Schedule 1 - Constitution of public benefit corporations
Health and Social Care (Community Health and Standards) Bill
4:00 pm
Ms Hazel Blears (Parliamentary Under-Secretary (public health), Department of Health; Salford, Labour)
We have said in the guide that there will be extra resources available to help with the process, because it is a new process and it is right that it should be taken forward. I do not have a global figure because we are in the early stages. I have no doubt that, as the process continues and we get to the second and third waves, there will be economies of scale and some central administration, thereby minimising the costs. We do not want to incur extortionate costs for the process. We want to spend enough money to ensure that it works and is effective, and that it is a real process of engaging members rather than a sham organisation that does not achieve what we want.
I think that I have said enough about the amendments in general terms. Amendment No. 97 would require the constitution to define the public constituency. I am sorry to tell the right hon. Gentleman that the amendment is unnecessary. It is not that I dislike it, but the schedule requires the constitution to define the public constituency. Paragraph 3(1)(a) states that the constitution shall set out the public constituency. It was important to make the point about defining the public constituency, but the constitution will have to put that forward and the public constituency will vary from some of the examples we have heard today. It may be one local authority area or two, depending on patient flow and the constituency that the organisation serves. That is sensible because the public constituency must reflect the people who feel a genuine stake in the organisation. The constitution will define the area and will be subject to assessment by both the Secretary of State and the independent regulator when deciding whether that application should go forward as having a sufficiently robust constitution.
Amendment No. 125 is, I am sorry to say, unacceptable also because it would circumscribe the area of the public constituency into an area covered by a primary care trust or family care trusts, which are principal providers. It is difficult to define accurately what a principal provider would mean in practice and there is an enormous range of primary care trusts with which prospective NHS foundation trusts could have contracts; it could be from one PCT to practically all of them. The right hon. Member for North-West Hampshire cited the example of Moorfields eye hospital. In that case, services commissioned from any PCT amount to no more than 2 per cent. of any activity of an individual primary care trust. A small number of patients may be involved, but the hospital may be a principal provider in its particular field of clinical activity for most if not all PCTs in the London area because that is where they seek to refer their patients.
To give a contrasting example, services commissioned in the North Tees and Hartlepool NHS trust account for 62 per cent. of services provided for Hartlepool PCT, 48 per cent. for North Tees PCT, 34 per cent. for Easington PCT and only 9
per cent. for Sedgefield PCT. That trust is the principal provider for Hartlepool PCT and could account for more activity than any other single provider for North Tees and Easington PCTs, but, clearly, not for Sedgefield PCT. There are a variety of circumstances and it is not appropriate to try to circumscribe that matter in the Bill. The amendment would be confusing, impracticable and unworkable and I suggest that it should be rejected.
Amendment No. 175 would provide that all patients should fall within the public constituency part of the constitution. Again, that is not appropriate. NHS foundation trusts should have the flexibility to shape their constitutions to meet individual circumstances. Some specialist centres take patients from all over the country. Many teaching hospitals provide a wide range of services to people outside the area. The hon. Member for South Cambridgeshire gave the example of Addenbrooke's and Papworth hospitals; in both cases, it might be appropriate to include patients and carers from outside because they are specialist trusts.
My local hospital has a neuroscience centre for the whole north-west of England and it may be appropriate to take patients from outside the area. Other trusts provide almost all their services within a well-defined geographical area and may provide the one local hospital. In that case, it might not be necessary to include provision for patients who live outside the area. It is a matter of horses for courses. They may treat a small number of patients who come on holiday or pass through while at work, but that will be a matter for local constitutions to deal with, so it is inappropriate to put that in the Bill.
Amendment No. 118 seeks to define further the definition of carer to include the families of patients who have been treated. We have included provision for the carers of patients to be eligible for NHS foundation trust membership. When a patient is too ill or unable to carry out their duties as a member or governor, a carer can do that in their place, which is perfectly proper. A patient's principal carer will often be a family member. To extend that further by allowing other people in the family to become members of the NHS foundation trust would allow a single patient to exercise undue influence through the multiple votes of their family, so we shall reject that. When the carer of the patient is a member of the family, they will be entitled to be a member of the public constituency, but we would not want that to be extended to the whole range of family members who may at some point be involved in the care or attendance of the patient. I can imagine a situation in which an extended family of perhaps 10, 15 or 20 members might be involved and that, clearly, would be excessive.