I beg to move amendment No. 217, in page 22, line 40, at end insert—
'(mm) the referral of matters of a prescribed description to—
(i) any overview and scrutiny committee in relation to which the Primary Care Trust or NHS trust for which the Forum is established is a local NHS body by virtue of regulations made under section 1(4) of the Health and Social Care Act 2001 (including that provision as read with section 8(5)) and as applied by section 10(2) of that Act; and
(ii) the relevant Strategic Health Authority.'.
With this it will be convenient to take the following amendments: No. 218, in page 22, line 42, leave out 'and'.
No. 219, in page 22, line 43, after 'Authorities', insert
'and overview and scrutiny committees'.
No. 220, in page 23, line 7, at end insert—
'(3A) Where an NHS trust provides significant services for patients resident in areas covered by more than one overview and scrutiny committee, the membership of the Forum for that Trust should be drawn proportionately from each of those areas.'.
New clause 3—Duty of overview and scrutiny committee to review and scrutinise—
'In section 21 of the Local Government Act 2000 (c. 22) (overview and scrutiny committees), leave out paragraph (2)(f) and insert—
''(2A)Executive arrangements by a local authority must ensure that the overview and scrutiny committee or committees of an authority to which section 7 of the Health and Social Care Act 2001 applies, has a duty to review and scrutinise, in accordance with regulations under that section, matters relating to the health service (within the meaning of that section) in the authority's area, and to make reports and recommendations on such matters in accordance with the regulations.''.'.
New clause 4—Functions of overview and scrutiny committees: supplementary provisions—
'(1) In line 1 of section 7(3) of the Health and Social Care Act 2001, leave out ''may'' and insert ''shall''.
(2) In section 7(3) of the Health and Social Care Act 2001, there is inserted—
''(aa) as to matters relating to the health service in the authority's area which it must refer to the Secretary of State''.'.
New clause 5—Patient Forum representation on overview and scrutiny committees—
'In section 21 of the Local Government Act 2000 (c. 22) (overview and scrutiny committees), there is inserted—
''(10A) When fulfilling its duty under subsection (2A) above, the overview and scrutiny committee of a local authority, or any sub-committee of such a committee, shall include at least one member of each Patients' Forum established for each NHS Trust and Primary Care Trust which provides services to the area of the local authority concerned.''.'.
This is an important group of amendments, designed to probe and to raise concerns that the current arrangements, particularly for oversight and scrutiny, are not as they might be. The Health and Social Care Act 2001 and the Local Government Act 2000 were predicated on a wider change. However, with the onset of the general election—on which we all look back with relief and pleasure—some aspects of legislation had to be dropped for the time being, so there may be omissions. I know that the Under-Secretary will have studied the matters carefully and I hope that she will be able to reassure hon. Members who share my views about them.
Amendment No. 217 would insert into the supplementary provisions in clause 18 an additional paragraph, and some of the words in the amendment are lifted from another part of the Bill. One of the important functions of community health councils is the ability to ensure that there is scrutiny of local decision-making. I will speak later with regard to whether overview and scrutiny committees have the relevant powers and duties to make the appropriate referrals. However, the first point I want to make explicit is that regulations should be provided for the referral of these matters to overview and scrutiny committees.
By misfortune rather than by design, I do not think that there is any problem in recognising which overview and scrutiny committee is relevant for each area. Indeed, there are arrangements for joint committees where required, and clearly some primary care trust patients forums will overlap more than one overview and scrutiny committee. That will not be a significant difficulty as regards the amendment.
The people already involved in the matter recognise that this amendment would allow patients forums to refer matters to relevant overview and scrutiny committees, and to strategic health authorities. As the Government would have it, patients forums would have first-hand knowledge of services, and should be able to put issues of concern on the agenda of overview and scrutiny committees. The second amendment in this group is amendment No. 219, which is consequential. Amendment No. 219 would insert into line 43 the need to have relevant regulations regarding membership. There may well be other members of the Committee who have strong views on those issues.
Amendment No. 220 again talks about membership. I am sure that the hon. Member for Wyre Forest will speak in his customary style, which is brief and to the point, on these matters.
Indeed. The hon. Member for Wyre Forest speaks with great clarity, normally.
There is a question about whether the geographical membership of patients forums will reflect the geographical areas covered logically. There is also a question of whether the overview and scrutiny committees, which are geographical in their nature—by definition, and by their establishment—will have members on the patients forums to which they can relate clearly. I hope that those amendments are self-explanatory.
I now move to the three new clauses that are to be considered in this group of amendments, which are important. New clause 3 is complex and I suspect that, in terms of drafting, it needs to be read in relation to the Local Government Act 2000. I have looked at this carefully and, while there may be drafting errors, I hope that it was sufficiently clear for the Minister to understand its intention. That intention is to place a duty on overview and scrutiny committees to carry out the scrutiny of local health services. Under the Health and Social Care Act 2001, overview and scrutiny committees have the power to scrutinise, but not the duty. Therefore, some local authorities could choose advertently, or inadvertently—I seem to say that so often in relation to this Bill—not to exercise this power, leaving the local community with no powers of scrutiny for the NHS.
Paragraph 1 of schedule 7 to the NHS Act 1977 places community health councils under a duty to
''(a) represent the interests in the health service of the public in its district; and
(b) to perform such other functions as may be conferred on it . . .''
The CHC Regulations 1996 expanded upon this duty. Regulation 17 places a duty—not just a power, but a duty—upon each CHC to:
''keep under review the operation of the health service in its district, to make recommendations for the improvement of that service and to advise any health authority upon such matters relating to the operation of the health service within its district as the Council thinks fit.''
The amendment, effectively, puts a similar duty on the overview and scrutiny committees. If the Minister cannot accept this new clause, I would be grateful if she reassured me that she has plans to provide this duty, because I have been told that it does not exist. Otherwise, I ask her to in some way seek to reassure me that the worries that prompted the amendment are unfounded.
