Schedule 1 - Constitution of public benefit corporations
Health and Social Care (Community Health and Standards) Bill
2:30 pm
Dr Evan Harris (Oxford West and Abingdon, Liberal Democrat)
I should not need to be clear about why we have tabled a tier of amendments. Our preference is for direct democracy on a full scale in the commissioning side of the health service, whereby commissioners are elected not just by 50 or 500 people, but by an electorate of 50,000, and everyone has a vote on the policies put forward by elected commissioners who decide what services should be delivered where. That preference was set out in writing in our policy that was published and advertised last year. I have discussed it with the Secretary of State, so the Under-Secretary should be aware of it.
It is because of that preference that we propose that the public constituency should be removed in order for it to be a proper stakeholder mutual without a sham form of public democracy that would rival the true democracy on the commissioners' side. The Under-Secretary may not like the policy, but she needs to understand that it is a clear, published policy. It is incumbent on all parties to say, in the debate, what they would do differently.
I am not confident that amendment No. 213 will be successful. I do not think that the Government will accept it. It is therefore reasonable to have a second preference, given that we shall be forced to have a model with a public constituency. That electorate needs to be at least 500 for a typical organisation, but, as it is important to be flexible, it may be best to return with another amendment that mentions a proportion of the eligible people who might become members, rather than have a hard-and-fast figure. That approach deals with the issue that was raised about small hospitals in small communities versus large hospitals in large communities. It will be for the organisation to set that electorate by setting the boundary; the Minister has made that clear in earlier debates. It could be set at 1 per cent. or 10 per cent., just to show that there is public support.
I am sympathetic to the points made by the hon. Member for Epsom and Ewell, that to avoid entryism and the necessity for members of staff to go through the process, all members of staff should automatically be members. That is why we have an amendment that refers to a minimum number of members for the public constituency. I am trying to deal with the point that the Under-Secretary was making that implied that we would not have a staff constituency if we deleted ''each'' and replaced it with ''the public''. I am tempted to go down the line implied by amendment No. 69 in the next group, as set out, quite correctly, by the hon. Member for Epsom and Ewell.
In my rush to be brief in my four-minute introduction, I was wrong to imply that amendment No. 206 should be taken with amendments Nos. 176 and 177. I apologise to the Committee for that. Amendment No. 176 and amendment No. 177 should be taken together. Amendment No. 206 is part of a separate group of amendments, though selected with this one. We do not need to get into issues of constituency in the public if we adopt the proposals under amendment No. 206.
I apologise—as I have already done so privately—for being unreasonably grumpy with the hon. Member for Epsom and Ewell, who was pointing out that what I had said earlier was incorrect. It is amendments Nos. 176 and 177 that are grouped, and I certainly did not mean to criticise the person who drafted amendment No. 206, because that was me. It is part of another group of amendments, although it has been grouped with this one for debate.
We might wish to table an amendment proposing that a proportion of those eligible for membership become members in order for the Government to demonstrate that their proposals have public support. I can foresee a situation in which a hospital that is keen to get such freedoms will apply for NHS
foundation trust status, regardless of the views of the local authority, the overview and scrutiny committee or local people.
If there is no support for NHS foundation trust status in the local community, that could be got round by foundation trusts setting a very low minimum membership requirement. The Secretary of State is desperate to set up foundation trusts, and he will have little regard as to whether that is a realistic minimum number. I hope that the Minister will look kindly on the proposal to have a percentage minimum rather than a minimum number.