I beg to move amendment No. 163, in page 20, line 3, leave out subsections (1) and (2) and insert—
''(1) The Community Health Councils established for districts in England under section 20 of the 1977 Act are reformed and are renamed Councils for the Involvement of Patients and Public (''Councils'') and the Community Health Councils Regulations 1996 are amended accordingly.
(2) 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, make regulations in relation to Councils in England providing for—
(a) the inclusion in Councils' annual reports of details of the arrangements maintained in that year for obtaining the views of patients, carers and the wider community in their localities;
(b) the commissioning of, or delivery by, Councils of services under section 19A of the 1977 Act (independent advocacy services) within their areas;
(c) the preparation of reports on the operation of the independent advocacy service to be compiled by Councils and provided to the Secretary of State, the Commission for Patient and Public Involvement in Health, the relevant overview and scrutiny committees, Strategic Health Authorities, NHS trusts, and other appropriate organisations;
(d)(i) promotion by Councils of the involvement of members of the public in its area in consultations or, processes leading (or potentially leading) to decisions by those mentioned in section 19(3), or the formulation of policies by them, which would or might affect (whether directly or not) the health of those members of the public;
(ii) co-operation with the Commission for Patient and Public Involvement in Health in carrying out this function;
(e) the provision of advice, reports and recommendations by Councils to strategic health authorities, Primary Care Trusts, NHS trusts, and overview and scrutiny committees;
(f) the furnishing and publication by NHS trusts, Primary Care Trusts, Strategic Health Authorities and overview and scrutiny committees of comments on the reports, recommendations and representations of Councils referred to in paragraph (e) above and paragraph (h) below;
(g) the discharge of any function of a council by a committee of the Council or a joint committee appointed with another Council;
(h) representation by Councils of the views of members of the public in its area about matters affecting their health to persons and bodies which exercise functions in a Council's 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);
(i) co-operation with The Commission for Patient and Public Involvement in Health in its duties.''
With this it will be convenient to take the following amendments: No. 171, in page 20, line 21, leave out ''(2)(c)'' and insert ''(2)(e)''.
No. 172, in page 20, line 22, leave out ''Patients' Forum'' and insert ''Council''.
No. 173, in page 20, line 24, leave out ''Patients' Forums'' and insert Councils''.
No. 174, in page 20, line 27, leave out subsection (5)'.
No. 175, in page 20, leave out line 39.
No. 176, in page 20, leave out lines 44 and 45.
No. 177, in clause 16, page 21, line 15, leave out ''Patients' Forums'' and insert ''Councils''.
No. 178, in clause 16, page 21, line 20, leave out ''Patients' Forum'' and insert ''Council''.
No. 179, in clause 16, page 21, line 22, leave out ''Forum's'' and insert ''Council's''.
No. 164, in clause 19, page 23, line 20, leave out subsection (1) and insert—
''(1) the Association of Community Health Councils for England and Wales established under paragraph 5 of Schedule 7 to the 1977 Act is reformed as a body corporate and is renamed the Commission for Patient and Public Involvement in Health; the NHS (Association of Community Health Councils) Regulations 1977 and the Community Health Council Regulations 1996 are amended accordingly.''
No. 165, in clause 19, page 23, line 23, after ''following'', insert ''additional''.
No. 182, in clause 19, page 23, line 32, leave out ''Patients' Forums'' and insert ''Councils''.
No. 167, in clause 19, page 23, leave out lines 36 and 37.
No. 183, in clause 19, page 23, line 36, leave out ''Patients' Forums'' and insert ''Councils''.
No. 184, in clause 19, page 23, line 41, leave out ''Patients' Forums'' and insert ''Councils''.
No. 169, in clause 19, page 23, line 45, leave out paragraph (g) and insert—
''(g) co-ordinate and support the activities of Patients' Councils in respect of their activities provided for at sections 15(2)(h)''.
No. 185, in clause 19 page 24, line 35, leave out ''Patients' Forum'' and insert ''Council''.
No. 154, in clause 20, page 25, line 21, leave out subsection (3).
It is almost with a feeling of trepidation that I begin the debate on these important clauses. I note that my amendments have been signed by Conservative Members and I welcome that. Before the Minister tries to judge what I am about to say, patient and public involvement is not something that divides, or should need to divide, along party political lines. We should all be in the business of finding the best solution.
Resources do not play a huge part in the clauses. Many types of formula have been hit on to find the right approach, and the amendment constitutes one of them. I am happy for it to be described as a varied, amended or reformed status quo; that is what the Government intend for the NHS. The Minister has just said that it is not the intention to tear up or abolish the NHS and start again. On that basis, it is reasonable and appropriate that the Government consider amending the system before cancelling it out and imposing a new one.
A few things will be said at the beginning of the debate that will have been heard before, but bear restating. Those who support the amendments, which address the existing community health council structure, and those that address clause 19, which address the reform of the Association of Community Health Councils of England and Wales—here, we are talking about England—do not necessarily feel that every community health council is as good as another. In earlier debates, we would not have argued that every provider, or commissioner, was as good as another, even if they had all been given the same resources. However, that does not mean that we should abolish the lot. We should not abolish every provider or commissioner simply on the basis of varied performance; we should seek to ensure that they have the right powers, the right monitoring and the right support, both from the centre and from their own staff, to do the best possible job, at least to minimum standards.
Throughout this debate, which has now spanned two Parliaments, the Government have never set out clearly enough why the current system cannot be reformed and has to be abolished. That point has been made at length by Conservative Members, Liberal Democrat Members—including my hon. Friend the Member for North Devon (Nick Harvey)—and the former and current Chairmen of the Select Committee on Health.
Does the hon. Gentleman agree that the Government have never coherently, or even satisfactorily, explained the need to abolish CHCs and replace them with another structure?
Quite so. That is a useful and clear summary of my preamble.
