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After section 5

National Health Service Reform (Scotland) Bill: Stage 3 – in the Scottish Parliament at 10:45 am on 6th May 2004.

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Photo of David Davidson David Davidson Conservative

The Health Committee took a lot of evidence about the proposed new Scottish health council and discussed the matter fully. I find it strange that although the Executive has spun the fact that the council is to be established and will be an important body, the bill does not refer to it. That is staggering given that the minister has regularly stated in public that the health council represents a vital part of the modernisation of one aspect of health care in Scotland.

Amendment 13 would include the Scottish health council in the bill and would reinforce the fact that the council should be an independent body and not merely a department of NHS Quality Improvement Scotland or a body that is subject to joint management. The Scottish health council should stand alone.

Local health councils are keen to be linked into a proper national body—neither they nor I object to that proposal—but they want that body to be truly independent. In the past, they worked closely with but were funded by the health boards. However, the Scottish health council should be a truly independent body that considers NHS performance from the point of view of patients and staff and visits the different health establishments in which local health councils have been active and welcome in the past. Currently, one or two local councils do not have the resources or the manning to enable them to be efficient. Amendment 13 would clarify the position. I think that the minister is sympathetic to that aspect of the matter and I ask him to accept that the Scottish health council should be covered in the bill. It is vital that we give the public confidence that independent bodies are there for them and that they can turn to such bodies to investigate any failure in the system. NHS QIS measures quality standards in health service performance on a technical basis; it does not consider that aspect.

Photo of Dennis Canavan Dennis Canavan Independent

I have some sympathy for the member's position, but amendment 13 states:

"The general duties of the Scottish Health Council shall be to ... co-ordinate the work of the local health councils on a national basis".

However, local health councils will be dissolved under section 6. I do not see the point of co-ordinating the work of bodies that will be dissolved.

Photo of David Davidson David Davidson Conservative

The minister seeks to set up local advisory councils. The local health councils want those to come together in a national body that would support and help them. If the bill is passed, local advisory councils will replace local health councils, as the discussions in the Health Committee acknowledged.

I am sympathetic to Shona Robison's amendment 14 and I will listen carefully to what she says. If amendment 13 is not agreed to, we might support amendment 14.

I move amendment 13.

Photo of Murray Tosh Murray Tosh Conservative

I beg your pardon. I made an error; I should have first called Shona Robison to speak to the amendments in her name.

Photo of Shona Robison Shona Robison Scottish National Party

I seek the retention of local health councils, but that does not mean that I do not recognise the importance of the new national body, the Scottish health council. The two are not mutually exclusive—they have distinct roles. I will say a bit about the independence of the Scottish health council in a minute.

Throughout the passage of the bill, I have expressed concern about the dissolution of local health councils and the loss of their important role, particularly their advocacy work. The councils help some of our most vulnerable people to complain or to find their way round the health service. People have given years of service to their local health council, but the local expertise that has been built up is, unfortunately, in danger of being lost. I have spoken to a number of people who have been involved in local health councils, and they are disappointed and feel that they have been cast aside because their services are no longer required. Although the intention is to try to involve some of those people in the new local advisory councils, those councils will not have the same role, and so a number of people will choose not to be involved.

As I have said throughout the process, I cannot understand why the establishment of the Scottish health council should lead directly to the dissolution of local health councils. It is unfortunate that the Executive has linked those two measures. The Scottish health council and local health councils would have distinct roles. I urge members not to throw the baby out with the bath water and to retain the role of local health councils.

I share David Davidson's concerns about the independence of the new Scottish health council. It would be unfortunate if the message that the public received was that the council was not fully independent or able fully to protect their interests. It is difficult to argue that the council will be independent when it is to be located within NHS Quality Improvement Scotland, which is an NHS body. There are arguments for establishing a different structure to guarantee the new council's independence. I am happy to support David Davidson's amendment 13 to achieve that end.

Photo of Murray Tosh Murray Tosh Conservative

Since I started Christine Grahame, I will allow her to finish.

Photo of Christine Grahame Christine Grahame Scottish National Party

My colleague has addressed David Davidson's amendment 13. It is important that the new Scottish health council is put on a statutory basis for the reasons that David Davidson expressed. In evidence to the Health Committee, a recurring theme was the strongly expressed concerns about the independence of such an organisation. The Executive appears to be going for a symbiotic relationship with NHS QIS, but the evidence to the committee shows that there is a strongly perceived conflict of interest, if not an actual one, in relation to the proposal.

