Clause 17 - Annual Reports

NHS Reform & Health Care Professions Bill – in a Public Bill Committee at 2:30 pm on 6th December 2001.

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Photo of Richard Taylor Richard Taylor Independent, Wyre Forest 2:30 pm, 6th December 2001

I beg to move amendment No. 212, in page 21, line 44, at end insert—

''(e) the Members of the House of Commons representing constituencies in the relevant locality.''

It gives me great pleasure to move the amendment. I have not been here long, but I have achieved one or two ambitions. One of them was to see an amendment that had not necessarily been tabled by the Government achieve something. This amendment is a tremendous opportunity for that. It is supported not merely by the Opposition, but by me—I would prefer to sit in the middle if there were a seat.

From the response to the listening exercise, ''Involving Patients and the Public in Healthcare'', one can see that the Government have accepted that the amendment is necessary. In paragraphs 3.21 and 3.28 on pages 10 and 11, they agree that local MPs should be the people to receive forum reports and the amendment seeks to enshrine that requirement in the Bill. It would show that the Government and the Under-Secretary are listening—as she promised that she would—and taking action. I want to see those in my amendment added to the list of people who receive reports from forums.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

I support the amendment. One strength of the community health council system has been the generous way in which CHCs have kept Members of Parliament informed by sending them agendas, reports and information on other proceedings. Earlier, I said that I had become aware of the problems of one of my local hospitals because the CHC had brought them to my attention through reports and minutes of meetings.

However, there are other ways in which the aim of the amendment—that reports come into the possession of hon. Members—could be achieved. Provision could be made for a report to be laid before Parliament. Another way would be to give the Secretary of State permission, or require him, to publish a report that he receives. I therefore want to check with the Under-Secretary that there is not already something in the Bill that would cause such reports to come into the possession of Members of Parliament.

Photo of Hazel Blears Hazel Blears Parliamentary Under-Secretary (Department of Health)

I understand the wish of the hon. Member for Wyre Forest (Dr. Taylor) to see the amendment enshrined in law. I am pleased that he acknowledged that the listening document was genuine. As he pointed out, paragraph 3.21 of our response to the document states that local MPs have a role to play in shaping their health services, as they have an important role in raising issues in Parliament. We shall ensure that they receive copies of patients forum reports from their constituency so that they are kept aware of important local issues. We must ensure that the information in those annual reports is widely available.

It is inappropriate to put a provision into primary legislation because it is a matter of good practice rather than statutory responsibility and requirement. It would set a strange precedent for legislation if we were to require copies of a document to be sent to individual Members of Parliament. We could, however, require copies of all reports in which Members of Parliament might have a legitimate interest to be sent to them individually.

As we said in the listening document, we shall ensure that Members of Parliament get copies of documents and that they are kept in the loop regarding events in their constituency. I certainly appreciate being kept informed by the patient groups, including the community health council, in my constituency. Members of Parliament should receive that information, but it is inappropriate for a requirement to be placed in the Bill in this way. The spirit of the suggestion made by the hon. Member for Wyre Forest is sensible and we will ensure that what he has suggested happens, but for those reasons we must resist his amendment.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health) 2:45 pm, 6th December 2001

It is true that other Acts contain a provision that the person who receives the annual report is the Secretary of State, and there is also a duty to publish. Does the Under-Secretary envisage that such a provision would apply here, or would it be unnecessary because the forum would be publishing the report itself? The Bill stipulates what the report must include, but it does not require it to be in the public domain; many people would think that it should be.

Photo of Hazel Blears Hazel Blears Parliamentary Under-Secretary (Department of Health)

Perhaps I can reassure the hon. Gentleman. We envisage that patients forums' reports will be widely available in the community, and that they will publish them themselves in addition to sending them to the Secretary of State. The regulations under clause 18(2) will provide for the publication of patients forums' reports:

''the preparation and publication of reports by Patients' Forums (including the publication of reports under'' clause 17. There is a provision to ensure that that information is in the public domain. It would otherwise be of limited use because it is obviously the type of information that people would want to consider and act upon. There is currently no provision in the community health council regulations for reports to go specifically to Members of Parliament, but we know that they do because we receive them regularly. The amendment is therefore superfluous, but its spirit will be acknowledged and acted upon.

Photo of Richard Taylor Richard Taylor Independent, Wyre Forest

On the Under-Secretary's assurance that we will automatically receive those papers, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Photo of Richard Taylor Richard Taylor Independent, Wyre Forest

I beg to move amendment No. 213, in page 22, line 1, after 'include', insert '—


Photo of Mr Alan Hurst Mr Alan Hurst Labour, Braintree

With this we may discuss the following amendments: No. 214, in page 22, line 2, after 'Forum', insert—

'(b) details of the arrangements of the Trust to which the Forum relates under section 11(1) of the Health and Social Care Act 2001.'.

No. 215, in clause 18, page 22, line 29, after 'in', insert 'the'.

No. 216 in page 22, line 29, leave out from 'the' to end of line 30 and insert 'Commission for Patient and Public Involvement in Health'.

