Clause 14 - Abolition of community health councils in england
Health and Social Care Bill
10:30 am
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.