Dennis Canavan is right. Mr Davidson's amendment 13 states:

"The general duties of the Scottish Health Council shall be to ... co-ordinate the work of the local health councils on a national basis."

Mr Davidson is trapped by his amendment: he has no option but to support Ms Robison's amendment 14.

Photo of Carolyn Leckie Carolyn Leckie SSP

I concur with that point and I hope that Mr Davidson will support amendment 14.

I want to place the debate in context. I hoped that the Executive would listen to the views of organisations such as the Transport and General Workers Union, Unison and the Royal College of Nursing on the proposed abolition of local health councils, which is a serious assault on the independence of the system. A non-statutory body that is located within NHS QIS will be nowhere near a replacement for the rigorous work of local health councils, whose work could be improved further, because there is always room for improvement.

I support David Davidson's amendment 13, which would create a national body to oversee the work of the local health councils—I presume that he supports amendment 14. Amendment 13 would not introduce enough democracy, but it is better than nothing. To give a wee bit of political history, in England, proposals that were similar to the Executive's were at first removed because of opposition by the Tories, Labour back benchers and the Liberal Democrats, but Tony Blair, in his no-reverse-gear mode, insisted on reintroducing them. I hoped that that attitude would not be reflected in the Executive's bill, but unfortunately it is. However, it is never too late—we should stick up for health councils today.

I seek clarification on the policy and intentions of the Lib Dems. When Nora Radcliffe was the health spokesperson for the Lib Dems, she had a members' business debate on 4 October 2000 to celebrate the success of local health councils. I understand that it is published Liberal Democrat policy to support health councils and to oppose their abolition. Perhaps the Lib Dems will let us know what they are doing. We have an opportunity to reach a consensus through which we could retain health councils and introduce an independent national health council.

Photo of Mike Rumbles Mike Rumbles Liberal Democrat

I am delighted to respond to Carolyn Leckie. I cannot help thinking that if the Executive had proposed another quango, Carolyn Leckie, Shona Robison and David Davidson would have argued how terrible that was. As the Health Committee realised, a number of different options could have been chosen.

What has been missing from the debate so far is a focus on the bill, rather than the amendments. The problem is solved in section 5, which for the first time will introduce in legislation a duty to encourage public involvement. Section 5 states:

"It is the duty of every body to which this section applies" to consult the public, not only on "planning and development" but, importantly, on "decisions to be made". As the Health Committee knows, people throughout Scotland are dissatisfied with the public involvement and consultation processes of the 15 health boards in Scotland. I am pleased that the Executive is taking action through the bill to ensure that we have real consultations, not consultations after decisions have been made. The bill turns round the situation by talking about "decisions to be made".

Photo of Shona Robison Shona Robison Scottish National Party

We all agree about the importance of public involvement, but we are talking about the abolition of local health councils and the independence of the new Scottish health council. As Carolyn Leckie said, the previous incumbent of Mike Rumbles's post as health spokesperson had strong views on the retention of local health councils. What is his view on their abolition?

Photo of Mike Rumbles Mike Rumbles Liberal Democrat

Thank you very much for that. I am trying to put across the point that the National Health Service Reform (Scotland) Bill will radically change public involvement in the health service in Scotland. I hope that SNP members will support the bill at decision time. They would be mad not to accept that the Labour Party and the Liberal Democrats are radically changing the situation, which has moved on in the past four years.

The key issue is the duty to involve the public. As the Liberal Democrat spokesperson on health and community care, I am satisfied that we have the right approach and that the bill will introduce significant changes in public involvement. Therefore I am relatively relaxed about not creating another so-called independent, non-accountable body, which is what David Davidson would like. It is not at all necessary. The whole raison d'être has changed, so placing the Scottish health council within NHS QIS is perfectly acceptable.

