'.—(1) The Secretary of State shall lay before Parliament within 12 months of the date of coming into force of this section regulations setting out a scheme for the reform of the Community Health Councils in England.
(2) The scheme set out by the Secretary of State in regulations under subsection (1) above shall extend to all parts of the health service (including the provision of Part II services under the 1977 Act).
(3) The Secretary of State may make regulations providing for access by members of a Community Health Council to premises from which services under Part II of the 1977 Act are provided.
(4) The scheme set out by the Secretary of State in regulations under subsection (1) shall provide for the proper representation of the population in the area served by a Community Health Council on that council.
(5) Regulations under subsection (1) may not be made unless a draft of the statutory instrument containing the regulations has been laid before, and approved by a resolution of, each House of Parliament.'.—[Mr. Burns.]
Brought up, and read the First time.
With this it will be convenient to discuss the following: new clause 5—Establishment of Patients' Councils—
'(1) The Secretary of State shall, subject to subsection (2) below, establish a body to be known as a Patients' Council ("Councils") in England in each area for which an overview and scrutiny committee has been established under section 7 of the Health and Social Care Act 2001 (c.15); each council shall be appointed from among members of relevant Primary Care Trust Patients' Forums and NHS Trust Patients' Forums operating in that area and representatives from relevant community interest groups.
(2) Where it appears to the Secretary of State that there is a need to establish a Council for an area other than that represented by a local authority with overview and scrutiny functions, he shall, after local consultation, establish a Council for such other area as appears to him will meet the needs of the local community.
(3) The functions of a Council are to represent the interests in the health service of the public in its district and in particular to—
(a) facilitate the co-ordination of the activities of member Patients' Forums including by the provision of staff and services to Patients' Forums,
(b) provide or make arrangements for the provision of services under section 19A of the NHS Act 1977 (independent advocacy services) at the direction of the Commission for Patient and Public Involvement in Health,
(c) represent to persons and bodies which exercise functions in its area (including in particular the overview and scrutiny committees and the joint overview and scrutiny committees mentioned in sections 7, 8 and 10 of the Health and Social Care Act 2001) the views of members of the public in its area about matters affecting their health,
(d) advise the bodies mentioned in subsection (4) on involvement of the public in its area in consultations or processes leading (or potentially leading) to decisions by those bodies or the formulation of policies by them, which would or might affect (whether directly or not) the health of those members of the public, monitor the effectiveness of this involvement and co-operate with the Commission for Patient and Public Involvement in Health in carrying out this function.
(4) The bodies referred to in subsection (3)(d) are—
(a) health service bodies,
(b) other public bodies, and
(c) others providing services to the public or a section of the public.
(5) The Secretary of State shall, following consultation with the Association of Community Health Councils for England and Wales, Community Health Councils, patients' and carers' organisations and the wider community, by regulation make provision in relation to Councils as to—
(a) the Patients' Forums and other community interest groups from which members of the Council are to be appointed,
(b) any qualification or disqualification from membership,
(c) terms of appointment,
(d) the proceedings of a Council,
(e) the discharge of any functions of a Council by a committee of the Council or by a joint committee appointed with another Council,
(f) the circumstances in which Councils will co-operate with each other in the exercise of their functions and exercise functions jointly with one or more other Councils,
(g) funding of Councils and the provision of staff, premises and other facilities,
(h) the preparation and publication by a Council of annual accounts,
(i) the provision of information (including descriptions of information which are or are not to be provided) to a Council by an NHS Trust, a Primary Care Trust, a Strategic Health Authority, the Commission for Patient and Public Involvement in Health, the relevant local authorities or a person providing independent advocacy services (within the meaning given by section 19A of the NHS Act 1977),
(j) the provision of information by a Council to another person,
(k) the preparation and publication of reports by Councils,
(l) the furnishing and publication by NHS trusts, Primary Care Trusts, Strategic Health Authorities and Overview and Scrutiny Committees of comments on reports or recommendations of Councils, and
(m) the referral of matters of a prescribed description to any overview and scrutiny committee, the relevant Strategic Health Authority, the Commission for Patient and Public Involvement in Health or the Secretary of State.
(6) The regulations shall include provision applying or corresponding to any provision of Part 5A of the Local Government Act 1970 (c.70) (access to meetings and documents).
(7) In section 21(10) of the Local Government Act 2000 (membership of overview and scrutiny committees) after the words "who are not members of the authority" there shall be inserted ("and shall include a person appointed by the relevant Patients' Council").
"(d) persons appointed by the relevant Patients' Councils.".'.
New clause 7—Duty of Secretary of State and Strategic Health Authorities to consult—
'In subsection 11(2) of the Health and Social Care Act 2001, paragraph (a) is omitted and the following is inserted—
"(a) the Secretary of State,
(aa) Strategic Health Authorities,".'.
New clause 8—Functions of overview and scrutiny committees—
'(1) In subsection 7(1) of the Health and Social Care Act 2001, after "recommendations" the words "and referrals to the Secretary of State" are inserted.
(2) In subsection 7(3) of that Act, after paragraph (a) there is inserted—
"(aa) as to matters relating to the health service in the authority's area which the committee may refer to the Secretary of State,".'.
Amendment No. 1, in clause 15, page 20, line 2, leave out Clause 15.
Government amendments Nos. 33, and amendment (a) thereto, and 34.
Amendment No. 2, in clause 16, page 21, line 4, leave out Clause 16.
Amendment No. 73, line 20, at end insert—
'(but for the purposes of this section "promises" shall not include the private living quarters of any person)'.
Amendment No. 3, in clause 17, page 21, line 31, leave out Clause 17.
Government amendment No. 37.
Amendment No. 4, in clause 18, page 22, line 13, leave out Clause 18.
Amendment No. 70, in page 22, line 27, after "Forums", insert—
'by the Commission for Patient and Public Involvement in Health'.
Amendment No. 63, line 27, leave out "other facilities and staff" and insert "and other facilities".
Government amendment No. 38.
Amendment No. 64, line 37, after "by", insert "a Patients" Council,".
Government amendment No. 39.
Amendment No. 65, in page 23, line 1, after "by", insert "a Patients" Council,".
Amendment No. 71, line 2, after "Authorities", insert—
'and overview and scrutiny committees'.
Amendment No. 72, line 3, after "of", insert ", or referrals from,".
Amendment No. 66, line 20, after "Forum", insert ", a Patients" Council".
Amendment No. 67, line 24, after "section 15" insert—
'and a Patients' Council under section [Establishment of Patients' Councils]'.
Amendment No. 68, in clause 19, page 23, line 43, after "Forums", insert "and Patients" Councils".
Amendment No. 69, in page 24, leave out lines 5 to 10 and insert—
'(g) coordinating and supporting the activities of Patients' Councils in respect of their activities provided for at subsection (3)(c) of section [Establishment of Patients' Councils],'.
Amendment No. 5, in clause 20, page 25, line 23, leave out Clause 20.
Amendment No. 11, in page 26, line 5, at end insert—
'(7A) This section may not be brought into force until the Secretary of State has issued a certificate stating that in his opinion the bodies established under section 15 are fully functional and performing their duties effectively throughout England.'.
Even at this late stage, new clause 2 will try to stop the Government making a pernicious and vindictive attempt to stifle any opposition to the abolition of community health councils. As most hon. Members in the Chamber will remember, there is a long history to this sad and sorry affair.
When the Government introduced the Health and Social Care Bill during the last Parliament, they tried to remove CHCs. They were ruthless in their determination to brook no opposition in this place, to have their way and to ensure that the CHCs were removed by what is known in common parlance as a patsy—a lapdog of an apology for a forum for patients who had grievances against the local NHS in their area.
Far too many people saw through that attempt to get rid of a "troublesome priest"—in the words of Henry II. The CHCs were a thorn in the side of the Government because they had the guts and the courage to represent the people they had been created to look after and to speak their mind about failure in the provision of health care locally or about injustice in the health service.
The Opposition and—to their credit—several independently minded Labour Members fought the case vigorously, but the Government steamrollered the measure through the House before the general election. However, their attempt to abolish CHCs was thwarted by the common sense and experience of another place. The Government had to drop their disgraceful proposal so as to ensure that the remaining contents of the Health and Social Care Bill reached the statute book before Dissolution in May 2001.
