Dr Peter Brand (Isle of Wight, Liberal Democrat)

I beg to move amendment No. 46, in page 8, line 9, leave out `Secretary of State' and insert

`local authorities specified in section 7(2)'.

Mr David Madel (South West Bedfordshire, Conservative)

With this it will be convenient to take the following amendments: No. 47, in page 8, leave out lines 10 to 12.

No. 48, in page 8, line 16, leave out `trust' and insert `trusts'.

No. 49, in page 8, line 18, leave out `trust' and insert

`overview and scrutiny committee and relevant trusts'.

No. 50, in page 8, line 20, leave out `trust' and insert

`overview and scrutiny committee and relevant trusts'.

No. 51, in page 8, line 25, leave out

`A Patients' Forum for a'

and insert `In respect of'.

No. 52. in page 8, line 25, leave out `Trust' and insert `Trusts a Patients' Forum'.

No. 53, in page 8, line 33, after `Authority', insert

`and overview and scrutiny committee'.

No. 54, in page 8, line 35, after `Authority', insert

`and overview and scrutiny committee'.

No. 55, in page 9, line 4, leave out `for' and insert `duties in respect of'.

No. 42, in clause 12, page 9, line 21, leave out `trust' and insert `trusts'.

No. 43, in page 9, line 21, leave out

`for which it is established'

and insert

`it covers and the establishing local authority'.

No. 60, in clause 13, page 10, line 5, leave out `trust' and insert `trusts'.

Dr Peter Brand (Isle of Wight, Liberal Democrat)

I was grateful to have an opportunity to speak in the clause stand part debate on clause 9 because it was so relevant to clause 10. It is right that each trust should have a patients forum, but it also important that these patients forums do not become the tame possession of that trust. I hope that we are not seeing a statutory establishment of leagues of friends of particular hospitals, and particular trusts. My experience of lay involvement, and some of the criticisms of community health councils voiced earlier today, shows that the lay public are well disposed towards health providers as a rule, and there is a great risk of them going native—if one dare use that term.

Our amendment would result in the patients forums becoming a more cohesive power. While it is important that they have a link with the trust, it is equally important that they are required to work collectively. This could be within the health authority area, but we have chosen to go the route of the local authority area, which would match the arrangements that we have already established.

It is important that patients forums are seen to be representative of the public, rather than representative of the trust. For that reason, we suggest that the local authority, mirroring the arrangements that we discussed earlier, should be the umbrella body for these patients forums. This would increase the local accountability, rather than the direct trust influence.

Mr Desmond Swayne (New Forest West, Conservative)

I have a question, which follows on from what the hon. Member for Isle of Wight has said. We are told that the membership for the patients forums is to be drawn from local patient and voluntary groups—he is right to point out the importance of the voluntary groups—of which the league of friends will be one. Half of them will be drawn from the respondents to the trusts' annual surveys. The explanatory notes go on to say that members of the public who will be appointed to the patients forums must have been treated, or still are being treated, by an NHS trust or by a PCT.

I suspect that a significant portion of those being treated by trusts are children or are elderly and infirm. It is most appropriate that those who care for these patients should be allowed to sit on the forums, because they will have a great insight into the problems of, and the services provided by, those trusts. The requirement that those serving on the forum must have been recently treated or still being treated, leaves out a whole category of people who would be very useful to the forum.

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

The hon. Member for Isle of Wight raises a number of issues. First, should the forum relate to the trust or cover a wider area? Secondly, will the forums become of the trust rather than relating to the trust—in other words, will they loose their independence? Thirdly, the relationship with the local authority was raised. The fourth issue, raised by the hon. Member for New Forest, West, is whether the broad proposal that we have set out for membership is right for the function of the patients forums.

The patients forums will be independent of the trusts to which they relate because the provisions of the Bill establish them as independent and statutory bodies, because they will be funded separately to the trusts and because they will have clear powers in relation to the trust. Their membership will be appointed by the independent appointments commission, rather than by the trust. They will be able to select a non-executive director of the trust and will have the powers to carry out visits and inspections, which we discussed earlier. They will have specific functions.

Under clause 9, we discussed the patients prospectus, but I omitted to say that we intend the patients forum to have the right to sign off the patients prospectus. The fears that were expressed about a glossy document saying how wonderfully the trust was doing will not be realised. The patients forum will need to agree that what the prospectus says about patients' views is correct. For all those reasons, the patients forum will be an independent structure.

The big question is whether the patients forum should relate directly to an individual trust or primary care trust or whether it should cover a wider area. There may be a simple philosophical difference between hon. Members on both sides of the Committee. The Government believe that the forum needs to relate to the particular organisation, its management structure, culture and ethos if it is to bring about change.

