My Lords, I too thank the noble Lord, Lord Harris, and declare an interest, not only as a long time champion of user and carer recognition in health and social care but also once upon a time as chief officer of a community health council.
I have much admired the work of CHCs and also the work of the Association of Community Health Councils for England and Wales, of which the noble Lord, Lord Harris, was a much respected chief executive for many years. Fan though I am of CHCs, we must acknowledge, as other noble Lords have done, that they vary tremendously in the quality of work they do and in their effectiveness. As we know, the reasons for that variability are many, but we have to acknowledge that such variations exist.
Moreover, CHCs are now 25 years old and it is entirely right that the role and function they perform on behalf of patients is reviewed. I do not want to argue tonight necessarily for the retention of CHCs but rather to emphasise the importance of ensuring that the patient voice in the NHS is as strong as possible and to give examples of factors which must be taken into account when any new arrangements are being considered.
Perhaps I may acknowledge the huge progress which has been made in recognising patients' needs in recent years. No one can possibly pretend that when it was set up the NHS put patients first. But today the experience of patients and their families is valued. Even since 1974 when CHCs were established, the culture around recognising the importance of patients has changed radically.
Any system for improving patient experience of the NHS must first and foremost concentrate on empowering patients and making them feel centrally involved in their own health care. Public advocacy is therefore absolutely crucial. The Government must be sure that any new arrangements they consider will strengthen, not weaken, that advocacy function. In addition, as we have heard many times, one of the criticisms of CHCs is their variability, so we must not make that problem worse. I am all in favour of allocating more power to patient organisations which are run by patients, but clarity is needed about how they will relate to the NHS and to each other. This argues too for some kind of national structure or body to oversee the new system.
Next, I should like to emphasise the importance of relating to primary care, as other noble Lords have done, as well as to trusts. As the noble Baroness, Lady Barker, reminded us, that is where most people experience the NHS. Again, the functions of the CHCs or any other body must be reviewed and care taken to ensure that primary care is not only included but given complete recognition as the most important interface between patients and the NHS.
Concerns have been expressed regarding local authority involvement in the proposed new arrangements. That concern usually revolves around the politicisation of patient advocacy and complaints procedures. But that could work to advantage, particularly if we think about the overlap between health and social care which is so important. We are beginning to see evidence of the Berlin Wall coming down, and that could help. Above all, we must ensure that the new arrangements are not only independent but seen by patients to be independent.
I am also concerned that so far there has been no mention of statutory rights for the new bodies. That must be addressed. Notwithstanding the more favourable and sympathetic climate in which we now operate in regard to patients' rights, we must ensure that sufficient power is vested in any new arrangements to enable the voice of patients to be as strong as possible.