Mr Paul Burstow (Sutton & Cheam, Liberal Democrat)

I beg to move amendment No. 44, in page 6, line 20, at end insert—

`( ) as to the commissioning of independent advocacy services and requirements placed on any officer of a local NHS body or other specified body to assist the advocacy service in discharging its duties,'.

Mr David Madel (South West Bedfordshire, Conservative)

With this it will be convenient to take the following: Amendment No. 237 in clause 9, page 8, line 8, at end add—

`(4) It is the duty of every body to which this section applies to commission independent advocacy services to support any formal complaints made against that body and to support patients' use and access to services provided by, or under arrangements made by, that body.'.

New clause 5—Patient Advocacy and Liaison Services—

`.—(1) The Secretary of State shall make regulations requiring all NHS trusts and Primary Care trusts to set up services to be known as Patient Advocacy and Liaison Services (PALS) and making provision for such services, including the establishment of links with Patients' Forums.

(2) It is the duty of each PALS to provide advocacy services to patients both in relation to everyday use of services provided by, or under arrangements made by, the relevant trust and in relation to complaints, including formal complaints, about the provision of such services.

(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 Paul Burstow (Sutton & Cheam, Liberal Democrat)

Welcome to the Chair of this Standing Committee, Sir David. We are having very interesting deliberations. I want briefly to address this group of amendments, which deals with two related issues. The first is independent advocacy, which we spent some time discussing in the broader debate that we had this morning. We now come to the more specific details of how we are to secure that independent advocacy. The second is the further examination of the proposals for the patient advocacy and liaison services staff, which are not in the Bill but were referred to in the Government's explanatory notes.

Amendments Nos. 44 and 237 deal with the question of advocacy and would enshrine in the Bill the Government's commitment to providing the funds and the necessary regulations to ensure that independent advocacy services are established. They would also provide that whoever is responsible for funding those services--the pay and the rations--be it a local authority or a health authority or some other potential commissioner of these services, it is able to ensure that the advocacy service can operate effectively on behalf of patients. It should ensure that any NHS body it deals with understands that it should signpost patients to the advocacy service when that is appropriate, and should set out when that would be appropriate so that there is no doubt about that. It should also ensure that the various agencies within the trusts are willing and able to co-operate with the advocacy service.

New clause 5 also deals with the role of patient advocacy and liaison services. Even at this late stage, we should reconsider the name of these services, especially as the Government have not been persuaded of the merits of including in the Bill provisions governing the operation of this particular function within trusts. This morning we were told that many people in hospital who want to complain are not aware of the existence of community health councils. I fear that confusion will be sown by calling it an advocacy service, because, on any standard definition of that role, the post will not actually operate as an advocate. We are in danger of causing confusion. This is not merely a point of semantics. People will be confused when they consider the range of bodies that they are asked to deal with when they have problems with the NHS. We need to be careful about the language we use so that we minimise that confusion. I hope the Minister will comment on that, because we currently have two bodies that use the term advocacy in very different ways.

New clause 5 seeks clarity on the boundaries between PALS, the independent advocates and the patients forums. It would enable the Secretary of State to use regulation-making powers, and would at the very least allow further scrutiny, through secondary legislation, of the details of how PALS will be rolled out and operated on the ground. That is why we tabled these amendments. We do not want to diminish the value of such services within trusts—that has not been our argument—but this important role should have a statutory basis. That is what new clause 5 asks for, but if the Government cannot accept the amendments, I hope that they will be willing to table similar amendments.

How soon will the Government make proposals on advocacy services to guarantee that they are secured? How do they intend to secure the funding arrangements? Will there be new funds? Are funds already included in the comprehensive spending review, or will additional moneys be made available to fund the development of a comprehensive network of advocacy services? On the face of it, the comprehensive spending review does not contain the wherewithal to fund that significant expansion throughout the country.

I look forward to the Minister's response, and I hope that it will be positive.