At the first opportunity in the new Parliament, the Government shamelessly brought back those proposals in this Bill, but for the life of me I cannot understand why. Community health councils were created as long ago as 1974. They represent and help members of the public within the orbit of the health service. They are independent bodies, which is crucial. They have teeth and power; for example, if a CHC does not agree with a health authority or a trust about a proposed hospital closure and formally objects, the proposal has to go to the Secretary of State for decision. They have built up tremendous expertise and experience in looking after patients, and the Under–Secretary will certainly be aware of that.
I shall come to the Under-Secretary's role a little later, but she will be aware that I believe that CHCs have done more than enough to justify their retention. On average, they assist about 30,000 people a year. A recent poll conducted by Health Which? found that 84 per cent. of those who had contacted their CHCs found the advice given to them very or fairly useful, which suggests an extremely high satisfaction rate.
Similarly, a recent report, "Hidden Volunteers", conducted by Community Service Volunteers, estimated that CHC members contributed through their dedicated work about £7.9 million worth of free labour to the NHS. No one in the Chamber would underestimate their work. They have been extremely brave. They have devoted a great deal of their time and effort to fulfilling their role, looking after those people whom it is their job to represent and help.
What do the Government want to do? They want to abolish CHCs. I shall not be convinced by their reasons for wanting to abolish CHCs, whatever the Under- Secretary says, because there is only one reason: they do not like opposition. Those who oppose them and have the temerity to embarrass them, by highlighting failings in their policy or in its implementation, have to be silenced because they are out of kilter. That is an extraordinary reason to get rid of any organisation, and I shall be particularly interested to hear the Under-Secretary's response. I have heard her response once before in Committee, and I suspect that it will be along similar lines today.
The Under-Secretary chaired Salford CHC from 1993 to 1997, so more than any hon. Member in the Chamber tonight she has a working experience and knowledge of how good CHCs are. I suspect that, between 1993 and 1997, she thought with justification—she chaired that CHC and she is an able individual—that Salford CHC was very good indeed at fulfilling its functions. I do not think for a minute that she wanted her CHC, or any other, to be abolished. As I am sure she would have said if the previous Government had proposed to abolish CHCs, they had an important, independent role to play, and they played it extremely well.
Sadly, times have changed, and the Under-Secretary will stand at the Dispatch Box later tonight to seek to persuade her right hon. and hon. Friends to sign the CHCs' death note, which is a staggering turnabout in four to five years. I do not believe that the quality of the work done by CHCs has deteriorated in four or five years to such an extent that it warrants their abolition. If the Government feel that CHCs have a patchy record or that improvements need to be made in some of them, why do the Government simply not reform them and change the law to improve and strengthen them? Surely that is the right way forward.
If satisfaction among CHCs' client group is high, if the perception is that they do a very good job in their local communities—the Under-Secretary was directly involved with them until relatively recently, and I assume that she thought that her CHC did a very good job, as I am sure it did—and if some of their functions could be performed even better, why not simply introduce legislation to strengthen and improve them?
Would we not have a very much better idea of why the Government propose to abolish CHCs if we had got round to discussing clause 20 in Committee? It is worth reminding ourselves that it was not discussed because of the ludicrous system of timetabling and programming Bills. We are blind about the Government's real reasons for wanting to abolish CHCs.
My hon. Friend is absolutely right to say that, because of the guillotine, the Committee had no opportunity to discuss what everyone considers the most important clause—clause 20. This, therefore, is the first time that we have been able properly to discuss the issue since Second Reading.
We attempted to discuss CHCs during debates on an earlier clause, but we are never able to discuss any amendment that we might have wished to move in Committee because of the tightness of that guillotine. I am grateful to my hon. Friend for making that point, and I hope that the report of his intervention will be read with keen interest, especially in another place, when it has to deal with the Bill later this year.
I have not followed the full detail of exactly which amendment the hon. Gentleman is talking about, but he will remember that, despite the guillotine, we had time to have a lengthy debate in Committee on whether CHCs could be reformed, not abolished, and that we voted on that amendment. We both agreed that we got little out of the Under-Secretary in terms of a considered response because she is passionate about her model, but most people prefer the model proposed in the new clause.
The hon. Gentleman is absolutely right. The only disadvantage or sadness about the debates that we managed to have in Committee was that they were related to earlier clauses on the back of the Government's proposals; we were unable to have specific debates on clause 20, solely under which CHCs will be abolished. The debate that we had was better than nothing, but we would have welcomed proper and full debate at the time on the specific clause that deals with the abolition of the CHCs.
The procedure that the Government have adopted to rid themselves of this network of councils throughout the country has been typified by a brazen lack of regard for the views of others. No doubt, those who support the Government on this issue will say that a consultation process took place. If they believe that, they will believe in a number of things that it is not wise to believe in.
When the Government sent out their consultation document, the basic assumption in point 1.5, which deals with this issue, was that CHCs would be abolished. The document did not ask whether they should be abolished, or whether they should be reformed and improved. It simply stated that
"the immediate focus of this document is the Government's intention to legislate at the earliest opportunity to replace CHCs."
That is really wonderful if one wants open, frank, straightforward and meaningful consultation.
Before discussion even began, the Government set down what they would do at the end of the process. If the views expressed in the submissions that they received from members of the public, people who have dedicated their lives to working for CHCs, hon. Members on both sides of the House, other organisations inside and outside the NHS and local authorities did not coincide with the criteria in point 1.5 of the consultation document, they were disregarded. That is what the Government have sought to do ever since they introduced their original legislation on the matter.
My preferred option is for retention, reform and improvement, which is what new clause 2 seeks to provide. It would give the Government a breathing space in which they could make proposals to improve and reform the existing structure. In no way do I support the Government's proposals, because they would not lead to the independent integrity of the complaints procedure and of the organisation for patients remaining intact.
Unfortunately, I am not confident that the Government are prepared to reconsider at this late stage and to abandon what they have been seeking to use their large majority to ram through Parliament. However, I know that some Labour Members will not be bamboozled into supporting such a Government poodle. When we discuss the other new clauses in the group, it will be interesting to hear the comments of other Members to hear precisely what their proposals intend to do.
The Government are making a great mistake and they do themselves no credit by sticking rigidly to their plan to ram clause 20 through the House tonight. I only hope that the other place gives careful consideration to the issue and to the comments of Members on both sides of the House. With its expertise and role as a revising Chamber, I hope that the other place will try to bring some common sense to the Government on this issue.
I wish to speak to new clause 5 and to its consequential amendments. It is worth making the point that all three main parties, as well as the Independent Member, have signed up to the new clause and that a number of outside organisations believe that it is the appropriate way forward. We have backing from the Patients Association, the Consumers Association, Age Concern, the Association of Community Health Councils for England and Wales, the Royal College of Nursing and several other important national bodies.
I shall briefly sum up the purpose of the new clause. I do not wish to speak at length, because the issue has been rehearsed several times in this Parliament, including on Second Reading, and in the last Parliament before the general election.
I have always been concerned that, since the inception of the national health service in 1948, there has been a lack of sense of ownership of the service by its users. It has been a challenge for successive Governments to address that question, and I am not sure that we have yet come up with a coherent solution. I have always been concerned that there has been a consistent lack of democracy in the NHS, particularly at a local level.
I have favoured a role for local government and I have been very conscious that the democratic deficit has been maintained by the concern of certain professionals—particularly in the medical profession—to obstruct what they regard as the political control resulting from politicians and elected people asking questions about the direction of the service at a local level.
Community health councils were advanced in 1974 as the patients' voice. I had the privilege of serving on a CHC from 1974, and was vice-chairman of one for many years before I became a member of the local health authority. It is fair to say that CHCs have had variable success. In some areas, they have done a first-class job in representing the interests of patients but, in others, they have been less effective.
I do not accept the statement of Mr. Burns that the Government do not like opposition and that their motivation for removing CHCs is the result of that. I believe that there are sound reasons for re-examining a system that since 1974 has, in some respects, served us quite well but, in others, not as well as it should have done. The time has come for reforms and I support aspects of the direction in which the Government are moving.
The previous Parliament considered the Health and Social Care Act 2001 and I recognise that it contained a number of positive elements. I certainly commended them at the time. I have always believed in an important role for local government, so I was very happy that the Government came up with the idea of having overview and scrutiny committees based in local authorities. They were given the power to object to key changes in policy, such as closures, and have the statutory function that CHCs have traditionally had.
I was always concerned that CHCs, as constituted, did not have a democratic mandate. Local authorities have such a mandate and are accountable to the electorate. Therefore, on issues such as closure and change of use, the local democratic system should play a major part and people should be able to express their views.