Ms Blears indicated assent.
I am pleased to see her nodding, which I accept in good faith. It gives me hope that I will be satisfied on the matter.
New clause 4 would amend the Health and Social Care Act 2001 to add an extra section, placing a duty on overview and scrutiny committees to refer matters of concern to the Secretary of State. Community health councils have the duty to refer to the Secretary of State a decision that has involved inadequate consultation or given rise to significant local unhappiness, thereby placing responsibility and accountability with him. In a previous debate, we heard how careful Ministers were to ensure that, where necessary, accountability lay with the Secretary of State, even if they were not keen that the performance of those duties should be expertly scrutinised.
The new clause, in conjunction with new clause 3, would ensure that the powers of overview and scrutiny committees were coupled with a duty to refer matters to the Secretary of State in circumstances prescribed by the regulations. I do not need to go into any more detail about the current powers of CHCs, but the new clause is intended to replicate those powers within the new structures.
New clause 5 would amend the Local Government Act 2000. Many long minutes, if not hours, were spent hunting down the sections that I wanted to amend, but I am pretty sure that the new clause is in the right ballpark in terms of accuracy. It would provide for overview and scrutiny committees or sub-committees to include at least one member of the relevant patients forum. That would be a way of feeding information from the work of forums into the work of the committees, providing a more integrated approach and greater co-operation between the two. OSCs will need first-hand knowledge of patients forum members to exercise their functions. At the moment, CHC members have the powers of referral, inspection and scrutiny and they must know what is going on. In the context of the new structure, it is important to link the two bodies more closely together; an effective way of doing so would be to ensure that OSCs have shared membership with the relevant patients forums.
There may be an argument for having a wider body within the new framework to represent patients forum views cited at overview and scrutiny committee level; it could be called a patients council. I suspect that, at a later stage, we might consider such arrangements. For the time being, we should ensure that OSCs have the powers and duties to scrutinise and refer, and that they have the expertise to call upon in terms of personnel to ensure that scrutiny is adequate and decisions to refer are appropriate.
I look forward to hearing the Under-Secretary's response to these important amendments and new clauses. We should take this opportunity to ensure that overview and scrutiny committees are workable.
The community health councils—which act as the local watchdog and independent voice—and the overview and scrutiny committees are interlinked. The role of the one, the CHC, is vital to the work of the other, the committee. I draw the Minister's attention to the emergency motion that was passed by Croydon council in December 2000. It said that
''this council is proud of the way Croydon CHC provides a strong independent voice for the people of Croydon on NHS matters . . . The involvement of an independent watchdog role is essential''.
There were numerous other articles in Croydon newspapers at that time, with headlines along the lines of , ''Health watchdogs play a crucial role''. The story ran again when the Government lost the previous provisions.
The amendments relate to one of the important interfaces if we are to have the changes; that between patients forums and overview and scrutiny committees. My party and I rather agree with the sentiments of the motion to which I referred. We are proud of community health councils and do not really see the need for the changes, but if they are to be made, patients forums will be the bodies with the first-hand knowledge of services. They must be in a position to refer matters to relevant overview and scrutiny committees. Amendment No. 217 is, therefore, right up our street.
The purpose of amendments Nos. 218 and 219 is to include overview and scrutiny committees in the list of bodies that will be obliged to make and publish comments on reports or recommendations made by patients forums. It is important that the overview and scrutiny committees use the powers that they are given. The hon. Member for Oxford, West and Abingdon (Dr. Harris) has raised concerns that giving a body a power is not the same thing as making it do the work.
Amendment No. 220 would ensure that the membership of patients forums contained representation from residents of the catchment areas and related to the relevant overview and scrutiny committees. That seems sensible to us. The new clauses would place a duty on overview and scrutiny committees to do their work. That might seem draconian, but I think that it is important that the work is done. This is a way of highlighting the importance that Parliament places on the duty that has been given to those committees.
Turning to new clause 4, regulation 18(5) of the community health council regulations places CHCs under a duty to refer inadequate consultations and contested decisions to the Secretary of State. In the course of carrying out the functions of representing the views of patients and their local communities in health services, CHCs sometimes disagree with plans being considered for those services. CHCs are relied on to provide the community perspective on plans, although they are always willing to look at other views. New clause 4 would provide a safeguard in the system, and we are tempted by it.
I am not entirely sure, from what the hon. Gentleman said, what the effect of new clause 5 would be, but I will be interested to hear the Minister's response.
Amendment No. 219 is absolutely crucial. As we have heard, it would add the overview and scrutiny committees to the list of bodies that comment on the forums' reports. Given that they are the only democratically elected bodies concerned, they have every right to be asked to comment on the reports.
Amendment No. 220 would ensure that all overview and scrutiny committees relevant to a trust were represented. That is only a small part of my concern about membership. We strayed widely, as your co-chairman Miss Widdecombe said at the time, Mr. Hurst, on to clause 18 this morning. There are various other points that I would like to make. Can we return briefly to the topic under clause stand part?
I have two brief comments. I congratulate the Government on including, under clause 18(3), in the membership of a patients forum,
''at least one person who is a member or representative of a voluntary organisation''.
I believe, as perhaps do other hon. Members, that that is vital. The Government should do much more to empower the voluntary and community sector in their efforts in the community in general. Here is an example of how they can be involved in local decision making; in this case, for health care provision. That is a good move.
Will the Minister clarify a concern that I have, relating to clause 18? Under the new proposal—
Order. The hon. Gentleman is spreading the discussion widely. He may have opportunities to say more during the stand part debate. At this time, he should keep himself strictly to the amendments and new clauses before the Committee.
It is clear that the amendments relate to operational aspects, which I believe are best dealt with through regulations. However, I will deal first with those amendments that relate to patients forums.
