Clause 19 - The commission for patient and public involvement in health

NHS Reform & Health Care Professions Bill – in a Public Bill Committee at 4:15 pm on 6th December 2001.

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Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon 4:15 pm, 6th December 2001

I beg to move amendment No. 221, in page 24, line 8, at end insert—

''(3A) It is also the function of the Commission to monitor the performance by NHS bodies of their duty of public involvement and consultation as specified in section 11 of the Health and Social Care Act 2001 (public involvement and consultation).''.

Photo of Mr Alan Hurst Mr Alan Hurst Labour, Braintree

With this it will be convenient to discuss the following amendments: No. 222, in page 24, line 27, at end insert—

''(c) the Secretary of State''.

No. 223, in page 24, line 35, after ''Forum'', insert

''those persons specified in section 16(1)(d) and (e) and in section 16(2)''.

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon

I shall be brief because some of us harbour hopes of discussing later clauses.

The purpose of the 2001 Act was to place on NHS bodies a duty to ensure adequate public involvement. It seems appropriate that that duty should be monitored, as other things in the health service are. It is also reasonable to say that the commission, which is set up with that duty in mind, is best placed to carry out the monitoring of the requirement to involve and consult patients and public on

''(a) the planning of the provision of those services,

(b) the development and consideration of proposals for changes in the way those services are provided, and

(c) decisions to be made by that body affecting the operation of those services.''

As happened with CHCs, there is a danger that people in the health service will think that that covers the public involvement element and that the issue need no longer concern them. The Under-Secretary will probably state with as much passion as she has so far demonstrated that that is not the intention. The amendment would serve her purpose well and I hope that she considers it satisfactory.

Amendment No. 222 inserts the Secretary of State into the list of bodies to whom the Commission for Patient and Public Involvement might report concerns about the safety and welfare of patients, if they are not satisfied about the way in which matters are being dealt with. It is reasonable that a line of report to the Secretary of State should exist. I understand the need for the commission to maintain independence, but we must be concerned about the safety and welfare of patients.

Amendment No. 223 would broaden the groups of bodies, or persons, who should provide the commission with information so as to include primary care practitioners and participants in local pharmaceutical services, pilot schemes and so on. Those people are referred to in clause 16(1)(d) and (e), and subsection (2). The amendment would also include people who own or control premises where services are provided. If the commission seeks information under its NHS duties, it is reasonable that everyone who will provide NHS services should be covered by provisions under the Bill.

Those are reasonable amendments and we ask the Under-Secretary to accept the lead amendment or give a reassurance that NHS bodies will be adequately monitored.

Photo of Richard Taylor Richard Taylor Independent, Wyre Forest

I shall be even briefer. The Under-Secretary has already assured us that promotion of public involvement will take place. We want to substitute the word ''monitoring'' to ensure that that happens. She has partly reassured me on amendment No. 222, which would ensure that there was a mechanism for a statutory body to refer to the Secretary of State. She has referred to that, but I am not clear in my mind which body it will end up being, so I would like a further reassurance that there will be such a body.

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

Three amendments refer to the functions of the commission and reporting arrangements. I do not think that they are necessary because sufficient powers exist, but that is not to say that the amendments are not important. Amendment No. 221 would give performance-management responsibility for the duty on the NHS to consult and involve the public. The commission's responsibility is to work with the local community and trusts to help them to deliver their responsibilities under section 11 of the 2001 Act. To ask them to help to deliver and to performance-manage would put the commission in an invidious position. The way in which the NHS carries out its duties in accordance with the rest of its organisational provisions needs to be performance-managed. We envisage that strategic health authorities will be the performance management bodies, and that they will ascertain how well the NHS is fulfilling a variety of its duties. However, it would be wrong for the Commission for Patient and Public Involvement in Health

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

In a moment. Under clause 19(2)(a), the commission will advise the Secretary of State

''about arrangements for public involvement in, and consultation on, matters relating to the health service in England''.

The commission is therefore empowered to explain to the Secretary of State matters such as relevant issues and concerns, and good consultation and good practice, but it would be wrong for it to carry out hands-on performance management of a function of the national health service.

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon

I can reassure the Under-Secretary that at no point in amendment No. 221 does the word ''management'' appear—it is concerned simply with monitoring performance. It is important to recognise that one can monitor performance without having to call it performance management. That is management-speak gone crazy.

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

I believe that the powers in clause 19(2)(a) will be sufficient to cover advising the Secretary of State on how well the situation is working. I should correct what I said earlier: in fact, regional offices of health and social care will performance-manage strategic health authorities, which will performance-manage trusts and PCTs. However, the powers under clause 19(2)(a) will be sufficient to cover that.