A patients forum that covered a wider area would have huge attractions in some ways, because not as many patients would be needed, it would not cost as much to run and so on. However, such a forum would be too remote from any individual organisation and its management structure to effect change on the patients' behalf. We may have to accept that there is a difference in view between hon. Members on different sides of the Committee.

None the less, it will be interesting to explore the potential relationship with the local authority, which is where the hon. Member for Isle of Wight sought to locate the larger patients forum. There are attractions in the idea that a local authority could offer a base or secretariat that supported a number of patients forums in the area. That would enable each forum to be individually independent and established in law. They would relate to an individual primary care trust or NHS trust, but share a common base or secretariat in the local authority. However, there are practical models of administration and co-ordination that would provide what we want to achieve, while delivering co-ordination across the patients forums in an area.

I said that the NHS appointments commission would appoint the membership. We envisage that part of the membership will comprise people who are or have recently been patients of the trust, perhaps drawing on people who have taken part in the annual patients survey. Others will come from local voluntary and patients' organisations. We are clear—probably clearer than the explanatory notes as I recollect—that carers must also be represented in the membership. They will form an important part of the membership of patients forums.

Dr Peter Brand (Isle of Wight, Liberal Democrat)

I am slightly confused. I think that we are covering amendments Nos. 81 and 82 at the same time as the constitution of the membership of the forums. I am quite happy to address that issue during this debate, because those are clearly exploratory amendments.

The Government are being too prescriptive by saying that the membership must be made up of past patients. Health care is not only about ill people, but about the larger community--people who want to avoid becoming ill and the steps that one can take and that trusts ought to take to promote that. I hope that the Minister will look again at the explanatory notes and the Bill, and not be quite as prescriptive on the membership of the bodies, because it will be difficult to find good people to serve on them anyway.

I am all in favour of more public involvement, but it must be real, rather than token, public involvement. I would not want to see the same busybody appearing on all forums at all times. Those of us who serve on voluntary bodies tend to meet the same people wearing slightly different hats—until, of course, they arrive in Parliament, having polished the front door plate often enough. As regards membership, it would be helpful if people could serve on more than one forum. For example, they might serve on a trust forum as well as an advisory body.

I was encouraged that the Minister recognised the need to support patients forums that relate directly to one trust, and that there is great merit in allowing or, indeed, requiring those forums to work together. In that way, members of the forums may not only develop a feel for what happens within the trust—I agree with the Minister that that is essential—but appreciate how that relates to the wider picture and other people's experience. Given those circumstances, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

I beg to move amendment No. 190, in page 8, line 22, at end insert—

'(da) in prescribed circumstances, to perform any prescribed function of the trust with respect to the provision of a service affording assistance to patients and their families;'.

The amendment provides for a specific element of power to be placed in the hands of patients, carers and representatives through patients forums. We believe that the patient advocacy and liaison services needs to be based in, and managed by, the trust and primary care trust. That is the way in which patients will be most effectively supported and assisted.

We recognise that such an arrangement might not work if the trust management were hostile. The amendment enables us to set up a system in which a patients forum that was concerned and able to show that a PAL service was consistently falling below acceptable levels of quality would be able to refer the matter to the Secretary of State, who could then specify that the PALS be withdrawn from the management of the trust or PCT, to be run in an alternative way. That would provide for the possibility of its being placed under the control of the patients forum. I regard that very much as a last resort and a long stop, and do not believe that it would be widely used. However, we have been convinced that it would be worth taking such a power as a protection against an advocacy and liaison service that was not allowed to operate effectively within the trust.

Mr Philip Hammond (Runnymede & Weybridge, Conservative)

The Minister has clarified what was in many of our minds—that is, what the Government had in mind when tabling the amendment. Will he explain a more general point that has troubled me? Why is it appropriate to establish patients forums through the Bill, with all the rigmarole that that entails, but not to establish the independent local advisory forum or the patient advocacy and liaison service in the same way?

From the remarks that the Minister made during the previous debate, it seems that the independent local advisory forum will be the key element in any strategic overview of service rearrangement. It might be argued that that is a more formidable and strategic function than the one performed by the patients forum. Why the asymmetry in the design of the arrangements?

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

With regard to PALS, as we discussed earlier, no comparable powers of functions of trusts are specified. With regard to patients forums and the advisory forums, the Secretary of State has the power, by directions, to do as the hon. Gentleman suggested. However, a patients forum established by direction of the Secretary of State to a trust would have too close a relationship to the trust to have the necessary independence of voice that people want from the system. We acknowledge in the Bill that the Secretary of State could have set up those bodies by direction.

A number of health authorities already adopt an advisory forum approach, which shapes their policy. I do not see that it needs to be independent in the same way, as it is an advisory body, a listening body, a sounding board and a body with which the health authority works in developing its strategic approach to the local health economy. The power that the Secretary of State has to establish it by direction will be sufficient. It is not playing the same role of representing the patient in relation to a specific organisation; that is a different function.