Photo of Richard Taylor Richard Taylor Independent, Wyre Forest

May I first make an inquiry? Amendments Nos. 215 and 216 refer to clause 18—do you still want to take them together, Mr. Hurst?

The Chairman indicated assent.

Photo of Richard Taylor Richard Taylor Independent, Wyre Forest

Amendments Nos. 213 and 214 allow us to ask a question. Clause 18 implies that the forum will be the only mechanism by which a trust can take citizens' views, but I wonder whether that is intentional. The trust should have that duty, not only its forum.

Amendments Nos. 215 and 216 concern clause 18(2)(j):

''the preparation by a Patients' Forum of annual accounts, and their inclusion in accounts of the NHS trust or Primary Care Trust''.

Will the Minster clarify whether it would be more appropriate to include the accounts in those of the Commission for Patient and Public Involvement in Health?

Photo of John Baron John Baron Conservative, Billericay

We must clarify how the different bodies will relate both to each other and to those working in primary and secondary care. To avoid confusion, the Department of Health should publish a clear guide for the public on where they can access information and advice; the British Medical Association would endorse that view. It would also help if health professionals were to be provided with information on arrangements for providing advice and gaining patients' views. To follow an earlier point, it seems inappropriate that the only way in which we shall be able to access patients' views is through the forum. There should be guidelines on how to obtain the public's view of how the health service is operating at the coal face, and professionals also need guidelines on where they stand.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

To follow the points made by my hon. Friend the Member for Billericay (Mr. Baron) and the hon. Member for Wyre Forest, the report should include information that patients forums come across on how trusts perform their duties to involve and consult patients and the public on issues such as the planning and provision of services, the development and consideration of proposals for changes in the way in which those services are provided and decisions that affect the operation of services. In Hertfordshire, consideration is being given to changing the way in which services are delivered across the county. The current arrangements for explaining the issues to people such as Members of Parliament, the public and councillors are good, although we have not yet reached the conclusions, which may be more controversial.

Whether a particular hospital continues to provide services such as accident and emergency is the type of issue about which patients and the public care most. They want to feel that they know how to complain and are aware of anything that might affect their services. The way in which trusts perform their duties to involve and consult patients and the public about the planning and provision of services is crucial. It is, however, not the sort of thing on which the Commission for Health Improvement would necessarily concentrate. Community health councils were ideal but, given that the Government are determined to abolish them, the annual report should include such details. That is the purpose of amendment No. 214.

The two amendments to clause 18 concern what should happen as regards the annual accounts for patients forums because the present proposals do not involve an independent set of accounts for patients forums. I may be wrong about that—the Minister will tell us in a moment if that is the case—but it looks as if patients forums will be seen as part of the trust accounts, and will not have a separate place. That raises questions about funding that we can come on to, if briefly, when we discuss clause 18.

Surely there is a case for having accounts concerning patients forums in with the accounts of the Commission for Patient and Public Involvement in Health. That would ensure that the accounts of the NHS trusts and primary care trusts, for which the forums are established, have accounts that are separately managed and presented from those of the forums themselves. The functions would then be separated out in every way. There is clearly a need for a rigorous watchdog, and if patients forums are to be that watchdog and to be independent, they should have an independent arrangement for their accounts.

Photo of Hazel Blears Hazel Blears Parliamentary Under-Secretary (Department of Health)

The hon. Member for Wyre Forest asked whether patients forums will be the only way for the NHS to consult. I can assure him that that is certainly not the case. The forums will be but one way in which we can find out the views of patients and the public about what our health services are doing, and whether they are providing the right quality of service. The new Commission for Patient and Public Involvement in Health will be given a specific remit to involve the public, and to ensure that public participation is a key part of developing health services and looking at reconfigurations. That will ensure that there is a wider input into those matters than simply from patients themselves, although they are important to the system.

Photo of John Baron John Baron Conservative, Billericay

Will the Under-Secretary clarify how the patients forums and other consultative bodies will relate to each other? It is not clear to me what communication there will be between them and how, at the end of the day, we will gather information from the general public on how the NHS is functioning at ground level. It appears that different bodies will be doing different things.

Photo of Hazel Blears Hazel Blears Parliamentary Under-Secretary (Department of Health)

The hon. Gentleman is right that different bodies will be doing different things. We have decided that the various functions have to be carried out at the different levels in the NHS at which they are carried out. There is a clear need to draw the system together to ensure that we get a coherent overview. Clause 19 outlines the role of the Commission for Patient and Public Involvement in Health, which will operate at the national, regional and local levels as the mechanism to draw all the different functions together. That will ensure that we get all the necessary data and intelligence about what is happening in our health economy.

The hon. Gentleman made a sensible point about providing a comprehensive guide to how the service will work. We are working on comprehensive guidance for everyone involved in the system, including health care professionals, patients, members of the public and local authorities who, for the first time, will have an active role and legal powers to take part in the system. I do not underestimate the importance of having clear, precise information available for everyone about how they can get involved in the system, which issues concern them and which part of the system they should go to for assistance. That will be the key to taking us forward to success.

