Local Health Councils

– in the Scottish Parliament at 5:00 pm on 4 October 2000.

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Photo of Lord David Steel Lord David Steel Presiding Officer, Scottish Parliament 5:00, 4 October 2000

The members' business debate today is on motion S1M-1140, in the name of Patricia Ferguson, on the 25 th anniversary of the establishment of local health councils.

Motion debated,

That the Parliament notes that the year 2000 marks the 25th anniversary of the establishment of Scotland's local health councils, congratulates the staff and lay members who have served the public through these councils during that time and recognises the important role that the councils have played in giving the patient an effective voice in the decision making processes of the NHS.

Photo of Patricia Ferguson Patricia Ferguson Labour 5:01, 4 October 2000

As members are aware, the motion congratulates members and staff of local health councils who have served the public over the past 25 years. Some of them are in the gallery for the debate. On this anniversary it is pertinent not only to look back at the history of local health councils but to record our hopes and aspirations for their future.

When I joined the NHS in 1976—it was that long ago—it was reeling from the major reorganisation that began in 1974. Little did we know that it would be the first of many reorganisations during the 1970s and 1980s. The main change brought about by the 1974 reorganisation was to shift some services from direct, democratic control by elected local authorities to health boards accountable to the secretary of state. That was rightly viewed by some as a reduction in democracy. To counter that, Bruce Millan, then a minister at the Scottish Office, said it would be

"important to have an organisation which is a good deal closer to the community than a health board can be".

Local health councils were established with the stated objective of representing in the NHS the interests of the public.

Since 1975, local health councils have carried out that function; they have provided the patient with a voice in the NHS and ensured that patients are listened to rather than talked at. They have helped to guide patients through the NHS maze to find where they want to be—through the layers of government, politicians, civil servants, health authority members, managers, professional groups, trade unions, universities, the media, local authorities and patient groups. They have helped patients with difficulties they have encountered.

In 1991, local health councils were restructured: their number was reduced but their remit was enhanced. That restructuring was largely successful, as a review of local health councils carried out by Jim Eckford in 1995 found. Mr Eckford also recognised that the NHS has changed radically since the 1991 reforms. He pointed to an increased need for and emphasis on public participation in strategy and service delivery.

The Government's 1997 white paper "Designed to Care" increased that emphasis, stating:

"every aspect of the planning and delivery of services should be designed from the perspective of patients."

I am aware that the Executive is considering its health plan and that what is being called the patients project is a great part of that. Susan Deacon has said that the patients project will change and improve the way in which the NHS communicates with and supports patients. I support that view.

It is also hoped that regulation of public consultation in the health service will be improved. That hope will be echoed by those who are involved with the Stobhill secure unit campaign—especially my colleague Paul Martin. There is a role in such consultation for the health councils. Dr Simpson, the reporter for the Health and Community Care Committee, has highlighted the role that is played by the Greater Glasgow health council in that regard. That is the kind of role that I would like local health councils to take on. They have been reformed at least once since their inception, which marks them out from community health councils in England and Wales, which have remained largely unchanged since 1974.

The proposals in the health plan for England and Wales have three fundamental flaws in regard to community health councils. They do not provide for independent bodies; they do not give a statutory obligation to those bodies; and they perpetuate a major flaw, as those health councils will still be funded through bodies that they will then monitor on behalf of the patient.

In looking to the future, I ask the minister to ensure that local health councils in Scotland continue; that they have a strengthened role, especially in consultation; and that they remain independent financially and in the choice of their members. I hope that the minister will find a uniquely Scottish solution to this Scottish question.

Photo of Shona Robison Shona Robison Scottish National Party 5:07, 4 October 2000

I commend Patricia Ferguson for securing this important debate to mark the 25 th anniversary of the establishment of Scotland's local health councils.

I pay tribute to the work of Tayside health council, which has been very vocal on a number of local health issues. It is a good example of why health councils are so important. It has been involved in discussions surrounding the concerns about the increase in parking charges at Ninewells hospital and has been on record raising the concerns of patients.

As I was going through the televisual system to find out what Tayside health council had said, I was overwhelmed by the amount of publicity it has had and the comments it has made. It has been involved in addressing concerns about the financial difficulties in Tayside and has had several meetings with the health board and the health trust to put forward vociferously the views of patients.

