Mr Philip Hammond (Runnymede & Weybridge, Conservative)

I beg to move amendment No. 250, in page 9, line 6, leave out subsection (1) and insert—

`(1) Authorised members of a Patients' Forum shall be permitted (subject to subsection 2 below) to enter and inspect, for the purposes of any of the Patients' Forum's functions, premises owned or controlled by—

(a) a Health Authority, or

(b) a Primary Care Trust, or

(c) an NHS Trust, or

(d) a person providing services under Part II of the 1977 Act or under arrangements under section 28C of that Act.'.

Mr David Madel (South West Bedfordshire, Conservative)

With this we may discuss the following amendments:

No. 83 in page 9, line 6, leave out `may' and insert `shall'.

No. 84 in page 9, line 13, after `inspect', insert `by arrangement and unannounced'.

No. 251, in page 9, line 15, after `The', insert

`Secretary of State shall make regulations in relation to the powers granted under subsection (1) above, and the'.

No. 238, in page 9, line 16, leave out `cases and' and insert `exceptional cases or exceptional'.

No. 239, in page 9, line 16, after `is', insert `not'.

No. 252 in page 9, line 17, at end add—

`(3) The Secretary of State shall make regulations providing for—

(a) publication of a report of any inspection carried out under this section;

(b) submission of any such report to the body controlling the premises inspected; and

(c) publication of a response from the body controlling the premises inspected.'.

Clause stand part.

No. 86, in clause 12, page 9, line 22, at end insert—

`(1A) Every Patients' Forum shall also—

(a) prepare reports on matters arising from premises visited within 60 days and send the same to the relevant Trust, overview and scrutiny committee, ILAF, and Health Authority, which bodies shall be required to respond; and

(b) have the right to refer any matters to the Secretary of State for action in the event that it is dissatisfied with the response from the above bodies'.

Mr. Hammond: Amendments Nos. 250 and 251 would change slightly the architecture of this clause. Instead of ``allowing'' the Secretary of State to make regulations'', it would state that the Secretary ``may'' make regulations. The amendments would insert in the Bill the requirement to allow authorised members of a patients forum the right to enter the premises of certain health bodies—thus enshrining that right in primary legislation—and would require the Secretary of State to make the necessary regulations to govern the way in which that arrangement is to work.

We think that the right of patients forums to enter the premises of designated NHS bodies is so absolutely fundamental to the performance of their function that it must be written into the Bill, and not left as something the Secretary of State may do by regulations. We fully accept that there will have to be arrangements governing the exercise of those powers, which will have to be preserved in regulation-making powers by the Secretary of State.

Every member of the Committee will be familiar with the Casualty Watch bulletins produced by community health councils. One of the high profile and very important functions of community health councils is to monitor what is actually going on in hospitals. A picture speaks a thousand words, and a snapshot that Casualty Watch can provide over a 24-hour period often gives us a clearer view of what is really going on in an NHS organisation than all the statistics published--or not published--by the Department of Health. I will judge the Government's motive in making these changes to the NHS's overview and scrutiny arrangements by the output of the new bodies.

If we do not continue to see a regular flow of often very embarrassing Casualty Watch reports, which contradict assurances that Ministers give to the public and to the House, and if we do not see these new organisations blowing the whistle on scandals or irregular practices occurring around the country, then we will know that the Government, in making these changes, have not improved the scrutiny and oversight of the NHS: they have diminished it.

For that reason, we believe that the right of entry must be enshrined in the Bill. It must, of course, be properly hedged around by regulations to ensure that the exercise of those powers does not damage the clinical effectiveness of the premises being visited. We see no reason to delegate this to a regulation-making power that the Secretary of State may or may not exercise.

Amendment No. 252 enables the Secretary of State to make regulations providing for the publication of reports of inspections carried out under clause 11, the submission of those reports to the NHS body concerned and the publication of the NHS body's response to those reports. Anything less than that will not provide effective public scrutiny or enable the patients forums to perform their function effectively.

Mr Paul Burstow (Sutton & Cheam, Liberal Democrat)

I want to ask a couple of questions arising out of page 15 of the explanatory notes, to which my hon. Friend the Member for Isle of Wight referred this morning. It would be helpful if the Minister could provide some further clarification. Paragraph 69 talks specifically about access and states:

``Access will generally be limited to areas where patients are permitted access (including consulting or treating rooms) and to reasonable times agreed''.

My hon. Friend rightly identified a number of places where patients may not normally seek access. However, in discharging a patients forums responsibilities, they should properly have access to places such as the mortuary, kitchens, laundries and so on. It would be useful if the Minister could confirm that the explanatory notes are wrong and that it is the Government's intention to widen it in that way. If not, it would be unfortunate if the explanatory notes were taken to be the basis of what this clause is about.