I also supported the idea of patient advocacy liaison services—PALS. The revised idea for PALS to be based in trusts to deal with complaints is a good one. I was in my local primary care trust only yesterday and saw the PALS organisation very well signposted. People can go there to seek advice and support, and I welcome that.
I also supported the proposal for patients forums. My concern was that there would be a need to examine the level above those forums in the local health economy, which is why we had an important debate on patients councils when we considered the Health and Social Care Act 2001. In a sense, we return to that debate tonight.
I believe that I had an agreement with the Under-Secretary's predecessors in the Department of Health before the election to include some positive elements of CHCs in the new framework. My slight concern, however, was that, when my amendments were discussed in another place, the Minister in the House of Lords gave a somewhat different version of patients councils than I had proposed in the Commons. Hon. Members who had followed the debate recognised that the emphasis was different in the two Houses, which is why it was difficult to get the proposals through the Lords.
I warmly praise the Under-Secretary's role, because she has gone out of her way to listen to those of us inside the House and elsewhere who have serious concerns. She has worked long and hard to come up with a solution that will come as near as possible to meeting my concerns and those of other hon. Members. It has been a pleasure to work with her, because she has genuinely tried very hard to find a solution. We are inches apart, but those inches are extremely important. Therefore, I wish to expand on the issues on which there is a slight difference between us.
The positive changes in the Bill include the creation of the Commission for Patient and Public Involvement in Health. I spoke at length to my hon. Friend about this issue last summer and I recognise that she has a passionate concern to engage in the health service disadvantaged groups and those who never had a say about their local health care. As she knows, I occasionally visit her constituency to watch rugby league and I am aware of the problems that it faces. I know that she wishes to engage in the health service people who were not previously involved in any way.
I welcome the fact that the commission will have an enabling role, will be involved in developing a public voice and will be concerned with those who have no voice. In the last Parliament, I made the point that the main users of the NHS in my area were young women with children, and they have no voice. The main users are not engaged with the health service in any way. I recognise the need to encourage that involvement and to listen to people with first-hand experience of the problems that they face.
I welcome my hon. Friend's proposal for a common badging system—I hope that it is taken a stage further. If we have a symbol that is known nationally and locally, people will know where to go to have their voice heard in the NHS. That idea could extend to advocacy.
I shall briefly list my key concerns about the Government's proposals. I am worried that the system is too complex and that many people will not understand it. I mentioned on Second Reading that I did not fully understand it. Although I now have a better idea of what the Minister is trying to achieve, I still believe that the system is over-complex and that it needs to be simplified.
The fragmentation of the separate patients forums also concerns me. They will focus on the individual work of their trusts and, as I said in a debate in the last Parliament, we need to look beyond that because it is too narrow. I am also worried about the lack of independent back-up and support for patients forums. They may well have to rely on the trusts that they are deemed responsible for monitoring.
In the last Parliament, the Health Committee examined adverse incidents in the NHS and the complaints system. In respect of serious complaints, it thought that independent advocacy, which is a stage beyond the PALS role, should be based within the CHCs. The patients councils that I propose should also have a role in the structure, and the monitoring and scrutiny of forums should be linked to the advocacy function.
New clause 5 and consequential amendments would ensure that patients councils were included in the Bill and that they were made up of forum members so that they offered an overview of local health issues, because that is lacking. I accept that the Minister made it clear that she expects the commission's local networks to do that job, but members of patients councils of individual forums need to be able to get together to look across the local health economy. The Government do not propose that, although I think that my hon. Friend said that it will be encouraged.
I want patients councils to be serviced by the commission's local network. The secretariats would comprise the commission's local networkers so that national standards are linked to the local priorities set by patients councils, which are close to the grass roots and patients' concerns.
Finally, the Health Committee envisaged basing the advocacy function within patients councils, which would give a consistent and easily identifiable base for that work. I hope that the badging system can be applied to that so that people are clear about where they need to go when they have serious problems.
I do not want to say much more because we have rehearsed these arguments several times and most hon. Members are well aware of the issues. I hope that my proposal would provide a unifying structure of lay people at the level of the local health economy, offering an overview of that economy that is lacking in the Bill. My hon. Friend the Minister implied that she will try to bring that about by regulation. I am afraid that I have been in this place long enough to have heard similar offers by numerous Ministers in different Governments. This is not meant as any disrespect to her, but I want that provision written into the Bill. I hope that even at this late stage the Government will accept my proposal.
I agree with what Mr. Hinchliffe said about the Minister's conduct. She has always been available to listen to the multiple objections to her proposals. It is just as well she is a listening Minister, because otherwise we would be even more frustrated.
I also agree with everything else that the hon. Gentleman said, and I shall not cover the same ground except to point out, as I think he would recognise, that we have discussed this before. During the passage of the Health and Social Care Act 2001, my hon. Friend Nick Harvey stood where I am now and moved a similar amendment or new clause before the Bill went to the House of Lords and the proposal ran out of time. I hope that we do not have to go as far this time and that the Minister will find a way to recognise that the proposal in new clause 5, which has also been tabled by the Liberal Democrats, is a compromise. Some people would have preferred community health councils to be reformed rather than abolished.
New clause 2 would have an effect similar to a proposal that we debated in Committee which sought to reform community health councils to take account of what the Government describe as the new NHS. We wanted to ensure that they had the functions and membership that Ministers, in many cases correctly, thought would be necessary to interact with the new NHS. The Minister rebutted or objected to our suggestions even more firmly than we argued them. New clause 2 is an attempt to persuade the Government to reform community health councils.
The Liberal Democrat party, which moved a similar amendment in Committee, supports the thrust of new clause 2, but we are also willing to put our names to an amendment that would go further. The advantage of new clause 5 is that it creates a structure for patients forums to interact in. Its functional approach places the roles of co-ordination and advocacy—advocacy in terms of changes to the local health service, not as defined in other parts of the Bill—at the level of overview and scrutiny committees. That will be of mutual benefit to patients forums that want to ensure that they have adequate mechanisms and structures to feed in opinions to the overview and scrutiny committees. It will also be of significant benefit to local authority overview and scrutiny committees to have patients councils that broadly cover the same area. They will be a single, effective and empowering channel—I am surprised to use the word "empowering"; I usually try to avoid it—for the concerns of patients and the public to be brought to the attention of the overview and scrutiny committees.
I join the hon. Member for Wakefield in thanking the Association of Community Health Councils for England and Wales. I also thank London Health Link. Not only did they provide advice on how our amendments and new clauses should be framed, but they recognised that things have to change. The Minister should at least concede that we are no longer fighting the principle of whether there should be patients forums. To an extent, if one accepts new clause 5, one accepts the abolition of CHCs. Those bodies have shown a willingness to meet the Government more than half way, because all the other structures that the Government propose will be in place. The framework is sensible. It is in tune with what the Government sometimes claim they want for the local networks. It is possible for us to rally around the framework and improve it.
I turn now to other new clauses and amendments in my name and those of my hon. Friends. New clause 7 seeks to insert in the Health and Social Care Act 2001 a duty to consult. That duty would fall not only on strategic health authorities, PCTs and trusts but on the Secretary of State, or rather on bodies that function at a higher level than strategic health authorities and to which the Secretary of State could delegate the duty. I am concerned about bodies such as the national strategic commissioning advisory group, or NSCAG, and the regional specialist commissioning groups, which have a significant input into health service policy. They make recommendations and proposals for changes to significant areas of care, such as heart and lung services at a national level and paediatric intensive care at a regional level. If we are to have a complete consultation system, the necessary mechanisms must be in place.
The Government feel that the new clause is not necessary because strategic health authorities have a duty to consult and some of those supra-strategic health authority bodies will be made up of strategic health authorities. One of those may act as the lead authority and will therefore have the duty, the time and the personnel to consult all the patients forums and relevant groups in the area. However, it is questionable whether those circumstances will always pertain. Certainly it is hard to see how there would be a lead authority for consultation on a decision made by NSCAG or even by a regional specialist group. The Minister should state clearly that there will be no gap in the procedure, or she should accept the new clause.
New clause 8 is important because it would close an existing loophole. Those of us who carefully followed the proceedings on this Bill and on the Health and Social Care Bill will know that the important power of referral to the Secretary of State is currently exercised by community health councils, which are to be abolished. That function has not been given to patients forums, so we must ask which body will have the power to refer to the Secretary of State significant issues such as the failure of consultation or concerns about decisions made following consultation.