One argument that the Government could deploy is that the performance of community health councils is patchy, as is that of the Association of Community Health Councils in its various functions. However, they have never commissioned a report to analyse the failings of individual CHCs and to find out whether they are failing as a result of their mere existence,
rather than as a result of their under-resourcing, having the wrong personnel, their inappropriateness to their geographical function or the fact that they have been too easily bamboozled by the local health care players that they are there to monitor. It is incumbent on the Government to present such a case before going for wholesale abolition instead of considered reform.
I greet the Under-Secretary and apologise for not having done so earlier. I know that she is prepared to listen and to consider the issues, and she probably does not bring much with her in the way of set views; she is relatively new to her job, although she seems to have been here for a long time because she has made a big impact. However, I suspect that some of her more senior colleagues have an absolutist position and will not consider anything short of what they originally envisaged. If that is so, it is regrettable, and it should be made explicit. I fear that it will not be made explicit, but it will be made regrettable; if not here, in another place.
The second argument that the Government could use to justify the abolition of CHCs is that they do not have the right powers for the ''new'' NHS; the NHS that the Government have created and are in the process of structurally recreating through almost every piece of legislation. Indeed, that argument was more than hinted at by the Secretary of State on Second Reading, when he complained:
''The CHCs had no role in primary care; patients forums''— the Government's preferred model—
''will have that role. The CHCs were refused the right to inspect GPs' premises; patients forums will have that right. The CHCs were partly appointed by the Secretary of State for Health; patients forums will all be appointed independently of both the Secretary of State and indeed the NHS. The CHCs had no formal rights of representation within NHS organisations; patients forums will elect, as of right, one of their members to sit on every trust board.''—[Official Report, 20 November 2001; Vol. 375, c. 203.]
The obvious response to that was given by the hon. Member for Wakefield (Mr. Hinchliffe), the Chairman of the Select Committee. He said:
''I accept that CHCs do not deal with primary care issues, but they could do, as the Secretary of State is aware. It would be easy for them to deal with those sectors that they have not been allowed to address. We need to modernise the CHC structure.''—[Official Report, 20 November 2001; Vol. 375, c. 214.]
I was surprised to hear him use the word ''modernise'', as I think that he has similar views to mine about its overuse in describing pointless reforms. I suppose that he was playing the game, as we all do sometimes.
In respect of all the powers that the Secretary of State described, the law could be changed to give them to CHCs. I hope that that is what the amendments would do. The Government have made an important point in saying that CHCs do not have the right powers to fit the shape of the NHS. The straightforward and simple solution to that is to make the necessary reforms to ensure that CHCs have those powers.
Apart from CHCs not having the right powers, I cannot think of any other good reason for the Government to abolish them, other than the patchy performance that is a function of their existence, rather
than being something that can be ameliorated. The Government have not taken such an approach with other parts of the NHS.
I will briefly go through the amendments to remind myself of their details and to help the Committee. Although in your wisdom, Miss Widdecombe, you have selected the amendments for discussion under clause 15, many of them apply to other clauses because they are consequential. With your permission, we will have to discuss some of the issues in the other clauses when dealing with those amendments. They must also be read with amendments that would have deleted whole clauses. They were not selectable because such matters should be dealt with under a clause stand part vote and not through discussion of an amendment. I hope that Committee members recognise that some of their amendments would be in this group were they selectable.
Amendment No. 163 would delete subsections (1) and (2) of clause 15 and substitute new subsections that would, in effect, rename community health councils. I think that that is worth doing, and I will explain why. I will also set out what would be their powers, and the powers of the Secretary of State to make regulations about them.
On the name, perhaps the Government feel that anything redolent of the old NHS needs to have its name changed and that ''community health council'' does not impart the idea of the need for patient involvement that they want. Those who tabled the amendment therefore thought it reasonable to rename community health councils as ''councils for the involvement of patients and public'', which can be abbreviated to CIPAP. Any other combination of those words does not lend itself to that abbreviation, but for the ease of the Committee, we refer to them as ''councils'' in the other amendments. The Minister and Committee members will notice that many of the proposals refer to patients forums as ''councils'', meaning these bodies.
The new subsection (2) that amendment No. 163 proposes sets out the councils' functions. Amendment No. 171 would change ''(2)(c)'' in clause 15, page 20, line 21 to ''(2)(e)'' because of necessary renumbering. Because of the pressure of time, it is not now appropriate to go through the functions in detail, but I will draw out a couple of them, to help the Committee.
The proposed new subsection (2)(b) discusses
''the commissioning of, or delivery by, Councils of services under section 19A of the 1977 Act (independent advocacy services)''.
There is an argument that the reformed community health councils—that is, these councils for the involvement of patients and public—should continue to attempt to deliver such independent advocacy. It was, however, often noted in the consultation that Ministers do not feel that such bodies should have a monopoly on the delivery of independent advocacy services.
Now is not the time to argue about that. I have some sympathy with the view that diversity can be helpful and that, as we commission all sorts of things in the national health service, it is reasonable to commission independent advocacy services.
That is why the clause is drafted in terms of the commissioning or delivery of independent advocacy services by councils. We could argue that separation is needed because the councils are later asked to make a report on the quality of the independent advocacy services. It may be appropriate to ensure separation within the new councils or separate delivery from the commission.
The Under-Secretary will see that many proposals for the powers of the councils are familiar to her. They are the sorts of powers that she wants her patients forums to have; many community health councils still have them.
Some of the amendments would replace patients forums with the new councils. Clause 19 contains an important provision to give internal symmetry to the proposals by renaming the Association of Community Health Councils for England and Wales the Commission for Patient and Public Involvement in Health, which is a creature of the Government. It recognises that the existing structures can be reformed in the way favoured by the Government for the new NHS. Clearly, some functions will be common to the renamed association and the Government's creature; a separate non-amended body, the Commission for Patient and Public Involvement.
One of the reasons why we want to remove clause 19(2)(g) from the Bill is that the Government envisage the national body as having the ability to get to the nitty gritty of local decision making through overview and scrutiny committees. That function is inappropriate for a national body and therein lies the problem with the Government's proposals. The patients forums simply will not have the facility to engage properly with the overview and scrutiny committees and to influence the committees' statutory powers of calling in. The Government suggest in clause 19(2)(g) that a national body can have that power, but it is surely too centralised and unwieldy. It seems reasonable to ensure that built into this arrangement is the ability of the Government's patients forums to allow councils to liaise at local level. Whatever decision is taken on this group of amendments, clause 19(2)(g) will require further thought.