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

I, too, welcome you to the Committee, Sir David. We have had some productive sittings, and I am sure that that will continue under your chairmanship.

It is an interesting group of amendments; they would be contradictory if we were to accept them all, but they allow us to explore the issues involved. The hon. Member for Sutton and Cheam (Mr. Burstow) asked whether PALS should be a statutory body. We envisage the service being one of the functions of trusts, and such functions—the specific services provided by trusts, such as running out-patients clinics or doing operations—are not provided for in primary legislation. It would therefore be rather odd to include PALS in the Bill. The hon. Gentleman will have noticed, however, that under later amendments we shall provide the means by which a failing PALS or one that had been neutered by management could be taken out of the trust. If those later amendments are accepted, we shall, in a roundabout way, have provided some protection of the advocacy and liaison service.

We disagree with the hon. Gentleman on independent advocacy to support patients through the formal complaints procedure. We have been persuaded by CHCs and others that that formal role needs to be separate from the advocacy and liaison service role. New clause 5 would seem to put PALS in charge, but we would not want that. Nor do I agree that the independent advocacy service should be provided by the local authority scrutiny committee, but where it should go is something for further discussion. There are two possible models of providing the independent advocacy service. It could either be commissioned by the health authority—the obvious choice—or by the local authority. In turn, the local authority could be either the commissioner of the service or a provider of the service, commissioning the service from itself.

At this stage, it is better to allow further discussion and even some local flexibility. Funds will clearly be needed. We may take a similar route to that taken for CHCs, which is to use the regional health authorities for that purpose. There are clear attractions in locating the advocacy service in a local authority, particularly if, as we suggest in the explanatory document, the authority were to provide the secretariat for the patients forum in the area. That would mean a concentration of staff; they would be working for the same service in the same location. It is better that the Bill is not too prescriptive. Discussions are continuing with the health service, the Local Government Association, CHCs and other patient groups. A clear line suggests itself, and we want to discuss it in more detail.

It has been a brief debate, but I hope that I have responded to the major points raised by the hon. Member for Sutton and Cheam.

Mr Paul Burstow (Sutton & Cheam, Liberal Democrat)

I am grateful to the Minister for having clarified one or two matters. In return, I shall clarify the thinking behind new clause 5. It is not intended to substitute powers for the provision of the independent advocacy service, and the Minister is right that it would be inconsistent for the other two amendments to be read alongside it.

The Bill should place a specific obligation on the Secretary of State to ensure that advocacy services are commissioned, even if we are not specific about the commissioner. Will the Minister suggest whether there would still be an opportunity for a legislative amendment if consultation on the matter were concluded before the conclusion of the passage of the Bill?

Although we may come back to these issues later, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Mr Paul Burstow (Sutton & Cheam, Liberal Democrat)

I beg to move amendment No. 45, in page 6, line 20, at end insert—

`( ) as to the composition of the committee so as to include representatives of the voluntary sector and the Patients' Forum'.

Mr David Madel (South West Bedfordshire, Conservative)

With this it will be convenient to take the following amendments: No. 25, in page 6, line 33, at end insert—

`(g) as to information which the committee shall make available to Patients' Forums.'.

No. 75, in page 6, line 33, at end insert—

`(g) requiring the committee to liaise with the Patients' Forums on matters of concern raised by the Patients' Forums,

(h) as to matters allowing the committee to set up local enquiries with the power to call for evidence,

(i) as to matters allowing the committee to refer matters of concern to NICE, CHI, the Audit Commission and the Secretary of State.'.

Mr Paul Burstow (Sutton & Cheam, Liberal Democrat)

These amendments are about representation and how we ensure that the overview and scrutiny committees are not made up only of local councillors, important though their contribution to the scrutiny process will be. As with other local committees, the scrutiny committee will deliberate on the interests and expertise of others. In the context of the amendments, I am thinking of the role of the voluntary sector in our communities, and also the scrutiny role of those serving on patients forums—or, as we would prefer, a patients forum for each locality. We need to establish firm links between the role of the overview and scrutiny committees and the role of patients forums, so that we can avoid issues falling between stools. An overlap of membership would go some way towards addressing that concern.