We have been assured that the function will be performed by the overview and scrutiny committees, but it is unclear whether the committees have that power, and it is important that the position be made clear. New clause 8 would do so—there is no disagreement about that—but I hope that the Minister will advise us as to whether the power exists. If she wants to resist the new clause, it would be nice if that advice were made available in written form. One would have hoped for it to be available before we had to decide whether to press the new clause, but the Bill has other parliamentary stages to come.
I may be able to explain amendment (a) to Government amendment No. 33 in interventions when the Minister is speaking to amendment No. 33. It makes a concession, which we requested in Committee, that patients forums will have the power to refer to the overview and scrutiny committee anything that they feel needs to be considered. Our amendment seeks to make it clear that the overview and scrutiny committee would have a duty to respond to that referral.
The Government say that they are reluctant to impose duties on local councils—indeed, they say that it is their policy not to do so—but that will come as a surprise to councils throughout the country. On such an important issue, where responsibility for consideration, oversight and scrutiny of health service changes is, in a welcome move, being shifted to local authorities, overview and scrutiny committees should have a duty to respond to patients forums. They should not necessarily have to take on all their concerns, but they should at least have to consider the issues. I hope that the Minister will ensure that that occurs.
There are many other amendments in this group, but I hope that the Minister will allow me to intervene to clarify the purpose of some of the Government amendments. In conclusion, I am determined to support the proposals, on which I took the lead in Committee, to reform community health councils because they are a tried and tested model, so I shall support new clause 2.
I am, however, much more optimistic that new clause 5 will secure support from hon. Members on both sides of the House, including the Government. I hope that we will find a way to ensure that the best of the Government's proposals are combined with the best ideas of the community health councils and of hon. Members of all parties to form an effective organisation, an effective structure and, most importantly, an effective function. We must ensure that the NHS is subject to the scrutiny and input of patients and the public.
I was unable to serve on the Standing Committee as I was a member of another Committee, so I rise to make points that I would have made in Committee if I had been present.
I always listen with great care to my hon. Friend Mr. Hinchliffe, but I cannot support new clause 5, which is a compromise. Neither can I support new clause 2. I served on a community health council for four years in the early 1990s, and I was a vice-chair in Manchester, just around the corner from my hon. Friend. It is unfair in the extreme of Mr. Burns to chide the Minister about the fact that nothing can change. The fact that someone has served on a community health council does not prevent them from seeing it in its true light. As the hon. Gentleman said, community health councils were set up in 1974, and times have changed. If he will forgive me for saying so, new clause 2 is opportunistic and backward-looking. It does not deal with the fact that substantial reform is necessary, as many hon. Members have come to realise.
The whole point of my argument is that reform is necessary. If the system does not seem to be working as well as it should, the Government should reform it, not abolish it.
I hear what the hon. Gentleman says, and I credit him for supporting his absent colleague, but I am afraid that he has not dealt with the illogicality of the position adopted by the hon. Member for Macclesfield.
I must tell my hon. Friend the Member for Wakefield that new clause 5 is over-fussy, over-lengthy and shares with new clause 2 the problem of not grasping the nettle that the Government have grasped in introducing the reform of community health councils. Both new clauses seek a delay.
The hon. Gentleman described new clause 5 as over-lengthy. To avoid comparisons with a certain king and accusations of having too many notes, perhaps he will say which bits of it are redundant to achieving the purpose sought by the change. Or does he think that there is a limit to the length of new clauses that hon. Members should introduce in principle?
I am afraid that I shall not go down that road—[Interruption.] No, no.
The strong support that my hon. Friend the Member for Wakefield received from Liberal Democrats shows that, in effect, his new clause has not grasped the issue; it is a compromise too far. The Bill is not the same as the one that came before the House in the last Parliament. I commend my hon. Friend's tribute to the Under- Secretary, my hon. Friend Ms Blears, who has indeed clearly listened. The Government have travelled a long way on reform; I urge the House to accept that she and the Government have travelled far enough. Some problems that were rightly identified have now been addressed. The Commission for Patient and Public Involvement in Health, for example, is a valuable addition.
I know that other Members want to participate in our debate so, to conclude, I will say only that new clauses 2 and 5 seek delay; they do not get to grips with the problem. The Government were right to introduce their proposals and I urge the House to reject both new clauses.
I, too, pay tribute to the Parliamentary Under-Secretary. As I have said before in the House, she has written that the views of citizens will be valued,
"'listened to and acted upon'".—[Hansard, 8 November 2001; Vol. 374, c. 468.]
I find myself in a similar position to Mr. Winterton's. If I had thought there was any chance of new clause 2 being accepted, I would have put my name to it. The compromise in new clause 5 is much more realistic and would allow us to take on and support some of the changes that the Government are making.
Why abolish community health councils? That question has never yet been answered. Mr. Hinchliffe takes a charitable view which, I am sure, is right. CHCs have achieved patchy success, are variable and could certainly be improved. Mr. Burns takes a more powerful view, which I share; in some instances, CHCs have been a thorn in the side of the Government. I know that only too well; my own CHC, of which I was a member at the time, had the resources to take the local health authority to judicial review. What did civil servants do locally? A high-powered officer of the NHS executive in the west midlands came to visit the little Kidderminster and District CHC, threatening that if it took the local health authority to court, that could cost it £220,000 to £250,000. The local CHC was sufficiently strong-minded not to bow to that threat.
I should like to explore a little more what we shall lose when we lose CHCs. At the moment, we have a thoroughly independent voice—an independent citizens' watchdog. I am deeply suspicious of the Secretary of State's attempts to establish independent bodies. To get him out of reviewing and making the final decision on hospital reconfigurations, we now have an "independent" reconfiguration panel. It is too early to know how independent it is. On the other hand, we already have an independent NHS Appointments Commission. This week, the Health Service Journal shows that it has appointed the 28 chairs of strategic health authorities, 24 of whom are already trust or authority chairs. Remarkably, 17 of them are health authority chairs who will be out of a job on
We are also losing a one-stop shop. I should like to illustrate that with an example from Worcestershire. The hon. Member for Wakefield implied that there will be a difficulty. In Worcestershire, we have three CHCs, conveniently situated in the major conurbations. We shall have six forums—I should love to know whether the plural is forums or fora—because we have three primary care trusts, a county-wide acute hospital trust, and an ambulance trust, and we shall have a mental health trust. Because the PCTs are sharing out health authority functions, one can see that a single patient might need to consult or take advice from three, possibly four, patients forums. That is the strongest reason for having a drawing-together body. The patients council, as suggested in new clause 5, appears to be a body that could draw together functions and situations, making it easier for individual citizens to express their concerns.
To conclude, as I have already said, I would much rather that CHCs were reviewed and strengthened, as is the case with Wales and with the equivalent of CHCs in Scotland. However, I have been in the House long enough to begin to realise what is possible and what is not. New clause 5, which would establish patients councils, appears to offer the chance of retaining independence and bringing organisations together within the overall framework of the Bill, so I commend it to the House.
I should like to comment on the context of new clause 5, which seeks to co-ordinate and integrate locally a replacement system for community health councils. I am tempted, but shall not go down the road of trying to summarise what has happened since July 2000, when the abolition of CHCs was first announced in the NHS plan. We have come a long way since then; much time has been spent trying to understand a replacement structure and system that, for too long, was over-complex and unclear.
After last year's general election, and notably in the Government's response to the listening exercise, which was led by my hon. Friend the Under-Secretary, we got to a point where we recognised that the fragmentation that had characterised previous thinking was unsatisfactory. The essential functions were integration; co-ordination; and informing and supporting patients forums, patient advocacy liaison services and local authority overview and scrutiny committees. The Government agreed with my hon. Friend Mr. Hinchliffe who, in an amendment tabled last May, tried to pull all those functions together in patients councils. They all seemed to be accepted, clarified, fully retained and acknowledged in the Government document published last September in response to the listening exercise. The only difference was that the Government did not want to call the new way forward patients councils. That is okay by me. The Government have described what they want to see put in place as patients councils plus. Fine. The intention was clear. Many of us who have considered these matters with some concern were reassured.
However, the Bill does no more than provide a framework. Many of the matters about which there are concerns in the House and outside will not be clarified until regulations are published. That is the problem. I suggested on Second Reading that perhaps draft regulations could be published during the Committee stage, to give people an idea of how the picture would emerge. We need to see how the mechanism might operate. I want it to work, and I know that the Government do as well. My suggestion was not taken up, but that is up to the Government.