Under amendment No. 222, the Secretary of State would be one of the persons or bodies to whom the commission might report a matter of concern relating to the welfare of patients, but under subsection (6) the commission already has the power to report to the Secretary of State. If it becomes aware of such a matter, it can report it

''to whichever person . . . it considers most appropriate''.

Under subsection (7), bodies to which the commission might report a matter ''include'' the regulatory body and the Commission for Health Improvement. Given the use of the word ''include'' the commission will, if necessary, be able to report a matter elsewhere, depending on what it is. The commission should have the discretion to decide what it wants to do with information that it obtains.

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon

Many times have I sought to create lists of things to put in Bills. The Under-Secretary has always said that we should not create lists because they might not be sufficiently inclusive. I am not arguing with her view, but why on earth, therefore, does subsection (7) exist, given that it could include anything? She seems to be defending her position with the very same argument that she employed to oppose the use of lists in legislation. I am happy for her to regard that point as rhetorical; none the less, I could not avoid making it.

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

I shall do as the hon. Gentleman suggests.

Amendment No. 223 would insert providers of local pharmaceutical services and primary care services into the list of bodies that must provide information to the commission. However, the commission does not need to obtain information from individual GPs and other providers of primary care, because its functions do not relate to such individuals. Instead, they concern the involvement of patients and the public in the NHS, and the mechanisms through which that is achieved, such as patient advocacy and liaison services, and patients forums. It is therefore not appropriate to extend the power in the way proposed in the amendment. As I have said, we need to get the balance right to ensure that the functions reflect the powers that the bodies must exercise.

In addition, we consider it wholly inappropriate for a body that rents its property to the NHS, but which is otherwise unconnected to it—for example, a leisure centre—to be compelled to provide information to the commission. We want to ensure that we get the balance right between getting as much information as we can, and avoiding unnecessary intrusion in inappropriate areas.

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon

May I give the Under-Secretary another example? Let us say that a large contract for delivery of NHS care is given to a BUPA hospital somewhere in Salford. [Interruption.] Lucky her, if she is saying that her constituency does not have one. However, I think that it might have one soon, given the way that things are going. Will there be a duty on such a provider of NHS services to co-operate with the commission over public involvement, or is the privatisation of the delivery of the services an excuse to skimp on co-operation with the commission and with public involvement in important issues of provision? Or will the Under-Secretary say that it is a function of the commissioner of those services to ensure that there is adequate public involvement and co-operation with the Commission for Patient and Public Involvement in Health?

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

A similar issue was raised this morning, and I said that we would ensure, through contracting provisions, that the views of patients and the public were properly taken into account.

I am delighted that the Committee seeks to make the commission an even stronger body than under the proposals. That is perhaps a recognition of the immense contribution that the commission will make at national, regional and local level towards ensuring that the system of patient and public involvement is more rigorous, independent, accountable, accessible and integrated than the previous one. I must resist the amendments. I do not think that they are necessary, or add to the powers and descriptions in the Bill. I ask the Committee to resist them.

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon 4:45 pm, 6th December 2001

I have listened carefully to the Under-Secretary. In response to her last remark, the fact that various amendments have been tabled suggests that hon. Members do not think that the Bill will achieve what she says it will. I will go away and reflect on her response. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

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

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

I have five points to make. First, ACHCEW asked why the commission staff could not be allowed to undertake the advocacy referred to in clause 19(2)(e). Mr. Tester of the Society of CHC Staff says:

''Unless staff can keep their NHS terms and conditions and remain NHS employees when working for ICAS they are unlikely to be willing to transfer.''

What is the Minister's reaction to that?

Secondly, the RNIB has asked what will be done to ensure close partnership between local societies for blind and partially sighted people, national bodies representing them and the commission. Thirdly, what outreach work will be done by the commission's local office staff, and how will the risk of isolation be averted?

As we are short of time, I will reduce my questions to four. If the local office of the commission is to bring together issues and concerns from across the strategic health authority area, it needs the power to place items on the agenda of an overview and scrutiny committee, if they are to be addressed. What powers to do that will the local office of the commission have?

Photo of John Baron John Baron Conservative, Billericay

I have one question for the Under-Secretary, regarding a point that I have already touched on. How will the different bodies relate to each other and to those working in primary and secondary care? I am intrigued by how the patients forums and the Commission for Patient and Public Involvement in Health will relate to each other to ensure that there are no traffic accidents, and to ensure the true independence of the patients forums. To avoid confusion—this is a thought from the British Medical Association—the Department of Health might perhaps publish a clear guide for the public on where they can access information and advice.