I want to talk about the amendments standing in my name and that of my hon. Friend the Member for Isle of Wight. What we are seeking to do here, in the same way as the hon. Member for Runnymede and Weybridge (Mr. Hammond), is to turn this permissive power to make regulations into a duty on the Secretary of State to make regulations. We then want to go further and stipulate specifically in the Bill that the regulations should allow for unannounced visits. Unannounced visits are invaluable for getting a picture of how the NHS is performing, and when CHCs undertake such visits, they often uncover things that may not revealed if the trust is aware of the visit. It is important that the Government are clear and upfront that they intend and envisage that, in all but the most extraordinary of circumstances, it would it be possible, to undertake unannounced visits in the same way as CHCs do now.

Amendment No. 86 deals with the issue of reporting. It seeks to establish that, having undertaken such visits, patients forums should be reporting to the relevant trust after a period of 60 days. Also—this is important to establish the interconnections between the various bodies that are to replace CHCs—it deals with the fact that the forums should report to the overview and scrutiny committees, the ILAF and the health authority. All those organisations that have an interest in how the trust is performing should be in the picture in respect of what the patients forum has found.

Mr Philip Hammond (Runnymede & Weybridge, Conservative)

I understand what the hon. Gentleman is seeking to do. However, as he goes wider, is it not better simply to require publication of those reports, as our amendment proposes?

Mr Paul Burstow (Sutton & Cheam, Liberal Democrat)

Our amendment seeks to identify the specific bodies and to ensure that the channels of communication exist. As both our amendment and that of the hon. Gentleman are intended to establish the Governments' intentions, I should be happy to support his amendment if there were to be a Division. The key point is that we have greater clarity about reporting lines and that the material is put into the public domain so that scrutiny can be carried through. With that point, I hope that the Minister will be able to give some reassurances, especially about unannounced visits, because of the benefit that they can have for the oversight process.

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

We have made it clear that patients forums should be able to visit and to inspect any aspect of the care provided to patients. The clause provides the framework that enables us to meet that commitment. As the hon. Member for Runnymede and Weybridge acknowledged, we do not want the process to be adversarial or combative—it should be done responsibly and productively. The capacity to make unannounced and short-term visits must be an option available to the patients forum but, in the normal course of inspections, one would want a more structured approach.

There are key areas vital to patient safety and services that the patients forums should be able to inspect. Equally, there are areas of trust responsibility, such as accommodation provided to nursing staff, for which it is unnecessary to create a right of unannounced inspection by patients forums. However, by agreement with trust staff, patients forums might want to take an interest in that. We must draw a sensible line, but we have no intention of denying patients forums access to places under the right circumstances, when it is relevant to their work.

Mr Philip Hammond (Runnymede & Weybridge, Conservative)

Will the Minister give way?

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

I should like to make progress.

So that there is no misunderstanding, I want to be clear about the way in which access will need to be secured. We are dealing with different types of premises. It is relatively straightforward, legally, to make it clear through directions that access to NHS premises will be provided. However, it is not appropriate to legislate in the Bill about private premises such as GP premises, because it would raise European Court of Human Rights issues, among others. We intend to seek access to those places through terms-of-service changes for GPs and have notified the profession of that. We intend that access to private sector providers should be provided for within the contract that the commissioning NHS body enters into, as with access by the Commission for Health Improvement.

Mr Philip Hammond (Runnymede & Weybridge, Conservative)

The Minister will forgive me if I draw a stark contrast between what he said about access to private premises and the premises of private providers and the approach taken by the Minister of State, Department of Health, the hon. Member for Barrow and Furness (Mr. Hutton), in the consideration of the Care Standards Bill. Draconian powers in that legislation allow unannounced access by inspectors to private premises providing care to elderly residents, at any time of the day or night. Why is the Minister proposing a less onerous inspection system for the NHS than is imposed on private sector providers of care?

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

The system for NHS patients should not be any less effective than that for patients in the private sector, but the contractual relationships differ from those dealt with by the Care Standards Commission. I thought it important to set out the ways in which we intended to achieve the aims that we all share.

Two issues have arisen as matters for discussion. First, it is clear from the Bill that patients forums have a duty to make reports and recommendations to the trust to which they relate. That would include reporting on the findings of inspections and visits. I am not convinced that we need a requirement in the Bill to report formally and publicly every single visit, as that would be a bureaucratic imposition. However, we would expect the patients forums to be able to report in that way.

The hon. Member for Sutton and Cheam raised another question, which now escapes me. He may want to raise the matter again.

Mr Philip Hammond (Runnymede & Weybridge, Conservative)

I confess that the Minister's answer has not entirely satisfied me. Opposition Members seek to establish the extent and nature of the access that is granted and an assurance that, in practice, the reporting and publication of visit information will not be less satisfactory than is the case with community health councils. If the Minister can say that it is the Government's intention that any changes will mean greater access to premises and fewer restrictions, that will be of great reassurance to members of the Committee.

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

I am delighted to be of assistance. I can give that assurance.

Mr Philip Hammond (Runnymede & Weybridge, Conservative)

I am grateful to the Minister. We are concerned that that assurance is not reflected in the Bill. We shall think more about the matter and hopefully we can find a way in which to make sure that the hon. Gentleman's intention will be translated into the provisions. However, given what he has said, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 11 ordered to stand part of the Bill