With this we may discuss the following amendments: No. 210, in page 21, line 14, at end insert—
'(f) prison service premises where such joint working as is specified in section 21 is taking place.'.
No. 211, in page 21, line 25, at end add—
'(4) In this section ''premises'' shall have the same meaning as in section 23(6) of the 1999 Act.'.
The amendments relate to the powers that the Bill will give to patients forums. Amendment No. 209 seeks to replace the word ''may'' with ''shall'' because entry and inspection is a critical function of any regime through which patients and community representatives carry out their tasks. However well-meaning the Secretary of State's intentions, it seems reasonable to require him to issue regulations on the entry and inspection of premises by patients forums, rather than leaving the matter to his discretion. Heaven forfend, as the Under-Secretary might say, but the current Secretary of State may not hold that post for ever; some might question whether he holds that post now in respect of certain health service functions. Regulations must also be made to clarify the way in which the clause's provisions will be implemented, and the amendment seeks to establish whether the Department will consult all relevant stakeholders when drafting regulations.
Amendment No. 210 concerns the powers of patients forums to inspect delivery of NHS care in prison premises where there are joint working arrangements, as identified in clause 21. In a previous sitting, the Under-Secretary said that we might discuss some of these matters when we considered clause 21, and I am happy to leave that to her discretion. However, it would be useful if she explained now whether the clause as drafted would enable such inspections.
By definition, it is difficult to discover what is going on in prisons. Such isolation has given rise to current concerns about the level of prison health care, although it should be said that those concerns are not necessarily a reflection on prison medical officers. The isolated nature of the delivery of prison health care is a critical factor in terms of quality. Opening up the environment in which NHS care is delivered in prisons would not only improve accountability and openness, but raise quality.
Amendment No. 211, which makes reference to section 23(6) of the Health Act 1999, is a probing amendment that is intended to establish whether privately owned establishments such as nursing homes and others in which NHS care is provided will be open to inspection. Does the Under-Secretary think that the Bill's current definition of the word ''premises'' will enable the widest possible coverage?
Patients are now being sent abroad and to other parts of the country for their treatment; we shall hear more about that later. Would the amendment allow a patients forum to inspect the treatment that patients from south-east England receive in France or Germany?
That question applies not only to inspections by patients forums, but, importantly, to quality control inspections such as those carried out by the Commission for Health Improvement. We touched on that issue earlier. The Bill was never intended to cover quality assurance and community participation because it was drafted long before the latest panic measure of exporting patients—shortly followed by staff—to Europe. There is no definition to which I can refer that would be wide enough to cover all the options that the Government are currently dreaming up.
None of us wants patients to wait longer than they need to, but the Government must think carefully about the areas in which they want NHS patients treated so that those patients will be adequately covered by quality assurance measures, the reach of civil litigation for negligence and the duty and right of patients forums to inspect those systems and input to them. The Minister described extensively—perhaps even eloquently—her vision of public participation in every area of NHS care. However, the hon. Member for North-East Hertfordshire (Mr. Heald) raised an interesting point about what sort of patient and public involvement there can be in those settings.
I do not want to be distracted from the point, which concerns the definition of premises. Having found the correct part of the Health Act 1999, I recognise that the definition suggested in this amendment—which I stress is a probing amendment—is more limited than the one it seeks to replace. I am unsure how that happened, but it was almost certainly a function of drafting the amendment late at night while examining many different definitions of premises. Will the areas listed in the clause include private health care providers whose premises are covered by the regulations that apply to the Commission for Health Improvement where it has been given the right to inspect premises?
I should have prefaced my comments by saying that during the last sitting, we had a heated debate about the Government's intentions. Liberal Democrat Members argued that there was no need to abolish community health councils and that the Government's proposals for patients forums were flawed.
Indeed, so did the Conservatives who spoke in that debate. However, the amendments that we shall discuss this morning are efforts to be constructive within the framework of the Government's proposals. In that spirit, I hope that we get a reasoned debate, a constructive response—that is likely with this Minister—and perhaps some give from the Government.
Clause 16 deals with the entry and inspection of premises, which—whether it relates to the national health service or any other area of service provision or commerce—is a critical power given to the authorities to enforce the provisions of legislation. In the past, various sectors and service providers have complained that powers of entry and inspection have been carried out in an over-bureaucratic and almost officious way.
Without wanting to get into arguments about Europe, a consistent source of complaint has been the fact that inspection powers that are brought on to the statute book via European provisions are often fine-tuned by British Governments, of whatever party, to make them much more onerous. That has been a particular problem in respect of food hygiene and standards. It is important to ensure that the provisions on inspection and rights of entry fulfil the intentions of the Bill without making it unnecessarily burdensome and officious, which is in no one's interests.
The clause gives the Secretary of State powers to issue regulations governing the nuts and bolts of powers of entry and inspection. In the first sitting of the Committee, my hon. Friends and I, and the hon. Member for Oxford, West and Abingdon (Dr. Harris), pointed out to the Minister that the Bill contains numerous regulation-making powers, yet we have not seen any draft regulations. It would have been extremely helpful to the work of the Committee, especially on this clause, had we been given a greater insight into what the Secretary of State may intend if he is minded to issue regulations.
My hon. Friend is making an important point. Does he agree that it is astonishing that we have not yet seen one draft regulation, given that we have now reached clause 16 and that the Minister promised at the very beginning of our proceedings, in response to my first point of order, that he would let us see them all?
My hon. Friend makes a powerful point, and he did indeed raise that point of order at the beginning of the first sitting. We are now approaching the end of the second week of our proceedings, yet we have seen no draft regulations in any shape or form.
The Government did not dream up the Bill in the last few weeks; it has been thought about for a long time. To return to the debate at the end of the previous sitting, this part of the Bill is frankly just a vindictive repetition of the provisions of the Health and Social Care Act 2001. I presume that, during the passage of that Act, the Department of Health must have been giving thought to powers of entry and inspection. That was in January, February and March of this year. We are now at the back end of the year and we still do not know how the Government intend to flesh out any regulations that the Secretary of State may wish to issue.
I should have thought that the Under-Secretary, having noted the Minister of State's response to the point of order made by my hon. Friend the Member for North-East Hertfordshire, would anticipate the debate and that the Department of Health would work overtime to prepare a skeleton of the draft regulations to enable us to get a better idea of the Secretary of State's intentions.
As the hon. Member for Oxford, West and Abingdon said, amendment No. 209 seeks to change the provisions in the beginning of clause 16 so that it would no longer be that the Secretary of State ''may'' make regulations, but that he ''shall''. That would place a duty on him—he would have to make regulations—and his choice would be removed; that would either strengthen the Secretary of State's hand or box him in, depending on one's point of view.
There is logic to the amendment. It is not desperately satisfactory to leave the decision up in the air and up to what the Secretary of State may want to do. If one concedes that patients forums should have the power of entry and inspection of premises, it would probably be in their best interests to have regulations that spell out those powers and how far they can act in fulfilling the duties in the Bill. I regret that we do not have such draft regulations.