Mr Philip Hammond (Runnymede & Weybridge, Conservative)

I accept that distinction, but does the Minister accept that the ILAF is taking over what many people will see as one of the key functions of community health councils without the statutory backing in primary legislation that, for example, patients forums have? There is a suspicion that that amounts to a downgrading of that part of the CHC function?

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

I believe that, in practice, the advisory forums will be more effective, more powerful and more influential on the future development of strategy than CHCs have often been able to be, despite their statutory role. That is certainly our goal and it is how we intend to go about establishing them.

Mr Paul Burstow (Sutton & Cheam, Liberal Democrat)

In the briefing sent to hon. Members, we are told that these bodies will be combining the views and experiences of all patients' forums within the single health authority area. The briefing says that they are seen as the arena where patients can look across the health economy. Surely those functions are vital to securing the oversight of the whole system. Surely the bringing together of these matters should be footed firmly in the Bill and not be the subject of direction and discretion by the Secretary of State.

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

I do not believe that that is necessary. Given how clearly we have set out what we expect the organisation to do, the Secretary of State's powers of direction will be perfectly adequate.

Amendment agreed to.

Mr. Swayne: I beg to move amendment No. 249, in page 8, line 22, at end

insert—

`( ) to belong to and cooperate with any body established by regulation to represent at national level the Patients' Forums created under subsection (1) above'.

The Chairman: With this we may discuss amendment No. 29, in

page 8, line 24, at end insert—

`(f) to provide advice, and make reports and recommendations, about matters relating to those services, including patients' views on those services, to the Association of Patients' Forums, established under section (Association of Patients' Forums).'

New clause 3—Association of Patients' Forums—

`.—(1) The Secretary of State shall establish an independent national body, known as the Association of Patients' Forums, with a duty to provide a national overview of the patient experience to the Secretary of State and National Health Service bodies, on a regional and national level.

(2) The Secretary of State shall make regulations for the purposes of subsection (1) above.

(3) Before making regulations for the purposes of subsection (1) above, the Secretary of State shall consult such bodies as represent the interests of persons likely to be affected by the regulations.'.

Mr Desmond Swayne (New Forest West, Conservative)

When I looked at the great pile of briefs in my in-tray this morning, I was gratified to see that it appears that a large number of those providing the briefs find themselves in support of the principle that lies behind our amendment. That was certainly my understanding having read the brief from the Consumers Association, the citizens advice bureaux, the Royal College of Nursing and ACHEW—I do not know who thinks up these acronyms. The Association of Community Health Councils for England and Wales takes a strong view of the principle to which amendment No. 249 gives expression. That association will be abolished as a consequence of the Bill. There will, therefore, be no provision for a national body in England and Wales to provide an overview of the patient forums we have been discussing. That is an important role and there should be an umbrella organisation to provide a whole range of functions, such as staff training, particularly of volunteers, promoting the exchange of best practice and the provision of performance standards and expert advice, whether that be human resources advice, research and publications or legal services.

One of the complaints that we have heard repeatedly is that the service provided by community health councils was patchy—the word ``patchy'' has been used—and that it was not always of a uniform standard. That was when there was an umbrella body specifically to provide community health councils with a measure of the support and the sharing of best practice that I have described. Consider how patchy the performance of forums is likely to be without the provision for that central umbrella organisation.

It strikes me that, under the Bill as constituted, there is no provision to enable information about the NHS at a local level to be used to influence national policy, but an umbrella organisation for patients forums would provide that. People should be able to expect the same standard of representation from forums wherever they live. That would be fostered—and there would be a powerful engine for sharing best practice—if such an organisation were set up. On Second Reading, the Secretary of State implied that the Department of Health was considering the feasibility of forming such an organisation to act as an independent umbrella body. For all we know, that may even have been announced down at Fulham today, where I understand that further examination of such issues is strangely taking place. We believe that it is an important role, and the Royal College of Nursing believes that

``such a role is vital if patient forums are to operative effectively.''

What will be the relationship between patients forums and, for example, the Commission for Health Improvement inspectors? Will they work with patients forums as a matter of course? I digress slightly from the issue of an overarching body, but such a body would provide guidance to members. Nevertheless, it is a good question. Without a central body, who will be responsible for recruiting, appointing and training the servants of forums? What training will be given? How will they be funded? Will funding come via the health authority, the trusts or primary care trusts? Will the reports that they will inevitably publish be made public, and be a matter of public scrutiny? All those are issues that we would expect to be thrashed out by an umbrella body, thereby establishing best practice. If there is no provision for such a body, as is the case under the Bill, will the Minister say how such issues will be addressed?

