Mr Paul Burstow (Sutton & Cheam, Liberal Democrat)

I beg to move amendment No. 85, in page 9, line 21, after `established', insert

`, the overview and scrutiny committee, the ILAF, the Health Authority,'.

Mr David Madel (South West Bedfordshire, Conservative)

With this it will be convenient to take new clause 6—Independent Local Advisory Forums—

`.—(1) The Secretary of State shall make regulations requiring every Health Authority to set up a body known as an Independent Local Advisory Forum (ILAF), and making provision for such bodies, including the establishment of links with Patients' Forums.

(2) It is the duty of ILAFs to provide independent advice to the Health Authority in determining the health priorities for the area and will be made up of residents of the local area including representatives from the local Patients' Forums.

(3) Before making regulations for the purpose 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 Paul Burstow (Sutton & Cheam, Liberal Democrat)

We have probably trodden this path several times today, but I want to refer again to the non-statutory basis of the independent area consultation bodies that are being established by the Government, but which is not covered in the Bill. During our discussions on the abolition of CHCs and their replacement, I began to wonder if anyone had drawn lines on a chart to show the connections between the various bodies, and I thought that I would have another look at the NHS plan to see whether there was a chart to help me navigate my way through the system. There is not, nor is there a chart in the briefing notes that we were provided with in advance of the sitting.

I imagine that a chart does exist, but I have not found the right document. It would be useful to see such a chart that showed the lines of accountability for the new bodies, their lines of appointment, the lines of communication between the bodies, the lines of authority for the gathering of information and details about from whom it can be gathered. That would provide us with a better understanding of how the different entities will operate with each other. That is why I want to return to the matter of the local advisory forums.

Earlier, the Minister said that the Government wanted to assure themselves and the public of the independence of patients forums—and rightly so. He said that the best way in which to secure such independence would be to give them a clear statutory basis. However, for some reason a body that has within its title the word ``independent'' does not need to have a similar statutory basis. Simply to call a body independent does not make it independent, so I tabled the amendment to give the Government a further opportunity to consider including in the Bill a measure that would deal with that problem.

The matter about which I am concerned is not the same as that regarding PALS. The Minister rebutted the amendments that dealt with the patient advocacy and liaison services on the basis that they were specific, managed services within the NHS. My argument is not about a managed service, but about the accountability mechanism that the Government want to put in place. It should have a statutory basis—at least as clear as the one that CHCs have had until now. Not to outline that in the Bill will be a cause of constant concern. It will give rise to the possibility of a considerable divergence of practice from one health authority to another.

Moreover, as a result of the reconfiguration of health authorities in London, we shall have large health authorities in London and probably in other parts of the country, too. Those bodies may have to consider whether one independent advisory forum is necessarily the appropriate structure. I hope that the Minister will give some further thought to how a statutory basis for the bodies can be secured in the Bill, so that they can act genuinely independently of health authorities when giving their advice to the authorities about the priorities for the local health economy. Without that, the patients forums that are independently based in statute will perhaps not have enough confidence that they should have in a body to which they will be obliged to provide information. I hope that the Minister will not only give us some reassurances on this matter, but will say how a statutory base could be provided.

Mr Philip Hammond (Runnymede & Weybridge, Conservative)

I have just a brief comment in support of what the hon. Member for Sutton and Cheam said. We have already discussed the issue of independent local advisory forums, and it seems anomalous that they are not provided for in the Bill. May I ask the Minister a specific question? If they are to be established using the Secretary of State's powers of direction, is he then going to have to use his powers of direction, or regulation making, again, to require health authorities and trusts to provide information to them? It is not simply a question of directing that they be created, or creating them, it a question of creating the web of reporting requirements and answerability that, in the case of CHCs, is provided for because of their statutory basis. In seeking to avoid one small extra clause in the Bill, is not the Minister creating quite a complex requirement for secondary legislation and directions, in order to ensure that the ILAFs can get access, as of right, to all the information that they need, and can require health authorities and other bodies to provide them with essential data and essential access?

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

On the latter point, the hon. Gentleman is quite right to mention that the Secretary of State has a range of powers to ensure that the information is provided. The very existence of those powers is the biggest reason why he would not need to use them all in the explicit way that the hon. Gentleman has suggested. The powers are there, if they are needed.