The hon. Member for Oxford, West and Abingdon also tabled amendment No. 210, which deals with Prison Service health providers and allowing patients forums to have powers to investigate problems and the provision of health care in the Prison Service. As he pointed out, there is no statutory remit for community health councils to look into the provision of health services in our Prison Service—there is outside prisons—but a number of community health councils, on a voluntary and ad hoc basis, have liaised and forged informal ties with prison health services. On balance, that is a good thing.
I do not want to pre-empt the debate on clause 21, but it would be fair and right to say that during many years, under Governments of both political persuasions, the provision of health care in the Prison Service has been a scandal. Improvements have been made in recent years, but, to be brutally frank, the provision of such health care has been at a level that would not be tolerated by constituents outside of prison.
That is not a criticism of the medical profession working in the Prison Service, but of a culture that has grown over years, and of the reluctance—until recent times—of the Department of Health to take over the running of the prison health service because the cost of doing so would come out of its budget and not that of the Home Office. At a time when our health service has been under constant and increasing strains because of rising expectations, increasing demand and targets set politically—by this Government in particular—the Department of Health would have found it difficult to incorporate the funding of the prison health service within its budget without a knock-on effect.
In many ways, the prison health service is out of sight and out of mind, by definition of its location, and the issue has not been high on many people's political agendas. Because of that and associated problems, this measure would provide a positive step forward for patients forums, if they ever see the light of day. The Bill has a long and winding journey before it reaches the statute book; who knows what may happen to it during its long passage through Parliament? Its predecessor was derailed earlier this year.
On the assumption that the Government will get their way--the only assumption that we can make--patients forums could provide a welcome and useful service not only in the provision of health care in general, but to the enhancement and improvement of health care in the prison system. I see no reason why they should not be extended to the Prison Service health care system. We have accepted the principle that the health service outside prisons should be monitored and that our constituents should have an organisation to monitor health care and investigate individual problems. Why should not the Prison Service? Why disfranchise that part of health care simply because it deals with individuals who have been disfranchised?
I hope that the Minister will have an open mind and will think seriously about an amendment that is designed simply to enhance and improve the Bill. If she is prepared to accept the principle in relation to patients forums, a belt and braces operation would be an insurance policy for her. She might want to concede the point in relation to community health councils if they were to be saved from this vindictive Government.
I am grateful for the opportunity to clarify the problem. I drafted the amendment to apply the definition of prescribed premises in section 23 of the 1999 Act, as amended by the Bill. That is jumping the gun, because the Bill is not yet an Act and—who knows?—may never reach the statute book. I hope that that is in order, Miss Widdecombe--if it is not, we shall have to return to the matter on clause stand part--to ask hon. Members to ensure that in lines 40-45 on page 18 the definition of prescribed premises in the new world of private sector delivery of NHS care is more appropriate.
I am extremely grateful for the hon. Gentleman's intervention and relieved that I allowed him to intervene. It has reduced my work and clarified what was becoming a somewhat confusing situation. So as not to add to the confusion, I will leave the hon. Gentleman's explanation of the amendment for the Under-Secretary to answer.
The clause contains some provisions outlining regulations that can be made. In the context of our discussion on the amendments and the fact that we do not have any draft regulations to examine, can the Under-Secretary explain one or two points? That will help us to make up our mind about whether our concerns, especially in amendments Nos. 209 and 210, will be met. Clause 16(3) says:
''The regulations may in particular make provision as to—
(a) cases and circumstances in which access is to be permitted''.
It would help if the Under-Secretary could flesh out in more detail how the Government envisage the regulations reflecting clause 16(3)(a).
Clause 16(3)(b) refers to regulations making provisions about the
''limitations or conditions to which access is to be subject.''
My hon. Friends will be interested to know what limitations and conditions the Under-Secretary has in mind. That brings us to the nub of my original point about the balance that is necessary in the regulations—which, we hope, the Secretary of State ''shall'', rather than ''may'' make—to limit the opportunity for them to become too nanny-statish and interfering. That would be to miss the important point and function of the regulations.
We are also interested to know whether the patient forums, under the regulations that we hope ''shall'' be issued in line with amendment No. 209, will be allowed to go everywhere that the Commission for Health Improvement can go. The intention is unclear in the Bill and its provisions for what regulations the Secretary of State may or shall make, and we have not seen any draft regulations to make that clear.
My hon. Friend the Member for North-East Hertfordshire raised an important new point that he probably could not have made had we discussed the amendments on Tuesday. Today's media show an unfolding drama and a change of circumstances in the provision of health care that is happening under our very eyes. Unfortunately, we have only the ''Today'' programme reports and, presumably, leaks in the national media to tell us what the Government have in mind. As the House will be sitting in an hour and a half's time, we may be notified soon as to whether the Secretary of State will make a statement on the Floor of the House about the treatment abroad of patients on long waiting lists in this country.
I see that you are looking perplexed, Miss Widdecombe; you may be wondering whether this has anything to do with clause 16. I would hate, for various reasons, to test your patience, so let me reassure you. The amendments, and the regulations that would emanate from them, deal with inspections by patients forums. They will have the power to inspect and monitor the provision of health care for all patients in this country.
When using the phrase ''in this country'', we have always assumed it to mean what it says. Until August of this year, we understood that, legally, the health service had to treat patients in England, Scotland, Wales or Northern Island. However, a whole new approach has opened up for the Government, whereby patients, by law, can be treated in European countries. There have been pilot schemes in parts of the south-east of this country over the last two months. If the leaks are to be believed, there will be an extension of the whole policy, so that any patient who has to wait more than six months on a waiting list for treatment will have the opportunity to go overseas to be treated.
That raises the question of what inspection will there be of the service and treatment provided for our constituents who may be treated overseas. Unless I misunderstand our amendments and clause 16, it seems that once our constituents are travelling on a train, plane or bus to Europe to be treated, the powers of entry and inspection of premises to ensure the provision of health care, will be taken away. The powers for bodies to act on behalf of our constituents will be denied in those areas overseas where they are being treated. This is an area where the Minister needs to reassure us.
Will clause 16, with its powers of entry and inspection of premises, apply to premises in Europe? Will the regulations made by the Secretary of State, for the patients forums to carry out their duties in this country, equally apply to those premises in Europe? Will clause 16 help our constituents who are being treated under the Government's latest policy to try and undo their abject failure to bring down the waiting list times? If the answer to that question is no, the patients forums will not have that power and that our amendment No. 209, will not apply to regulations that are made by the Secretary of State for premises in Europe, then our constituents are being deprived. What mechanism will there be to ensure that the premises overseas are of a sufficiently high standard, and that the provision and quality of health care is of a standard that patients would expect in this country? Would the provisions of clause 16 and the application of amendment No. 209 apply to premises in Europe, as they do in this country?
If the answer is yes, patients forums would have the power of entry and inspection of premises overseas —because the Government have some deal with providers of health care in Europe that are going to be treating British subjects —then that raises more issues. One would want to know how the system would work overseas and what legality this clause would have to the entry and inspection of premises overseas. It opens up a Pandora's box of potential problems, and, I imagine, a legal minefield. I hope that the Minister will be able to give us an explanation and seek to reassure us on this very important issue.