I had a slight concern about the delay in Tayside health council's funding. It does a lot of important work and often represents patients in the press. If it does not receive regular funding, or if its funding is delayed, the work that it can carry out is hampered. I hope that the Deputy Minister for Community Care can reassure us that there will be no delay next year in awarding funding to health councils.

It is obvious that delay jeopardises health councils' work and that they cannot plan when they do not know how much money they will have from one month to the next. Given the good work of health councils, any moves to diminish their role would be of great concern. As Patricia Ferguson said, we are looking for some reassurances on that front. The convener of the Scottish Association of Health Councils said that

"Health Councils recognise the need for modernisation but we don't want the baby thrown out with the bath water! Health Councils, like all organisations have strengths and weaknesses."

I seek reassurances on that this evening.

Like Patricia Ferguson, I am aware of worries about proposals for health councils in England—they concern funding, their statutory footing and their independence. I hope that we will have Scottish solutions to Scottish problems in relation to our health councils.

Photo of David Davidson David Davidson Conservative 5:11, 4 October 2000

I welcome the debate and congratulate Patricia Ferguson on bringing this issue, which is important in an evolving Scotland, to the chamber. I offer my wholehearted support and that of my colleagues to the work of local health councils.

I ought to declare an interest, as my wife was a member of a health council until we moved house in the summer and was a member of the Scottish Association of Health Councils. I therefore have first-hand knowledge of the work they do and of the opportunities that we face in this Parliament for securing their future.

I support what Shona Robison and Patricia Ferguson said about finance. It would be helpful if the minister could clarify the ideas of the Executive—not necessarily what will happen in practice.

Sometimes, I feel that health councils are an unsung hero. Many members of the public seem to be unaware of the important role they play as keepers of the public conscience on the work that is done for people who are sick. Something needs to be done on recruitment to ensure that capable people come forward who can take on this unpaid role and give this vital task the time it requires. I remind members that it is important that we have an apolitical approach to the membership of these bodies. We need a broad range of experience. It is important that one group or another does not have undue influence over community health councils—or local health councils in Scotland. There must be a broad range of opinion.

One issue that needs to be discussed is that the health councils do not have the right to turn up and view a facility. I agree that people should not be allowed to walk into an accident and emergency department or a surgery, but there must be a debate about how health councils can gain access, without notice, to see many of the activities in the health service.

Another issue that we need to sort out is health councils' relationship with health boards. Some health boards are good, but many have a statutory meeting only once or twice a year when only a few members turn up.

We need to have a debate on the opportunities for involving health councils in the local design of health care. They have proved their worth and it is incumbent on this Parliament to ensure that they get an opportunity to develop further. I wish them every success for the future and I hope that the chamber agrees with me.

Photo of Nora Radcliffe Nora Radcliffe Liberal Democrat 5:13, 4 October 2000

I echo what others have said before me and thank Patricia Ferguson for introducing this debate. It is good that we have an opportunity to commend the excellent work that is done by local health councils and the people who volunteer to serve on them and who make them work. They do a notional three days a week, but they spend an enormous number of hours doing background reading and going on monitoring visits.

I would like to say a few nice things about my local health council in Grampian. It works extremely well with the local health board and the health trusts. Some of the good work it does, with its increasing emphasis on involving people in consultation, has been exemplary. Currently, there is a debate about maternity provision in the north-east. We have two centres—at Insch and Huntly—neither of which is viable on its own, and the health council has been facilitating meetings with people in both communities to try to draw together a sensible solution. It would have been difficult for the statutory organisations—the health board or the heath trust—to undertake that sort of initiative. The health council's work on the consultation was excellent.

In Grampian, we are fortunate to have a healthy supply of good calibre applicants, with a balanced representation of geographical areas and genders. Before the health council was reorganised, it was based on the old district council area but, with roughly the same number of members, it now has an area about four times its original size, which covers the whole Grampian Health Board area. The element of very local representation has been weakened. That could be addressed and improved upon.

We should provide health councils with better funding to allow them to provide better services. Anyone who phones a health council may get through to an answering machine that says, "Please write a letter as there is nobody here to take your call." That is regrettable, as direct, personal contact makes the work of health councils much better and encourages people to use them.