I do not know for sure how the integration and support function of the Commission for Patient and Public Involvement in Health, through its local networks, working with lay reference groups and operating local outreach teams, will work. The intentions are clear, as I have acknowledged, but the mechanism has not yet been clarified sufficiently. We need some examples of how the local networks will work and the sort of geographical area that they will cover. It has been flagged up that they should be at PCT level, but that needs to be confirmed. I know that the Government do not wish to be prescriptive. I understand that, but the danger then is that we are too vague and we cannot see the picture, yet here we are, deciding on legislation tonight. We need to know also about the resourcing of the local networks of the commission, and about the staffing.
I am listening closely to the hon. Gentleman's thoughtful contribution. I know that he is asking questions about what the area should be, but whether it is patient councils or local networks coming from on high in the commission, does he accept that there is a strong argument for ensuring that the area is generally the area covered by the relevant overview and scrutiny committee, to enable co-ordination with the scrutiny function?
That should be the largest geographical area covered by the replacement co-ordinating body. I have some questions about that, but I shall not take up the time of the House. That proposal would be logical, but in some instances the area covered might be too big. Communities do not necessarily fall entirely into one county council area, for example. It may be necessary to split that into smaller areas. I would certainly argue for that in the case of Bedfordshire, but I did not intend to bring that into the debate, as I do not want to complicate it. The matter has been far too complicated, and for far too long. We need to come to some clear conclusions, preferably today, and not wait for the other place to deal with it.
I understood that the local networks would be established to carry out the local overview, co-ordination, support and integration work that many of us said was missing a few months ago. The Government acknowledged that and brought those functions back in. However, I am now not sure about that. I understand that the Government intend to create a locally based collective voice of patients forums, which could well be another body, in addition to the network—another body that will need to be resourced in order to function. That is the impression that I got from the briefing that was made available. It states that in black and white.
I understand that it is intended that the additional body that will be the collective voice of the patients forums will be underpinned by legislation, forcing patients forums to work together and forcing the networks and the wider commission to listen to the outcome of the deliberations of the patients forums. My questions are intended to be helpful and constructive, and to tease out these matters so that we can be clear and move on. I am not clear about the matter, and I have tried to follow it over recent months. The Government have had plenty of opportunity to remove all doubts, but I still have serious doubts.
New clause 5 has the advantage, at least, of being robust and clear. It provides a simple mechanism, which, last autumn, I thought that the local networks would fulfil. If that is the case, let me be persuaded. If my hon. Friend the Under-Secretary is to respond to this part of the debate, and if she does not want the House to accept new clause 5, she will have to explain clearly why. She will need to describe how the system will work and give an example of how it will work on the ground somewhere; otherwise these matters will continue to confuse. If we are confused at this stage in the legislative process, that could make matters far worse months and years down the line. We need the plan to work on the ground, with real people. It is time for us to move on to a better system. I urge my hon. Friend to help us to do that.
I am grateful for the opportunity to follow Mr. Hall in our short debate. He has made well a number of important points that have been worrying people, including members of the community health council in my constituency. We are moving into unknown territory, and at this late stage of the Bill, we still do not have answers to those questions. Dr. Taylor asked the most cogent question—why the Government are proposing such a system. We have had no proper explanation of why we need such a complicated change. I hope that at this late hour we will get an explanation from the Minister.
Rather more years ago than I care to remember, I used to be a member of something called an area health authority. Those were abolished, but seem to be coming back in a slightly different guise, called a strategic health authority. I remember only too well how our hearts sank when members of the community health council rose to speak. They were a thorn in our side. They discharged their job extremely effectively, and after a time we began to respect them for the way that they worked and their dedication to their job.
It is true that not all CHCs are perfect. Some were undoubtedly poor. My hon. Friend Mr. Burns made our position clear. We are not against change. Stephen Hesford seemed to think that we were going backwards and arguing for the status quo. We are not doing that. We argue that we should build on a good foundation, which the community health councils provide. Let us make changes, rather than throwing them all out.
The patients will be left with a confusing plethora of patients forums. In Northumberland we are to have one primary care trust, but in County Durham, for example, there are to be six PCTs, and each one will presumably have a patients forum. We will have an ambulance trust and a mental health trust, and I understand that the county council and the NHS are getting together to provide a community care trust, which will take over the functions of the social services department and merge them into one trust.
Even now it is hard enough to involve patients in the affairs of the NHS. The attitude still prevails that treatment from the health service is some sort of privilege, and that one should be grateful to be seen by a doctor. Increasingly, patients know that if they have a complaint, they can turn to the community health council. Citizens advice bureaux and others will point them in that direction, but patients will have great difficulty in finding their way through the maze to the appropriate patients forum.
Is not one of the strengths of the new system its location in the places that patients use? One of the downsides of the old system—perhaps the hon. Gentleman and other hon. Members share my experience in this respect—is that if we were to go into the street now and ask a British citizen whether they had heard of a community health council, they would say no. [Interruption.] That is my overwhelming experience. People have not heard of CHCs after almost 30 years.
I take the hon. Gentleman's point, but I must disagree. There is more chance of people finding community health councils than patients forums. If he thinks that the system would be improved by placing representatives in the major hospitals, ambulance stations or wherever else, the community health councils can consider that proposal. As we are proposing to reform CHCs, the suggestion is certainly worth discussing. I do not rule it out, but I must restate my view that we will lose a great deal by abolishing CHCs, which are independent and can build up a considerable body of expertise over the years. They know the health service in the areas that they serve, but we will lose that expertise, which is a great pity.
Northumberland community health council, which serves my area, has written asking me to support new clause 5 if the Opposition's proposal fails. It points out that it has dealt in the past 12 months with complaints about the health service from 178 patients in the county. That shows how much good work it does. The health service is going through another revolution as a result of the Bill and other legislation, so it is completely daft to abolish the patients organisation when it will probably be most needed and to introduce a new system that is untried and unclear at a vital time for the health service.
I want briefly to speak to amendment No. 73, which stands in my name and relates to patients forums and their power. We had a small debate in Committee about the matter with which it deals. My concern is that the patients forums are being given extreme power. In particular, they are given the right of entry into premises. All of us need to be guardians of our freedom. In that context, I cannot see any reason why members of a patients forum should have a compulsory right of access to health service premises, including the surgeries of doctors and pharmacists. My constituency has doctors and pharmacists who work as sole practitioners and operate from their homes. The pharmacists live above the shop, so to speak. The powers in the Bill give patients forums a right of entry into such premises. My amendment seeks to specify that the power should not extend to the living quarters of doctors and pharmacists and I hope that the Minister will be reasonably helpful in that regard.
I cannot see any reason why patients forums should have such powers and I would be grateful for some explanation. Can the Minister imagine a doctor saying "In no circumstances can you come into my surgery" to members of patients forums who are seeking an appointment to make a visit? In the rare event of that happening, the Commission for Health Improvement could use its powers of entry. Surely that is sufficient.
Yes, but they should not have compulsory powers. I am sure that the hon. Lady cannot imagine why they would need the powers. Why do they need a right of entry? It is inconceivable that a hospital or any other health body would say "You can't come in" to a patients forum. Why must we give patients forums draconian powers, giving lay people a right to rummage through the private possessions of a doctor or pharmacist? The hon. Lady shakes her head, but it is true. The powers in clause 16, which deals with entry and inspection of premises, allow the Secretary of State to make regulations giving the right and power of entry. We need to be aware of people's civil liberties. As I said, if entry is refused, the Commission for Health Improvement, which has the appropriate powers, can enter the premises if it is believed that something serious is happening.
I hope that the Minister will consider amendment No. 73, as I think that Parliament has a right to protect the rights of individuals. They have been sorely hammered in recent months, and this is one occasion when we could avoid hammering them even more.
I am grateful for that correction, but I think that the meaning was clear. In Westbury, people know all about their CHC. The point is that there are differences in practice throughout the country. There are good CHCs and some that are not quite so good, but the fact that they are good means that they are a good basis on which to build and reform. That is the thrust of the Opposition's argument about CHCs.
Bath and District CHC monitors health care services provided by two health authorities, two ambulance NHS trusts, two acute hospital trusts, a mental health partnership trust, two PCTs and a PCG. When my constituents are poorly, many of them—especially the vulnerable and elderly—end up dealing with local NHS services that are provided by two or more trusts. None the less, however many trusts they use, in their view, they are using the national health service in a fairly seamless fashion. My CHC centres its work on ensuring that patients receive the very best seamless provision of quality health services as they navigate their way around the multiple tiers of the national health service. Seamlessness is one of its strengths, but a strength that the Bill threatens.