In conclusion, with regards to amendments No. 209 and No. 210, for the reasons that I have outlined, I hope that the Minister will be minded to accept our two very reasonable amendments, which are solely to put down to seek to improve and enhance the quality of this part of the legislation.
In drafting the clause, the Government have taken into account only those matters that can be examined. They are going for the easy option, rather like the man who searches for his keys under a street light. Instead, the clause should deal with those areas of health care in which there is a crying and pressing need for inspection. In my experience, there is such a need in the prison medical service, but it seems that it has been specifically excluded. I should be grateful if the Under-Secretary would explain why.
It is taken as read in this country that the prison medical service is under-resourced, but it is also the subject of close scrutiny. As I have said, there is an extensive network of regulation, audit and inspection throughout the national health service—for the most part, that is welcome—but that simply is not true of the prison medical service. If one were to pick a group of people in this country whose health care was inadequate, it would be the prison population. It is the function of Government to focus on those areas in which they can do the most good first of all, but for some unfathomable reason they have ignored the prison medical service. I hope that the Under-Secretary will explain why.
The treatment of NHS patients abroad appears to be catching the Government somewhat on the back foot. When the Bill was drafted, the Government's plans for such treatment were not quite as well advanced as perhaps they now are, so the Bill needs to be updated to reflect the evolving picture. In terms of both the prison medical service and the treatment of NHS patients abroad—the two areas about which I am most concerned—the Government, patients forums and CHCs have a limited overview.
We have heard a lot about shipping people to the continent for operations, but little about quality control. If we are to accept the definition of health care that the Bill provides—we do not know whether the Bill's omission of these matters was deliberate or an oversight—we must ensure that patients treated abroad are covered by these forums in the same way as those treated in this country. Even though patients are being contracted out to a foreign provider, they deserve equally good health care. We have not heard much about quality control in and scrutiny of the provision of health care abroad on NHS trusts' behalf, and I hope that the Under-Secretary will clarify that issue.
I would go much further on this matter than my hon. Friend the Member for West Chelmsford (Mr. Burns). We are being asked to accept a clause that will give a potentially draconian power to patients forums, without first seeing the regulations that will govern the provision. That is an insult to the Committee; if my right hon. and learned Friend the Member for Sleaford and North Hykeham (Mr. Hogg) were in attendance, he would certainly spend an hour or two expressing his outrage at what is happening today.
Parliament is probably shell-shocked by the current volume of legislation curtailing the liberty of individual citizens. Many years ago, a proposal to give patients forums the right to access to what could be private premises would have prompted a huge debate, but we are being asked to nod it through without knowing what powers the Secretary of State will grant. I hope that the Under-Secretary will give us some idea of what those powers will consist of.
The Minister of State has added to the list of bodies that can grant such powers to patients forums. The list now includes health authorities, local health boards, local authorities and all who provide a service under the National Health Service Act 1977. I do not have a copy of the Act to hand, but I believe that it is widely drawn and might include those who provide drugs, and sole practitioners who practise from home. As members of patients forums, they would have a right of entry. Would they have the right, for example, to stage a dawn raid on a doctor's house, break down the door, examine patient records and fillet them for whatever information they wanted? According to the Health Act 1999, in effect, they do have such a right. A doctor or a pharmacist may well not want their premises to be turned over by unqualified people who are members of a forum simply because they were patients or belonged to a local voluntary organisation. Such people will have the right to enter the private premises of a pharmacist who lives above the shop, and loot his records for any reason that they like.
One chief concern that might arise, but which is not covered in the Bill's summary treatment of the responsibilities and powers of patients forums, is confidentiality. My hon. Friend rightly alluded to the probable make-up of patients forums, and although I am sure that they will consist almost exclusively of people of great probity and integrity, those people will nevertheless have the right to rifle through sensitive and confidential material if their responsibilities are not adequately defined. That is true not just of general practitioners' surgeries but, potentially, of sensitive areas in hospitals. The general public have a right to expect that that confidentiality be guaranteed, yet the Bill as drafted makes no mention of that.
My hon. Friend has expanded on the concerns that I have raised, and they do seem alarming. During consideration of clause 15, the Under-Secretary discussed membership of patients forums, but we were given no real clue as to their composition, even though we are granting such people considerable powers.
My hon. Friend may recall that, in the previous sitting, the Under-Secretary said that the people who will make up patients forums will differ in kind from those who make up CHCs, so it sounds as if the forums will not consist of the great and the good. The Under-Secretary should say whether she is contemplating that forums will consist of those who do not necessarily have an established reputation for, say, local community service. What exactly does she have in mind?
It is essential that the Under-Secretary answers that question. It is not just doctors' surgeries or the offices of primary care trusts and local councils that could be affected; the records of private hospitals, for example, could be turned over. My hon. Friend the Member for West Chelmsford raised the somewhat fanciful but nevertheless important point that the provision could apply to a hospital in France that provides patient services to the UK. I doubt whether it could in practice, given that our courts have no jurisdiction there. However, private hospitals and perhaps drug companies could be invaded—if that is not too strong a word—by members of patients forums. I find that incredible.
The regulations that the Secretary of State conferred on the Commission for Health Improvement through the 1999 Act presumably give some clue as to the regulations that will be granted to patients forums. They are draconian. They confer the right, in this case on the commission, to inspect premises at will. They do not consider the question of an appeal, or the need to obtain a warrant from a magistrate to prove the necessity of entering a premises. Section 23(4) of the 1999 Act states:
''Any person who without reasonable excuse obstructs a person authorised by the Commission . . . is guilty of an offence and liable on summary conviction to a fine not exceeding level 3 on the standard scale.''
I forget what level 3 is, but members of the Committee who are lawyers will no doubt be able to advise us on that.
That right comes with the power of prosecuting, convicting and fining, for example, a doctor who resists when a patients forum representative wants to enter and search his premises and take away letters and patients' files. As far as I can see, there would be no requirement for such a representative to explain why they wanted to make such a search and to obtain permission.
Why do they want to turn over this pharmacy? Why do they want to enter this drug company? Even people who provide services such as meals for patients could have their factories raided. There is great potential for infringement of personal and civil liberty.
I do not want to be attacked for being racist, but is the Under-Secretary seriously suggesting that gypsies should be given the power to raid doctors' surgeries? It is fantastic, and although I am sure that she will try to reassure us, she has not had the courtesy to bring the regulations before the Committee to allow us to see how the power will be exercised. She should do so, because this is a serious piece of legislation. It is the Committee's duty to examine the diminution of citizens' liberties, and she is not giving us an opportunity to do that.
I am incredibly confused. I thought that the amendments sought to widen forums' access to include prisons, which I heartily support. However, we are discussing restricting access because of the risk to confidentiality, which is something that must be taken in account. I expect that the Under-Secretary can reassure us on that, but as things stand I need to vote for both the amendment and the clause.