Amendments Nos. 217, 218 and 219 would provide patients forums with the right of referral to the overview and scrutiny committees. They would require overview and scrutiny committees and strategic health authorities to comment on the reports and the recommendations made by patients forums. Clause 18(2)(m) already provides for regulations to be made about the provision and publication of patients forums' reports. Section 7(3) of the Health and Social Care Act 2001 provides for the overview and scrutiny committees to have the same rights of referral that are currently held by community health councils.
We do not accept that we need further legislation in that respect, but I have heard the strength of argument with which the hon. Members for Wyre Forest and for Oxford, West and Abingdon made their points. They believe that there ought to be a right of referral for patients forums, or that the overview and scrutiny committees ought to respond to what patients forums raise. When we talk about the operation of the local Commission for Patient and Public Involvement in Health under clause 19, it will be seen that we intend the information arising from the deliberations of patients forums to be drawn together by the commission. The commission will have the power to refer those matters to an overview and scrutiny committee for its consideration. That will ensure that scrutiny is informed by what local people say, which is important.
I accept that I did not clarify amendments Nos. 218 and 219 very carefully, and I would like briefly to do so now. I think that the Minister understands them, so I will deal with her response.
The Minister maintains that clause 18(2)(m) will deal with my concern. My concern, however, is that there needs to be a duty—and regulations need to be available—for such bodies to respond to reports by patients forums. Clause 18(2)(m) refers only to regulations on the preparation and publication of reports by patients forums, not responses to them.
I take the hon. Gentleman's point, and I have said that the regulations provide for the preparation of reports. However, getting the overview and scrutiny committee to respond to the specifics of the report is important. I would like to think further about how we could strengthen that process and when we debate clause 19 and the operation of the commission at local level, hon. Members will become aware of our intention to ensure that all parts of the system are joined together and respond to the issues raised. The question of the overview and scrutiny committee being required to respond to issues raised by patients forums is important. I will think further about it and come back to hon. Members.
I accept that answer and will take the matter no further at this stage. The Under-Secretary cited section 7(3) of the Health and Social Care Act 2001, which refers to the functions of overview and scrutiny committees and the regulations that make provisions for them. Which particular paragraph of subsection (3) gives to overview and scrutiny committees the duties and powers to make the referrals that are stated in my amendment?
I shall endeavour to answer that when we debate the relevant amendments and new clauses.
Amendment No. 220, which is supported by the hon. Member for Wyre Forest, aims to ensure that the membership of a forum is drawn proportionately in areas covered by more than one overview and scrutiny committee. I understand the hon. Gentleman's desire to ensure that forums are representative and agree that those sitting on them should represent the whole community, as far as that is possible. However, it is appropriate for the regulations in clause 18(2) to deal with that. That clause refers to the appointment of members, the terms of appointment and how we ensure the widest possible representation. At this stage, it is inappropriate to include such fine points as the hon. Gentleman proposes in primary legislation.
The thrust of the Government's changes is to ensure that the representative bodies in the patient and public involvement system cover as wide a range of groups and individuals as possible, and that all voices, some of which perhaps have not been heard traditionally, have a say in the new system.
In response to the amendments on overview and scrutiny, it is important to return to the principle behind the placing of the scrutiny of the NHS in the hands of local government. We want scrutiny to be in the hands of an independent, democratically elected body. That proposal had widespread support when it was included in the 2001 Act. We also want the body to be in touch with the communities that it represents.
The local government overview and scrutiny committees should develop a degree of expertise in scrutiny. During the past 12 months, many local authorities have begun to undertake the scrutiny of their services in different areas. Many useful and worthwhile recommendations for changes to services that would make improvements to the local community have resulted. We want the expertise that local government has built up for scrutinising its own services to be extended, transferred, developed and deepened for the scrutiny of the NHS.
We want the exercise to be democratic, with locally elected representatives, but we must recognise that, because the bodies will be independent, they will be entitled to organise the way in which other bodies are scrutinised in accordance with their priorities and methods of work. We do not want to compel an independent body to behave in a manner that would conflict with the principle of independence. I cannot think of a circumstance in which a local authority will not want to represent the views of its community on the functions of the NHS. If it refused unreasonably to carry out scrutiny, or if such a decision were frivolous or based on irrelevant considerations, the matter would be open to judicial review. There is provision, therefore, to ensure that local authorities scrutinise properly.
With regard to the provisions from which the hon. Member for Oxford, West and Abingdon has quoted, under section 7(3) of the Health and Social Care Act 2001 regulations can require NHS bodies to consult overview and scrutiny committees. We can use the powers in those regulations to replicate the current position for community health councils. We have said on several occasions that the new powers for overview and scrutiny committees to refer matters to Ministers will be no less rigorous and powerful than those currently enjoyed by community health councils.
I should point out to the hon. Gentleman that, in statutory terms, the powers that community health councils currently hold relate to the process of consultation. They can refer in cases where the processes were inadequate, where the right people were not consulted, where there was insufficient time for consultation or where such decisions were arrived at in a defective manner. It is very much an administrative law provision, but there is no statutory right to refer matters on the basis of the merits of proposals. A tradition has built up over the years whereby provisions that are contested on their merits are referred to Ministers; for example, where there is a dispute in the community and people are at odds about the merits of a proposal.
It is clearly important that decisions on process and on substance be subject to proper scrutiny and review. I certainly want to ensure that the power of overview and scrutiny committees to make references is no less than that enjoyed by community health councils, and that issues of process and of substance are looked at in a sensible way.
I have been listening carefully, and I am not sure whether the Under-Secretary said that the right of referral has emerged but should no longer exist, or that it has emerged and should continue to exist. I think that she meant the latter. Referral involves taking away from the NHS the right to decide locally and giving that right to the Secretary of State, as can currently happen with controversial re-providing decisions; or hospital closures, as ordinary people call them. As it stands, section 7(3)(b) of the Health and Social Care Act 2001 grants the power to make reports, not referrals, so I am still not clear where in existing legislation the right of referral is granted.