The amendments deal with the type of information that will be available to patients forums. We want to establish clearly in the Bill obligations on the exchange of information between the overview and scrutiny committees and patients forums. I am sure that the Minister will tell us that that will happen anyway, but we have been told by Labour Members that the CHCs have not performed as well as they might, despite the fact that the regulations that establish them are detailed. All that I ask is for a reference point in the Bill, to make the fact that communication should take place between the two bodies clear and indisputable. The bodies are important to the establishment of the Government's framework for the new overview and complaint systems in the NHS.

Mr Desmond Swayne (New Forest West, Conservative)

I add my congratulations to you, Sir David, on taking the Chair. It is always a tremendous pleasure to address the Chair, especially when you occupy it.

I understand the rationale behind the amendments tabled by the hon. Member for Sutton and Cheam. I share his anxiety about creating an interlinking network between the patient advocacy and liaison services and the scrutiny function. That is important, especially as those who participate in the PALS will have had experience of complaint handling, and will have powers of inspection. An avenue for the passage of information should be opened up.

My concern is about the nature of the membership of the overview and scrutiny committees. I have always regarded such committees as an opportunity to redress a perceived—and, I think, real—lack of democratic accountability in the health service. It is therefore proper that the members of those committees should be elected councillors. By introducing co-opted members as full members of such committees, would we weaken that principle? That is my only concern with the amendment.

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

The first two amendments seek to prescribe, through the Bill and through regulations, the relationship between the patient forums and the overview and scrutiny committees, in a way that goes beyond what is desirable or necessary. We understand the need for patients forums and scrutiny committees to work together. Although that is desirable, the bodies have different roles, and they must exist separately. The amendments would go too far in trying to merge their functions, at least at the edges. Patients forums are about bringing patients' views into the NHS, for every trust. The scrutiny committees are about scrutinising the way in which the NHS is developing and delivering its services locally.

There will, in practice, be plenty of scope for co-operation between the two bodies. Under the local government legislation enacted last year, scrutiny committees already have the power to co-opt and involve people who are not elected councillors as members of the committee. I agree with the hon. Member for New Forest, West (Mr. Swayne) that that should be under the control and in the gift of the democratically elected councillors. It should not be set out in regulation by central Government that scrutiny committees should co-opt a certain number of such people under certain circumstances. It is better for that to remain the prerogative of the committees.

Similarly, it will be useful for pertinent information to flow and be shared between patients forums and scrutiny committees, not least to enable them to understand each other's perspective on local issues. However, it is overly bureaucratic to set out in regulations exactly what information should be passed around. There is nothing in our proposals that prevents scrutiny committees and patients forums from sharing relevant information. I hope the hon. Member for Sutton and Cheam accepts that we are not trying to block the co-operation that he seeks, but that there is a difference between us over whether such co-operation should be prescribed by the legislation.

Amendment No. 75 raises different issues. The scrutiny committees would be able to refer matters to the Commission for Health Improvement, to the National Institute for Clinical Excellence, or to the Audit Commission. The Commission for Health Improvement will often be the most appropriate body to which to refer issues that are raised in the course of scrutiny, because of its powers to investigate the management, the provision and the quality of local health services. Under existing legislation, the CHI can accept referrals from any individual or body, so the provision is already there for scrutiny committees to make such referrals. A committee would not have to limit itself. It could make its concerns known to the Secretary of State, or to regional offices of the health service.

I have more difficulty with the idea of scrutiny committees establishing local inquiries. The hon. Member for Sutton and Cheam did not say a great deal about that in his opening remarks, and I may have misinterpreted him, but we could be in great danger if we were to have a plethora of bodies that were all able to set up independent inquiries into the same incident or series of events. Normally, inquiries in the health service are set up under health service legislation. They may be less formal, and be set up by the organisation itself—the health authority or the regional office on behalf of the Secretary of State. More formally, they may be set up under, for example, section 84 of the 1977 Act, which is the legislation under which the Bristol inquiry was established. Under exceptional circumstances, powers under the Tribunals of Inquiry (Evidence) Act 1921 may be used, as in the case of the inquiry into Harold Shipman. The CHI may also set up an independent inquiry.