I echo the point about the regulations and the requirement that they be made. It is unhelpful that we have not seen the draft regulations, particularly as it is suggested in later Government amendments that a wider group of bodies than that which appears on the face of the Bill should be covered.
We must also know whether patients forums will have the ability to carry out the work that the regulations might contain. Another concern is whether patients forums will have an adequate budget to enable such inspections to take place. I recently asked a parliamentary question about the budget for patients forums, and I received the answer that that was still under discussion with the Treasury. We know that community health councils spend about £23 million a year, and this year an extra £10 million has been provided to set up patient advocacy and liaison services, but that was a one-off payment.
The estimate of public sector financial and manpower effects in explanatory note 191 states that
''the creation of Patients' Forums in each Strategic Health Authority will require some increase in public expenditure. This will be partly offset, however, by the funding allocated to CHCs and Patient Advocacy and Liaison Services (PALS) which totals £33 million.''
We must bear it in mind that £23 million of that is the on-going revenue budget of the community health councils, whereas the £10 million allowed for patient advocacy and liaison services was a one-off payment to set them up. Primary care trusts are concerned that there is no funding for PALS, and they are worried that they will have to find the money for the patient advocacy and liaison officers out of their budgets.
The Secretary of the State is not committed to make regulations, we have not seen any draft regulations although we were promised them and there is no budget for the entry and inspection of premises. Is this just window dressing as part of the Government's overriding aim to silence the independent watchdogs which have been showing the true state of the national health service in England today through documents such as ''Casualty Watch'', which shows how many people are waiting on trolleys, and the evidence that my local CHC produced on hospitals in my area? The excellent study on cleanliness at the Queen Elizabeth II hospital in Welwyn Garden City sparked a controversy, and my Labour opponents accused me of scaremongering when I referred to the CHC report in the run up to the most recent general election. The same CHC pointed out that the local health authority grossly overspent; when I mentioned that, I was again accused of scaremongering. Now we find out from the reply to my parliamentary question that my local NHS trust has hugely overspent. The Commission for Health Improvement toured my local hospitals and gave them no stars. The CHCs raised the alarm to show the true position, but they will be silenced.
A moment ago we heard a revealing contribution from the hon. Member for Hexham (Mr. Atkinson) when he used the phrase, ''I am not racist, but''. Before the hon. Member for North-East Hertfordshire concludes his remarks, will he let us know whether he agrees with his hon. Friend, and can we take that contribution as reflecting the Conservative approach to patient involvement in the NHS?
Let me answer the point—I am never reluctant to answer questions. ''Who will be appointed to the patients forums?'' is a legitimate question. I have the consultation document, ''Involving Patients and the Public in Healthcare Discussion'', paragraph 5.3 of which talks about
''independent bodies made up of patients and others from the local community, with extensive powers to inspect all aspects of the work of trusts.''
That does not tell one much about who is to be appointed. Given my support for CHCs and their work, I was alarmed when, in the previous sitting, I heard the Under-Secretary discuss not having the sort of people who have traditionally been on CHCs on the patients forums. She said:
''We must also go out and find people, so that we do not depend on the normal people who can come forward.''—[Official Report, Standing Committee A, 4 December 2001; c. 250.]
She made the legitimate point that we need to recruit more people from the black community—I agree with that—but went on to talk about the travelling communities. There may be some valuable members of the travelling communities who could do useful work on patients forums.
I did not say that. The sorts of people who served on community health councils wanted to give public service and had time to do so. Many of them knew about hospitals and health care. For example, the CHC in East Hertfordshire includes people who have inspected the Queen Elizabeth II hospital year after year, and there are people in North Hertfordshire who have inspected the Lister hospital year after year. They have a collective memory going back for many years about what those hospitals are like. They know where to look when they inspect hospitals, and it will be a pity if they cannot continue to play that role.
The Under-Secretary may just be trying to sound inclusive. However, I am afraid that she means that people who know all about health in a local area are to be turfed out, so that we end up with people who know nothing much about what goes on in hospitals.
The other point about consistency and continuity in patients forums is that if different people turn up to inspect hospitals every year or every six months, it does not make for consistency of application in terms of such inspections.
I agree, and I fear that the system that is being set up will include lots of new people, often for reasons of ''inclusion''. If they were going to do a good job, no one would support them more strongly than I. However, it is worrying if an organisation that acts as a watchdog is to lose its collective memory.
My hon. Friend is making a good point about continuity. The point that I was trying to make, which seemed greatly to upset the hon. Member for Leigh (Andy Burnham), was that we are giving these people a powerful weapon—the right of entry into premises—and I doubt very much whether someone of no fixed address who travels around the country is qualified to have that power.
I was about to come to that point. Let us by all means have as balanced a body as possible. However, I have seen no evidence to suggest that CHCs are not balanced, although they may have fallen down on inclusion. In many areas, certainly in mine, CHCs have done a marvellous job. I am in favour of spreading best practice, and I would be happy for my local CHC to have these powers. Indeed, I would strongly support their being able to look at all areas of hospitals. Patients forums may be set up all over the country only for us to discover that neither the way in which they operate nor the quality of people involved is uniform. That is worrying in terms of consistency.
The hon. Member for Hexham is explicitly opposed to the great unwashed having access rights to NHS premises, although they may have paid for them through their taxes. However, the hon. Member for North-East Hertfordshire just said that he is in favour of that. What is the Conservative position?
I am afraid that the bad news for the hon. Gentleman is that I had not yet come to that point. I was finishing my first point about not losing the collective memory of CHCs. I am worried that the Under-Secretary is falling into a trap, unless she is a willing accomplice to the crime. If one takes away a watchdog's collective memory by appointing a whole lot of new people with no experience, it may turn into a toothless tiger.
Before my hon. Friend moves on from the powerful point that he is making, does he agree that the Under-Secretary's comments during the debate on Tuesday are gratuitously offensive to many hard-working and dedicated members of CHCs, whose continuity is, as he says, so important?
Yes. The passage to which my hon. Friend refers is insulting. The Under-Secretary said:
''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.''—[Official Report, Standing Committee A, 4 December 2001; c. 248.]
Personally, I think that the people in my local CHCs have done a great job in inspecting local hospitals. Year after year, in a spirit of public service, they have undertaken hard, some might say boring, work. The fact that they did it consistently did not mean that they always found things that were wrong—indeed, they tended to be quite constructive—but when that was the case it was they alone who gave the warning. The Under-Secretary may set up all her new committees: patient safety, CHI—
My hon. Friend is absolutely right about the quality of the inspection work done by those public-spirited people. However, that is what the Under-Secretary would have been saying between 1992 and 1997. It is not the people or their performance of their duties that have changed, but the fact that the Government will not brook any opposition.
It is extremely foolish to set up all these other bodies and abolish CHCs, which are the bodies that overall—I accept that some did less well than others—gave the early warnings about quality and safety.