Photo of Dr Jean Turner Dr Jean Turner Independent 11:00 am, 6th May 2004

The beauty of debate is that one is able to change one's mind. Bills go through fairly quickly; as a new member of Parliament, I have found that the process can be difficult, because there is so much to take on board and one changes one's mind many times. I have always felt that it would be a great pity to dissolve the local health councils. Many changes happen in the health service and the most disadvantaged are always penalised. It would have been a great idea to leave the Scottish health council in the bill. In committee, I was persuaded in the end by the minister's assurance that the intention was that the Scottish health council would be independent, under the NHS QIS banner. On reflection, and on reading what has been said in the past, I think that such an important body should have been included in the bill. I go along with everything that has been said.

Mr Davidson said something that made me stop and think. If the Scottish health council comes under NHS QIS but is not included in the bill, it will be subject to regulations. If everybody's intentions are honourable at present, everything will go well. However, if people change, regulations could change, and the whole idea, as it is set up at the moment, might change. Since I am independent, I will vote for amendments 13 and 14. I would have loved it if the Scottish health council had been included in the bill. Throughout the evidence, people's fear that the Scottish health council would not be independent was a constant theme. In the light of the public's mistrust of health boards and the Government, it was a mistake not to put the Scottish health council in the bill.

Photo of Malcolm Chisholm Malcolm Chisholm Labour

I will explain why amendment 13 and amendments 14 to 20 should be rejected, just as they were rejected by the Health Committee. Amendment 13 seeks to establish the Scottish health council as a separate, independent body—or, should I say, a supposedly independent body; as Dennis Canavan rightly pointed out, the amendment would ensure that a Scottish health council would be composed of local health council representatives. The key point is that local health councils are appointed by local health boards. David Davidson, Shona Robison and Carolyn Leckie should all remember that point when they applaud the independence of local health councils.

The Executive has proposed that the Scottish health council should be established as a body with its own distinct role and status within NHS Quality Improvement Scotland. That is because the Executive regards patient focus and public involvement as an essential part of securing quality in the NHS. As I say repeatedly, the experience of every patient is the starting point for improving quality in health. In the Executive's view, improving quality should be about developing services that are more focused on patient experience and meeting what patients want through service redesign, managed clinical networks and other initiatives. The review and monitoring functions of NHS QIS will be strengthened by that body being able to draw directly on the expertise and patient networks of the Scottish health council. NHS QIS is at the heart of improving quality in the NHS. It operates separately from ministers and other boards. I am sure that anyone who knows the chair, Naren Patel, will understand what I mean when I say that.

I have written to the Health Committee setting out the Executive's proposals for ensuring the independence of the Scottish health council within NHS QIS, and I reiterate those proposals now. The council will be created through regulations as a committee of the board of NHS QIS. The chair will be appointed through the public appointments process. Members will be appointed through an open process by NHS QIS, and up to three members will be appointed from the local advisory councils to ensure strong local links.

Establishment of the Scottish health council through regulations will mean that there is parliamentary involvement in the process. The Scottish health council cannot be created by primary legislation, because NHS QIS was not created by primary legislation. Establishment through regulations will also mean that there will be a clear, legislative basis for the Scottish health council's work. It will ensure that the council's continuing existence is not just a matter for ministers and the Health Department, and that the council cannot be changed or abolished without parliamentary approval. The council's local advisory structure will mean that it is not a remote or centralising body. By creating a Scottish health council, we will be able to bring more professionalism and expertise to patient focus and public involvement in Scotland. At the same time, the existence of the local advisory councils will mean that there is local input from patients and the public, thus ensuring that the health boards communicate with and listen to patients and local people.

On community health partnerships, there will be the new public partnership forums, which will be important in ensuring that there is strong communication and engagement with the public and, crucially, feedback on key issues and policies.

Photo of Christine Grahame Christine Grahame Scottish National Party

The minister said that the Scottish health council could not be included in primary legislation because NHS QIS is not included in primary legislation. I do not understand the rationale for that, because amendment 13 makes no reference to NHS QIS. With respect, the argument is not logical.

Photo of Malcolm Chisholm Malcolm Chisholm Labour

Christine Grahame may not agree with the argument, but the Scottish health council will be set up as a part of NHS QIS and it is not possible to have a part of a body in primary legislation when the body itself is not in primary legislation.