I will come to that point. The Government certainly intend that the right of referral on contested reconfigurations, or on matters that were previously the subject of referrals, should continue. A better system of public and patient involvement will enable people to get involved at the outset when options are being developed. Given that there will be greater opportunity to shape proposals when they are first considered, I hope that we might see fewer contested matters. In my experience, giving people the opportunity to get involved at the beginning of a process sometimes minimises the matters that remain subject to dispute.
None the less, I should make it absolutely clear that the right of referral must exist in the system. If matters are contested and there is a great dispute in the community, a democratically elected body—the overview and scrutiny committee—must have the power to decide that it is right and proper that they be referred.
I have been reading an update on the costing exercise for the replacement of community health councils in England, which was prepared by Mr. Roy and given to me by the Association of Community Health Councils for England and Wales. Mr. Roy said that the assumption is that only three quarters of the NHS in England will be covered by local authority overview, and that specialised services and so on will not be covered. Is that why the Under-Secretary is not keen to accept new clause 3?
No, Mr. Hurst. The Health and Social Care Act 2001 refers to regulations relating to the requirement for local NHS bodies to consult the overview and scrutiny committees and provides, in section 7(3)(c), that the regulations can determine the matters on which local NHS bodies must consult the overview and scrutiny committees. That is wide enough to cover matters such as specialist commissioning in addition to the physical provision of services on the ground. The regulations can specify the matters on which the NHS must consult the overview and scrutiny committees to enable them to take a view.
Clearly, within the NHS there will be specialist provisions covering more than one area. A service could be pan-London, for example, or cover a conurbation, so the flexibility in the 2001 Act, which provides for overview and scrutiny committees to work together, to co-opt other members, and to have joint committees working together on scrutiny, is important. It is crucial that they have the flexibility to deal with issues that cross boundaries and cover more than one area. There is flexibility within those regulations for overview and scrutiny committees to operate in different ways depending on the circumstances of the issue that they are scrutinising. That flexibility is built into the system.
We are resisting new clause 3 because the powers to make reference to Ministers can be included in the regulations under section 7(3) of the 2001 Act. The overview and scrutiny committees have a power to scrutinise and they will have the power under those regulations to refer contested reconfigurations to Ministers in a way that is no less powerful than that pertaining to community health councils.
This is the nub of new clause 4, which covers referral. I have looked carefully at section 7(3) of the 2001 Act, which states:
''Regulations may, in relation to an overview and scrutiny committee of an authority to which this section applies, make provision''.
Paragraphs (a), (b), (c), (d), (e) and (f) then list the matters to which the subsection applies, but none mentions the words ''refer'' or ''Secretary of State''. It is difficult to see how the Under-Secretary can rely on section 7(3) and regulations therein to provide the power, let alone the duty, to refer to the Secretary of State decisions with which overview and scrutiny committees are unhappy. I am reassured by the Under-Secretary's view that it should be there, but I am not satisfied that she is correct in saying that it is there.
I understand the hon. Gentleman's concern. It is important to ensure that the law provides the power of referral. Section 7(3)(c) of the 2001Act provides a power to specify the matters on which the NHS must consult the overview and scrutiny committees and section 64(8) provides that the power in regulations can include a requirement to make incidental supplementary provisions on the authority making the order as we consider expedient. We could make provision here to decide what happens when the overview and scrutiny committees have been consulted. They would then have the power to decide, having been consulted, that they are happy with the proposals and therefore intend to make the referral.
However, I am reviewing the arrangements for community health councils and their power of referral. We shall be consulting on the policy framework on the regulations and the guidance for health scrutiny early in 2002, when we intend to invite the views of all stakeholders, which clearly includes local government. We are conscious that local government bodies are independent. We want a partnership with which they are comfortable. They will represent the views of their local communities and refer some very important matters to Ministers on the future of health services in their area, so we must ensure that the powers we put in place are powers that they also feel that they can operate properly to ensure that those referrals take place.
I appreciate that the Bill is a little tortuous at the moment. There are the regulations under section 7 of the 2001 Act, which then provide a further incidental power under section 64 of the 2001 Act, to ensure that referrals can be made when there is a contested reconfiguration. It may be tortuous, but it can certainly happen. I will be consulting on the regulations and guidance that we issue to ensure that the power for referral of contested reconfigurations is certainly no less than the power that the community health councils currently have. Hopefully it will be more coherent, because there is a slight difference between the statutory powers that they have now and the powers that they perhaps should have in future.
I would have been very grateful but for the last few words of the Under-Secretary's speech. I understood that such a review might have been done by now. If it had been done, we might have known where we stood when we were in a position to amend the Bill in Committee, instead of being obliged to wait for the review results.
Nevertheless, I accept what the Under-Secretary said in good faith. She has placed it on the record that she recognises that to describe the burying of a ''maybe'' power in a supplementary provision of a miscellaneous and supplementary part of another Act when it would be best put, for everyone's ease of understanding, with section 7 of the 2001 Act is rather tortuous might be an understatement.
I am grateful to the Under-Secretary and I should like to put those remarks on record. If the hon. Lady has not finished, I should also like to say a few words about new clause 3.
Perhaps I may help the hon. Gentleman in terms of the regulation powers. I understand that the primary legislation that relates to community health councils had no power to refer either, and actually used the same framework of powers used when the community health council regulations were made. There seems to be a history of tortuous legislation in this field, which we might be able to address.
Perhaps the Under-Secretary would write to me setting that out, because it is easier for me to see it at any time of the day or week when it is written down.