We are lucky to have health councils and I hope that we keep them and improve them.

Photo of Malcolm Chisholm Malcolm Chisholm Labour 5:16, 4 October 2000

We should all be grateful to Patricia Ferguson for raising this important subject.

This debate is an opportunity to look back and to pay tribute to everything health councils have done to help create a health service that is responsive to the needs and wishes of patients, to facilitate public involvement and to scrutinise, monitor and hold to account.

The debate is also an opportunity to look forward and to consider the future agenda for public and patient involvement. I think I am right to say that everyone agrees that health councils must be modernised. We must concentrate on their functions rather than on their form but, as Shona Robison said, we do not need to throw the baby out with the bath water, which has been done in England, unfortunately.

We agree that the functions that I have outlined cannot be concentrated in health councils alone. There is an exciting new agenda based on the patients project. We want to do things in a different and more radical way. It is essential that there is a statutory and independent element in the new regime that we are about to create. That is particularly important for the patient's voice, whether in complaints, advocacy or, more generally, for evidence-based work in giving, and finding out, the patient's view.

There is a danger that the rhetoric of patient involvement will not be matched by the reality. I believe that health councils have a continuing and vital role to play in ensuring that our hopes and expectations are fulfilled.

Photo of Robin Harper Robin Harper Green 5:18, 4 October 2000

I speak from the experience of being a member of Lothian health council in the early 1990s. I was thoroughly impressed by the dedication of my colleagues on that council in performing a variety of jobs: monitoring performance through observer groups in hospitals; conducting surveys of user views; assisting and commenting on future plans; advising patients on their rights; solving conflicts; assisting complaints procedures; and attending meetings of the health and hospital boards.

Those jobs involve a huge volume of work. During the recess, I cleared out some cupboards and took away three sackfuls of documents left over from my time on the health council. I remember the then chair of that health council, who had been retired for a couple of years, remarking to me, "Robin, this is not a retirement task; this is a full-time job." It certainly was for him.

There may be a case for reviewing the system and providing more support to the chairs of health councils. They get good support from their permanent staff, but the situation merits further review.

I underline how pleased I am to have heard all other members who have spoken in this short debate refer to the necessity of incorporating statutory rights into the new ideas that may come through the Executive. Health councils need legislative support to ensure that they are able to continue to provide the excellent work that they have provided in the past 25 years.

Photo of Euan Robson Euan Robson Liberal Democrat 5:20, 4 October 2000

I add my congratulations to those that have already been given to Patricia Ferguson in securing this debate, which is very welcome. I also welcome Mr John Taylor, the chairman of Borders

local health council, who I believe is attending this debate. Borders local health council's annual report reflects on the diverse nature of its work, which it undertakes from modest means.

My colleague Ian Jenkins and I have visited the health council, and we are aware of the extent of what it does—we are grateful for all that it achieves. Its annual report shows that the council continues to prioritise engagement with as wide a section of the public as possible. Recently, that was graphically demonstrated by its initiative to carry out a series of discussion groups throughout the Borders, to hear directly from individuals about what they think of local health services—the good as well as the not-so-good points.

Health councils' role in hearing from and supporting individuals in the health service is extremely important. They often lend support to people when they are at their most vulnerable. They have contributed to ensuring that health services are patient centred.

I served on a consumer body for many years. Local health councils are, in a sense, consumer bodies. It is of fundamental importance that local health councils retain their independence. That must be guaranteed. If their position is defined on a statutory basis, well and good, but that does not necessarily have to mean that they lose their independence.

I add my congratulations to health councils on their 25th anniversary and wish them well for the future.

Photo of George Reid George Reid Scottish National Party

I thank members for keeping their speeches tight, so ensuring that all members who wished to speak were called.

Photo of Iain Gray Iain Gray Labour 5:22, 4 October 2000

I am grateful for the opportunity to record both Susan Deacon's and my thanks and appreciation for the support that the health council movement has given to patients and the national health service over the past 25 years. That was formally recognised recently, when Susan Deacon hosted a reception in Bute House for past and present council members and their staff, but it is also fitting that this motion offers us the opportunity to mark in the chamber the significant contribution of the individuals who make up the health council movement.