Shona Robison's amendments 14 to 20, which are almost identical to those that the Health Committee rejected at stage 2, seek to preserve the status quo. A lot of good work has come out of local health councils—I pay tribute to all the people who have been involved in that—but everybody accepts that that work has been uneven. It is time to build on that good work and to move on. Preserving the status quo would be inadequate for the better public involvement that we want. Mike Rumbles got straight to the heart of the debate when he said that the new structure is all about ensuring better public involvement and better patient focus.

The bill's provisions for a new duty of public involvement and for dissolving local health councils are designed to support and underpin patient focus and public involvement. The Executive wishes to put greater responsibility on NHS boards to communicate with and involve patients and the public, and to encourage patients and community and voluntary organisations to represent their views directly to boards, rather than to have local health councils substituting, as it were, for the public and for those groups. I want to involve the public directly in the planning and design of health services, and not to have their views filtered through an outside body. The Scottish health council will monitor and quality assure that process, and that will do more to help to achieve a more responsive and patient-focused NHS than would be the case if we kept the current system.

I know of the dissatisfaction among members about the way in which public involvement has been facilitated in the past. The Scottish health council's new role will be crucial to guaranteeing better public involvement. For example, all the service change proposals that come to me for approval at present, partly on the grounds that there has been good public involvement, will all be considered by the Scottish health council. The council will report on that, and it will give annual reports on the extent to which boards are improving their work on public involvement. That is crucial to an objective that all members share.

From listening to Shona Robison today, and at stage 2, I know that she wants to maintain local health councils' discrete role in relation to advocacy. The Executive sees local advisory councils as having an important role in ensuring that health boards hear, understand and act upon the views, concerns and experiences of patients, carers, patients organisations and communities. That is a wider role than advocacy in the traditional sense, which is about supporting individuals and helping them to speak for themselves in their relationship with health services. When a local advisory council feels that the patient's viewpoint is not being adequately considered, or when there is not an appropriate patient support group, the local advisory councils will be able to put forward the views of patients and ensure that appropriate action is taken. I made that point at stage 2, and I have written directly to Greater Glasgow Health Council on the matter.

We want to encourage health boards to engage much more directly with patients and with local opinion; at the same time, we will ensure that strong feedback arrangements are in place where the patient's voice, for whatever reason, is not being properly expressed or heard.

We are not disregarding existing interests and expertise. Those people who are currently on local health councils will have an opportunity to be represented on the local advisory councils. They will be the local presence of the Scottish health council; in many cases, those who are currently on local health councils will be the ideal people to fulfil that role and I hope that many of them will choose to do so. They have played a valuable role so far, and they can do more in their new roles in the future. That would have far more value than staying where we are. Accordingly, I encourage members to follow the example of the Health Committee and reject the amendments in this group.

Photo of David Davidson David Davidson Conservative

In fact, it was the whipped ranks of the partnership parties in the Health Committee who voted down my amendment at stage 2, not the committee at large—although we have to accept the numbers game.

Photo of David Davidson David Davidson Conservative

No, not at this time. I will come to Mr Rumbles eventually.

This has been an interesting debate, but I do not think that the minister has grasped the significance of my amendment 13. I do not think that he understands the public's worry about the matter or the perception about having a health council that is not regulated, other than through ministers' directions. That is an example of the minister's desire to control all aspects of health in Scotland from his desk. The public are getting very concerned about that centralising approach.

I appreciate the support that I have had on this matter from the other side of the chamber, particularly the points that were made by Shona Robison and Carolyn Leckie. It is important to have a statutory body that can be clearly identified by all members of Scottish society and which acts not just at the behest of the minister, but in a clear, independent manner.

I thought that I heard Mr Rumbles talking about public involvement, and I think that the minister got round to speaking about that, too. What is wrong with public involvement? This is about how we deliver our public services, for goodness' sake. If the public do not have a right to say something, what rights do they have left? If NHS QIS is not enshrined in primary legislation, that is a fact of life. That is why we need to include the Scottish health council in primary legislation, as a distinctly separate, independent body, which is perceived to be independent and to act in the best interests of the patients. That is what the health service is there to do.

Once again, we have seen a Liberal Democrat squirm out of policy commitments from the past, just because there has been a new agreement. I find that very strange, and I think that the Liberal Democrats should be more honest about that.

Photo of David Davidson David Davidson Conservative

I am just trying to warm him up, Presiding Officer.