Health professionals must be provided with clear guidance and information on arrangements for providing advice and for gaining patients' views. Clarification of that would be welcomed by all parties concerned to ensure that traffic accidents are kept to a minimum and that everyone remains focused on the task in hand.

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

I shall deal with the many points as swiftly as I can. The Commission for Patient and Public Involvement in Health will commission independent complaint and patient advocacy services, set standards, and ensure that advocacy services are consistently good and of high quality and that local people have the same access to advocacy services wherever they live, which is important. It is therefore not appropriate for the commission's staff to provide those advocacy services, because of the danger of conflict of interest—the body commissioning services and setting standards and frameworks would then also be the body seeking to provide those services. It is more appropriate for the commission to focus on places where good advocacy services exist already and seek to commission those while, in places where there are gaps, seeking to establish new organisations that can fill those gaps for advocacy services in the community.

Clearly, on transfer of staff, the transfer provisions that apply to members of staff in any organisation who transfer to new organisations will apply under TUPE. In addition, I have already said to the trade unions that, wherever possible, we will seek to ensure that people are not placed in a less advantageous position than they were in previously. Such staffing issues are properly the subject of current negotiations between employers and employee representatives. However, we are certainly anxious to meet the legitimate concerns of staff about their future security and terms and conditions as far as we can.

To facilitate the input not just of the RNIB but of a range of organisations representing people with various disabilities, voluntary organisations and patients groups, we have set up the transition advisory board, as I said. We want to ensure that part of its work concerns who should be on the commission, how it should operate, and how to ensure that we have the widest range of views on the commission at national level, which will be translated to local organisations. That will ensure that we pick up all the concerns of all stakeholders in the health service and beyond—a process that includes reaching out into local government. Clearly, many of the issues dealt with by local government have a huge impact on people's health and well-being. The transition advisory board is a key to the success of all those systems, as its recommendations will underpin the proposals that are eventually implemented.

I shall now discuss outreach work for the local network of staff. I am conscious of the risk of isolation. I want to ensure that local staff from the commission work with colleagues who are already doing a range of community development work in many areas, whether staff from the councils for voluntary service or people working on urban regeneration or in local strategic partnerships—the whole fabric and network that makes up civil society. I want to ensure that those staff are keyed in so that they are not duplicating work, but finding where the gaps are, and where they can help to fill them and make the system stronger and more vibrant.

Clause 19(2)(g) provides a specific power for the commission to place items on the agenda of the overview and scrutiny committee. It is important that, once it has drawn together the patients forums and the independent complaints and advocacy service, it should see what trends are emerging at local level. It can then make the overview and scrutiny committee aware of those trends, as it has the legal powers to deal with them. At local level, the commission is the glue that brings the system together. I want to make it flexible enough to meet local circumstances, and not one-size-fits-all. I want to ensure that it regularly brings together all the different parts of the system, so that we may learn the lessons, and learn from the information, data and intelligence available. That will provide a much wider view of what is going on in the health service at a local PCT level, which can be fed in to enable not just the overview and scrutiny committee but the strategic health authority to be informed about what is going on.

As I told the hon. Member for Billericay, it makes sense to produce clear guidance on how the system will work and where people can access it. The PALS system will be on the spot in the trust, and NHS Direct will direct people, but it is also important to have the overview.

I want to correct the position with regard to staff, as negotiations are on-going. As I understand it, they will be applying for new posts within the system rather than transferring under the TUPE regulations, but I am keen that a proper route should be available to them. They should have every assistance to ensure that they have a place within the new system.

I believe that I have dealt with all the issues raised by hon. Members. The commission will be a tremendous way of strengthening the whole system of patient and public involvement. When we carried out the listening exercise, the main thing that people told me was that they wanted a body that was independent of the health service and of local government, that could be a challenging feature of the whole system and that could exercise real power and influence with the health service and with local authorities to try to ensure that services were developed in the best interests of patients.

The commission is not about speaking for itself, but about enabling local people to get their voices heard and facilitating their involvement in the system. That is not easy, but the commission will provide an excellent way forward.

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

The Committee divided: Ayes 8, Noes 3.

Division number 10 Adults Abused in Childhood — Clause 19 - The commission for patient and public involvement in health

Aye: 8 MPs

No: 3 MPs

Ayes: A-Z by last name

Nos: A-Z by last name

Question accordingly agreed to.

Clause 19 ordered to stand part of the Bill.