The Association of Community Health Councils is, understandably, rather hurt and upset. Indeed, it is bewildered. It said:
"The proposed alternatives to CHCs as set out in the Bill fall far short of meeting the widespread concerns about the independence of the new bodies and their lack of integration. If the Secretary of State pushes ahead with this bill in its current form patients will lose a respected, effective, independent health Watchdog and in its place they will get a system that is more fragmented, more confusing to the public and less independent."
CHCs are certainly watchdogs, but what we have been offered in their place is poodles, and lots of them: oodles of poodles, in confusing myriad PALS and patients forums. The proposals made by Mr. Hinchliffe in new clause 5 are interesting, but they are second best. They suggest that we should keep our poodles and merely have something that might turn out to be a watchdog.
That brings us to cost. Despite the advice of the Opposition, the Government have set their face against building on the CHC model. My CHC costs £118,664, but its chief officer estimates that it will cost £750,000 to provide PALS alone. Indeed, the current edition of the Health Service Journal suggests that it will cost 10 times the amount spent on CHCs to provide the new services outlined in the Bill.
Roy Carr-Hill, professor of medical and social statistics at York said of the new system:
"We're going to end up spending all the possible savings from Shifting the Balance of Power and it's still unclear how effective this . . . will be."
We should ask not only about the source of the money and the opportunity costs involved, but where the Government suppose that the army of volunteers required for staffing will come from. Those of us who have been heavily involved in the voluntary sector know that it has become increasingly difficult to get people, especially those with the right skills, to commit themselves for nothing. If public enthusiasm for the Bill is anything to go by, it seems unlikely that folk will queue up to lend their services to PALS and patient forums.
I am sure that my CHC's plea for a more integrated approach is echoed throughout the country. Patients, who view the NHS as a whole, not in little bits, would thus have a one-stop shop for their anxieties and representations. Conservative Members believe that reforming CHCs, not abolishing them, is the way ahead. If that is beyond the Government, can we place a duty on trusts to ensure that their poodles in a geographical area at least talk or bark to one another? Surely there is scope for sharing financial and human resources, thus driving down the appalling costs that informed opinion has forecast for the proposals, and making the best use of finite voluntary effort.
The Bill would abolish CHCs in England without replacing them with any community-led overview of the local NHS. England would be the only part of the United Kingdom without CHCs or a similar body. The measure proposes a confusing array of new mechanisms, which would make it more difficult for people to understand the system, influence the local NHS or obtain independent help when they needed it.
The proposed new system is difficult to understand because it is so fragmented and complex. The Bill proposes overlapping and separate organisations, which may serve only to confuse patients and the public. Without clarification from the start, there is a danger that much energy will be diverted into sterile competition as different organisations jockey for position in their local communities. That would be a complete waste of resources and energy. Elizabeth Manero, the chair of London Health Link, warned that the proposed system would be "a charter for tokenism". She said that it was "fragmented" and did not comply with recommendations from the Bristol inquiry for fully independent bodies.
Individual patients forums would have a remit for considering only their trust's services, with no formal mechanism for coming together to provide an informed overview of the local NHS from the patients and the public's perspective. Patients forums would be run entirely by volunteers and have no paid staff. I imagine that they would seek support from a separate body of paid staff—the Commission for Patient and Public Involvement in Health—or that they may be forced to rely on help from the trust that they monitor. That would compromise their ability to be an effective and independent watchdog.
People who require independent help with problems with the NHS or complaints would have to approach other organisations, for example, the independent complaints advocacy service. Separate organisations make up ICAS, and it would therefore be more difficult to scrutinise and monitor complaints as they were processed. Staff of the Commission for Patient and Public Involvement in Health would be tied up in the bureaucratic exercise of tendering, monitoring and evaluating ICAS.
I have two further anxieties. First, the Bill removes the requirement to consult about changes to functions and boundaries of key NHS organisations, such as strategic health authorities, PCTs and NHS trusts. Community health councils must currently be consulted on such changes. The Bill does not specify the organisation that will take on that function. That is worrying.
Secondly, the new structures will be much more expensive than CHCs. It is proposed to abolish CHCs without any guarantee that sufficient funding will be made available to ensure that their replacements are properly resourced. Again, that is worrying. Community health councils should be given more time to reform. They have had faults in the past, but, overall, they have championed patients by monitoring the health care in their local communities. They should be given more time to reform and I therefore support new clause 2.
I support new clauses 2 and 5. Dr. Taylor is not naive, but I have observed him on the Select Committee on Health, and he is a gentleman in every sense. He asked the Minister why CHCs should be abolished; perhaps I can help him. The Government dislike any criticism, and they are especially upset about criticism from Labour supporters. When Labour Members were in opposition, they loved CHCs because they were critical of the Conservative Government. Now we have a rotten Labour Government, and they cannot abide criticism from CHCs, especially from Labour activists.
The Under-Secretary who will reply to the debate has been a great champion of CHCs. The hon. Members for Wakefield (Mr. Hinchliffe) and for Bedford (Mr. Hall) also have an honourable record in consistently championing the cause of CHCs. However, there is no doubt that what we are being offered as a replacement will not do. The proposals are ill thought out and shambolic.
If CHCs continued to exist, they would champion the cause of one of my constituents, a lady, who was diagnosed with lung cancer eight weeks ago. The cancer is operable, but she has been waiting eight weeks for an operation. The cancer is pressing on the spine but nothing has been done because of delays. Southend community health council will take up the lady's cause. As her Member of Parliament, I am doing everything that I can. I have tried to talk to the bed manager, who was on holiday for a week. No one was in charge during that time. When we spoke to the person today, we were told that further time was needed to examine the matter. Southend community health council is disgusted by the fact that my constituent has had to wait eight weeks. Her family are distraught about the circumstances, and they will not forgive the Government unless something happens.
I have received a letter from Southend community health council, as my hon. Friend Mr. Atkinson said, which expresses its anxieties about the Government's plans. Community health councils are enthusiastic about changes that benefit patients and the public. They do not claim that there should be no change. They are certainly not arguing for the status quo.
CHCs have been an effective independent watchdog in the NHS for the past 27 years. In that time, Southend community health council has helped thousands of people. Stephen Hesford said that people in his constituency had not heard of CHCs. I am surprised at that. In my area, and those of most other hon. Members, if people had not heard of CHCs before the current campaign, they jolly well have now. People probably took them for granted, but now they are clutching at this precious commodity, and saying that what is being offered in its place will not do.
The new proposals threaten to eliminate the only effective, integrated independent watchdog that patients have, without putting forward an adequate replacement. The letter that I received from Southend community health council states:
"In the wake of recent scandals, such as Shipman, Ledward and the fiddling of waiting lists, this seems particularly ill advised."
It goes on to say that the proposals with which the Minister will probably try to seduce the House shortly are
"fragmented and confusing . . . without a unifying community-led element at local health economy level."
The Government, when they were in opposition, never turned away from using any briefing from the British Medical Association. For 18 years, the BMA was the Labour party's watchdog. However, since 1997, we never hear the Government say a word of good about the BMA. All hon. Members will have received a briefing from the association, stating how disappointed it is with the proposals.
The Secretary of State for Health put his foot in it in a big way today. Those of us who witnessed what happened during the private notice question and heard not one "Hear hear" from the Government Benches saw his proposals go down like a lead balloon. Today, the Labour Government are privatising the national health service. There can be no doubt about that. It has taken a Labour Government to do so. A number of hon. Members who sit on the Select Committee on Health are present in the Chamber now. When the Secretary of State came before us last week to give evidence on the private health sector, not a word was mentioned about these extraordinary proposals when we questioned him.
Mr. Dobson was obviously extremely upset about the proposals earlier, and I think that says it all. No doubt we shall hear from the Labour party in the weeks ahead about its plans to charge for all sorts of services that have traditionally been free under the national health service. It is not too late for the Government to admit that they are wrong about abolishing community health councils, to rethink their proposals, and to accept new clauses 2 and 5. If they did that, the hon. Member for Southend, West and the whole of the country would think far more of the Government than they do at the moment.
Following the last contribution, I will try to bring us back down to earth, and closer to reality and to the clauses that we are discussing. I want to deal with new clause 2 and the consequential amendments and then new clause 5. Obviously, many of the same issues are involved in both new clauses.