I want to take the opportunity to press the hon. Lady a little further on new clause 3. We have covered new clause 4, but new clause 3 does make a significant change. The current arrangements are set out in the Local Government Act 2000 in section 21—which is amended by section 7(1) of the Health and Social Care Act 2001—which adds, in order to deal with the overview and scrutiny committee in the context of the health service, an extra paragraph (f) to section 21(2). Section 21(2) is predicated on the basis of executive arrangements by local authorities, which must ensure that the overview and scrutiny committee has the power to do various things. While new clause 3 takes this health issue out of that section, it adds a new section that states:
''(2A) Executive arrangements by a local authority must ensure that the overview and scrutiny committee . . . has a duty to review and scrutinise''.
I should like reassurance from the hon. Lady because, if she is continuing to resist that new clause, the Government would be foolish not to do something. As the hon. Member for Wyre Forest has said, there are wheels within wheels between some trusts and some people in local authorities, particularly when local authorities have huge political majorities on less than an overall majority. Therefore, we do need an assurance that there will be a duty to scrutinise, and not just the power to do so if they feel like it.
I can confirm that we are resisting this new clause. I explained previously that with regard to scrutiny—even councils scrutinising the decisions of their own executives—local government does have a power, not a duty. Local government is an independent organisation and we do not seek to compel councils to operate in any particular manner. I have said that where they unreasonably refuse to scrutinise, they would be open to judicial review, as any public body would be in relation to an unreasonable refusal to exercise its powers.
Therefore, we do not wish to depart from the general provisions that relate to scrutiny of local government functions, as they relate to the NHS. We want the scrutiny of the NHS to be part of a framework of scrutiny, and therefore to be dealt with in a consistent manner by local government, as it would deal with the scrutiny of its own executive functions. It is also important to confirm that those in local government will not be the only scrutineers in the new system. Our debates on patients forums have confirmed that they will scrutinise trusts at a local level by inspecting, monitoring and assessing standards. Several bodies will be scrutinising the system, and that will provide a series of checks and balances.
The Under-Secretary will remember that in schedule 7(1) to the National Health Service Act 1977, community health councils were placed under a duty
''to represent the interests in the health service of the public in its district''.
The overview and scrutiny committees will address that issue, but they are not under a duty to do so. This is taking something away from the watchdog when that is not what we want to happen.
It would be difficult to describe transferring the functions of community health councils to democratically elected local government as reducing and diluting existing powers. The decision to transfer powers to local government was broadly welcomed because local government has a standing within the community, its members are elected at local level and it represents constituents on a range of issues. To include the way in which the national health service functions in terms of local government's powers is therefore correct. I referred to community health councils having no statutory duty of referral on primary legislation with regard to contested reconfigurations, which is why this situation remains as it is.
Transferring community health councils' powers to local government will enable some issues to be looked at in a broader framework, with the effect that health service decisions will be examined in the context of the wider decisions that local authorities must make, making the process more robust. I have said twice that it is inappropriate to compel local government to operate in a certain manner, and I am sure that it will exercise the powers of scrutiny in what I hope will be flexible, imaginative, innovative and creative ways that are in the community's best interests.
New clause 5 relates to the requirement for patients forums to be members of the overview and scrutiny committees. I agree that when they are scrutinising, local authority committees should be able to draw on an informed patient perspective when considering specific health care provision. Patients forums are an obvious place for insight into and expertise on these issues, but we should not oblige local government to operate in a specific way in these circumstances. We are clear that it is good practice for forum members to be co-opted on to overview and scrutiny committees, and we shall be promoting that as part of the consultation on how overview and scrutiny committees should operate. I am keen for overview and scrutiny committees to co-opt as members, taskforces or sub-committees—whatever arrangements they want to set in place—as many local people as they can to inform the agenda.
Especially in the early days—when perhaps local government members will not have as much expertise as some people already in the system have—it will be crucial for local patients and members of former community health councils to be able to inform the overview and scrutiny committees on the top community issues that must be looked at as priorities. The evidence base from the patients forums will feed into the overview and scrutiny committees so that the scrutiny consists not only of a formal appearance by the chief executive of the trust every six months when they tick the boxes, but an in-depth analysis of the quality and standards of service that are provided to the community. Drawing in the expertise of the patients forums will be key, and it is a matter of good practice. However, it is inappropriate to compel local government to organise itself in a particular way. That would involve a diktat from the centre, but we want overview and scrutiny committees to grow organically and develop best practice for their local communities. For that reason, we shall resist new clause 5.
New clause 5 contains the word ''shall''; if it contained the word ''may'', it would be more acceptable. Is the Under-Secretary also saying—she may be right—that that power already exists in section 21(10) of the Local Government Act 2000, which states:
''An overview and scrutiny committee of a local authority, or any sub-committee of such a committee, may include persons who are not members of the authority . . . and any such persons are not entitled to vote''?
Is the Under-Secretary satisfied that that covers good practice satisfactorily even though it does not specify patient forums and health care?
However the hon. Gentleman ''may'' choose to put his case, in these circumstance it is inappropriate to place that power in the Bill. It is a matter of good practice, and I have no doubt that good practice will be established across the country. Section 21(10) of the Local Government Act 2000 provides that people such as members of patients forums and others who have a degree of expertise that can help to inform the overview and scrutiny committees' deliberations should be part and parcel of the process by bringing their skills to those committees' proceedings. For those reasons, we must resist new clause 5.
For the moment, I am prepared to accept the Under Secretary's undertaking that there will be clear guidance that it would be good practice to involve members of patients forums or other bodies related to patients forums at overview and scrutiny committee level.
On new clause 4, the Under-Secretary is giving some hope that she will be able to explain to me that the power to refer—and the possibility of regulations creating the power to refer—will be made clearer. If that happens, I look forward to receiving a letter from her that clarifies the situation.