Health councils were created more than 25 years ago to ensure that the views and wishes of the public and of patients were heard by the NHS in Scotland. While their work in the wards and committee rooms of the NHS has often been central to the development of the health service, it has often—as Mr Davidson was right to point out—gone largely unnoticed by the public and patients who benefit from it.

If anyone here doubts the influence of these lay volunteers, they need only consider the impetus that the health council movement has given to the concept of patient-centred care. Local health councils and their national association have long advocated such a commonsense concept, and the success of their campaign has resulted in a significantly increased demand for their services. They have not complained at that, however; they have simply got on with the job.

I will return shortly to the issue of work load, but I will first pause to underline the commitment and dedication—and, as Mr Harper pointed out, the cupboard space—of the 250 or so individuals who do an immense amount of work at any one time. The benefits and improvements that have flowed from health councils' partnership with the NHS and the people it serves can never be fully measured and, on behalf of the Executive, I am happy to salute the efforts of this small band of volunteers who, in the best traditions of public service, give so freely of their time and talents for the benefit of us all.

However, as Malcolm Chisholm was correct to say, anniversaries are not simply a time for congratulations; they also offer a chance for reflection on achievement, on successes and on failures and, most important, lessons for the future.

Twenty-five years of health council effort has taught us the value of listening and learning from patient experience. It has taught us the value of partnership—councils have forged strong links between people and communities and the NHS bodies that serve them. It has also taught us the value of progress, through renewal and modernisation. The health council movement has, like the NHS, which it serves, changed beyond recognition in its lifetime.

The Executive shares with the health council movement a commitment to listening to and learning from direct patient experience. The programme for government pledges to

"strengthen the patient's voice and . . . work to ensure that patients, and their carers and families, get the response and support they need through every stage of their care."

Our partners in the health council movement strongly support that commitment, which encapsulates a change in culture for which they have long argued.

A change in culture is required whereby the NHS learns to listen to and act on the direct experience of patients and carers. The message is clear. Patients and carers want a seamless approach to the delivery of care and to receive the care that they need quickly and with confidence. Only a culture of partnership can provide that.

Partnership working is at the heart of our plans to modernise the NHS in Scotland. It is a different way of developing and implementing health and social care, which will enable us to harness the ideas, enthusiasm and commitment of the staff who deliver the services and the patients and public who use them.

As several members said, involving users in the redesign and reconfiguration of services offers the best prospects of soundly based decisions that achieve sustainable improvements. A partnership with patients is at the heart of the health council movement. Patients are a part of developing the vision of the patients project, to which Patricia Ferguson referred. It is a project that will ensure that boards and trusts become and remain more patient centred and publicly accountable. It will involve more members of the public in the health service, in different ways, so that they will become more skilful and knowledgeable, as will the service professionals with whom they are involved.

When Susan Deacon met the Scottish Association of Health Councils last year, it supported that vision but felt that the challenge and work load associated with such a step change in the culture of the NHS presented the movement with some key questions about its future direction and development. In spite of the fact that, as Patricia Ferguson pointed out, health councils have gone through two major reorganisations since 1975, they agreed to do so again and to examine the need for and role of the health council movement against the background of the wider public involvement agenda. Funding has been provided for a development officer to support health councils further in that work.

With the decision to develop a Scottish health plan, we are keen to build on the unique public involvement experience of health councils and their staff. We have therefore commissioned the Scottish Association of Health Councils and the chief officers group to submit papers addressing the strengths and weaknesses identified in current patient and public involvement arrangements.

The chair of Greater Glasgow health council has agreed to be a member of a group to consider what the plan might say on policy development and public involvement. Two health council chief officers have been seconded from their posts to provide full-time support to the development of the plan. The involvement of the movement in developments is central. The abolition of community health councils that is outlined in the English NHS plan is of no direct relevance to the process in Scotland; indeed, our solution will be a Scottish one.

We remain committed to ensuring that the public and patients are fully involved in the design and delivery of our health services. We can achieve that only by drawing on the experience of the health council movement, which we are celebrating tonight. I know that members will join me in congratulating health councils on 25 years of hard work supporting the development of a truly patient-centred NHS.

Meeting closed at 17:29.