right thing to do.
We have had a slightly odd debate. On one hand we had allegedly not consulted and on the other hand we were accused of making it up as we went along. The reality is that we have published a set of proposals and we have listened to what people have said about them. Some of the detailed legislative proposals that we are considering and some of the policy points that I am making reflect that discussion. Our approach remains intact, but we have sought to build in some of the safeguards that right hon. Members or people in CHCs felt were necessary and that is a perfectly proper way to proceed.
Dr Liam Fox (Woodspring, Conservative)
The Minister has been talking about the accountability of the trust unit and the role of the patients forums, but much of what the trust does will be influenced by either the health authority's policy or the resources that it distributes to the trust. How will they be held to account?
Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)
I am not sure I have grasped the point that the hon. Member for Woodspring is trying to make. In a previous sitting we discussed the general system of performance management for trusts, but that is a slightly different issue. If the hon. Gentleman is inquiring whether patients forums or local authorities' scrutiny committees will be able to form a view about the level of resources or their deployment within the health service, the answer is that they will be able to do that. That is quite clear. Nothing in our proposals would constrain those bodies in that way.
Dr. Fox rose—
Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)
I should move on. Perhaps we could discuss the detail later.
Dr Liam Fox (Woodspring, Conservative)
I was not trying to catch the Minister out. I was simply looking for clarification. In respect of the availability of a particular treatment or drug, for example, how would the patients forum guarantee representation of patients' rights given that the policy on such matters comes from the health authority and not the trust?
Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)
The patients forum would be able to take a view on any aspect of the care that was offered by a hospital trust or primary care trust. There are many health authorities that already discuss prescribing policies, in broad, strategic terms, with forums established at local level. We would expect that to happen. The proposal for advisory forums is built on the existing work of health authorities in conducting strategic, consultative forums at a local level. If one is seeking a group of patients that is able to take a view on the care that is offered to a patient in a particular provider part of the health service, the patients forum is just such a group. That is an issue that has been raised, and it is a matter for debate. We are focusing on the provider structure in the NHS, for the reasons that I have given. That is a matter of deliberate choice on the part of the Government.
I should like to cover a few relevant points. Although we have touched on it only briefly this morning, there is a case for ensuring that the individual patients forums are properly supported and that patients are properly represented at a level above the local. That issue was raised by the right hon. Member for North-West Hampshire (Sir G. Young). We are working with a group of patients' organisations, including the patients forum, the long-term medical conditions alliance, and the College of Health, with whom we have funded a study, which is under way. The report on the study will be available in March.
The study is concerned with establishing the best way of doing two things: providing a national focus for the new system of patient representation, and identifying the type of support that should be offered to patients who use the system. That is covered in the briefing that we circulated a few days ago. It is important because it may be necessary to take a broader view, and it will certainly be necessary to learn from current best practice in making the new system work as effectively as possible.
Dr Doug Naysmith (Bristol North West, Labour/Co-operative)
It has been said that CHCs will be in existence until 2002. They are currently backed up by ACHCEW. Will the Minister confirm that funding for CHCs and for ACHCEW will continue until that date?
Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)
The NHS plan has set 2002 as the date on which the new system will replace CHCs. I see no reason to vary that timetable. We are committed to continuing funding, to ensure that there is no gap in between the two systems.
Amendment No. 241 suggests that we should run the new system before getting rid of the old system. That is an interesting idea. If the previous Administration had decided to keep the publicly managed railways going until we saw whether privately managed railways would work, we might not be where we are with the transport system. Clearly, it is important to ensure that there is a proper transition from one system to another. That is an issue not of legislation but of management. We must ensure that there is a proper transition. In practice, it would not be possible, financially or organisationally, to have a double running of the new system and the current system. I will ask the Committee to resist amendment No. 241.
There will be other elements. We touched briefly on the local advisory forums. We envisage those as relating to the strategic planning function of a health authority, both in response to the new duty of consultation, and to involve the public in priority assessing and planning. We want to take a flexible approach, building on what is good locally, but we envisage a core panel of patients and public, including representatives from patients forums and a wider pool of representatives.
I want to mention the overview and scrutiny committees. Local authorities are establishing those committees to scrutinise local government decisions, and the Bill extends their role explicitly to include scrutiny of the NHS. That will help to address the democratic deficit in the NHS. Health bodies will be required to provide information on local services to the overview and scrutiny committee, and it will make reports and recommendations to the NHS bodies that it reviews. If a trust does not act on the recommendations of the overview and scrutiny committee, it will have to justify that decision.
Over the past few months, we have been talking and listening to the views of stakeholder groups, including CHCs, on how to build on what is good and maximise the potential of a new system. Some of the measures before the Committee today are the direct result of that dialogue—specifically, the status and independence of patients forums, the commitment that I have made to commissioning of independent advocacy, and the feasibility study on the creation of a national patient body. Those developments help to show the work that we have done.
The clause follows, rather than leads, the decision to adopt a more effective and focused, and in some ways more broad ranging system of patient and public representation in the NHS. We should support it and resist the Opposition amendments so that we can make progress in establishing and, later today, discussing the detailed elements of, the new structure.
Dr Liam Fox (Woodspring, Conservative)
It is fair to say, in summary of the arguments that have been advanced, that even the CHCs themselves would not claim to be universally excellent. They have more than willingly accepted that there are shortcomings in many areas. However, some of them are excellent, as the Minister mentioned in his remarks to the Committee. Logically, that is an argument for reform rather than abolition. Some CHCs work very well, which proves that they can work well and provides an argument for bringing them all up to that standard. The rationale adopted by the Government in clause 14 seems to be that any organisation is to be judged by its poorest exponent, and that that should trigger abolition. That would be a very harsh test to apply to any Government organisation, never mind Government personnel. It smacks of a conclusion reached before its justification has been properly considered.
The Government's handling of the matters that we have been discussing has been appalling. I am sorry that the Minister expressed no regret for that and did not apologise to the CHCs, which have been treated disgracefully, especially as they were not consulted about the contents of the plan and had to hear it, like everyone else, from the Prime Minister's lips. Staff who have given great service have been discarded in an unacceptable way. There is ample precedent for shadow authorities. It makes sense not to leave patients vulnerable until it is possible to be sure that a new system will work properly. There is a growing feeling, which has been reinforced today, that Ministers are making all the new systems up as they go along. For the reassurance of the public I want to press amendment No. 241 to a vote.
Question put, That the amendment be made:—
The Committee divided: Ayes 6, Noes 10.
Division number 3 - 6 yes, 10 no
Voting yes: Peter Brand, Simon Burns, Paul Burstow, Liam Fox, Desmond Swayne, George Young
Voting no: Adrian Bailey, Ben Bradshaw, John Denham, Lorna Fitzsimons, Michael Jabez Foster, John Hutton, David Jamieson, Kali Mountford, Doug Naysmith, Ian Stewart
Division number 4 - 10 yes, 6 no
Voting yes: Adrian Bailey, Ben Bradshaw, John Denham, Lorna Fitzsimons, Michael Jabez Foster, John Hutton, David Jamieson, Kali Mountford, Doug Naysmith, Ian Stewart
Voting no: Peter Brand, Simon Burns, Paul Burstow, Liam Fox, Desmond Swayne, George Young