The hon. Member for North-East Hertfordshire put his finger on problem with new clause 3. The perception is that there is a duty for CHCs to make that referral, but the Under-Secretary is not replacing that duty with another duty. That is the problem that she will have in reassuring people that the regime is robust. The best thing would be if we go away and reflect on that matter, and perhaps it can be considered further in another place.
I must assume that the hon. Member for Wyre Forest, who is a friend but nevertheless in parliamentary language not a hon. Friend, heard what the Under-Secretary said about membership because I know that that is something about which he feels strongly.
It may well be that I have had adequate reassurance regarding amendments Nos. 217 to 219 because I still do not take the view that the existing arrangements require reports back to patients forums by bodies such as the ''overview and scrutiny committees'' mentioned in amendment No. 219. I will reflect on the Under-Secretary's remarks, and I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Question proposed, That the clause stand part of the Bill.
Some people have expressed concern that appointments of members of patients forums will be made from members of the local commission
because they are the people with the right to appoint members of the forum. It is all starting to look a bit cosy. Will the Minister explain how she expects to find the other kinds of people whom she mentioned to widen the membership of patients forums? Alternatively, does she take the view that because the local commission will have a wide base it does not matter if it becomes the local forum?
I want to ask the Under-Secretary about funding. In the context of subsection (2)(h), the new system will need adequate resourcing if it is to work. Supporting patients forums will necessitate employing and paying numbers of staff. We started a discussion that we did not complete about how forums would be funded. I have received a note from Mr. Roy of the Association of Community Health Councils for England and Wales in which he estimates that costs for patients forums will be about £32.5 million in 2003-04. In making that calculation, he assumed a total of between 400 and 500 forums, which is far less than some had thought; took account of the narrower range of responsibilities of CHCs; assumed that the independent complaints advocacy service element would be taken out; and put in an adjustment to reflect the extended remit into primary care and parts of the private sector.
The other aspect is patient advocacy and liaison services. I may have unwittingly misled the Committee this morning when I said that the cost of PALS was £10 million and that it was a one-off payment. A better way of putting it is that a small number of pathfinder, or pilot, PALS were given £10 million this year and will be given £10 million next year. But when the system is rolled out nationally, none of the other PALS will get anything. The money will therefore have to come from PCT budgets or some other source.
We know from the financial assessment in the notes to the Bill that the Government are effectively saying, ''We shall take account of the £33 million that is spent on PALS and CHCs in funding the new structure.'' This morning I asked the Under-Secretary for an assurance that at least as much money would be available for patients forums as for CHCs; that is, at least £23 million. That would be a lot less than ACHCEW considers is needed, and she will recall that the Audit Commission estimated £60 million. I have assumed a figure of half that, but even so at £23 million the cost of CHCs is much lower. Can the Under-Secretary promise us that at least £23 million will be available for patients forums?
Concern has been expressed to me by Mr. Tester of the Society of Community Health Council Staff about the way in which CHC staff will be treated over the transition. Apparently, health authority staff are being assured that they will have a job for 12 months after health authorities cease to exist in April 2002, but no assurance has been given on what will happen to CHC staff. Can the Minister give us any information about that? Appointment of staff, of course, is an issue to be dealt with in the regulations that we have not yet seen.
I have three quick points and questions about membership of the forums. I was very pleased to hear the Under-Secretary say this morning that there will be arrangements for CHC members to be considered for membership of the forums. Under the proposed implementation programme—if all goes through—CHCs will not actually be abolished until April 2003. There will be some members of CHCs whose appointments come to an end between now and then, and it will scarcely be sensible to appoint new people. Can there be some mechanism whereby, if they wish, people can extent their appointments until April 2003?
The Under-Secretary said yesterday that she thought that about half of the people on forums will be representatives of voluntary bodies and that half will represent patients and carers. That was much more encouraging than the phrase ''at least one'' in the Bill. Can she add some detail about the size that she envisages for patients forums?
Finally, one reason why I object to the changes is the plethora of new bodies with which we will be faced. There are at least three commissions; I am not sure whether I am confused, or whether the people who have written the response to the listening exercise are confused. On page 5 of that response, the seventh bullet point of paragraph 2.6 says that
''the NHS Appointments Commission...will be charged with making the appointments to Patients' Forums.''
However, page 11, paragraph 3.26 states:
''The Commission for Patient and Public Involvement in Health will conduct the appointments process.''
Which commission will actually make the appointments?
I welcome the involvement of the voluntary and community sector in membership of the patients forums. It is very important that the Government do their best to empower that section of society and recognise all that it can do. I would, however, like some clear guidelines on how the forums are to function and be regulated. That follows on in part from the comments of the hon. Member for Wyre Forest. For example, can we have clarification on the forums' access to information and advice? What information will they be able to access? Will the public be welcomed into them? How public will they be? Will they have an advisory role? Those questions relate to who is appointed to the forums, as the make-up of the forum will obviously reflect its nature and function. I would be grateful for more details about that.
Can the Under-Secretary clarify the selection process? For example, are opportunities going to be advertised locally? Will an effort be made to advertise in deprived areas, to ensure that there is good representation from a cross-section of society? Will the Minister reassure us that the appointments will not be controlled by the health authority, or by the trust? The independence of the forums will be crucially important, because they will play an important part in ensuring that health care meets patients' requirements. Forums must be independent and willing to question as they see fit.
I apologise to the Committee if I have missed something, but I do not understand where the money will come from for the forums. Will it come from primary care trusts or from central Government? Whoever controls the funding will have a relatively important say in how the forums function. I assume that the funding comes from central Government and will bypass primary care trusts, which I welcome as a way of ensuring the forums' independence.
There seems no collective voice for patients above the level of the forum. Currently, local lay representatives elect representatives who oversee the regional national bodies. Under the new proposals, the voices of people who act at strategic health authority level will be staff-led and have no element of lay decision-making. Will the Under-Secretary give her views on that?