I reject absolutely the idea that this is a vindictive or pernicious attempt to attack community health councils, as has been alleged by Mr. Burns. He knows very well that, in Committee, I put on record on three or four occasions my personal tribute to the excellent work carried out by many community health councils up and down the land. That stems partly from my own experience, and also from my fairly detailed knowledge of the work that has been carried out over many years by staff in CHCs and, crucially, by volunteer members who have given of their time unstintingly to try to improve the health service.
That is not to say that realistic, down-to-earth, grounded people do not recognise the limitations of those organisations. Many such people want actively to embrace change and to consider new ways of working; they have the courage to examine new forms of organisation that can strengthen the patients voice.
It was not Wigan, it was Wirral. That CHC has welcomed the proposals. Many members of CHCs have been in touch with me, either in writing or in person. Many came to the nine regional listening events that were held up and down the country, and broadly welcomed many of the proposals. Yes, they had concerns, but they were willing—unlike some intransigent, inflexible Conservative Members—to embrace change and to consider new ways of working that could help to strengthen the voice of patients and the public in the system.
Our new system aims to be more accessible, accountable, independent, robust and effective. We are not starting from scratch. We have genuinely tried to build on the best of the existing work being done in public and patient involvement. That involves not only CHCs. We must not forget that a whole range of patient organisations has been involved in this work for many years. There is a tendency to think that public and patient involvement involves only CHCs. The process that we have undertaken over the past few months has enabled many organisations to get more involved and to see how they can make a more effective contribution in future.
The current system of CHCs has been in place for about 27 years. Inevitably, any change will encounter resistance and uncertainty, and people will cleave to what they know because they do not know what the new system will look like. I acknowledge that there has been a need for the Government to try to explain the changes. Certainly, over the past seven months, I have been out and about with other Ministers and officials from the Department, talking to people in local communities to ensure that we get our vision of a more effective, independent, integrated system across to them.
Only last Thursday, I spent three and a half hours meeting representatives of the Association of Community Health Councils for England and Wales. We agreed at the end of the meeting, as my hon. Friend Mr. Hinchliffe said, that we were only inches apart in terms of the things that we wanted to do. We made many changes during the listening exercise and as a response to the listening document. We showed that we had not just listened; we had not just heard what people said, we had acted on it as well. This was not a sham process, an empty attempt at consultation. This was real, engaged activity. We were prepared to listen and to act.
There is broad consensus about the functions of the new system. The functions of the new commission have been broadly welcomed. There is also consensus about the need to involve people who traditionally have not had a say in the health service—people in excluded and marginalised communities who have been ignored for many years when services have been shaped, developed and drawn up. There is a willingness in the field to draw in a wide range of individuals and groups, and to make sure that their voices are right at the centre of shaping services for patients.
The consultation process has been an extremely good one, and that is not just my view. I draw to the attention of hon. Members a letter circulated by the Long-Term Medical Conditions Alliance. The alliance represents the Alzheimer's Association, the British Cardiac Patients Association, the National Schizophrenia Fellowship, all long-standing, respected patients' organisations. They welcome the new proposals, and state, quite realistically, that
"bearing in mind the impossibility of accommodating everybody's wishes in their entirety, the key concerns raised during" the consultation
"have been addressed in the latest set of proposals."
They welcome the initiatives in the Bill, specifically the local networks, which will enable the commission to bring together patients forums to build capacity for involvement in the community. They say:
"would lead to the strangling of genuine citizen involvement and the promotion of bureaucracy at the expense of the voice of individual users of the NHS."
I want to deal with that point in particular.
I have read the LMCA letter, but those bodies represent people with long-term medical conditions who are regularly engaged with medical services. Patients forums are therefore much more likely to involve patients who take a long-term interest in them. Those with acute conditions go in and out of the system. With respect, the view of those organisations is not necessarily representative of patients as a whole.
I would not say that that is the view of all patients, but it is extremely important, given which organisations are members of the alliance, and it shows that widespread support exists.
"offers a compromise and an opportunity for patients to have an independent and powerful say in what's happening to their health services locally."
Organisations take specific views and I shall outline why our proposals encompass all the functions in new clause 5 and will enable us to go even further. I have described them to my hon. Friend the Member for Wakefield as patients councils plus, and I genuinely believe that those on the way in which the commission would operate are exactly that.
We have heard the arguments about reform on various occasions. Over the past five years—the period highlighted by the hon. Member for West Chelmsford—the NHS has changed dramatically and it is about to change even more fundamentally still. Therefore, there is a need to put in place a new system of patient and public involvement that properly reflects all the different NHS levels and functions to ensure that, where there needs to be public involvement, it is sited in the most appropriate place in the service so that it can act as a key lever for driving up standards and change. No longer should patients be outside the system, able to react only after the event.
Mr. Amess has gone to his CHC to look after the interests of his constituent, who appears to be in a dire situation, but the CHC has to act after the event and from the outside. The new structures will put the PALS system inside that trust, so it will be on the spot to provide assistance to that constituent where it matters and when he or she needs it. The system will be a powerful force for ensuring that the trust, its consultants and the service that that constituent receives improve. Therefore, I genuinely believe that what we are introducing is much more appropriate for the changed NHS. We are putting patients and the public right at the heart of the system, which is where they need to be and where they can make the most difference.
I want to deal in detail with the concept of patients councils in new clause 5. As my hon. Friend Mr. Hall said, it is important that I set out how the commission would work so that people can visualise the way in which the system may be drawn together. All the concerns about fragmentation can be addressed. Many Members have mentioned the need to ensure that the system is integrated and that there is an overview of the whole health community. That is very important.
The concept of patients councils, which was introduced by previous legislation, has helped to inform the arrangements before us. Over the past year, we have developed our proposals in the light of those ideas and many others. This has not been a static process in which the Government have taken a fixed view. We have taken on board the views of many stakeholders in the system and the proposals have been much improved over the past year or so.
The system will take on board all the functions set out in new clause 5, but it will also allow for a more dynamic and much more influential arrangement that is fit for the purpose of empowering all the people whom we want to involve in the NHS. First, we all agree that there must be a mechanism to pull together the informed overview of the patient experience across a specified area. That overview is fundamental. We must ensure that we collect all the data from PALS, the patients forums, the trends and the themes that emerge from independent complaints and advocacy services so that we have in one place all the information we need to know what the NHS is like in a certain community or neighbourhood and what is causing concern regularly, not just as a one-off. Currently, there is no one place in which all that intelligence can be held, but we shall be able to ensure that there is such a place in future.
The commission will go out locally and engage hard-to-reach groups and people from marginalised communities. It will get not only the views of long-term and acute patients, but, perhaps, those of the homeless, people in the travelling community and people from black and ethnic minority groups—the voice out there that has never shaped the service before. The commission may use that data, that intelligence, those views and those concerns to ensure that reports are prepared not narrowly—
I apologise, Mr. Deputy Speaker.
The commission will draw in all that experience across the local area. We all agree that patients do not fit conveniently or snugly into NHS or local government boundaries and that patients' experience often transcends various trusts—they go from one to another. It is important that we are able to draw that experience together. We must ensure that patients forums and ICAS providers are sufficiently supported so that they can develop.
Patients forums in particular are new organisations and they will need to be properly staffed and facilitated to ensure that they can grow. Those organisations must work together to share their outcomes, plan joint work and identify trends and themes. Above all, the whole patient and public involvement system must be geared to hearing the voices of people, not a few representatives who purport to speak for the community. The community must find a way to express itself.
The public will want to know how they can gain access to every part of the public and patient involvement service, where they can get in touch with PALS, how to get in touch with patients forums, what the overview and scrutiny committees will do, what the Commission for Patient and Public Involvement can do for them and where, at every single point, they can get their needs, concerns and grievances addressed. It is absolutely crucial that all those organisations be led by the public and by patients—lay members determining their priorities in the community.
All those provisions are dealt with in the Bill, so new clause 5 is unnecessary, not because the issues are unimportant, but because they are catered for and because such a patients council might prove inhibiting to other important features.
The Commission for Patient and Public Involvement in Health is the fundamental change to our proposals following the introduction of the Health and Social Care Act 2001. It will have core national functions and a range of local functions that have been universally recognised as being pivotal to the system's effective operation. The Bill says that the commission must operate at PCT level in local communities.
Patients forums will have their ear to the ground in respect of the trusts and PCTs to which they relate. They will have a real insight into what patients really think about trust services. We acknowledge that they will be trust focused, so we must ensure that that knowledge and insight is brought together. What does it mean for patients overall? We intend to require patients forums to come together regularly to share their findings and to talk about emerging trends.