We do not need to add another formal system for establishing inquiries into that field of provision. Clearly, in the broader sense of the word, scrutiny committees will inquire into various issues. They will be able to call in chief executives, ask about the accident and emergency departments or the provision of maternity services or whatever issue they choose to scrutinise. They will hold inquiries, rather like Select Committees. However, that is not the same as looking into a formal clinical incident, such as happened in Bristol.

Mr Paul Burstow (Sutton & Cheam, Liberal Democrat)

I am grateful to the Minister for commenting on that point. Certainly the intention behind the amendment is not to set up a second-guessing exercise around such important inquiries, but perhaps to consider issues of reconfiguration and performance. The Minister said that the Bill should not be too prescriptive about the provision of information. Does he accept that the Bill already contains considerable powers to stipulate what information can and cannot be provided by NHS bodies? Why cannot the Secretary of State stipulate what information should be exchanged between patients forums and overview and scrutiny committees?

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

The provisions on information are to ensure that the legislation reflects the safeguards that are provided in the wider operation of scrutiny committees in looking into local government services. They do not govern the flow of information from one body to another. I suspect that we are at one in wanting to see a useful flow of information between the two bodies. That would be eased considerably if we were to combine the secretariat and support for these functions within, say, a local authority.

Mr Paul Burstow (Sutton & Cheam, Liberal Democrat)

We welcome the proposition in the briefing notes that local authorities should provide the secretariat. Local authorities may well provide the glue in the new system that pulls it all together. If so, that will be very welcome. However, it would be strange if there were Chinese walls between the different institutions when it came to information exchange. We want to ensure that that does not happen.

The Minister usefully referred to the danger of a plethora of bodies undertaking inquiries. I share that concern, and may come back to that point. I welcome the fact that the Minister is seeking plenty of opportunities for co-operation between these bodies. Therefore, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Mr Desmond Swayne (New Forest West, Conservative)

I beg to move amendment No. 243, in

page 6, line 20, at end insert—

`( ) as to matters relating to co-operation between the health service in the authority's area and providers of personal social services in that area'.

Amendment No. 243 need not detain us long because all it does is to add an item about which regulations may be made concerning the scrutiny committees. It strikes me as an obvious that co-operation between the health service and providers of personal social services should be included. I cannot imagine any circumstances in which a scrutiny committee would not consider that issue. There is a long history of institutional barriers between the NHS and the providers of personal social services, although much progress has been made in recent years in breaking down those barriers and moving forward to a better agenda. The creation of this new scrutiny function provides yet another institutional opportunity by which to pursue that agenda. As we are here to help, I thought we should place it in the Bill.

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

The hon. Member for New Forest, West is right about the need to be able to scrutinise both health and social services. I am advised that this is not a necessary provision, and that the combination of the measures that we are taking in this Bill and those that are already in the Local Government Act 2000 make it possible for scrutiny committees to undertake that function.

Mr Desmond Swayne (New Forest West, Conservative)

In view of what the Minister says, I accept his assurances and 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. 187 in

page 6, line 32, leave out `or other specified body'.

This is a minor amendment concerning the arrangements that the scrutiny committee will make with the NHS for its scrutiny. The Secretary of State is permitted under the terms of this clause to make regulations concerning the requirement for NHS officers to appear before the scrutiny committee. It is envisaged, for example, that the scrutiny committee may call the chief executive of the trust to account twice a year. The scrutiny committee will assess, among other things, how well the trust has carried out its duties to consult and involve the public under clause 9. It is not necessary for the Secretary of State to be able to regulate for any ``other specified body'' to appear before the scrutiny committee. It should be just involve the health service, so the amendment removes the reference to ``other specified body''.