Time is pressing and there will not be time for me to go into the detail of all the amendments in this group, but I hope that I have given the flavour of our overall approach. I accept responsibility for and absolve other hon. Members who tabled the amendments if they are not complete. I fear that the proposal to abolish clause 20 is not included, but we shall have a chance to deal with that later and it may be inappropriate to try to abolish it now. Some matters are not covered, but we can only do what we can do. Help has been provided by the Association of Community Health Councils for England and Wales, which is busy at the moment with
its statutory functions. I hope that the Minister will not simply rely on the fact that there may be drafting errors in the amendment and that he will address the substantive proposal.
In summary, I believe--I hope that other Committee members agree--that our approach is rational. The Government must demonstrate why it is inappropriate and why they must abolish community health councils without first trying to reform them.
I am genuinely fascinated to know what line the Under-Secretary will take in her reply, because from 1993 to 1997 she was chair of the Salford community health council. No doubt she did a good job and came fully to appreciate what a valuable contribution that community health council made to the lives of the people of Salford by acting as an independent voice in health care provision and helping individuals in the community with their problems. It also played an important role in the local area in helping to advise, formulate and fulfil the provision of health care for Salford. At last, we have a Minister who knows something about the subject that she is debating, but she will have to behave like a juggler to repudiate the views that she held so deeply during that period.
I am not a cynical man, so I will not say that the hon. Lady loved and supported the proactive role of community health councils in 1993 to 1997, because the Government in those days were Conservative, not Labour. She saw the role of the community health council as emphasising the problems facing the health service at that time. If that had that a knock-on effect politically, it was all well and good for the Labour party.
During the prolonged debates that we had on the abolition of community health councils and the imposition of patients forums in the past six to nine months, I have noticed that this Government, who brook no opposition and hate the idea of any criticism, see community health councils as too successful, independent and determined to do their job properly in representing the interests of local people with regard to the provision of health care. I suspect that Ministers in the Department of Health petulantly decided that they would rid themselves of this ''troublesome priest.'' They came to the conclusion that it was not in their interest and did not fit in with the spin that they like to put on their policies for there to be an independent, free-thinking organisation doing to a tee the statutory duties that were imposed on community health councils at their inception.
To bolster the need for the amendments, one has only to consider the record of community health councils over the 27 years since their inception in 1974. You will know, Miss Widdecombe, that those councils were established as patient advocates in the NHS. By any criterion that one chooses, their success in being good, formidable patient advocates is beyond dispute.
They have been at the forefront of ensuring that the patients' voices are heard and their complaints listened to.
Most recently, community health councils played a pivotal role in ensuring that Rodney Ledward was exposed and that the relatives of the victims of Harold Shipman were supported during a difficult time. I suspect that if hon. Members were honest, they would admit that such people have done a good job. The hon. Member for Crawley (Laura Moffatt) is a former state-registered nurse, so she will have first-hand experience from the other side of the excellence of the work of community health councils. If all members of the Committee examined their souls, they would know from their experience as constituency MPs—not as Ministers or poodles to the Government Whips Office, but as individual Members of Parliament representing their constituents—how good a job the community health councils do, by and large.
Of course there is a case against the community health councils, as I am sure that they would be the first to admit. In some areas, they could be improved. Certain community health councils and some of their members may not be as efficient as others. There are grounds for improvements, but that does not necessarily mean that there are grounds for the abolition of an independent voice and its replacement by a poodle. The patients forums as envisaged by the Government are nothing more than a lapdog. They are an attempt to silence opposition to what is going on in the health service, and to deprive our constituents of an independent and powerful advocacy service on their behalf.
To put that in perspective, I would like to mention what the community health councils have done to justify their retention, albeit in a reformed format. On average, they assist around 30,000 people with complaints. A recent poll conducted by Health Which? found that 84 per cent. of those who had contacted their community health council at some point found the advice given very or fairly useful, which suggests an extremely high satisfaction rate.
A recent report, ''Hidden Volunteers'', conducted by the Community Service Volunteers estimated that community health council members contributed through their dedicated work about £7.9 million worth of free labour for the national health service. No one in the Room would underestimate their work—those who would must be extremely brave. People have devoted their time and effort to ensuring that the institutions that Parliament set up in 1974—according to research, the Labour party was in favour of it at the time—have more than fulfilled their potential, and continue to do so even as we discuss their future yet again tonight.
The trouble is that community health councils are a thorn in the Government's side. To be effective, they have to be a thorn in the side of every Government, regardless of their political persuasion. That is their role as an independent advocacy service. They are there when trusts and health authorities propose to close wards to save money. They have the real power
to get such decisions called in to Ministers if they do not agree that they are in the best interests of local communities.
I will give the Under-Secretary an example that shows how the people of mid-Essex must be more than grateful in the end—it is sad that I have to say in the end—for the work of their community health council. The management of the Mid Essex Community and Mental health trust was fairly rotten until 18 months ago. In the end, it was replaced, and Ministers would be the first to accept that that was the right decision, certainly based on waiting list figures. The then management decided to close two wards in an attempt to save a little under £1 million to combat its financial problems. The way in which the proposals were implemented suggested that that money would not be saved because of the ensuing bed blocking, but the two wards would have been closed and all those acute care beds would have been lost.
In the end, the community health council stepped in and formally objected, which meant that the matter had to go to Ministers. It turned out that the community health council was absolutely right. The wrong decision had been taken—it would not achieve any savings or improve the provision of health care in any shape or form—and the community health council put a brake on the process. The trust abandoned the proposals; a decision that has been more than justified over the past 18 months. Without a community health council with those powers, those closures would have gone ahead and the situation for the provision of health care in mid-Essex would have been even worse than the trend suggested.