It is a debateable point whether the advisory forums would be significantly stronger if the whole plan of structure and constitution regulations had been put in the Bill. Given the function of the ILAFs as an advisory forum for the health authority, the Secretary of State's power of direction, the ability that we have to ensure that the patients forums are representatives within the advisory forums and our keenness to allow the sort of flexibility that can deal with the problem—identified by the hon. Member for Sutton and Cheam—of health authorities wishing to approach this role in different ways, we have preferred not to put it on the face of the Bill. I agree that this is a debateable point, but I do not believe that anything is lost by doing it through directions from the Secretary of State, and that will be proven to be the case in years to come.

Mr Philip Hammond (Runnymede & Weybridge, Conservative)

At the beginning of his remarks, the Minister said that the existence of these powers of direction that the Secretary of State has makes it very unlikely that he will ever have to use them. That was a welcome recognition from the Minister, and I hope that he will reflect on it, and it is precisely the point that Opposition Members have been trying to make throughout our proceedings. Where the Secretary of State takes powers as reserved powers, he effectively hangs a sword of Damocles over the organisations that are threatened by them. The Minister has acknowledged that, where the Secretary of State has reserved powers, he probably will never have to use them, because the mere threat of those being used is enough to ensure that the whole organisation, the whole NHS, runs in the way that the Secretary of State wants. That is not as a result of transparency, of over-regulation or directions given, but merely because the organisation is required to interpret the drift of Whitehall thinking, knowing that the Secretary of State has those significant reserve powers available to him. What the Minister has said is a significant comment on the whole architecture of this Bill.

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

Let me make it quite clear that none of the powers to make information available are powers that have been taken by this Government, they are ones that were enjoyed by previous Secretaries of State. The hon. Gentleman's point is therefore somewhat fatuous, unless he can explain why previous Conservative Secretaries of State did not give up those powers. I am sure that he would not want to get into that.

Mr Philip Hammond (Runnymede & Weybridge, Conservative)

Without wanting to take up the Committee's time, let me say that the Minister knows that my hon. Friend the Member for Woodspring has expressed the view that, were he to occupy the job that he covets—Secretary of State for Health—he would seek to reduce the power of that office, recognising something of the point that the Minister just made. The powers to which I refer are those that the Government are giving to the Secretary of State in this Bill. Those powers appear to give the Secretary of State dramatic rights to intervene in the running of trusts and health authorities. The Minister soothed the Committee by saying that those rights would be exercised only in extreme cases. He has just explained that the mere existence of those rights is enough to ensure that the will of the Secretary of State will be done throughout his empire.

Mr Paul Burstow (Sutton & Cheam, Liberal Democrat)

The hon. Gentleman is clearly not persuaded by the argument, and unfortunately, the Minister is not yet persuaded, except that he has accepted that it is still debateable. Perhaps we can work on that and persuade the Minister of our case in due course. He did not address the question that I asked about provision of information about lines of accountability and so on. Does such a chart exist yet? Has one been drawn? It would be useful to see it. If there is one, when will it be published?

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

It is not a map of the universe. Patients forums relate to trusts; local government has a scrutiny function; ILAFs help shape the health authority's direction; the independent advocacy service supports those patients who cannot be helped through the PAL system. The idea that it is a cat's cradle of accountability is not the way the system works. The functions have been identified clearly. It is then necessary to make sure that adequate liaison takes place, at the right points, between the different elements. I am not sure what kind of chart the hon. Gentleman means, but it betrays his lack of understanding of the proposals.

Mr Paul Burstow (Sutton & Cheam, Liberal Democrat)

I do not know whether it is a lack of understanding or a desire to understand what the Government are introducing. As the Committee has progressed, it has become more and more apparent that the Government do not have a clear idea of how the arrangements will fit together. I understand that, given the nature of the Committee, the Minister cannot give us a PowerPoint presentation of such aspects. Painting pictures as the Minister has just done makes it difficult to grasp what is the interface between such bodies. Surely it is not beyond the wit of the Department to provide a simple organisation chart, so that we can see how the different bodies work together.

I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Mr Philip Hammond (Runnymede & Weybridge, Conservative)

I beg to move amendment No. 253, in page 9, line 25, at end add—

`(3) A report prepared under this section shall be published in such form as the Secretary of State shall direct within 28 days of the date on which it is submitted to him.'.

The amendment would require the publication by the Secretary of State of a patients forum annual report. Currently, the Bill provides that the report will be delivered to the Secretary of State. We merely seek an assurance that it will be placed in the public domain. If the Minister can give that assurance, I shall be delighted to withdraw the amendment.

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

It will be in the public domain.

Mr Philip Hammond (Runnymede & Weybridge, Conservative)

I am grateful to the Minister. It is a shame that that is not stated in the Bill, but I accept what he has said. In those circumstances, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 12 ordered to stand part of the Bill.