Mr Desmond Swayne (New Forest West, Conservative)

I was intrigued about who else the Government thought might have been summoned when they drafted the clause, given that they have now changed their minds?

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

Ours is not to speculate on the workings of the minds of parliamentary counsel. Various suggestions are made to Ministers to be helpful, but after close scrutiny it is sometimes possible to identify helpful things that one should not take a power to do.

Amendment agreed to.

Mr Desmond Swayne (New Forest West, Conservative)

I beg to move amendment No. 244, in

page 6, line 33, at end add--

`( ) requiring any member of an overview and scrutiny committee who is also a member of a Health Authority, NHS Trust or Primary Care Trust not to take part in the discharge by the Committee of the functions described in subsection (1) above.'.

It strikes me that there is an opportunity to discuss at some length Dame Fritchie's report on appointments in the NHS, but given the lateness of the hour, and knowing that we only have until 10 o'clock, I shall pass up that opportunity.

There has been a sharp increase in the number of local government representatives, to which Dame Fritchie's report bears testimony. I commend that report to all members of the Committee. NHS trusts, PCTs and health authority boards will inevitably have a not insignificant number of councillors of a political persuasion. It will make nonsense of the scrutiny function if members of local authority scrutiny committees scrutinise the responsibilities that they have discharged as board members. The amendment is entirely proper, as it would require them not to do so, and would exclude such conflicts of interest from the Bill.

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

I am happy to accept and to echo the sentiment behind the amendment.

Dr Peter Brand (Isle of Wight, Liberal Democrat)

I am grateful to the Minister, and I think he is sensible to accept the spirit behind this amendment. Would he go a little further and say something about members of social services committees and those members of the executive of local authorities who are responsible for social services matters? They, too, should not be members of this scrutiny committee, as with joint commissioning the same conflict of interest may well arise.

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

The hon. Gentleman makes a helpful point. A conflict of interest may arise in a number of different circumstances with the operation of overview and scrutiny committees. The Department for the Environment, Transport and the Regions is working with the Local Government Association to produce a code of conduct for overview and scrutiny committees across a range of possible conflicts of interest, including financial conflicts of interest and conflicts of responsibility. We are working together on that code.

I understand that a draft code of conduct will be published within the next two weeks; it will certainly be available before the full parliamentary scrutiny of the Bill has been completed. It is worth saying that executive members on local authorities cannot be members of overview and scrutiny committees, but the hon. Member for New Forest, West makes a fair point about councillors who may also be board members.

Mr Desmond Swayne (New Forest West, Conservative)

When the Minister said that he accepted it, I thought for a moment that he meant the amendment and not merely the sentiment behind it. In view of what he has said about the imminence of the code of conduct, 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. 188, in page 6, line 34, leave out subsection (4).

Mr David Madel (South West Bedfordshire, Conservative)

With this it will be convenient to discuss the following: Amendment No. 227, in page 6, line 37, at end insert—

`(4A) Regulations under this section may also provide for functions under section 21(2)(f) of the Local Government Act 2000 to be performed under joint arrangements, to be determined locally, between a county council and any or all districts within the county council area.'.

Government new clause 9— Joint overview and scrutiny committees etc.—

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

We flagged up this group of amendments and the Government new clause before lunch. We are trying to set up an improved joint scrutiny committee structure that allows flexibility for local authorities and for the NHS. Amendment No. 188 and Government new clause 9 allow for a range of options from which local authorities may choose the most appropriate format.

The new clause allows two or more authorities, which can include district councils, to form themselves into a single overview and scrutiny committee to scrutinise health organisations. If a district council joins with a county council, the scrutiny is the county council's responsibility; the county council therefore remains in the lead.