On the NHS's general duty to consult, we are working on various guidance frameworks to ensure that the NHS knows what a good piece of consultation ought to involve. In many areas, consultation has improved dramatically in recent years, but we must ensure that good practice is spread right across the system so that there is a template for good consultation involving the public and patients. They will not be the same in every area, because communities are different and there must be flexibility, but some core competencies will be contained in any good piece of public involvement. I hope that all parts of the NHS and other bodies taking decisions on health—the broad definition in the Commission's powers—will learn from the framework documents to ensure that their consultation is of the highest possible quality.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health) 3:00 pm, 6th December 2001

We have heard a good deal about pieces of guidance and regulations being prepared. The Minister of State promised us on the first morning that we could have copies of things as they were ready. Are any of those documents ready? If not, have Ministers decided on their contents? We would like to know what they are.

Photo of Hazel Blears Hazel Blears Parliamentary Under-Secretary (Department of Health)

This morning, I gave hon. Members the proposed implementation plans, which set out the time scale for developing guidance and consulting on regulations. I can assure the hon. Gentleman that had the documents to which he referred been ready, they would have been shared with the Committee. We envisage that guidance for the NHS will be published early next year, and that there will be discussion and consultation on that. My right hon. Friend the Minister of State did not promise to produce regulations that do not exist.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

It may be tiresome for the Under-Secretary, but it is our job to scrutinise. It is always tiresome for a Government to endure the scrutiny of an Opposition; in the past I felt much the same as she does.

In respect of the patient advocacy and liaison services, it is stated that guidance will be developed and issued in January 2002. Is the Under-Secretary seriously suggesting that no substantial, worked-on document exists on that subject? It is clear that work is on-going in respect of these matters. Why cannot a progress report be published, setting out what has been decided so far?

Photo of Hazel Blears Hazel Blears Parliamentary Under-Secretary (Department of Health)

I have tried to do as much as I can to share information on the proposed implementation plan, and I hope that I have answered many of the questions on how we envisage the system developing. I can promise the hon. Gentleman that there is no question whatever of our keeping up our sleeve drafting regulations and guidance in a deliberate attempt to avoid scrutiny. We are more than happy to be open and transparent, and to share as much information as we possibly can. I want not only patients and the public but hon. Members to be involved in this process, so that they feel they have a role in shaping how legislation develops.

Photo of John Baron John Baron Conservative, Billericay

Following on from the suggestion of my hon. Friend the Member for North-East Hertfordshire (Mr. Heald), it would have helped had we been given this information a few days earlier. I thank the Under-Secretary for producing the programme, and there is no doubt that it is useful, but it has given rise to questions—for example, on patients forums—that we might otherwise have considered. I, for one, would have wanted to know more about the progress of the agreed pilot projects, given the body that they are seeking to replace. Instead of providing such information on the day of discussion, it would be useful, if possible, to have at least a couple of days' notice. Given that the pilot projects have been agreed, the information could have been produced sooner, which would have helped the Committee in its deliberations.

Photo of Hazel Blears Hazel Blears Parliamentary Under-Secretary (Department of Health)

I am pleased that the hon. Gentleman is finding the document useful. It constitutes a gathering together of the progress on all the pieces of the jigsaw, so it has not been possible to share such information earlier. I wanted to gather together all parts of the system for the Committee's benefit, because I recognise that this is a complex issue. The greater the understanding, the more robust our proposals will be. I can assure members of the Committee that we have provided the information as soon as was possible.

On monitoring the duty on the NHS under section 11, the Commission for Patient and Public Involvement in Health will be responsible for reporting to the Secretary of State on how well all the public involvement mechanisms are working. There is provision in the Bill to check how well the NHS is performing the duty to consult. I am very keen to make certain that we have an audit process. In the past, no body has been able to monitor how well the system is working in different parts of the country, and there has been variation in standards. One hopes that the commission will provide that consistency across the board, so that people will have access to the same high standards that they have every right to expect, regardless of which part of the country they live in.

I turn to amendments Nos. 215 and 216, on the funding stream for patients forums, and the suggestion that that would be more logically contained within the remit of the Commission for Patient and Public Involvement in Health, rather than the trust. I take the point made by the hon. Member for Wyre Forest, and we have been considering the matter for some time. It may be more appropriate for the funding stream to be delivered in a different way and I undertake to consider the matter further with a view to introducing an amendment at a later stage. We are aware of the issue, we intend to address it and I assure the hon. Gentleman that we shall do so.

For all those reasons, I ask the Committee to resist the amendments, which are not appropriate in terms of the annual reports. We shall introduce the requirements by good practice rather than in the Bill and I undertake to look again at the funding stream for patients forums.

Amendment negatived.

Question proposed, That the clause stand part of the Bill.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

It may be that the hon. Member for Wyre Forest did not want to withdraw the amendment, as one might have expected, but I hope that the Minister's assurance that she will look again at the matter, particularly the issues under clause 18, still stands; I am sure that it does. It may be possible for another way to be found to return to the matter on Report. I was going to raise one or two points but, after further thought, I shall leave them.

Clause 17 ordered to stand part of the Bill.