My Lords, I should like first to express my thanks to the noble Lord, Lord Harris, for initiating this debate. I hope he will share my perception that the concerns that he has so clearly expressed are widely held both inside and outside the NHS. However, in many respects, the NHS plan is a document full of plans and aspirations with which we can all readily agree. If I had to single out the section which gives me the greatest personal grief it is that which announced the new patient advocacy service.
Community health councils have been with us for 26 years. Depending on where you go around the country, you hear different opinions of the job they do. In some areas, the CHC is not regarded as being particularly effective. In others, such as the one near my home in the Chilterns, for example, they are highly thought of and seen as performing a useful role. But even if the way that CHCs have worked has been variable, one thing is agreed upon by everyone; the concept of CHCs is sound. A watchdog for patients keeps the NHS on its toes. And if it is to mean anything, such an organisation must be independent of the NHS and able to exercise the legal right to be heard and consulted. Without those features it will not command the confidence of the public.
Of course it would be odd if, after 26 years, we could not identify any scope for changing or improving CHCs but what we certainly should not do is scrap them without being sure that the arrangements we put in their place retain the features of CHCs which we all value. At this stage I suspect that I am not alone in not knowing exactly how the proposed new structures will function and interact with each other.
What strikes you immediately when you read the NHS plan is that the functions of CHCs are to be divided up between a number of different bodies. That fragmentation is bound to mean that no single body will be able to take an overview of the broader patterns which emerge from individual complaints or from problems which come to light in the provision of services. Still less will it be possible to do what the ACHCHW does so valuably at the moment in looking at failures in the system from a national perspective and feeding its views to government. From the point of view of an individual patient, it may often mean having to seek help from a number of different bodies instead of just one. That does not seem the way to achieve greater patient empowerment. Empowerment of patients depends ultimately on rights enshrined in law. At the moment, CHCs have the right to be consulted, the right to require information from health authorities, the right to inspect and report on hospital facilities and others, and the right to refer contested plans to the Secretary of State for Health. Those rights are valuable levers. It is all very well the NHS plan stating that patients' forums and independent advisory forums will act as "sounding boards" but what does that really amount to? It looks to me like a dilution of rights, not a strengthening of rights.
On an individual patient level, the role of an advocate presupposes a degree of genuine detachment from the organisation being criticised. I do not believe that if PALS are employed by the trusts and situated on hospital premises patients will view them as truly independent. Advocates worthy of the name must be free of any conflicts of interest, either real of perceived. They have to be in a position to take the initiative in providing support and advice and to do battle on behalf of the patient. Again, PALS seem to be a step down from present arrangements.
I refrain from attributing any motives to Ministers for the changes they have announced. I simply say to the Minister, with considerable regret, that I believe these proposals to be a mistake. I hope that the Government will find it possible to think again.