My hon. Friend the Member for Hexham referred to the approach that should be taken to entering the premises of a private individual such as a community pharmacist or a GP. When an inspection is carried out, it is important to be certain that the patients forum has good grounds for proceeding, that it is not based on the grudge of a dissatisfied person, that it forms part of a proper, sensibly organised investigation of a quasi-judicial character, and that the inspectors are the sort of people who will make a properly objective assessment of the information that they find. I wonder whether the Under-Secretary has borne that in mind at all. We have no draft regulations for the framework of entry and inspection, so there is no flavour of whether reasonable grounds will have to be given for them to be carried out. We have no hint of whether there will be even the mildest vetting of those who are to serve on patients forums. If the Under-Secretary is to go out and find members of the travelling community without assessing, in any detail, who they are, concerns will be raised.
If there are good members of the travelling community who can do a good job, we would like to know about it, but plucking people from the streets and byways of Britain would cause concern. The Under-Secretary could produce regulations that would give us an idea of how the appointments process will work, and that might tell us what she means when she talks about going out and searching for people. We would welcome that.
In the course of my hon. Friend's remarks, will he consider what someone who wanted to resist such a visitation could do? The 1999 Act refers to:
''Any person who without reasonable excuse . . . obstructs a person''.
Presumably, the only recourse would be for them to refuse entry to the patients forum, and if they did so they might then appear in front of a court and put their case as to why they had not admitted the forum to the premises. I do not know how it would work but I am sure that my hon. Friend, as a lawyer, can advise the Committee.
Of course, one way is to allow oneself to be the subject of prosecution, but that raises the concern that the citizen's position would not necessarily be protected. It will be useful to know how the Under-Secretary intends to deal with abuses of the system. If there was an unjustifiable use of the power, what would be the recourse of action for the community pharmacist or the general practitioner?
I shall now discuss whether regulations should be made on a mandatory basis. The wording of clause 16 refers to the premises being entered—amendment No. 211 addresses that. Which parts of premises could not be inspected? There may be parts of a hospital that the Government would like people to look at—the entry hall or, perhaps, a new shop—but one might be concerned that an inspection would not penetrate serious clinical areas. What does the Under-Secretary have in mind? We want to know whether we are to have a pick-and-mix, a la carte approach before forming our view of the clause.
On the subject of places abroad and those in far-flung parts of this country, a primary care trust might discover that the patients in its area are typically taken to Germany or France for treatment and that the quality of treatment there is far better than it is here. On our tour, members of the Opposition Front Bench team have been pleasantly surprised by the sheer quality on offer on the continent. Let us suppose that patients forums were concerned about the quality of treatment, or about what redress was available to patients who went to a hospital in France or Germany and received poor treatment. Would they be able to inspect premises in those countries? Does the Secretary of State envisage reaching agreements with the authorities in France and Germany to allow inspection of their premises?
I think that the hon. Gentleman has got over-excited and has not listened. Our position is very clear. The Conservative party's view is that we should retain CHCs but improve them and give them the powers that they need to do their job properly. I have made that point, and my hon. Friend the Member for West Chelmsford made it at great length the other day.
The European decision in July was to the effect that patients in need in this country have a right to go abroad for treatment. For a short period, the Secretary of State spun that as being rather a good thing. If a lot of patients are to be shipped from the south-east of England, where the current pilot is, to France and Germany, and the watchdog bodies will be the patients forums, I think that it is legitimate to ask the Under-Secretary—I am sure that the hon. Member for Leigh will agree—whether patients forums will be able to go into premises where patients are being treated. If, for example, a hospital in France had a lot of spare capacity and the NHS made an agreement with it—which could easily happen in the current climate—that that hospital would do 500 or 5,000 operations a year, would a patients forum be able to examine it and ensure that patients from its area were getting satisfactory treatment there?
The facilities for medical care for the armed forces are now within the NHS. Will patients forums be able to visit the hospital in the midlands that deals with the armed forces?
Notoriously, Prison Service health facilities are less good than those of the NHS. That subject will be debated more fully later, but what watchdog role will patients forums have over mental health services in prisons? As the Under-Secretary knows, that is a matter of great concern. I recently spoke at the MIND conference in Scarborough. I was surprised by the number of people who asked about prison medical services, in particular, the mental health services available there, a cause of dissatisfaction. They think that that regime is far less sympathetic than the NHS, that treatment is more old-fashioned and that prisoners do not get the quality of care that they would get even in one of our hard-pressed acute mental health wards.
Will the Under-Secretary explain the role of patients forums in prisons, and how the entry and inspection requirements will work? Clearly, there are difficulties with allowing individuals to enter prisons as a right.
There are security reasons why one might worry about that, especially as appointment details for patients forums are not well known. The Home Office might have concerns about some individuals being allowed, as a right, to enter prisons.
On costs, which I mentioned earlier, it is clear from paragraph 191 of the statement on financial effects that there is currently no budget. Can the hon. Lady give us some good news on that and, as a baseline at least, assure us that patients forums will have the £23 million that CHCs have?
I was offering the Under-Secretary an opportunity to intervene and say yes. I hope that she will cover that point when she replies.
I had three further points to make, but I will reduce them to one. I have been speaking for some time, and it is always good to curtail one's remarks.
My hon. Friend says that I am doing very well, but I will curtail the points that I was going to make.
It will be the role of the Commission for Health Improvement to enter and inspect premises. I understand that guidelines suggest that it should get round to each hospital once every four years or so; the Under-Secretary may confirm that. Will patients forums be allowed to go into premises whenever they wish, or will regulations introduce some regime to limit the number of occasions or provide for the adoption of a bureaucratic system to give early warnings about their visits?
That has been a vexed subject with bodies such as Ofsted. Questions have always been asked about whether the notice period that it gives is a good idea. Some people say that it should undertake on-the-spot inspection: just turn up, go in and see what is going on. Others say that it is a good idea to give some notice so that all the staff are present and everyone in the enterprise is visible. What is the Minister's view about the patients forums' visits? Will they have a straight power of entry and inspection, as the police have in certain circumstances, or will that power be circumscribed by early warning systems and a bureaucratic system?
Dr. Harris rose—
Order. Before I call the hon. Gentleman, may I tell the Committee that I have listened to the debate with interest and considerable restraint? It has gone far wide of the subject of the amendments. Indeed, it has gone round the equator and back on the subject of clause stand part, also touching on matters that should properly be debated under clause 18. I therefore give the Committee notice now that I will not allow a clause stand part debate on this clause. Hon. Members may wish to bear that in mind during the remainder of the debate on the amendments. I shall also take into account the wide-ranging nature of this discussion when we come to discuss clause 18.
I am grateful to you, Miss Widdecombe, for giving me a second bite at the amendments. I entirely agree with your diagnosis of the debate that we have had and am more than happy to forgo a clause stand part debate.
I want to comment on some points that have been made on the amendments before the Under-Secretary replies, if she will indulge me. I am delighted that my three amendments have stimulated the Conservatives to make such lengthy contributions, but I am conscious that we are running out of time and I want to deal with the issue that the hon. Members for North-East Hertfordshire and for Hexham raised about the appropriateness of including certain people in inspection teams.