As is argued for the patients council, information sharing is critical to ensuring that the patient's journey is truly understood and captured. We shall use the regulation-making powers in clause 15(4) to require patients forums to work together. That will enable best practice to emerge and inform the commission about those areas in which there are stresses and strains and where further work is needed. A strength of CHCs was that they could see such trends emerging. We shall ensure that that strength is not lost in the new system.
We envisage the commission and patients forums forging partnerships across different boundaries. We do not want to tie those boundaries down to specific and restrictive areas, because they will work in many different ways. Many issues span different PCTs and the commission will need to work across those areas and with lay members in partnerships and to have the flexibility to do so.
We think that the concept of a patients council, as expressed in new clause 5, would inevitably result in a limiting of the remit of the public and patient involvement system. It would also require a service organisation to support that organisation. I am keen to maximise the use of our resources in carrying out the consultation work that local people want to happen, instead of in servicing committees, taking minutes and the other aspects of a bureaucratic organisation. There would need to be 150 patients councils established, which would mean another 150 bodies in what hon. Members have already called a complex and complicated system. I do not want us to be tied to servicing such organisations, although the functions of the patients councils are crucial to making the system work.
We have to ensure that the commission will respond to what patients forums tell it are the important issues in their community. We have the flexibility in the Bill to make secondary legislation that will set out the relationship between the commission and patients forums, to ensure that when forums highlight an issue the commission takes it on board. We can ensure that patients forum representatives—the lay members—set the work programme for the commission and ensure that community priorities are at the top of the agenda. We shall use regulation-making powers to require the commission to have specific regard to the recommendations of joint patients forums when planning programmes of work.
By using the two regulation-making powers already in the Bill, we will be able to set up all the functions of the patients councils, as set out in new clause 5, and we can do much more. We will not be rigid or tied to a specific structure. The commission will go out into communities and hear those different voices and draw in those socially excluded groups and marginalised communities. We will be able to move on. It is a matter of having the courage to consider new ways of working. We are all tempted to stick with what we know because it is comfortable and we have seen it in practice, but we must now push forward the boundaries and consider new ways of working to empower the public, too.
Nothing in new clause 5 prevents the Secretary of State from making regulations to fine-tune the functions of patients councils, but the Minister described the provision of staff who would enable patients to make their views known to the relevant organisations as creating a bureaucracy. However, when staff are provided to support other organisations, that is called providing appropriate support for effective mechanisms. Simply labelling something a bureaucracy when the Government do not like it is not worthy of the issues involved.
I assure the hon. Gentleman that there will be staff. The staff of the commission will support the patients forums. The staff will also go out into the communities to find the volunteers mentioned by Dr. Murrison and give them support, education, training and guidance—which they have never had before—before they are placed on patients forums and other bodies. That will ensure that patients and the public are empowered to challenge professionals. The representatives will be really fit for the purpose of serving on those bodies and will be able to feel that they can make a significant difference and a real contribution.
One of the aims of patients councils will be to make real links with local government. Some of the biggest determinants of good health are the issues that local government is responsible for, such as education, housing, transport and the environment. The commission will not be confined to an NHS model but will be able to make crucial links with local government, which have been championed by my hon. Friend the Member for Wakefield on many occasions. I am a little disappointed that my hon. Friend is not able to trust the Government's undertaking to put these measures into law through the use of the regulation-making powers. I have put our intention to ensure that those functions are carried out on the record and I am disappointed that my hon. Friend will not accept that.
Amendment No. 73, supported by Mr. Atkinson, deals with the rights of patients forums to inspect various properties. The matter was raised in Committee and I said that I would consider it. It is not our intention to hand to patients forums a set of draconian powers. We have said that patients forums should be able to inspect everywhere a patient goes, but that does not mean a right of access to private living accommodation. There will be appropriate limitations and restrictions in the regulations that we intend to enact. It will be necessary to spell out the circumstances in which patients forums can inspect various properties, and we will have to be conscious of the right to privacy under the human rights legislation. I therefore reject the amendment, but I hope that the hon. Gentleman will accept my reassurance.
Amendments Nos. 38 and 70 relate to the accounts and funding arrangements for patients forums. Independence for patients forums was a key issue in Committee and it is our intention to reinforce their independence through the legislation. There is a saying that he who pays the piper calls the tune, and concern was expressed in Committee that if trusts were to be responsible for the finances of patients forums, those bodies would not feel able to be critical or independent. Government amendment No. 38 will ensure that it is the Commission for Patient and Public Involvement in Health that will provide the funding and accounts for patients forums as arm's-length independent organisations. That will ensure that patients forums are independent of trusts in every way, including in their financing. I would hope that that will be sufficient for Dr. Harris to withdraw his amendment.
I turn to the relationship of patients forums with the rest of the proposed system. Patients forums will be powerful and influential bodies, but we recognise that there will be times when the forums might feel that a significant issue from the patient's perspective has not been properly taken account of by the trusts that they monitor. In such circumstances, the forums might want to alert the overview and scrutiny committees, which will have the legal powers to scrutinise the NHS on that issue. Local OSCs will provide the democratic element, through democratically elected members, and we think it right that forums should refer issues of concern that have not been satisfactorily addressed to the OSC. The amendment has been widely welcomed by ACHCEW and patients' organisations, and I hope that hon. Members will also welcome it.
The democratic rights of local government must be a matter for its determination. We do not want to add to the Bill a requirement for OSCs to respond to referrals from the patients forum, because it is properly a matter for local government to decide what to do with those referrals in the course of the programme of scrutiny. However, it would be good practice to respond and we shall put in guidance our view on how OSCs should perform their functions. We would like to see a close relationship between OSCs and the patients forums. The OSCs should indicate, when they get a referral, what they intend to do—whether they will note the matter or look into it further. Government amendment No. 33 will join up the system between patients forums and OSCs, and I hope that it will be welcomed. Consequential amendments provide the necessary definitions and, on that basis, I would ask the hon. Member for Oxford, West and Abingdon to reconsider his amendment.
In Committee, the important matter of the right of overview and scrutiny committees to refer contested reconfigurations to the Secretary of State was raised. At the moment, the way in which community health councils deal with the matter is, as I said in Committee, tortuous, in that they rely on referrals to regulations. These are important matters, and I want the new powers for overview and scrutiny committees to refer contested reconfigurations to the Secretary of State to be no less rigorous than those that community health councils enjoyed.
I also want to clarify the situation about referrals on process and on merit. In relation to new clause 8, I would like to be able to consider further the details that are proposed. The drafting proposed by the new clause may not be sufficient to achieve the objective, and I would want to consider the proposals further.
Finally, new clause 7 seeks to amend section 11 of the Health and Social Care Act, which provides a duty on the NHS to make arrangements to involve and consult the public on decisions that it takes about the provision and delivery of services. It is not necessary to include the Secretary of State in the list of bodies to whom section 11 of the Act applies. The Secretary of State himself delegates all functions in relation to health services—to health authorities, to NHS trusts or to PCTs.
A full list of potential providers of health services is already included in the Health and Social Care Act. Paragraph 34(a) of schedule 8 to the Bill extends the provision to strategic health authorities. On that basis, I would resist the new clause. There is sufficient definition of the bodies that are required to consult under section 11 to fulfil all the scenarios that have been put before us. The hon. Member for Oxford, West and Abingdon is going down the road of hypothetical situations and the Bill will be sufficiently robust to meet his concerns.
I have made the point that all the health service's functions are delegated by the Secretary of State. The way in which the consultation is carried out—whether by a lead strategic health authority or by a national organisation—is a delegation by the Secretary of State of a function of the health service. I genuinely believe that the Bill is comprehensive enough to cover the scenarios set out by the hon. Member for Oxford, West and Abingdon.
I hope that, during my speech, I have answered most of the issues that hon. Members have raised. Through the new system, we are genuinely trying to achieve a much more robust, independent and effective system of patient and public involvement. Hon. Members must look forward and have the courage to embrace new ways of working. They must not simply look for the traditional systems that they know and love but which do not provide an effective, independent and vigorous system for patients in our health service. This system will deliver that for the good of the people whom we represent.
I listened carefully to the Under-Secretary, and I think that she and the Government are trying to sell us a pup. She gave no credible reason why community health councils should be abolished. She gave no credible explanation of why they could not be reformed and kept in an improved state. For that reason, I ask my right hon. and hon. Friends to support new clause 2.