Schedule 1 - Constitution of public benefit corporations
Health and Social Care (Community Health and Standards) Bill
4:15 pm
Ms Hazel Blears (Parliamentary Under-Secretary (public health), Department of Health; Salford, Labour)
We have had an interesting debate on a broad range of amendments, which deal with the electoral system and wider governance issues. I shall deal first with Government amendment No. 218 and amendments Nos. 127 and 130, because they are about the electoral system. I shall come to the amendments of the hon. Member for Oxford, West and Abingdon later.
The introduction of local accountability through the Government arrangements that will apply to NHS foundation trusts is a key part of our policy. All trusts will need to ensure that their governance arrangements provide for the full range of members' interests to be represented, with a proper balance between the different interest groups within the membership. It is important that the process for selecting the representatives of the local community, who will sit on the board of governors and help to shape policy, is fair and transparent, which is why the legislation ensures that the governors who represent patients, the public and staff must be chosen by election.
It is essential that the governors represent the interests of the constituency that elected them, so Government amendment No. 218 provides that
members may elect governors only from within their own constituency. That makes it clear that members of the public constituency elect public members of the governing body, who will be in the majority, and that members of the staff constituency elect the staff representatives. The amendment maintains the integrity of the two different sections of the constituency in the Government arrangements.
On amendment No. 127, the legislation as drafted deliberately allows the NHS foundation trusts the flexibility that they need to ensure that the membership and board of governors are genuinely representative. Some NHS foundation trusts might want to take steps to ensure that minority interests, particularly in areas of deprivation, are properly represented. I take issue with the hon. Member for Oxford, West and Abingdon describing the governance arrangements for NHS foundation trusts as golf club-style membership. Nothing could be further from the truth.
With the introduction of new arrangements for public and patient involvement in the health service, including the Commission for Patient and Public Involvement in Health, the advent of patient forums and the duty under section 11 of the Health and Social Care Act 2001, the thrust of Government policy for several years has been to widen the number and type of people who can take part in shaping the service. We have given a commitment in legislation and in practice to support all our institutions in going out into communities to find, and to put at the centre of the NHS, people whose voices have rarely been heard—they might be those in inner-city communities, homeless people, elderly people, young people or those with mental health problems.
I happily agree with Members that that is not easy to achieve. Creating mass-membership organisations is difficult, but I am tremendously disappointed by Opposition Members who seem to think that because it is difficult, we should not bother trying. I urge all Members to see that the attempt to get a better, more representative group of people involved in our public services is something we need to pursue.
I want to maintain the flexibility of the system to allow NHS foundation trusts to reflect their communities. Trusts might want to have weighted electoral colleges, particular geographical constituencies or constituencies of interest. We should leave it to them to make proposals, with the safeguard of having the support of the local community when they go out for consultation. There are three safeguards: community support, the support of the Secretary of State and the support of the independent regulator. The process will be robust. It is important that the electoral system is open and flexible enough to allow for different models.
I am sorry to say to the hon. Member for West Chelmsford that the amendment does not make a great deal of sense. Normally, under the first-past-the-post voting system, a single person is being elected from a group of candidates. The circumstances that we envisage are elections being vigorously contested by a wide range of candidates and people voting five, or
perhaps 10, members on to a board. In those circumstances, it would be difficult to use a simple first-past-the-post system to elect people who will properly reflect the health service. However, it is for NHS foundation trusts to deal with that in their constitutions.