Schedule 1 - Constitution of public benefit corporations

Health and Social Care (Community Health and Standards) Bill – in a Public Bill Committee at 11:00 am on 13th May 2003.

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Photo of Hazel Blears Hazel Blears Parliamentary Under-Secretary (Department of Health) 11:00 am, 13th May 2003

I beg to move amendment No. 151, in

schedule 1, page 93, line 9, at end insert

'and, if the corporation is an NHS foundation trust, its name must include the words ''NHS foundation trust'''.

I join all of the other Committee members in welcoming you, Mr. Griffiths, as Chairman of this Committee. I have not had the pleasure of serving on a Committee with you as Chairman, and I look forward to doing so over the coming weeks, if not months, by the time the Bill leaves Committee.

The amendment seeks to include the words ''NHS foundation trust'' in the description of the public benefit corporation. The purpose of the amendment is to make it crystal clear that NHS foundation trusts will remain fully part of the NHS. It is important that that is clear to users, staff, patients and the local community. When patients access services, it is important that they have the reassurance of knowing that they are receiving NHS care and that that care will be provided to national standards, will be free at the point of use, and will reflect the values of the NHS. For that reason, the amendment requires that all NHS foundation trusts include the words ''NHS foundation trust'' in their names.

The amendment will serve the additional purpose of raising people's awareness of their foundation trust. I hope that that will encourage them to begin to take an active part in its governance. That will serve the useful purpose of raising awareness of this new form of public benefit corporation right across the community.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health) 11:15 am, 13th May 2003

I am very grateful to the Minister for that explanation, which confirmed my views of the amendment. It is in many ways a technical or drafting amendment, but with far-reaching implications behind that technicality and drafting.

Whether it achieves its objective of further linking people to the ownership of their local health facility remains to be seen. It would have been odd if there had not been a requirement for the title to be an important part of the organisation. For that reason, the Opposition will not seek to oppose the proposal. I fully agree with the sentiment that the NHS should be free at the point of use.

Photo of Patsy Calton Patsy Calton Liberal Democrat, Cheadle

The Liberal Democrats support the proposal. There are practical, far-reaching implications to the naming of an NHS foundation trust, particularly if I revert to my point about the protection of assets. It is important that all the assets of an NHS foundation trust are clearly labelled as being part of the assets of an NHS foundation trust.

Amendment agreed to.

Photo of George Young George Young Chair, Standards and Privileges Committee

I beg to move amendment No. 97, in

schedule 1, page 93, line 9, at end insert

'and shall define ''public constituency''.'.

Photo of Mr Win Griffiths Mr Win Griffiths Labour, Bridgend

With this it will be convenient to discuss the following amendments:

No. 125, in

schedule 1, page 93, line 12, leave out from 'area' to end of line 13 and insert

'covered by a primary care trust or primary care trusts for which the corporation is the principal provider of hospital based services, or'.

No. 175, in

schedule 1, page 93, line 15, leave out 'may' and insert 'shall'.

No. 118, in

schedule 1, page 93, line 17, after 'including', insert

'their family members involved in their attendance and care as patients or other'.

No. 144, in

schedule 1, page 93, line 17, at end insert—

'(2A) A ''carer'', for the purposes of subparagraph (2), means an individual aged 16 or over who provides or intends to provide substantial care on a regular basis for the patient and does not provide the care in question.

(a) by virtue of a contract of employment or other contract with any person; or

(b) as a volunteer for a voluntary organisation as defined in the National Assistance Act 1948.'.

No. 119, in

schedule 1, page 93, line 18, leave out 'Subparagraph (1)(a) does' and insert

'Subparagraphs (1)(a) and (2) do'.

Photo of George Young George Young Chair, Standards and Privileges Committee

Amendment No. 97 is one of several amendments that address a key issue in schedule 1—the definition of a constituency. That is a concept with which the Committee is familiar, but one which is rather vague in the Bill. ''Public constituency'' is referred to in schedule 1, paragraph 3(2), but it is not defined. To get an idea of the Government's intentions, one must read ''A Guide to NHS Foundation Trusts'', which was published in December 2002. In the guide, the Government set out who should be eligible for membership of an NHS foundation trust. We are interested in schedule 1, paragraph 3(1), which covers members of a public benefit corporation.