Dr Peter Brand (Isle of Wight, Liberal Democrat)

Amendment No. 28 and new clause 3 try to achieve the same end. It is essential to have a national arena in which patients forums can share information, for two reasons. First, forums will be able to carry out their functions better at local level by networking nationally, and sharing experience and knowledge. After all, health authorities network and share experience and knowledge, as do trusts. It would be wrong to place the patients forums at a disadvantage. Secondly, it is important that the national strategic thinkers for this country's health system have access to a national body representing patients forums. The process would therefore work in two directions. That cannot be left to accident or whim; it must be established, if only to ensure that such an organisation is funded.

On a minor note, ACHCEW—a wonderful acronym—has been a fruitful source of Members of the other place with great knowledge of the national health service. I would hate the Government to be deprived of such expertise.

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

As I said this morning, we are sympathetic to the idea that there needs to be some form of national body to reflect patients' views. That is why we funded the first part of a study proposed by the College of Health, the Long-Term Medical Conditions Alliance and the patients forum, to which we have given £20,000 in the first instance. One of its aims is to identify the options for a national patient body.

The research brief states that

``a number of the demands arising from''

the Government's

``proposals are best supported on a national basis. For example, support for the recruitment, appointment and development of patient and public representatives; national guidance to ensure that work is properly undertaken. There are also questions about how best to pull-together and roll-up local information to ensure influence on regional and national services and policy developments. Fundamentally, there is a need to be confident that the new arrangements will ensure the system for involvement in the NHS is being strengthened''.

That is part of the brief that we are supporting.

The scoping study is regarded as the first stage in two subsequent studies on, first, the detailed design of a national patient involvement organisation, and, secondly, plans for its implementation. That study is already being supported. Among the aspects that it will examine are the scope for a new national body, its main roles and functions, the models of good practice and current capability that it should draw on and what, if any, formal powers and authority it would require. We are moving broadly in the direction suggested in the amendments, but I would not want to tie us to the specific models implied in the amendments. There is no need for the national body to be set up on a statutory basis, as has been agreed by some of the organisations that are taking part in the study. We are considering the issues that underlie the amendments.

Dr Doug Naysmith (Bristol North West, Labour/Co-operative)

Has my hon. Friend the Minister any idea how long the study will take and when we can expect results?

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

We hope to receive the results of the scoping study by 31 March, when we shall be able to move on to the other studies that I have mentioned.

Dr Peter Brand (Isle of Wight, Liberal Democrat)

I am in no way persuaded by the Minister, which is unusual, because he usually makes a strong case. I do not understand why we need research or a consultant to establish the scope for a national body. Perhaps he wants to be absolutely certain that a national body will be tied to ministerial restrictions, so that it restricts itself to comments on matters on which the Minister is prepared to receive representations. If we are to have a national body representing patients forums, it is for those patients forums collectively to determine the agenda of that body. The only study that the Minister must do is into how to fund it. Spending £20,000 on calculating how much it might cost to duplicate ACHCEW seems a waste of Government money. We are being presented with £20,000-worth of buying time and paying off organisations that recognise a need for a national presence on the matter.

Mr Desmond Swayne (New Forest West, Conservative)

The Minister said that the first of the studies would be received by 31 March. That strikes me as taking the Government out of any significant danger in relation to the Bill in Committee and, indeed, the House, although perhaps not so with respect to its passage in another place. We shall consider carefully what the Minister has said, and we shall consult outside bodies with a view to returning to this matter, or it may receive further scrutiny in the other place.

I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Amendments made: No. 191, in page 8, line 23, leave out

`by regulations made by the Secretary of State'.

No. 192, in page 8, line 33, at end insert `and the trust'.

No. 193, in page 8, line 35, at end insert `and the trust'

No. 194, in page 8, line 41, leave out

`(within the meaning of the 1977 Act)'.

No. 195, in page 8, line 43, leave out from `of' to `, and' in line 44 and insert

`section 31 arrangements in relation to the exercise of health-related functions of a local authority'.

No. 196, in page 9, line 1, leave out `in pursuance of such' and insert

`(and not as part of the health service in England) in pursuance of section 31'.

No. 197, in page 9, line 3, leave out `subsections (2) and (3)' and insert

`this section--

``the health service'' has the same meaning as in the 1977 Act;

``patient'' includes (as well as a patient within the meaning of that Act) a person who receives services provided in pursuance of section 31 arrangements in relation to the exercise of health-related functions of a local authority;

``prescribed'' means prescribed by regulations made by the Secretary of State;'.

No. 198, in page 9, line 5, at end insert—

` ``section 31 arrangements'' means arrangements under regulations under section 31 of the Health Act 1999 (arrangements between NHS bodies and local authorities).'. —[Mr. Denham.]

Clause 10, as amended, ordered to stand part of the Bill.