National Health Service

Part of the debate – in the House of Lords at 8:37 pm on 26th October 2000.

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Photo of Lord Clement-Jones Lord Clement-Jones Liberal Democrat 8:37 pm, 26th October 2000

My Lords, as someone who has not sat on a CHC, I can say that we have had some notably well-informed speeches tonight. It was interesting that even those who are not wholly opposed to the Government's proposals would probably need to reinvent CHCs in order to put into effect their own proposals.

The fact is that after 26 years of useful life, community health councils could have expected rather more consideration from a Labour government, many of whose members, like the noble Lord, Lord Harris, have links with them. We heard that from many noble Lords on the Benches opposite. Also we must thank the noble Lord, Lord Harris, for raising an extremely important issue.

The reference to abolition of CHCs is almost an afterthought in the "Changes for Patients" chapter of the national plan. It is not difficult to unpick the proposals. The scrutiny role goes to local government, but there will be a potential conflict of interest with the increasing integration of health and social services. There is also the question of how their boundaries will fit with hospital trusts. The consultation role goes to the patients' forums, but will be dependent on the good will of the hospital trust. How well will they be supported in terms of resources?

The advocacy role will go to patients' advocacy and liaison services, but they will not be independent. The complaints role will probably go to CABs, but how will they develop the specialist expertise? All that will take place without any indication in the national plan of the resources to be allocated or the training to be given in the new roles.

The Government's proposals generated considerable heat within my party, and were described as "fragmented" and "ill-conceived" at our recent conference in Bournemouth. The truth is that we need to integrate the various roles, not fragment them. For example, complaints help to inform scrutiny and consultation. There may well be patterns of behaviour in complaints. To discern patterns, there needs to be overview by a single local body. It is rather ironic that the national plan talks about patient empowerment and then proceeds to abolish CHCs.

Of course, community health councils are sometimes awkward customers, but that is their merit. Independence is their key asset, as the noble Lord, Lord Harris, pointed out, especially in making complaints. They are not part of the medical establishment. No reasoned case has been made out for abolition; it is simply tagged on to the end of a chapter of the national plan. It would be better to look at some of the proposals put forward by the commission on the NHS chaired by Will Hutton in its report, New Life for Health, which we debated--thanks again to the noble Lord, Lord Harris--in June. It did not deny that CHCs had their problems. There is no legal indemnity for its members and no adequate definition of the variations in health services which entitle them to be consulted. There are differences in availability and commitment of their members, variable standards and unlimited statutory rights as health services have changed, particularly in primary care and community services.

At the end of the day, however, the commission said that there needs to be more accountability in the NHS, not less. It suggested greater powers for CHCs, not their abolition. On Tuesday, the Secretary of State said that people have long argued that there is a democratic deficit at the heart of the NHS. That is perfectly true, but we on these Benches do not believe that abolishing the one body which currently carries out independent scrutiny is the way to cure the deficit. I prefer what his predecessor, Mr Dobson, said in 1998:

"I look to CHCs to continue to play a role in ensuring that patient and public views are known to the NHS decision makers both nationally and locally".

I wonder which of those quotations the Minister prefers.

We should follow the example of the Welsh Assembly in seeking not to abolish CHCs but to make them more effective. The answer is not abolition; we need to ensure that they have adequate powers and resources. At the end of the day, the abolition of the CHCs will require primary legislation. It will have to be very different from the proposals in the national plan if it is to receive support from these Benches.