The new clause provides for two or more authorities whose scrutiny committees are responsible for scrutinising the NHS to give the lead to one authority so that it exercises the others' functions in relation to health scrutiny. Two or three local authorities could agree that one of them would exercise the scrutiny function. The clause also provides for a county council and a district council to arrange for the district to undertake the county council's responsibility of scrutinising health services in the district. That is likely to happen when a primary care trust is being reviewed. The clause provides for a county council to co-opt one or more district councils' OSC members on to its own OSC; and the county council may also co-opt district council OSC members if the county is part of a joint scheme with another OSC.

The aim is to allow flexibility and to enable the building of local scrutiny models that are fit for the purpose. The clause specifies that regulations relating to the joint arrangements will set out the circumstances and conditions under which joint schemes can be established. It should be noted that district council involvement in the joint scheme arrangements will be set out in regulations.

As I said earlier, the lead will always be with local social services authorities, and regulations and directions may also provide for those circumstances in which authorities will be required to put joint scheme arrangements in place. The regulations that relate to the normal arrangements for scrutiny and review of the NHS by OSCs will also apply to the scrutiny and review of the NHS when joint schemes are in operation.

New clause 9 provides real flexibility for local authorities when undertaking

their health scrutiny role. It will result in the most effective use of resources, and when appropriate district council involvement can be included. The Committee will know that that has been a particular concern to the Local Government Association and will have noted that the LGA has warmly welcomed new clause 9 in its briefing note.

Mr Desmond Swayne (New Forest West, Conservative)

I shall not go back over ground that was covered this morning on amendment No. 245. However, I had hoped that the Minister would say rather more than that the regulations will cover the operation of the overview and scrutiny committees. I seek some understanding of how the Minister sees the system operating. Many people, including myself, are not clear about how it will operate and how the local authorities will divide up the patch between them.

We know of the correspondence from Epping Forest district council, but I shall quote the Democratic Health Network, as it is time that it had a second outing after its tour de force last week, which provoked a response of stony silence from Labour Members. It states:

``one health scrutiny area might include a Health Authority, several PCTs, a Care Trust and several acute Trusts as well as services provided under partnership arrangements''.

If, as a minimum, we expect the scrutiny committee to deal with the chief executive twice a year, its burden and work load may be significant. I would like to follow the Minister's concept of how the overlapping local authority responsibilities knit together. Rather than simply being told that regulations will provide that the process works, I want an understanding of how it will work.

Dr Peter Brand (Isle of Wight, Liberal Democrat)

Clearly, our amendment No. 227 is in the spirit of Government new clause 9. I recognise that the new clause is essential in areas not blessed with coterminosity, such as the Isle of Wight.

Will the Minister explain how the joint committees will address the democratic deficit that he says is behind some of the changes? Committees will be composed of democratically elected individuals who may be democratically accountable as individuals. However, I cannot see that a joint body of perhaps four or five local authorities, and a local authority that perhaps has to service two or three joint authorities, creates a direct link between a democratic process and the scrutiny that is so important to the community. We will not end up with anything more directly accountable than a CHC, as it has elected members.

The nearest pattern that I could think of was the local land drainage committees, one of which I was a member of for some years. They travel around the country and see splendid things, but have no influence over anything. I am concerned that we will set up a mechanism to produce window dressing that is not accountable for the work that it does. I would like the Minister to explore what would happen on a joint committee, as opposed to a lead authority, if members of it or the sub-sets of the lead authority committee were of completely different political flavours, persuasions and backgrounds.

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

As a former member of a land drainage committee, I can bring relevant knowledge to bear on the subject. I recall that the committee often involved an extremely good lunch, and that a suspiciously large number of farmers who owned low-lying land seemed to be co-opted on to it.

I understand the points that both hon. Members raise. Guidance will clearly be needed about how local authorities come together, although we would want to leave some flexibility for people to work matters out locally. I shall take the example of the Southampton and South West Hampshire health authority, which I share with the hon. Member for New Forest, West. It is clear that there would be cases where there would be a desire to scrutinise the overall strategy—the health improvement plan and so on—of the health authority. At the very least that would require co-operation between Southampton city council, which is a unitary authority, and Hampshire county council. Other areas, such as that of the operation of primary care trusts in Southampton, might be solely a matter for the unitary authority in Southampton, because it happens in its area. Some flexibility in arrangements on topics is likely to be necessary, over time. It would not be possible or desirable for us to prescribe, from the centre, exactly what arrangements should be made in each case.