I have two chief concerns. First, the make-up of forums is opaque. Secondly, public access to them is similarly opaque and the subject matter of regulations that we have yet to see.
The Local Government Association made a good point in its response to the consultation. It said:
''Membership . . . should reflect a representative sample of the local population to ensure that hard to reach groups are included''.
I agree with that, but we must also have people with the adequate skills so that the interests of users are adequately represented. How does the Minister propose that we tap in to the right skill mix so that those views are adequately represented and members are effective advocates? We can make the analogy with school governing bodies, to which it is difficult to recruit volunteers with the right skills mix to take responsibility for such things as health and safety and finance; matters for which many are not well equipped. I seek the assurance that the forums will be made up of people who are representative and have the right level of experience and skills mix.
Does my hon. Friend agree that the Under-Secretary might have proposed that those who are severely handicapped or who have the problems as set out in the briefing of the Royal National Institute for the Blind should serve on patients forums? It is a surprise that she has not proposed that. We have heard a great deal about having a wide variety of members, but someone with those problems might be a useful person on a forum when considering access to hospitals and how services could be provided for people who are visually impaired, or deaf and blind.
My hon. Friend makes a good point. It is easy for us to say that we need to ensure that the forums are representative, but putting that into practice is extremely difficult. Of course, we must try, and to that extent I welcome the Under-Secretary's comments. However, I would emphasise that people must be adequately skilled to do the job that we are asking of them. Public access is important. As some of us will know from attending the public meetings of community health councils, the meetings are valuable and well attended. We should ensure that the patients forums act in a similar way.
I am delighted that we are discussing important issues for patients and the public at large in terms of how the new system will work.
First, in relation to appointments to patients forums, the hon. Member for Wyre Forest referred to pages 5 and 11 of the response to the original document. I am pleased that he has the response document, because things have moved on apace in consultation. The hon. Member for Billericay may be reading from the original document rather than the response. I will deal with his points in a moment.
The criteria for appointments to patients forums will be set by the independent appointments commission, which will take on board the concerns expressed by the hon. Member for Westbury (Dr. Murrison) about people having the right skills and ability to do an important and complex job. When we consulted, people said clearly that they did not want a formal process that would exclude many people from a range of different communities. If an advertisement is not placed in The Times, or a traditional recruitment process is not employed, some may feel that they do not have the necessary skills to make an application. If the process were national, it might seem bureaucratic and remote from communities.
People said that they wanted the rigour of the independent appointments commission criteria, but thought that recruitment should be done at a local level by people in touch with local voluntary organisations—such as citizens advice bureaux—and with the whole network that makes up the fabric of many communities, many of whose activists are involved in a range of organisations.
The criteria will be set by the independent appointments commission but the recruitment will be carried out by the staff of local networks of the Commission for Public and Patient Involvement in Health. The independent statutory corporate body will do the recruiting and appointment at local level in local communities, which answers the point made by the hon. Member for Billericay about independence. That body will also be charged specifically with building local capacity in the community, in recognition of the fact that volunteers do not appear out of thin air.
We must bring volunteers through the system and gradually get them more involved, while giving them more skills to take on responsibilities. The local workers of the commission will be specifically charged with going out to the community and finding people who are interested in taking part. Those people may not be ready to take part from day one; they may need more support, education and training on specific issues, so their contribution is a real one. The local commission will be charged with doing that.
The way in which we propose to recruit patients forum members has the best of both worlds; the rigour of the independent appointments commission, and the local connection at a community level of the local networks of the Commission for Patient and Public Involvement in Health. In that way, many volunteers will apply.
Although there is sometimes difficulty in finding volunteers for a range of public organisations, the Wirral community health council, which is obviously keeping in close contact with our debates, sent me an encouraging e-mail yesterday. It stated that when it set up its private health forum a couple of months ago, it received 64 requests for information and 32 applications for 12 places. It shortlisted and interviewed 18 people, and said that the response was much more than had been the case via the traditional processes. It said that it might be able to export a few spare people to help other areas. I am delighted that people are coming forward and want to take part in the new structures.
I can confirm to the hon. Member for Wyre Forest that we will set up a transitional advisory board to help us manage the transition. As a result of the listening exercise, I am conscious that people did not want a big bang. They did not want CHCs abolished before the new structures were up and running, so we will have a board that comprises representatives of CHC staff, CHC members, Unison, the Society of Community Health Council Staff and others. We are delighted that ACHCEW is involved, as are other patients' groups, such as the Long Term Medical Conditions Alliance. Patients have a real input to make, as do representatives from local government, because they are involved in scrutiny. A wide-ranging board will help us independently to manage the transition.
One of the problems that the board is specifically charged with considering is how to work out a way in which members of the current structures can find their way into and populate the new system. The board will consider whether it is practical to extend their terms of office. By amending the CHC regulations, we would be able to ensure that people whose terms of office were due to expire could stay on and be managed through the process. As hon. Members have seen from the post-implementation plan, it is proposed that CHCs disappear in April 2003 as part of the managed transition into the new structures.
Public access to information and advice on the proceedings of patients forums is vital. Clause 18(4) states that the regulations will apply or correspond to the provisions of the Local Government Act 1972, which covers access to meetings and documents. That is to try to ensure that patients forums are at least as open as CHCs have been. I hope that that reassures hon. Members on the issue.
I do not have the 1972 Act in front of me, which is a terrible admission. Access to public meetings is fine, but my experience suggests that if they are not advertised and widely known about, there is no point in having access as no one knows that they are taking place. May I have clarification on that point?
The hon. Gentleman makes a good point, which is that the proceedings of all the bodies will need to be properly advertised. There is no intention that any of them operate in secret. I am not sure whether the provisions for local government on access to information provide for pre-advertisement, although I recollect that they do so, based on my time as a councillor. I remember having to put forward documents that would have been available for inspection before a meeting, which leads me to think that members of the public would need to be notified so that they could inspect them. I shall check, but I think that a statutory provision requires notice of meetings and of the documents to be considered. The provisions provide that the tiny proportion of private meetings need a good reason for not being open to the public. We want to ensure that that is followed as rigorously as possible.
