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Mr. Philip Hammond (Runnymede and Weybridge): Given that the hon. Gentleman is inside the big tent, can he help me to clear up some confusion? The Secretary of State spoke earlier of nursing care in nursing homes being provided by NHS nurses with NHS equipment. Is it the hon. Gentleman's understanding that NHS nurses will be put into private nursing homes, or will the NHS fund the nurses that are already there? That is an important distinction. The Secretary of State said "providing" rather than "financing".
Mr. Harvey: It has not been my understanding that the nurses in question will have to be NHS nurses, but I confess that it is a long time since I have been in any sort of tent, so I could not really say. No doubt the Minister will make the point clear at the end of the debate if he sees fit to do so.
We are concerned that some aspects of health care will be paid for in one context, but not in another--whether that be physiotherapy, incontinence pads, which the NHS does not currently supply to nursing homes, or the practice of GPs charging for call-outs to residential and nursing homes and those costs being passed on to residents. The Government's desire to maintain this wholly artificial, wrong and illogical division between the two categories of patient is inconsistent with the provision in the Bill to bring together primary and community health care and social care. As they are bringing those organisations together in one, they have the opportunity to get rid of the artificial divisions and distinctions once and for all. If we entrench this completely artificial division in legislation, the opportunity will be missed.
We are concerned that older people and others will no longer be able to establish under what legislation services are being provided, and thus whether their care should be free, as an NHS service, or charged as a social service. The Bill provides the opportunity to clarify that once and for all. It is entirely reasonable that people are expected to make their own financial provision for their accommodation, the roof over their head, the food they eat, heating and so on, but it is wrong that people who are suffering from chronic long-term conditions will have to pay for their personal care, whereas others with acute
conditions will enjoy a different degree of financial support and will have the services they receive paid for under the Bill. It would surely be right for the same treatment, often given in the same establishment and by the same staff, always to be provided free. This is a missed opportunity to iron out some of those anomalies at a time when the organisations are changing.The care trusts are welcome. The Liberal Democrats have long campaigned for and supported the bringing together of health and social care. The formation of primary care trusts provides a context in which to do that which is different from any that we have considered in the past. If they are to be brought together into the care trusts, we have some reservations, especially about accountability. The role that local government could play should be considered further, and smoked out.
I agree with the hon. Member for Wakefield that it would be more logical for public health to be vested in the hands of local authorities rather than health authorities, because so much of the public health agenda is influenced by issues outside the health service, such as housing, transport, job opportunities and a variety of other social issues. To some extent, the Government acknowledge that by having local authorities play the part that they do in health improvement programmes. In the Bill they propose to take that role further by giving local authorities a significant role in scrutiny of primary care trusts--and also, presumably, the wider care trusts, when they come in--and NHS trusts. It would be logical to take that a little further by using local authorities as a mechanism to hold all those bodies more democratically to account.
In future, all trust boards will be more independent, in the sense that their composition will be handled by the new commission, and I welcome that. The Secretary of State is right to have relinquished that power. I listened with some amazement to the hon. Member for Woodspring talk about the number of Labour councillors who have apparently been appointed to the trust boards. Perish the thought that the previous Conservative Government would have stuffed the boards full of their appointees. Those people were independent business men, not Conservative councillors; they had taken the precaution of losing their seats first, so they were ex-Conservative councillors.
It is no good knocking the matter around on a party political basis. Nothing happening now is any different from what went on under the previous Government. That is why the Secretary of State is right to have put things on an independent basis, and it is right that he should have relinquished that power in order to do so. [Interruption.] I am sorry that the Tories do not like what I am saying, but they should look in the mirror and see what happened under their Government.
Mrs. Virginia Bottomley (South-West Surrey) rose--
Mr. Harvey: I give way to the right hon. Lady, who I think was one of the leading culprits.
Mrs. Bottomley: I hope that the hon. Gentleman will withdraw that comment when he considers the evidence. I was responsible for the appointments of Baroness Hayman, Baroness Dean and Dame Rennie Fritchie, quite apart from Julia Neuberger and Baroness Thomas. Dame Rennie Fritchie was a leading health service regional
chairman under the previous Government. If the situation then was as the hon. Gentleman describes, it is surprising that she should have written quite such a critical report. Will the hon. Gentleman investigate for himself the truth of his statements?
Mr. Harvey: I shall be more than happy to do what the right hon. Lady suggests and look at the evidence. If by any chance I find that what I have said is incorrect I shall certainly withdraw it, but I sincerely doubt whether that will be the case. We all have recollections of such matters. I well remember, in my constituency, how each time one particular Conservative councillor lost his seat on a further tier of local government, he was rewarded with another place on some quango or other--including the local health care trust.
The final issue to which I shall refer is the abolition of the CHCs. I recognise the successful role that CHCs have played in many communities in the past 25 years, but it is important not to have too starry-eyed an idea about how successful they were across the board. They were good in some areas and not so good in others. Everyone to whom I have spoken in the CHC movement in the past few months has recognised that there was a need for major reform of the whole function.
We must be wary of throwing the baby out with the bath water, but the Government have tabled some proposals and we must address those and consider what merits they have and how they might be improved. The Government's proposals have improved somewhat since the original blueprint put forward last summer.
To consider the individual components for a moment, the patient forums were originally to have been supported and staffed by employees of the trusts that they were supposed to be monitoring. We now learn that they will be set up on a completely independent footing, and that must be a significant improvement. However, the Secretary of State was wrong to dismiss quite so firmly the point made by my hon. Friend the Member for Isle of Wight (Dr. Brand).
If the forum is to consist of representatives of patient groups with particular concerns about particular conditions, and a cross-section of patients who have used the service in the preceding year, it will not really represent the wider community and those who have not recently been health service users. The CHCs have made that point in recent representations. It is right that those who have recently used the service should be represented, but there should be a slightly wider focus and remit.
Most CHC chief officers to whom I have spoken have been candid about the fact that the handling of complaints has been one of the weakest areas of CHCs' performance. They have not felt that they have had adequate funds for the task, and it has often been the poor relation when they have had to prioritise.
Having heard the Secretary of State's speech, I am still not entirely clear about what the new system is to be. The patient advocates are within the hospitals and the trusts; as my hon. Friend the Member for Isle of Wight said, they sort out the problems that are appropriate for sorting out within the organisation. However, I understand that if a patient still has a fundamental complaint, there will then be an independent complaints procedure.
I understand that the Secretary of State is awaiting the report that he commissioned, and perhaps he will say more about that presently. He suggested in his speech that
it might be possible for local authorities to provide the service, area by area. The criticism of the Government's plans to replace the CHCs that has rung truest with me is that the component parts that they want to introduce, although each has a certain logic, do not really hang together.If the scrutiny role is to go to local government, why not also give it the responsibility for commissioning the independent complaints procedure, area by area, and for funding, staffing and supporting the patients forum? Then at least the three essential component parts would be together. Local government could fulfil the scrutiny role on the basis of the information gathered from the patients forum. That could begin to solve some of the problems of fragmentation that form the strongest case against the Government's proposals.
We are talking about local government ceding its traditional role in managing social services to what is essentially a health service body--the care trust. Giving local government a good deal of responsibility for defining what provision there ought to be in a community, and for monitoring what goes on, would therefore be a significant way of remedying what might otherwise be deficiencies in democracy and accountability in those trusts.
We welcome many of the proposals, but we have some major reservations.
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