I do not agree with the hon. Member for Isle of Wight (Dr. Brand) that because two authorities come together the democratic element is lost. After all, both organisations are democratic, and would need, within the guidance, to agree on the way in which they brought their functions together. Such co-operation would provide a sensible and practical way for the scrutiny committees to operate at local level. One would expect reports to be made not just to the NHS body that is being scrutinised, but to the host local authority, to be considered by the wider body of council members.

Dr Peter Brand (Isle of Wight, Liberal Democrat)

On a practical point, would it be possible for the joint authority to publish minority reports, or would that depend on the report going back to one of the host authorities, which would then evaluate it. I doubt whether there can be a mechanism for doing that, as it would be very difficult. In the Minister's own patch, where Eastleigh and Romsey share health services, there are two distinct views of how those services should be delivered by the local authorities.

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

First, minority reports are, and would be, possible under the scrutiny committee approach. During the scrutiny process, one would expect different local perspectives to come through from the councillors who were involved. The process is not a way of expressing the view of the local authority per se. It is a similar scrutiny process to those that apply to other local authority services. I do not see any major difficulty in local authorities sensibly co-operating with each other, and being able to explore, through the scrutiny process, all the relevant issues. Surely that is the most important point. The LGA was keen to make a similar provision for district councils for fear that a particular local perspective, or view of a topic, would otherwise be lost. With the new clause, we are ensuring that such perspectives are not lost.

Dr Peter Brand (Isle of Wight, Liberal Democrat)

I fully agree with the latter part of the Minister's reply, but he also implied that we were talking about pure scrutiny. I thought that the new body would take over the strategic planning commentary, which was such an important part of the role of CHCs. Clearly, such a commentary is not just a matter of scrutinising what is currently happening, but of monitoring the direction in which local health provision is moving. That can be very different for different authorities—some may gain and some may lose.

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

The hon. Gentleman is right, and I had included, in my mind, the scrutinising of those major reconfigurations within ``scrutiny,'' so we agree on that. The hon. Gentleman seems to be concerned that the Government would somehow try to run the system so that geographically distinct or minority views were corralled into a wider body and thereby suppressed. I understand his concern. We must deal with that in the guidance on when scrutiny committees can come together to share their functions. I acknowledge his point, but that is something for which we can make proper provision.

Amendment agreed to.

Question proposed, That the clause, as amended, stand part of the Bill.

Mr Desmond Swayne (New Forest West, Conservative)

Although our debates have covered most aspects of the clause, it is still not clear how local authorities will find the resources to discharge the responsibilities that we are placing on them. We have been given no inkling. Equally, our debates on the amendments have made it clear that those who will be discharging the scrutiny function will not have the benefit of having handled complaints or of having been inspected, which are two vital elements of scrutiny. In my view, those three counts place a large question mark over the fundamental nature of the clause.

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

There is some danger of going over old ground, but it is the Government's view that enabling local government to scrutinise the health service is a step forward because it will allow them start dealing with the democratic deficit in the NHS. It is inevitable that the pattern of health provision will not map directly on to local authority provision. We therefore need to make flexible arrangements to allow that to happen effectively. As scrutiny committees develop their role, they will gain great expertise, prove to be effective and, for the first time, bring a democratically elected local authority voice into shaping health services.

I acknowledge, as I have throughout, that it will be useful for the scrutiny committee to be informed by a range of information provided by the NHS, patients' organisations in general and patients forums, which undertake the inspections. We have set out in the explanatory notes a number of arrangements to ensure that it happens. I believe that it will be an informed process of scrutiny.

Question put and agreed to.

Clause 7, as amended, ordered to stand part of the Bill.