It is of course essential that we advertise for members of patients forums, and not only in traditional ways. We could advertise in supermarkets, post offices and newsagents to try to bring the positions to the attention of a range of people who traditionally might not have been notified of them. We want to recruit our members actively.
The hon. Member for Billericay raised an issue about the voices represented and a lack of lay members above patient forum level. I directed him to the response to the listening document, which moves the debate on significantly. As regards clause 19 and the commission, there were concerns that the voices were not local and independent lay members. Everyone loved the functions, but was concerned about the structures. The response moves us on. It says that the local networks of the commission will have reference panels of local lay people to guide the work programme. There will be lay people involved at the level of patients forums. I do not like the word ''above'' because I do not see this as a hierarchy. . There will, however, be people at every level of the system. There will also be lay members on the national commission, which will be made up of people from patients' forums and local strategic partnerships to ensure that there is a lay voice at every level of the proceedings. That is important, and we must make sure that it happens.
Under clause 18(4), we can even modify the provisions of local government legislation. I think that that legislation provides for prior notice, but even if it does not, we certainly can. We would provide prior notice to enable the greatest number of people to know when and where meetings are and how they can get involved.
As I said, I hope that there will be more ways of consulting than just meetings. I recently talked to people in a rural area who told me that it was sometimes difficult to get to meetings. It was a farming community, and most of those to whom I talked were farmers. They really wanted to have a say in their health service. They said that they were all on e-mail and that we could use technology to have a consultation. That would mean that they did not have to travel 20 or 30 miles to take part in meetings. Using new technology to improve our consultations will be important.
I am not sure whether the hon. Member for North-East Hertfordshire was here when I spoke about funding this morning. I said that I did not want to isolate each individual part of the system and allocate a particular pocket of funding to it. We must see the whole system as coherent package of measures to strengthen patient and public involvement in the NHS. As I said, the system will be backed up by adequate resources. I recognise that good involvement requires the staff to service it. People must be helped to have a say, and I recognise that that will take resources. However, I do not want to pick off individual parts. We must fund the system as a whole, just as the system needs to operate as a whole. That is my intention.
I thank the Under-Secretary for her modest clarification of funding. I apologise if I missed the answer, but my question was about where the funding will come from. If patients forums are to be truly independent, funding should not come from the budgets of primary care trusts. We rely on patients forums to ensure that the service meets the public's requirements. If forums are funded by local primary care trusts, there could be a conflict of interest.
I dealt partially with that when we discussed earlier amendments on the requirement to ensure that the funding stream came through the commission and not the trusts, so that there would be an element of independence. I told the hon. Member for Oxford, West and Abingdon that I had identified the issue as important and that we would table an amendment to strengthen independence in that regard.
The hon. Member for North-East Hertfordshire raised two other issues, the first relating to the position of CHC staff. I said on Tuesday that I went to the staff conference a couple of weeks ago. We launched a human resources framework document that was directed specifically at CHC staff. We have already given a commitment that they will be treated like all the other health service staff who are going through structural and organisational change as the balance of power is shifted. They must go to clearing houses and look at vacancies to see where their new role will be in the system. We want to ensure that CHC staff, including the staff of ACHCEW, have the same opportunities to find their way through the new system.
I understand Mr. Tester's point that the commitment is to ensure that staff in the NHS as a whole have a job for at least 12 months from 2002, which is when the main functions in ''Shifting the Balance of Power within the NHS'' come in. CHC staff are looking for a similar guarantee beyond 2003, which is the timetable proposed in the implementation plan. I understand that that matter is still being discussed among officials and representatives of the staff's trade union. I understand their point. We will endeavour to give them as much protection as we can, but we do not want one group of staff in the health service to be treated differently from the other staff. We want to provide equity, but we are conscious of the need to ensure that people find, where they want it, a new role in the new system.
Finally, I shall deal with the point raised by the hon. Member for Westbury about ensuring that people bring a range of skills to patients forums, including people with disabilities. I commend to him the campaign currently being conducted by Scope, an excellent organisation. I learned about what it calls its ''missing persons'' campaign recently at a conference. The organisation is identifying people with a range of disabilities and the campaign's theme is, ''Have you seen this missing person—as a magistrate? Have you seen them as a school governor, or in your health service?'' It is a marvellous campaign and it brought home to me that we hardly ever see people with disabilities shaping our civil society. That is a key issue for us. Such material helps to put it on the agenda, and we intend to operate a lot of missing persons campaigns. It is time that missing people had a say in our health service.
I echo the Under-Secretary's remarks. Disabled people should be given more prominence in all spheres. Scope does a great job. However, I should like to take the Committee back to the money, if I may. It is obvious that more needs to be spent on the new bodies than was spent on the community health councils. The estimates are £35.6 million for the commission, £32.5 million for patients forums and about £12 million for the advocacy service.
The Under-Secretary says that she wants to look at the matter in the round. Does she agree, first, that more money needs to be spent than was originally spent on the community health councils? Does she also agree with Mr. Tester, who, as she said, thinks that the proposals are better than the original ones but who also says that although the proposed system has the potential to be dynamic, it will also depend on being adequately resourced?
If the Under-Secretary cannot even say that the same amount of money—£23 million—that was spent on community health councils will be available for patients forums, which is about £10 million less than the estimate of what is actually required, does that not suggest that the Government are thinking of not adequately resourcing the measures? Considering the figure of £32.5 million, which is a low estimate anyway—as I said, the Audit Commission has estimated £60 million—will the Minister at least say that the Government are committed to providing the £23 million, and might even do better?