That shows the importance of community health councils and that is why it is important that the Government should think again and be prepared not to proceed with an idea that they cannot justify. During the debates on the Health and Social Care Act 2001 earlier this year, another place, thank heavens, through a combination of its Members' actions and the time scale of the general election, managed to stop this proposal from going ahead. Sadly, Ministers, almost as if they are feeling insulted that Parliament has stopped a proposal, however cock-eyed and difficult to justify, seem to believe it should be punished after the election by bringing back what is to all intents and purposes the same proposal.
No doubt the Under-Secretary will try to produce a fig leaf, not only for her own change of heart on the effectiveness of community health councils but for the proposals in this Bill, which are similar to those in the previous ones, although in some ways they are even worse.
The amendments would enable the Secretary of State to revise and extend existing regulations governing the operation of community health councils so that they might be retained and reformed in England. Of course, Miss Widdecombe, you will have noticed, as will any other perspicacious Member of this Committee, that community health councils will not be abolished in the Principality of Wales. It is a pity that the Under-Secretary of State for Wales, who has attended many of our Committee meetings, is not here.
It would be interesting to hear his views as to why Wales is allowed to continue with the structure of community health councils, but England is not. [Interruption.] I thought that I heard ''devolution'' from an hon. Member on the Labour Benches; I have no doubt that that is the reason. Why is it that a devolved Assembly in Wales, which-unless my mathematics and my memory are wrong; the First Minister is a Labour politician-is run by the Labour party, has had the common sense to keep the community health councils in the Principality?
I do not know whether I am assisting the hon. Gentleman or the Labour party by pointing out that the Administration in Wales is a partnership between the Labour party and the Liberal Democrats. Who knows exactly who has taken which position, but it is likely that one of the conditions of that partnership government was that there was true democracy at local level in the community in the health service and that is why CHCs were saved.
If I understood that intervention correctly, the hon. Gentleman was claiming that because of conditions laid down by the Liberal Democrats community health councils are being retained in Wales. I am afraid that I have no way of verifying that fact. I hesitate to take it at face value, not simply because it is a Liberal Democrat claim, although that plays a role in my hesitation, but because the hon. Gentleman did not categorically say that that was the case. He said that he thought that that might be the case. Will he clarify the matter?
There are many reasons why Wales has a different system. First, the Assembly has a system of proportional representation that allows partnership government. Secondly, there is partnership government, which means that matters are not decided in the politburo negotiations of a single party. Thirdly, at least one party in Wales—possibly two—is concerned about the exercise of local democracy, democracy in the health service and adequate patient and public oversight, and seeks to retain the CHCs on that basis.
The hon. Gentleman's figures are wrong. There are not only two parties in Wales with those concerns, because the Conservative party in Wales also supports the continuation of community health councils. I cannot believe that Rhodri Morgan would retain community health councils in Wales if he did not believe that they should be retained. Unusually, I would give the Labour party in Wales the credit for that sensible policy. As I said earlier, I only wish that the Under-Secretary for Wales were here tonight, because he would be able not only to elaborate on the mechanics of the matter but to explain to the Committee why it is important for Wales to retain these invaluable bodies and for the English not to do so.
Wales has got it right and the Government have got it totally wrong in England, because they cannot realistically explain why they are hell-bent on taking this action. They are making a grave error. If the proposals are approved in another place, the Government will deprive all our constituents of a service that is proven, tried and tested. It works, is independent and has the interests of local communities and their health care at heart and conducts advocacy on patients' behalf in a highly effective way.
I would say to the Under-Secretary, particularly as she is a new Minister, that she should think again, because there are ways, as the amendments suggest, in which community health councils could be reformed to meet any criticisms that the Government may have. The failings apparent to the Government, but not to many other people in the country, can be remedied. The Under-Secretary is making a grave blunder at the beginning of her ministerial career if she puts behind her her first-hand experiences as the chair of a community health council and, for narrow, party political dogma and to silence opposition and criticism, decides to go ahead with a pernicious and petty proposal.
I shall be brief, because time is short, but I must make two points in support of amendment No. 163. As an illustration, I would like the Under-Secretary to put herself in the shoes of somebody in my county. We have three major conurbations with three community health councils, so patients have to go only to one CHC for any of the services that are currently and, I hope, will continue to be, within its remit. Under the new arrangements, there will be five patients forums, and a given patient in one of the conurbations might have to consult three separate organisations. That is my first point—what a tremendous inconvenience. CHCs have all services under one roof.
The second point is about the constitution of CHCs, which include representatives from the voluntary sector who in my experience not only represent their own voluntary sphere but act as very good spokespersons for the whole community. They also include a number of elected councillors, and that introduces a democratic element. There is also a relatively small number of appointees. It does not appear that forums will be constituted in the same way.
I must say that the Bill is not exciting a great deal of enthusiasm among my constituents, but if I were to pick out an item from it that has raised a collective eyebrow it would be the proposal to abolish community health councils. CHCs have been going for about 27 years. It takes a long time for people to get used to institutions, but they have finally got used to CHCs. Broadly speaking, people know what they are and the geographic area that they cover, and they are comfortable with them. CHCs are like a pair of old carpet slippers; people have become used to them. Now, for no good reason, the Government propose abolishing them; they want to throw out the comfortable carpet slippers and replace them with
something unknown. In all likelihood, it will be another generation before people are fully used to the change and comfortable with the replacement. Doing that with good reason is fine, but we have yet to be provided with a good reason for disposing of CHCs.
The Association of Community Health Councils of England and Wales was upset. It does not understand why the Government want to abolish it, particularly as its feedback suggests that it is doing a good job on behalf of patients, carers and the general public. 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 the 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.''
That is quite polite. A good analogy would be of poodles and watchdogs. We are losing a watchdog, and it will be replaced by poodles—lots of them. There will be fragmented poodles, poodles for primary care and poodles for secondary care.
Where is the joined-up Government in that? Surely we should have a seamless join between primary and secondary care. People do not necessarily distinguish between the two. They know when they are unwell that they need access to health care. It would be far more helpful to have fewer such watchdogs—watchdogs that will take people through the whole multi-tiered layers of the NHS, from primary to secondary and tertiary care, but hopefully not beyond that—but it should be seamless. People do not want to be bothered with multiple tiers and multiple layers. They want a one-stop shop. That is what they have now; and that is what they are about to lose.