I first have some questions that relate to the definition of premises in clause 13(2)(c)(ii), which I ask as formally as I can. A discussion on the amendments—I refer especially to amendment No. 211—is not the best place for this, but as there will be no clause stand part debate will the Under-Secretary say whether that definition covers premises abroad and whether the Commission for Health Improvement go into premises abroad under contract to the NHS? By extension, is that the correct definition for the inspection rights of patients forums under the clause, and would patients forums have the right, if their budgets allowed, to examine provision abroad?
Secondly, may I ask why special health authorities are not included in the list in paragraphs (a) to (e) in clause 16? If I am right, high security mental health trusts, for example, function as special health authorities, but are not covered, even with the Government amendments in the next group.
Thirdly, confidentiality is important and was raised by the hon. Member for Westbury (Dr. Murrison) and mentioned by the hon. Member for Wyre Forest (Dr. Taylor). There is nothing new concerning confidentiality that does not already exist for community health councils. We want ''Casualty Watch'' and we realise that when watching ''casualty'' we are watching casualties, who have a right not only to confidentiality, but to privacy and that is not available in corridors, regardless of whether the beds have wheels. There are issues concerning privacy and confidentiality and I am sure that the Under-Secretary accepts that she must reflect on whether new issues arise and whether she is satisfied with the current arrangements for community health councils.
Finally, I want to respond to the point about alleged unsuitability of some people to take part in patients forums. The hon. Member for Hexham made a controversial statement, which may have been inadvertent. It does not help to shout down such comments or to use words such as ''racism''. Nevertheless, some of the assumptions made must be challenged and I shall do so. The hon. Member for North-East Hertfordshire said something along the lines of, ''if there are good people in the travelling community'', the implication being that there are no good people in the travelling community. When he said ''good'', I think he meant that we should add value to the process.
In a moment, because I want to ensure that the hon. Gentleman understands what I am saying. His assumption is dangerous and is the same as the assumption that there is an automatic risk to owners of premises from people in the travelling communities, whether defined as gypsies or otherwise.
I will give way because it is important to do so and I am inviting the hon. Gentleman to clarify his comments. Making his point in the way that he did—it may be valid and I do not challenge his right to do so, nor am I accusing him of racism--emphasises the fact that there will be providers in the health service who share or make judgments about the travelling community and gypsies that are inappropriate, prejudiced and unreasonable. For that reason, the inspection regime must ensure that it covers any concerns that people may have that they are being excluded and subjected to prejudice. There may be racism in the health service--I am not saying that that is the hon. Gentleman's view--which is why it is important to go out and find people in those communities who can say whether the health service is responsive to their needs. Another example is that of asylum seekers, who are also a vulnerable group of patients.
I do not believe that community health councils need to be abolished to provide inclusiveness. Oxfordshire community health council has done a darn sight more to protect the health care of asylum seekers than any Government legislation, which is repressive in this area--
In a moment.
Government legislation denies detained asylum seekers access to decent health care. It is not necessary to abolish CHCs, but the Government are right to identify what needs to be done.
I could have said, ''If we could find a good member of the accountancy profession'' or any other body. What I meant by good was someone who could make a valuable contribution to a patients forum. I hope that the hon. Gentleman agrees that there is concern--I am angry about the abolition of CHCs--that good members of CHCs who have given years of service may be turfed off and unable to continue doing their useful work. That was the context of my comment.
The hon. Gentleman is mixing up two issues. I have no problem with members of patients forums talking to gypsies, the travelling community or asylum seekers to find out about their health needs and I hope they would do that. However, it manifestly defies common sense that members of a group that is itinerant by nature should serve on a forum. That is not an attack on them because they are travelling people; it is simply that they would not have the knowledge of the community, area or, indeed, the medical institutions necessary to be members of a forum.
But members of that group have knowledge of their own experience and that of people in their community. We are discussing not premises and geography, but the delivery of health care to individuals. The hon. Gentleman misunderstands the reason for inclusiveness, which is to ensure that when inspections and overviews take place, decisions are made for all sections of the community, and not just for those that are established. It is a difficult area. The idea that people who are established in the community might be ''turfed off'' a forum by ''itinerants'' is dubious. That line could be used by other people whose views are inappropriate and who might not want travelling people to take their place. I am sure that that is far from the hon. Gentleman's view, but his position worries me, because it could be seen to share some interpretations with people who feel that the health service is for the white middle class.
On a point of order, Miss Widdecombe. I apologise that I have been called away from the Committee on an urgent matter. I apologise particularly to the Under-Secretary because I wanted to hear her winding-up speech, but I shall read it carefully in Hansard.
I shall give the Under-Secretary the opportunity to wind up, but I want to put on record my concern about the approach taken by Conservative Members.
I shall do my utmost to cover all the points that have been raised by hon. Members. We have had a wide-ranging debate on the amendments, which raised a significant number of important issues.
Amendment No. 209 would make it mandatory for the Secretary of State to make regulations. It is not usual to oblige the Secretary of State to make regulations in any legislation. That would create uncertainty about the extent of the duty being imposed and might oblige him to make regulations in respect of every paragraph; he would not have the power to decide which were appropriate for regulations. I shall resist the amendment because it is not appropriate to have such a provision in the Bill. Nevertheless, it is important that the regulations cover many of the issues raised by hon. Members.
The hon. Member for Oxford, West and Abingdon asked whether all stakeholders would be consulted about the content of the regulations, how they would operate, which premises would be included, how visits would take place, who would have access and whether prior notice would be given. He also mentioned details about confidentiality. These are all extremely important matters. I can confirm that in drawing up the regulations, there will be widespread consultation with all the stakeholders in the system to ensure that we get the regulations absolutely right. These are matters of practicality, and the regulations need to balance the rights of patients forums and those of other people in the system. We want to ensure that we get that balance absolutely correct, and the content of the regulations will be much better if they are formed after consultation and debate. We intend to allow that.
That is the very reason why the draft regulations are not before the Committee; they have not been drafted and they are not ready. It is not a matter of the Government's withholding regulations from the Committee. My right hon. Friend the Minister of State actually said that he would share the regulations if they were prepared, but he confirmed that they were not prepared. The reason is that we want to conduct extensive consultation on the contents of those regulations.
At this point, it may help if I draw Members' attention to a document that I have placed on the Table today. It is a proposed implementation programme for all the patient and public involvement provisions. I am keen to share that with hon. Members, because it sets out a project plan that takes us all the way up to April 2003 and beyond.
I should like to give Members a sense of how the proposals will be implemented, when consultation will take place and when regulations will be drawn up. I appreciate that the document is complex, so I want Members to have a chance to look at it, perhaps before we debate some of the later clauses dealing with patient and public involvement. The heading of the document refers to a ''proposed implementation programme''. Obviously these matters will be subject to consultation with people in the field who are already involved in community health councils, patients forums, local authorities and a wide range of bodies, who I hope will play a real and substantive part in drawing up a coherent framework for patient and public involvement. I hope that the document will help hon. Members to see that this is not a hastily conceived plan, but a structured and managed programme for implementing patient and public involvement.
