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Mr. Hilton Dawson (Lancaster and Wyre): I welcome the renewed role of local government in scrutinising vital health services. Will my right hon. Friend assure me that, where a shire council and a district council have different functions, both will be involved in scrutiny at district level, which is crucial?

Mr. Milburn: There are two points on that issue. First, the lead will probably be with the social services authority. In some cases, that will be in the old so-called district councils, as in my area of Darlington, which has a unitary council, and in others it will be in county councils. We will ensure the involvement of district councils.

Secondly, we will work very closely with the Local Government Association to ensure that appropriate guidance is given to local health services and authorities. Council boundaries form a patchwork quilt--some local health services cross many local authority boundaries--so we shall have to ensure co-ordination. I believe that that can be addressed through guidance.

Mr. David Hinchliffe (Wakefield): On democratising the health service and the relationship between it and social services--I support my right hon. Friend's desire to achieve that--why not simply shift the health authority function to local government and deal with the job lot in one go?

Mr. Milburn: My hon. Friend has been extremely consistent on this point, and I have been extremely consistent in resisting it down the years. I do not believe that that is what the national health service needs. It has had years of structural and organisational upheaval. Of course we need to change the structures when that is appropriate, but our emphasis now is not just on the

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structures but on incentives and on breaking down barriers between services and staff. That is precisely what the NHS needs.

I do not believe that the best way forward is for the NHS to have a local government takeover. Incidentally, I do not believe that the best way forward for local government and social services is to have a national health service takeover. When services work together on the ground--the new care trust will provide a model for that--partnership among organisations is enhanced and the service to patients is enhanced and more seamless.

I am sure that, like me, my hon. Friend meets the most vulnerable people in his constituency surgery who find the current system byzantine. It must change, and it must be made easier. We must have more seamless services, better co-ordinated planning and more consistent assessment of people's health and social care needs. That is precisely what our proposed reforms will do, including the care trusts.

Mr. John Bercow (Buckingham): Will the right hon. Gentleman give way?

Mr. Milburn: I shall give way to the hon. Gentleman, and then I shall make some progress.

Mr. Bercow: On 31 October last year, an early-day motion was tabled that rightly celebrated the work of the community health councils. Does the Secretary of State recall the letter that shortly thereafter was sent by the Prime Minister's agent, Mr. John Burton, which said "Tony agrees with every word of the motion. Tony would certainly like to add his congratulations to the work of the community health councils over the past 25 years, and he wishes them every success in the future"? Had the Prime Minister at that stage already decided to scrap those community health councils, or did he stumble on that stupidity only at a later stage?

Mr. Milburn: I was looking for a reasoned argument from the hon. Gentleman, but more fool me. I am not privy to the Prime Minister's correspondence, but of course many community health councils have done a good job--some have and some have not. We should not be conservative about this issue. We should consider what is needed from the patients' point of view. No organisation has a God-given right to exist. Governments do not have a God-given right to exist. Community health councils do not have a God-given right to exist. MPs do not have a God-given right to exist.

If the hon. Gentleman looks at the problem from the patients' point of view, what do they need? If they are in a hospital or in a primary care setting and they have a problem--heaven knows, people encounter problems in the national health service--they need somewhere to go to get it nipped in the bud before it becomes serious or it engenders a serious complaint. They need a complaints system that is accessible, open and independent. If they have a serious complaint, they need help through the complaints system. They also need a form of inspection and accountability so that they are able to assess how well the local health service is performing. We are putting all those measures in place.

Mr. Simon Burns (West Chelmsford): Will the right hon. Gentleman give way?

Mr. Milburn: I shall make progress, but I shall give way to the hon. Gentleman in a second.

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The Bill establishes entirely new, independent and statutory patient bodies in every part of the country. Every NHS trust and every primary care trust will have a patients forum made up of individual patients and representatives from patients' groups and voluntary organisations. Patients forums will not be managed by the trust, they will not be funded by the trust and they will not be answerable to the trust. The Bill makes it clear that it is the other way round. NHS trusts will have to answer to the patients forums.

The forums will be wholly independent. Unlike CHCs, which are partly appointed by the Department of Health, members of each new statutory patients forum will be appointed independently by the new independent NHS appointments commission. Furthermore, every patients forum will have the power to appoint a non-executive director to the trust board. For the first time, patients will elect a patient to the governing bodies of local health services as of right. For the first time, too, a patients' organisation, the forum, will be able to monitor, review and inspect all aspects of local health services from the patients' perspective. It will be able to visit and inspect every place in which patients are treated--hospitals, nursing homes, private health care, and, for the first time, all primary care settings.

Mr. Clive Efford (Eltham): I am grateful to my right hon. Friend for his reference to the involvement of the voluntary sector because, in my experience as a former member of a CHC, it provides enormous expertise and insight into the way in which the NHS operates, which has allowed it to be an effective patients' advocate. How will patients be selected for the patients forums? At the moment, they appear to be self-selecting. How patients become part of the forums is a bit of a mystery to me.

Mr. Milburn: There will be two points of entry to the patients forums, but only one organisation responsible for the appointments, which will not be me, other Ministers or the Department of Health but the completely independent appointments commission. I hope that that deals with the concerns that are being expressed about independence.

As we all know from our constituencies, extremely good local patient and voluntary organisations do a brilliant job, whether they be the local branches of the Alzheimer's Disease Society or the Multiple Sclerosis Society. It is right and proper that we should give such organisations the opportunity better to influence local health services. Therefore, they will be represented, as of right, on the patients forums.

The second group of people who will be represented is simple and straightforward--the patients who have previously used the health service. That is reasonable. We all use local health services, but the people who really count are the patients themselves, so it is right and proper that they should have an opportunity to put themselves forward to the independent appointments commission, which will make a decision and try to achieve the right balance between different interest groups, genders, races and so on to ensure that every primary care trust and NHS trust has an organisation that it can be legitimately said is standing up for and properly representing the needs of patients.

Mr. Burns: If the forums and patient advocacy liaison services will be so independent and reflective of the

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wishes of local people, can the right hon. Gentleman reassure the Parliamentary Secretary, Lord Chancellor's Department, the hon. Member for Wyre Forest (Mr. Lock), that they will have more effect and influence than community health councils and other local people on the changes to Kidderminster hospital, which are so deeply unpopular?

Mr. Milburn: I thought that the hon. Gentleman intended to make a serious point. I am happy to have a serious debate about some of these issues. He will know, having dealt with such matters as a Minister in the Department of Health, that local service changes are always under way in the NHS, and rightly so. Some are more controversial than others. At the moment, a contested local service change will land on my desk, and, ultimately, Ministers have some responsibility for ensuring that the right decisions are made. In future, an independent reconfiguration panel, comprising clinicians, managers and patients, will assess whether a decision is in the best interests of the local NHS and patients. That will be a much more coherent way to make decisions and it will help to take some of the silly party politics out of such issues.

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