Except for patient forums, patients lack a collective voice. The community health councils are recognised by the public as somewhere to go if they have concerns about the health service. They will be abolished. As a general observation, it seems that the Government have started from the standpoint of wanting to abolish CHCs—it seems to be a constant theme—but they have not told us why. They do not explain adequately how the functions of CHCs will be carried out under the new system. They merely present us with alternative institutions.
The notion that the Government started with the idea of abolishing CHCs without knowing exactly why and without knowing how the replacements for CHCs would carry out the functions currently undertaken by CHCs is my principal concern about the Bill.
I am delighted to have the opportunity, under your chairmanship, Miss Widdecombe, to deal with the amendments. I hope that I can enlighten members of the Committee about the reason for the Government's proposal and that I can even convince one or two of them that the new system will be more independent, integrated, accessible and accountable and much stronger than the previous system. It will give patients a much better and more vigorous voice within the national health service—and beyond it.
I shall now mention the amendments tabled by the hon. Member for Oxford, West and Abingdon. I shall be generous and not go through the detail of them because they would create a jumble of functions between patients forums and the commission. Many names would be changed. I did not think that the hon. Gentleman favoured style over substance, but his amendments skim the surface of the proposals rather than deal with the in-depth nature of the changes that the Government want to make.
If the Under-Secretary considers that our amendments and those tabled by the hon. Member for Oxford, West and Abingdon are poorly drafted but concedes the case that they make, surely she can allow her own fine parliamentary draftsmen to knock them into shape.
The amendments are beyond being able to be knocked into shape. They fail to appreciate the nature and depth of the Government's proposal. I shall deal with their substantive nature, however, rather than the way in which they are drafted.
The hon. Lady said that the amendments would merely change names. I hope that she will accept that they would, in fact, reform the existing system, including the change of name. We should not just change names when we say that we are making reforms, but carry out the reform. I am upset that the hon. Lady has accused me of doing what the Government have tended to do.
Both hon. Gentlemen have asked us to explain why we want to replace community health councils with patients forums working inside each trust. That is the key to the matter. We want bodies that are within the structures of the national health service that can really act as levers for change. We want them to drive up quality and have sufficient influence and clout within the system to make a difference for patients, and we want them to be balanced by equally strong bodies on the outside, which can effectively overview and scrutinise the system.
It is a difficult balance to strike but, in the past, the community health councils had virtually all of their powers on the outside. They often reacted after events had occurred. They were often not able to influence the shaping, the configuration and the options that were being developed about the health service. They felt that, no matter what their powers were, those powers were exercised in response to events. They were reactive organisations. I say that with some feeling, having been a chair of a community health council for several years and having often been faced with a set of
events in which I had no alternative but to threaten legal action because I and my association had no right to be on the inside and to be party to such decision-making processes. A fundamental part of the Government's proposal is to ensure that not only patients, but members of the public have a voice in shaping the health service from the inside. Clause 15 is the key to achieving that, because it recommends patients forums in each trust. The forums will be able to work from the inside. They will have a member on the trust board. They will know what is important to patients and will be able to do something about it.
I am grateful to the Under-Secretary for allowing me to interrupt her flow. She argued that community health councils were currently too responsive and reactive. Why not make them less responsive and reactive by—to use the hon. Lady's words—bringing them on board for each primary care trust? Why cannot she give councils for the involvement of patients and the public at local level a place on the trust board, as she proposes for her own creation?
I hope that, when the hon. Gentleman can appreciate the breadth and sweep of the provisions under clauses 15 to 20, he will see emerge a coherent system that will provide an influence on the inside that is balanced by a rigorous scrutiny position on the outside, too. Taken as a whole, that system will fulfil the need of patients and citizens for a stronger voice. I hope that I shall convince the hon. Gentleman during our debate that we shall not have a mish-mash or a jumble of provisions, which, with respect, his amendments would put in place, but a coherent system. At trust-based level, the patient advocacy and liaison services system and the patients forums will be on the spot. On the outside, the scrutiny will be done by the commission, the local workers of the commission, the independent complaints and advocacy service and the overview and scrutiny committees of local authorities. That provides a real balance to ensure rigour, strength, accountability and integration in the system.
The Under-Secretary will know that it is her proposals, at their various stages, which have been called a mish-mash. I did not attack her proposals. Before she defends her proposals, she must say why the existing structures cannot be reformed to provide exactly what she has described. Nothing in the amendments says that the PALS system should not exist, or that the overview and scrutiny committees should not exist. Before she talks about her coherent system, she has a duty to explain why the existing one cannot be made coherent through reform and legislative change.
And I certainly will do that. If one takes out the PALS system, which is the on-the-spot advice, patients forums, which provide the monitoring and inspecting, and the right to refer contested decisions to Ministers, which is the overview and scrutiny part of
the community health council's functions, one already has a denuded organisation. There comes a point at which, after one separates out the functions and makes them stronger and more integrated, what is left is an empty shell of an organisation. Therefore, one must have a new system that properly reflects a multi-layered organisation such as the NHS, and one must ensure that the voice of the patient is heard at every single access point to the health service. Taken as a whole, that is a coherent system.
I am afraid that the hon. Gentleman is suggesting that, as well as all the other things, we have some kind of additional body. That would really be a mish-mash system, and very difficult to understand.
When my hon. Friend the Member for Wakefield (Mr. Hinchliffe) was promoting patients councils during debates last year, he was promoting a different animal from that which is referred to as a council in the amendments. He was seeking to provide a body within the system that would draw together all the patients forums and ensure that all those views were brought together regularly, to engender within the health community a sense of the issues being raised at local level. That would ensure that patients forums were not isolated in each trust and unable to get their view across. Under the Government's proposals, the local parts of the Commission for Patient and Public Involvement in Health will provide exactly the function of the patients councils advocated by my hon. Friend the Member for Wakefield. They will be patients councils plus, because they will have a number of extra statutory powers. Therefore, we are building on the proposals of my hon. Friend the Member for Wakefield, rather than simply putting them in place.