I am grateful for the information provided and I have no questions about it at this point. I want to take the Under-Secretary back to her original rejection of amendment No. 209, in which she said that accepting the amendment would make it mandatory for the Secretary of State to make regulations relating to the list of premises. It is appropriate that that is mandatory because, presumably, these are the premises where there should be some rights of inspection. I am not suggesting in this amendment that those would be full rights, because clearly the nature of the rights would have to be negotiated, for reasons that have been given by Conservative Members.
The implication that the Secretary of State might not then make regulations providing for the inspection of one of those areas implies that the Under-Secretary envisages circumstances in which there would be no inspection and entry rights for patients forums. That would be a diminution of the powers currently held by community health councils. The Under-Secretary should clarify whether that is the implication of her remarks.
No, I do not envisage the circumstances that the hon. Gentleman has suggested. The provision is right to allow the Secretary of State to make regulations in relation to these matters. I do not think that that detracts from the power or strength of the provision, and the amendment is resisted on that basis.
I shall now discuss the ''prison clauses''. Obviously, we shall have a debate under clause 21 about the substantive nature of the partnership arrangements between the Prison Service and the national health service. It might help if I now deal with the powers of entry and the powers of patients forums in relation to the Prison Service.
The primary responsibility for the environment of care for prisoners rests with the Prison Service. There are already established mechanisms for independent inspection and scrutiny of prisons. These cover health care services for prisoners and are provided by Her Majesty's chief inspector of prisons, who conducts a regular programme of announced and unannounced inspections, covering the full range of prison activity, including health care provision. As part of their inspection, the chief inspector's teams carry out survey work to assess patient satisfaction with health services, and they have direct access to prisoners to assess their views. Other inspections in prisons are carried out by boards of visitors, comprising independent laypeople. They are in place at all prisons, and they provide an element of day-to-day independent oversight of all aspects of prison activity, including health care. Boards can raise concerns with the prison's governor and through their annual report to the Home Secretary.
Several hon. Members rose—
The Government are keen to involve people from the widest section of the community. That approach applies across Government: we want their involvement in boards of visitors, education services and regeneration projects, for example. When we talk of public involvement, we are committed to ensuring that we are not simply using words or offering an empty shell, but that individuals who offer a wide range of experience participate in such bodies.
I am sure that boards of visitors do excellent work in their own way, as does Her Majesty's chief inspector of prisons in respect of detention centres for asylum seekers with medical problems and in the prison health care system—excellent work, which is often ignored by the Home Secretary. However, it is certain that the boards of visitors do not have expertise in health care areas or reflect patient and public community involvement. If NHS provision is to be given to prisons, it is eminently reasonable to provide the same rights of access, entry and inspection for patients forums or, were they to remain, CHCs. That would all come under NHS care. The idea that one can have details of a patient's condition and of any complaint about a prison's governor wholly disregards the key separation, which the Prison Service recognises must exist, between the clinical confidentiality of a prisoner and other areas over which the governor has charge.
I believe that I have outlined that the primary responsibility for the care environment in prisons lies with the Prison Service, and that independent inspection regimes exist in prisons. During the debate on clause 21 and partnership arrangements, hon. Members will appreciate the step-by-step incremental approach being taken to improve health care services in prisons. Many hon. Members acknowledged that those services had suffered from considerable deficiencies in the past. At present, independent inspection lies with Her Majesty's chief inspector of prisons and the boards of visitors.
I have spent sufficient time on the clause and we shall have an opportunity to discuss more general matters of prison health care under clause 21.
On a point of order, Miss Widdecombe. Can you clarify something for the Committee? If there is not enough time under the guillotine to discuss clause 21, is not the ministerial assurance that we may discuss matters during the debate on that clause meaningless? It will all be dictated by the timetable.
I am keen to make progress so that we can discuss the substantive issues of clause 21, which covers more than access to premises and is important to improving health care. I shall make my comments as swiftly as I can.
Several hon. Members raised points about how to achieve the right balance between allowing access to premises and recognising that visits from patients forums to those in private properties should not be intrusive or comprise of dawn raids that turn over people's premises. I acknowledge the worries about that but, as the regulations develop and are consulted on, we shall try to ensure that when services are provided from private premises, access will generally be limited to the areas to which patients are permitted access, and will be accessed only at reasonable times that are agreed to by the occupier. We must be conscious that premises, such as those of community pharmacists, are often used as living accommodation.
Confidentiality, which is extremely important, has also been raised. It is not envisaged that patients forums will be given the right to access confidential information, such as patient records. Records are protected under the Data Protection Act 1998 and under common law. It is very important that patients have confidence that their personal matters will not be exposed to unnecessary and inappropriate scrutiny.
Patients forums are not an inspectorate body, as the CHI is, in terms of quality. Patients forums are designed to involve patients in the services that are provided by their trust, and to listen to patients' views. They need to have access to premises to look at things such as cleanliness, food and patients' environment, and to ensure that the facilities are appropriate. The forums are not an inspecting and monitoring body; that is not their prime purpose. They are there to get patients' views on services in the trust. It will be absolutely crucial to achieve a balance between the rights of patients forums and the rights of other individuals.
I turn now to the issue of the members of patients forums, although this discussion may stray into other areas. I want to give the assurance that, in many cases, the members of patients forums will be existing members of community health councils. I have no doubt about that. We are specifically trying to provide a transition path, as hon. Members will see from the implementation plan. We want to work with community health council members to see whether they can find a place within the new system that enables them to bring in their skills, experience, expertise, and depth of knowledge. We would be foolish in the extreme to discard the depth of knowledge that members of community health councils have acquired over many years.
I am absolutely determined that we find a pathway for staff of community health councils who want to take a part in the new system, members of community health councils and members from all the other communities that I identified on Tuesday. I genuinely believe that it is important to hear from all of them if the NHS is to respond properly to the whole of our community.
The Under-Secretary is being rather contradictory now. On Tuesday, she rather foolishly dismissed the current membership of community health councils as basically being local politicians who like to attend meetings on Monday, Tuesday, Wednesday and Thursday evenings. She suggested that a whole new wave of people would be brought in to be more representative of the local community. The Minister now seems to be backtracking and saying that, actually, most of the new members of the forum will be existing members of community health councils. What is it to be?
With respect to the hon. Gentleman, he seems incapable of grasping a complex situation that combines the merits of both. He seems to feel that we need an exclusively either-or position, and this matter is too important to embark on that path. I remind him of Tuesday afternoon's debate, in which I explicitly said that we would 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 said:
''I made an explicit point that the proposals build on the best of work done by community health councils and, especially, their members.''—[Official Report, Standing Committee A, 4 December 2001; c. 254.]
I am on the record as saying that, and I believe it. I can confirm that that will be the case. That does not mean that we do not need to be much more creative and imaginative about how we involve a wider range of people in future. I am sure that we will do that.
I should like to deal with the issues of finance and resources. Rightly, people in a range of organisations are anxious that the new system be properly resourced. I am not in a position to give specific details today, but I can reassure Members that the new system of public and patient involvement is more complex and will need resources. We need to ensure that those resources are adequate so that patients and the public can influence their health care.