I refer to some of Jean Turner's comments. As a former practising medic in the community, she understands very well the public perception of the situation. Her route to Parliament demonstrated the public's desire for input.

In the interests of democracy, I will allow Mr Rumbles to intervene.

Photo of Mike Rumbles Mike Rumbles Liberal Democrat

I would have preferred it if the intervention had come from Nora Radcliffe, because she could have put Mr Davidson right on some facts. My point is that our policy has not veered one iota in four years. Is it not rather odd to suggest that committee members from an Executive party should be willing to vote against a policy that they are advocating?

Photo of David Davidson David Davidson Conservative

That says it all, really.

I beg the minister to reconsider the Executive's position on this matter. The proposal in amendment 13 would be an important step forward. If the minister believes in democratic input, as I think that he does, deep down, he should get away from wanting to do everything by regulation. He should have some courage and include the new body, the Scottish health council, in the bill, so that it can actively work for patient care throughout Scotland and build on the good work that has been done. Everybody who is involved seeks a properly resourced national body that is independent enough to work where it wishes in the NHS.

Photo of Murray Tosh Murray Tosh Conservative 11:15 am, 6th May 2004

The question is, that amendment 13 be agreed to. Are we agreed?



Division number 4

For: Aitken, Bill, Baird, Shiona, Ballance, Chris, Ballard, Mark, Brocklebank, Mr Ted, Byrne, Ms Rosemary, Crawford, Bruce, Curran, Frances, Davidson, Mr David, Douglas-Hamilton, Lord James, Ewing, Mrs Margaret, Fabiani, Linda, Fergusson, Alex, Fox, Colin, Fraser, Murdo, Gallie, Phil, Gibson, Rob, Grahame, Christine, Harper, Robin, Harvie, Patrick, Hyslop, Fiona, Ingram, Mr Adam, Johnstone, Alex, Kane, Rosie, Leckie, Carolyn, Lochhead, Richard, MacAskill, Mr Kenny, Martin, Campbell, Mather, Jim, Maxwell, Mr Stewart, McFee, Mr Bruce, McGrigor, Mr Jamie, Milne, Mrs Nanette, Mitchell, Margaret, Monteith, Mr Brian, Neil, Alex, Robison, Shona, Ruskell, Mr Mark, Scanlon, Mary, Scott, Eleanor, Scott, John, Sheridan, Tommy, Stevenson, Stewart, Sturgeon, Nicola, Swinburne, John, Turner, Dr Jean, Welsh, Mr Andrew, White, Ms Sandra
Against: Alexander, Ms Wendy, Baillie, Jackie, Barrie, Scott, Boyack, Sarah, Brankin, Rhona, Brown, Robert, Butler, Bill, Canavan, Dennis, Chisholm, Malcolm, Craigie, Cathie, Curran, Ms Margaret, Deacon, Susan, Eadie, Helen, Ferguson, Patricia, Finnie, Ross, Gillon, Karen, Glen, Marlyn, Henry, Hugh, Home Robertson, Mr John, Hughes, Janis, Jackson, Dr Sylvia, Jackson, Gordon, Jamieson, Cathy, Jamieson, Margaret, Kerr, Mr Andy, Lamont, Johann, Lyon, George, Macdonald, Lewis, Macintosh, Mr Kenneth, Maclean, Kate, Macmillan, Maureen, Martin, Paul, May, Christine, McAveety, Mr Frank, McCabe, Mr Tom, McMahon, Michael, McNeil, Mr Duncan, McNeill, Pauline, McNulty, Des, Morrison, Mr Alasdair, Muldoon, Bristow, Mulligan, Mrs Mary, Munro, John Farquhar, Murray, Dr Elaine, Oldfather, Irene, Peattie, Cathy, Pringle, Mike, Purvis, Jeremy, Radcliffe, Nora, Raffan, Mr Keith, Rumbles, Mike, Scott, Tavish, Smith, Elaine, Smith, Iain, Smith, Margaret, Stephen, Nicol, Stone, Mr Jamie, Wallace, Mr Jim, Watson, Mike, Whitefield, Karen, Wilson, Allan

Photo of Murray Tosh Murray Tosh Conservative

The result of the division is: For 48, Against 61, Abstentions 0.

Amendment 13 disagreed to.