In ''A Guide to NHS Foundation Trusts'', it is clear that the trust will define its own constituency within broad parameters. Paragraph 2.7 of the guide states:

''There will, however, be a requirement that the membership community must include people living in the area covered by the local authority in which any of the facilities run by the NHS Foundation Trust is located.''

For example, the people who use the facilities at Moorfields eye hospital live in a large number of local authority areas. Paragraph 2.7 goes on to say:

''An NHS Foundation Trust will be expected to extend the definition to cover neighbouring local authorities''.

I think that we understand that. At the end of paragraph 2.7, it states:

''The policy is about inclusion rather than exclusion so the aim is to be as flexible as possible.''

Paragraph 2.8 goes on to say:

''An NHS Trust will be expected to set out the boundaries of its proposed membership community in its application for NHS Foundation Trust status.''

It goes on to make suggestions about advertising eligibility for membership and about being proactive. The foundation trust will have a great deal on its mind. It will be navigating uncharted waters, as there is, apparently, no precedent for the type of organisation that we are debating. There should be clarity on how a prospective foundation trust sets about drawing up this key part of its constitution.

Paragraph 48 of the explanatory notes repeats the minimum eligibility criteria that a foundation trust must include in its public constituency, but it does not shed much more light than that.

Last Wednesday we had a fairly devastating critique of the Government's performance on this when the Health Committee published its report. In paragraph 37 of that report, the Health Committee described the arrangements that the Government have put into the Bill on this matter as ''fragmented, confusing and inequitable''. On pages 15 and 16 of the report, the Committee posed some questions on the definition of a constituency, to which it is reasonable to expect the Government's response in this debate.

The first point that the members of the Select Committee make is that, unlike any other democratic organisation in this country, the foundation trust will define its own constituency. We would all like to define our own constituencies, and if we did that, we would all be here for a long time—in fact, for as long as we wanted. It is unusual in the name of democracy to set up a new democratically elected body and then tell it that it can choose its electorate. There is something incestuous about leaving a democratic body so free to decide who shall have a mandate and who shall be part of it.

Paragraph 34 of the report states that

''the Guide is not clear whether people will be able to be members of more than one Foundation Trust''.

I assume that the answer to that is yes, but it would be helpful if the Minister would confirm that. Questions are posed in that paragraph as to whether membership should be restricted to certain groups of the population. It states:

''Will one-off users of A&E services be offered membership or will this be restricted to patients being treated for an ongoing problem?''

It would be helpful to have the Minister's views on that issue.

Photo of Andrew Murrison Andrew Murrison Conservative, Westbury

One particular group whose representation we may wish to consider is, of course, the military constituency. We now have medical district hospital units that accept patients from a long way away. We have debated the issue before. How will governing bodies view that constituency? We could see self-interest with guile creeping in to foundation hospital governing bodies. What does my right hon. Friend think about the possible representation of that important constituency under the Bill?

Photo of George Young George Young Chair, Standards and Privileges Committee

My hon. Friend's right hon. Friend is paid to ask questions rather than to think. The thinking has to come from the Government. My hon. Friend has a military medical service background and he poses very good questions about hospitals that provide a service for our armed forces. He raised the interesting point that if not many people sign up and pay their £1, it might be possible for trusts to be captured by particular organisations—some people have a firm view, for example, on abortion, euthanasia or other forms of treatment. The Health Committee discovered that members would be able to veto decisions taken by the governing body. There is a risk that, if not many people join, control could go to people with firm views who take the time and energy to join and to vote but who may not be wholly representative of their community. There is a later amendment to be tabled by my hon. Friend the Member for West Chelmsford that sets a minimum membership that can be appointed before a foundation trust can be established.

The Health Committee also asked about what happens with an organisation such as Moorfields eye hospital where there is a particular issue concerning representation from the primary care trusts—there might be 50 PCTs represented on the board. That will be the subject of a separate amendment. How does the Minister envisage members joining the foundation that looks after the Moorfields eye hospital? By definition, the constituency will be very dispersed and difficult to communicate with. Although the model may make sense in the context of a popular district general hospital with a well-defined area, it is more difficult to understand the concept when we consider more specialist hospitals that provide services.

It being twenty-five minutes past Eleven o'clock, The Chairman adjourned the Committee without Question put, pursuant to the Standing Order.

Adjourned till this day at half-past Two o'clock.