The specific question asked by the hon. Member for North-East Hertfordshire, who sadly is not present, was whether the patients forums would be getting the £23 million that CHCs currently have, or whether some of the money would be absorbed along with the £10 million that has been allocated to the purposes of PALS and the National Care Standards Commission.
We must view the system as a whole. I have previously argued that all the different components of the system add up to a coherent entity, and we need to fund the whole system, rather than its constituent parts, to ensure that it operates properly.
The issue of treatment abroad has been raised. I understand hon. Members' concerns about patients forums being involved. Treatment abroad is not entirely a novel idea; many patients in the past have been treated in European countries under forms E111 and E112. We are all aware of the system and the reciprocal arrangements that have been in place for many years for treatment here and in other European Union countries. In terms of that issue and of private health care, we envisage that rights for inspection will be included in the contracting process. It is clearly not possible for the Bill to affect law in other countries, but we do intend to ensure rights to quality monitoring and inspection. They are important to the interests and safety of patients in the private sector and, indeed, wherever care is commissioned on behalf of the national health service.
The Under-Secretary is right to say that people have been treated abroad under various agreements for many years. However, the point is that the Bill introduces a raft of new regulations and inspections, both through CHI and through patients forums. Many members of the Committee will be worrying about how we can inspect or regulate services provided abroad, so that those treated there may expect the same standards and regulatory functions as those treated in the United Kingdom.
I believe that we would all share the concerns of patients. It is right that we think about quality, standards, aftercare and the way in which patients are treated, wherever they might be, provided that treatment is under, and funded from, the national health service. We therefore need to look at the contracting provisions to ensure that such proposals are in place and are effective.
I believe that I have dealt with most of the issues raised by hon. Members—
Perhaps I may assist. Will the definition of premises in clause 13 allow the Commission for Health Improvement to inspect the quality of care given abroad? Will, by implication, patients forums be allowed to undertake monitoring visits—I recognise that they will not be as rigorous as CHI visits—and should a better definition of ''premises'' replace that given in clause 16?
I should begin by pointing out that the definition of ''premises'' in clause 16 seeks to reflect the functions as set out in clause 15(5). Patients forums are a different creature from CHI, and the premises in question are those connected with the functions and services that patients forums are intended to inspect. That is why there is a different definition.
I do not have information to hand on the definition in clause 13 and the question whether CHI will be able to inspect abroad, but I undertake to write to the hon. Gentleman on those matters.
The other issue that I did not deal with, which was raised by the hon. Member for North-East Hertfordshire, is the armed forces. As I understand it, if members of the armed forces are treated on NHS premises—they are longer treated in separate armed forces facilities but in NHS hospitals—or if they receive services provided by, or arranged by, a trust, such services will be subject to patients forums' rights of inspection and monitoring under clause 16. The provision would cover hospital premises in which members of the armed forces were being treated.
On that specific point, will patients forums have access to military facilities where NHS patients are being treated? I am thinking in particular of service families.
The intention is that patients forums will have access to premises in which NHS patients are being treated, and that they will follow those patients, whether they are in primary care or secondary care. It is very important that, in representing to trusts the views of patients and the public, patients forums can base those views on evidence that they have been able to collect.
I thank the Under-Secretary for offering some further explanation of the regulations. It is clear that she has a good idea of what they will contain, given that she was able to read from a draft. It is a pity that we could not have had those regulations for today's debate.
I am glad that the private parts of doctors' and community pharmacists' properties could not be raided, but the Minister has said nothing to convince me that the patients forums need such powers at all. If they go into doctors' surgeries or community pharmacies to inspect cleanliness and talk to patients, only a tiny number of the doctors or others in charge of premises will refuse to admit them. If a forum is refused admission, surely it can go to the Commission for Health Improvement and ask it to undertake an investigation, because regulations will give CHI the necessary powers. Those powers would be needed on only an extremely small number of occasions. We are giving excessive powers to the patients forums.
The Minister has not said anything about how the Committee, or the House, will consider the regulations. Will they be made by affirmative or negative procedure? Will we see and debate them? Will there be proper parliamentary scrutiny? Can she reassure us further on that?
I believe that the powers that we are giving to patients forums are necessary. It is important that they do not simply form a view without that being informed by patients and service users. It is the whole essence of the system of patient and public involvement that patients forums do not speak simply for themselves, but make an effort to go and find out what service users have to say.
A key part, although not the only part, of that process is for the patients forums to look at the physical facilities available to see whether they are effective, appropriate and suitable for their use. The hon. Gentleman said that a tiny proportion of people might refuse to let the forums in. I think that it is right and proper that when people are willing to get involved in such voluntary organisations, we give them the necessary powers and facilities to carry out their work properly.
I am sensitive to the need to strike a balance between the activities of patients forums and the privacy and dignity of patients, which addresses the point that the hon. Member for Oxford, West and Abingdon made. We must ensure that patients' privacy and dignity is not compromised by visits from patients forums, which would defeat the object of having them. That balance is crucial, as is ensuring that they do not duplicate their visits so that people receive one visit after another. Where there are several patients forums, they must be properly co-ordinated so that they do joint visits to look at a range of issues. Such matters are not beyond our wit or ken. We are competent enough to organise a system that creates neither duplication nor the problems about which the hon. Gentleman expressed concern.
We want to have extensive consultation on regulations with all those involved in the field. Their ideas might help us to get an even better system, in terms of its practical working. People who have been involved in such activities often know what works best, what is not a good idea and what is impractical. I want us to be very well informed before we promote regulations to the House.
I do not disagree with the hon. Lady's points about the membership of patients forums. That is not where she and I have disagreements.
On the definition of premises referred to in amendment No. 211, I am not entirely satisfied because she has not been able to answer one of my questions and has said that she will write to me. However, for the reasons that I have given, amendment No. 211 is not in a fit state to be pressed.
On amendment No. 210, I disagree strongly with what the hon. Lady said in her attempted reassurances. If we are allowed, I note that we could have that debate under clause 21. I fear, however, that we will not have time then to cover either that or CHI's remit in prisons, which the Minister of State, the right hon. Member for Barrow and Furness (Mr. Hutton) promised could be examined under clause 21 when we discussed it earlier. Those points might have to be dealt with at a later stage or in the House of Lords.
On amendment No. 209, I disagree with the Minister's comment that the wording should not be ''shall'', but I do not believe that it is appropriate to press the amendment. I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Amendment No. 156 does not represent any policy change. We have always intended patients forums to have a right to inspect any premises where NHS patients in England go to receive health care. That sometimes includes premises owned or controlled by Welsh NHS bodies, and local authority premises where services are provided under a section 31 agreement with the local authority.
Until proposed structural changes to the NHS in Wales were introduced into the Bill, Welsh NHS bodies were covered by the original wording of the clause. After those changes, trusts in Wales will still be covered—
It being twenty-five minutes past Eleven o'clock, The Chairman adjourned the Committee without Question put, pursuant to the Standing Order.
Adjourned till this day at half-past Two o'clock.