I think that my hon. Friend the Member for Wakefield will be interested to look at the discussions in this Committee. The conclusions that he reaches are a matter for him. Some of the proposals genuinely build on the ideas that he advanced, but his ideas are very different from those in the amendments tabled today, which refer to turning patients forums into patients councils, which was not within his contemplation at all. He was talking about co-ordination, drawing together, learning the lessons and joining up the system, not replacing patients forums with patients councils, which serves to confuse the matter even more.
I shall now explain why the new system is necessary, and why we need patients' forums. The NHS is more complex and multi-layered, and different functions are needed in different parts of the system. Most people involved in community health councils would recognise that there was inconsistency across the piece. Some brilliant community health councils were doing
fantastic work, but it would not necessarily be done the same way in Bristol, Bath, North Yorkshire and Cornwall. Performance was extremely patchy.
The hon. Member for West Chelmsford mentioned the fact that my community health council in Salford did some excellent work. I can also confirm that, for years, it has been trying to pilot new ways of working, which we are proposing to use to involve citizens and find groups who are never involved in public consultation. We want to involve the socially excluded and marginalised: homeless people, asylum seekers, travellers, young people, those who cannot turn up to a meeting on the second Tuesday of the month at the public library, but whose views are equally valid in shaping the health service. The most progressive community health councils carried out that sort of public involvement work and welcomed those ideas, so they have drawn in the views of the wider community.
Over the past six months, I have devoted much time to our listening exercise—talking to CHCs, councils for voluntary service, local authority groups and a range of voluntary groups in the NHS. We have had nine regional listening events and 1,000 people—
There were 1,000 people at the consultation meetings, and we have received 1,000 letters, one of the biggest ever responses. Many CHCs welcomed the proposals.
As well as many patient organisations that have welcomed the proposals—
I received a personal letter written on behalf of Wirral community health council. The writer said that at the council's meeting on 15 November, it examined the Department's latest proposals—we had changed our proposals because we do listen and it was a proper exercise in consultation. The writer of the letter said that members of the CHC agreed that the new proposals offered a much more cohesive approach. They applauded the emphasis on co-ordination of the new structures at a local level by the Commission for Patient and Public Involvement in Health. They commended the inclusive nature of the consultation. They said that they themselves were piloting new ways of working, engaging local people in health decision making. They said that in November, they would be presenting to local MPs an evaluation of their pilot NHS comments hotline and that whilst the announcement in the NHS plan of the intended abolition meant an uncertain year for them, they had worked hard to embrace the spirit of reform heralded by the plan and had no doubt that the new proposals would ensure that that position was enhanced and strengthened. I am delighted that, after a year of
consultation, Wirral community health council welcomed the proposals with such open arms; it is not alone.
Does the hon. Lady accept that she is a Minister for England, not just the Wirral? If she is going to increase support one body at a time, it will take several years before she can cover a county. How can she argue that the amendments are dealing with an empty shell when all the reformed CHCs' functions, including PCT representation on boards, are set out in amendment No. 163? Are those functions important?
The functions are extremely important, which is why they belong to the patients forums inside each trust. Other bodies must carry out functions in a coherent system of patient and public involvement. We need a new system to create powers to follow patients wherever they go in the system. Patients forums can work together. In primary care trusts, a patients forum will allow us to study the premises of GPs, dentists and pharmacists. Where joint arrangements with local government exist, patients forums will also have the power to follow people in local authorities. In private sector arrangements, a condition of the contract will be that patients forums are allowed to monitor, inspect and ensure that the quality of services is up to the mark.
CHCs, no matter how good they are, would acknowledge that they are not fully representative of their communities. My constituency CHC is not because it is a static membership organisation that meets on the second Tuesday of the month. It tends to be self-selecting in the sort of people who can, or want to, take part. It is mainly politicians who enjoy going to meetings on the first Monday, the second Tuesday, the third Wednesday and the fourth Thursday of the month. Asking people in a voluntary sector setting to give that type of commitment is sometimes extremely difficult. We need to be more creative and more imaginative about the way that we seek to involve patients and the public in a range of public services, but particularly in the health service.
What I find very disappointing about the amendments that have been tabled by the Opposition today is the fact that they are designed to perpetuate the status quo. From the Conservatives I am not surprised but I am surprised that we see the Liberal Democrats in alliance with the forces of reaction. I am surprised that they do not want to be forward looking or progressive or to raise their sights and consider whether there might be better ways to involve the public and patients in our health service. Do they simply want to say that the status quo is good enough? [Hon. Members: Hear, hear.] Certainly that is not my view. I believe that we have a challenge and a duty to improve the way in which we involve the public and citizens in our public services.
I am finding this Committee stage rather a metaphysical experience because we go from broad generalisation about the need to involve people and the forces of reaction to the citing of the fact that there is something in the existing legislation surrounding CHCs—or something in the water that they drink—
that restricts them to second Mondays and third Tuesdays. I find this whole debate surreal. I want the Minister to address the argument, which I tried to make constructively in my opening remarks, that there is no reason why all the powers and new models, systems and, presumably, meetings in the ether rather than at a specific time cannot be used by reforming, not reacting to the existing system.
I have tried to explain to the hon. Gentleman that his proposals to—as he says it—reform simply tinker with the system at the margins. They do not reflect the new shape of the NHS or that, as I have said we shall have PALS on the spot in the trust. We shall have patients forums inside the trust, levering up standards and quality. We have already transferred the legal duty to refer contested reconfigurations to the local authority over the scrutiny committee; that is one function that has already gone. We shall have the Commission for Patient and Public Involvement in Health, specifically charged with being the grit in the system to bring some rigour and ensure that we involve a wide range of people—whose voices have traditionally not been heard—in shaping the way that our health service develops. It will be a statutory body, whose job it will be to go out and create community capacity, to find the people, to populate all of these mechanisms and to ensure that those people can have a real say and make a real difference to the way that the health service works.
It is not right simply to reform the status quo. What is needed is a completely fresh look at the system. The best CHCs were doing some of that good work. We want to set up a new system that reflects the way in which we are devolving power to the PCTs—a system that ensures that patients and the public have a say at every single level within the system, that they are properly empowered to make a difference. There is nothing worse than asking local volunteers—I readily acknowledge that many members of CHCs have given 10, 15 or 20 years of fantastic voluntary work—to go on to bodies without the necessary back-up, training, education, support and guidance to enable them to feel that they can make a real difference in the decisions in which they are asked to participate. That is the type of system that we want to set up. We want to create a band of really active citizens who are able to shape the health service that they pay for as taxpayers—and long may it remain so—and therefore deserve to have a real say in shaping.
We have heard about these armies of volunteers who will spring up and populate patients forums, PALs and everything else. Those of us who have experience of the voluntary sector and specifically of CHCs know that it is extremely difficult to get people to volunteer for them. I would be fascinated to know where the hon. Lady will get this army of volunteers to populate her new bodies.
No, they will not, they will come from their own communities and they will come because they will feel that they can make a difference. The one thing that motivates people to become involved in public sector activity or service is the feeling that the two or three hours a week that they have to spare is being put to good use. They want to feel that they are not sitting in meetings dealing with correspondence, apologies and matters arising, but are making a difference to the health service.
I shall give the Committee an example. Recently I visited Somerset and saw independent health panels at work. People are asked to serve on them completely at random, so it is a varied group of individuals, and they sit on the panel for three years. They learn the ropes in the first year, engage in the issues in the second and are mentors for the new first-year people in the third. It is independently facilitated and all the decisions in the health community are referred to the health panel for consideration. At the end of the sitting, the panel has a matrix to show which proposals were changed as a result of its consideration.
During the period that I was told about, the panels had made a difference in 72 per cent. of issues. The members of those panels told me that that was why they wanted to be involved. They did not expect all the suggestions that they made to be adopted, but they realised that their two hours a week could make a difference to shaping the health service. That is not about sitting in static meetings, but about being engaged because members consider that the national health service is important, care enough about it and have the experience.
Half the people on patients forums will be recent or past patients and the other half will be voluntary sector organisation representatives. If they can examine a particular task or service—maternity, urology or coronary heart disease services, for example—that will engage people. We must also tell people that we value them and ensure that they are compensated for time off work. We must ensure that they can find the next step in their voluntary activity, and that we give them training, education and support to bring them through the system. We must tell them that their voluntary work is valuable and that we want to draw on their expertise, knowledge, talents and potential. We must also go out and find people, so that we do not depend on the normal people who can come forward. We must ask whether we have anyone to represent the black or travelling communities. Is anyone speaking for the homeless or young people?
In my constituency, we recently consulted people with Alzheimer's. People would say that we could not consult those with Alzheimer's, but we did. It is hard work, but if we are determined we can go out and do it. That is how we get volunteers to take part: value them, bring them forward and make extra efforts to bring them in. That is why we must be creative. Simply moving amendments that ask for the status quo is not the way forward for our health service. It does not value people's contribution and put them on the inside of the system in the patients forum, where they can make a difference, and tell the trust board that
something is wrong and that they want something done about it. They can call people to account and drive up the quality and performance in the health service. That is why patients forums are crucial to the measures that the Government want to put in place, and that is why I ask all hon. Members to resist the amendment.
As a Committee member asking the Government not to do something, I feel like the sole patient or public voice on one of the new boards. Will the Government suddenly be so cowed by such a volunteer that they say, ''Of course, we are wrong. The fact that you are here as a representative of a patients forum and not a community health council means that our historic approach to ignoring, if we have been ignoring, patient involvement has been entirely wrong''? I suspect that the majority of board members who are supposed to jump to the voice of the lone volunteer will behave like the Government in Committee today. They will not really address the concerns that have been raised—any more than the Under-Secretary has today—but merely restate mantra-like the fact that things must change.
I invited the hon. Lady to explain why community health council-type organisations had to be abolished rather than reformed. That was my challenge. I put it to her that the fact that they were variable did not mean that, with all the powers of legislative change, the Government could not impose minimum standards and issue guidance to ensure that that variability did not exist. The Secretary of State is rather good at making regulations and, if practice makes perfect, he should be getting better, although I am not too sure about that. The Under-Secretary has not addressed my challenge.
I cited the hon. Member for Wakefield because he asked, as I did, why the focus of community health councils cannot not be created around the new communities if the Government believe that those councils do not have the relevant powers or shape, or why they cannot change their names, if the Minister thinks it appropriate. Why can those councils not have the necessary functions once other organisations have been set up? Why can there not be reform and evolution, which the Government use as a defence, in the Bill?
The Government do not say that they will abolish all hospitals when some hospitals under-perform. They do not abolish a position when some people are not doing a job especially well or do not have the relevant powers. They defended their action on that basis when they did not abolish general practitioners, but gave them the powers to commission. That has also not been addressed. When hon. Members of either House come to consider the issue, it is important to stress that the Under-Secretary has not dealt with it.
The Under-Secretary says that the system is coherent, and cites in her defence what appear to be her own deeply held views, which one CHC seems to endorse. That is little more than the power to aver that something is so. She claims that when PALS are set up,
when scrutiny committees exist, when there are patients forums in every hospital or members of those forums on the trust board, all that would be left would be an empty shell once the other functions had been given to the reformed CHCs. I believe that those CHCs could be the bodies with a member on each trust board.
I invited the Under-Secretary to consider the list of powers that the amendments would still leave with those reformed CHCs, which she describes as empty shells with nothing valuable to do. I also invited her to consider the inclusion in councils' annual reports of details of the arrangements maintained in that year that pertained to the views of patients, carers and the wider community. [Interruption.] The hon. Lady is arguing from a sedentary position—a point that she made, in fairness—that patients forums will have that role. She has not addressed my question about the Government's need to create a new structure when the existing structure could use the experience and enthusiasm of the people already involved—[Interruption.]—because they have been through a lot recently—
Order. I am sorry to interrupt the hon. Gentleman, but several conversations are taking place and it makes life difficult for the Hansard writers.
The Under-Secretary must explain why the existing structure, with all its powers and the enthusiasm of those of whom she spoke so warmly when she talked about the notional new volunteers, cannot be channelled towards the kind of functions that she wishes to see. The amendments include the duty to ensure that the views of patients, carers and the wider communities are obtained. That would not make the reformed CHCs empty shells.
The commissioning and delivery of independent advocacy services by CHCs in their areas is an important function, and not one that would be found in an empty shell. The preparation of reports on the operation of the independent advisory service that would be provided to the Secretary of State, the Commission for Patient and Public Involvement in Health, the overview and scrutiny committee, strategic health authorities and trusts is an important role and not that of an empty shell.
It is also the function of community health councils, as reformed, to promote the involvement of members of the public in their area in consultations or processes leading, or potentially leading, to decisions by those mentioned in clause 19(4)
''or the formulation of policies by them, which would or might affect (whether directly or not) the health of those members of the public'' and to co-operate with the Commission for Patient and Public Involvement in Health to carry out that function. That is in the Bill, so the Under-Secretary cannot simply dismiss the amendments for not addressing points on which she waxed extremely lyrical. Those features are in the proposals that I am recommending. They set out important duties, before
a decision is made. The roles that the Under-Secretary said were so important are proactive. I believe that she sincerely believes in the importance of duties such as
''the discharge of any function of a council by a committee of the Council or a joint committee appointed with another council''
''representations by Councils of the views of members of the public in its area about matters affecting their health to persons and bodies which exercise functions in a Council's area''.
The amendments show, if one accepts drafting errors, that such duties can be achieved through the current system.
Much has been said about the refusal of people in the other place and the outside world to accept reform, and about how unreasonable they were when the previous Bill had its passage. I suspend judgment on that because, at the time, I was not doing my current job or involved in negotiations, although I studied the debate. However, the surreal quality of our debate and the Under-Secretary's refusal to explain why the existing system could not be amended to provide for the nirvana of volunteering that she described makes me believe that, if anything, people in the other place were too willing to meet the Government halfway. Perhaps they will still be willing to do so. The Under-Secretary will have to do a better job of persuading them and me why the existing functions are not important.
The Under-Secretary mentioned the importance of making a real difference and described how people in the community could do so. She veered off to dismiss all the work that members of community health councils have done to date. Even the people whom she does not believe to have done their job properly have worked hard. Then she veered toward the other danger of being patronising to people who fulfil that role, which she will be keen not to do. I urge her to exercise caution. If the Under-Secretary lifts her ambition and understands that people do not require their roles to be abolished or to be kicked in the face to achieve her aims, we have a real opportunity. I am prepared to accept PALS and Liberal Democrats have accepted overview and scrutiny committees and the need for patient involvement at board level in primary care trusts and in other areas. Negotiations are the order of the day, but the starting point must be to amend the existing system. That is the rational way in which to make law and structures and to approach reform. Unless the hon. Lady shows that she is prepared to examine the matter wider, I intend to press the amendments to a vote.
I shall deal with the hon. Gentleman's points briefly. I did not say that the functions that he proposed for his councils were unimportant. All the functions are vital and will be carried out by either patients forums or the commission. The hon. Gentleman's amendments would jumble up and blur the boundaries between the functions of the patients forums and the commission. Each function that he outlined is extremely important and is totally covered
by either the patients forums or the commission. I do not say that the functions need not be carried out or supported.
I made an explicit point that the proposals build on the best of work done by community health councils and, especially, their members. I went out of my way to recognise the years of excellent voluntary commitment that people have given to community health councils. I know many such people personally, and it is wrong for the hon. Gentleman to say that I patronised them or dismissed their contributions. I wish to find a transition through which staff and members may find new roles within the new organisations. We have gone out of our way to do so and to ensure that people will be helped if they require extra support and training to take a new and enhanced role in the new system. The Society of Community Health Council Staff welcomed the proposals. I attended its annual conference three weeks ago, and 150 members were present. Following my presentation I did not know how what reception to expect, knowing how controversial the proposals were last year, but I was received extremely generously.
I received a testimonial, which I shall not read out, from the chairman of the society, Tony Tester, to say that the society welcomes the proposals from the point of view of community health council staff. Every effort has been made to ensure that we draw in the best ideas of the CHCs and of members. We will set up a transition advisory board to ensure that members in the system see a key role for themselves in future and can take on new responsibilities.
I want to respond to the points made by the hon. Members for Wyre Forest and for Westbury. To the hon. Member for Wyre Forest I say that it will be important to provide proper signposting to the new parts of the system that are designed to involve patients and the public; the patient advocacy and liaison services system will be on the spot in the trusts, more visible and accessible to everyone than community health councils.
We shall arrange for NHS Direct to provide a signposting facility so that anyone who telephones with a query needing independent complaints and advocacy services will be pointed in the right direction. If they need PALS, or want the commission to help them in taking part in a public consultation they will be able to get in touch with them. We want to make the system as accessible as possible.
We want to ensure that members will be appointed at local level by the commission and draw on people to take part in the patients forums who would not automatically reply to an advertisement in The Guardian, for example, and go through a formal process. We want rigorous criteria and selection procedures, but we also want to make them flexible enough to draw in groups that have not been well represented in the past.
In response to the hon. Member for Westbury, I am not sure that most community health councils would like to be described as a pair of old carpet slippers. Many of their members are forward-looking, progressive, imaginative and creative people who put a great deal of work and energy into drawing people into
public consultation and involvement. People take time to get used to institutions but I hope that in the new system they will find a range of mechanisms in a rigorous system that enables them to get properly involved and to influence the shape of health services, rather than a comfortable pair of old carpet slippers.
The Under-Secretary is being meddlesome. She knows full well that my comments about carpet slippers were made in the best possible sense and were to do with familiarity, which is important for the public in such matters.
Question put, That the amendment be made:—
The Committee divided: Ayes 5, Noes 8.