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6.10 pm

Mr. Patrick Hall (Bedford): I welcome the wide-ranging reforms promised in the Bill as they advance the prospect outlined in the NHS plan of a health service in which the patient is to be the most important person and in which NHS institutions are open and accountable, better to serve the patient and the wider community.

That is a truly radical approach, requiring nothing less than the transformation of the service. Until now, for more than 50 years, the NHS has done a good, worthy and cost-effective job for the people of Britain. However, those people have had to fit in with the NHS, rather than the other way round. That has been the dominant culture, and still is. That unacceptable state of affairs has gone on for too long and needs to change. In my view, it represents a poor appreciation of the concept of public service. I am delighted that the Government understand that and are prepared to take on ambitious reform.

Given my role as chair of the all-party parliamentary group on community health councils, I should like to concentrate on part I of the Bill, which deals with the abolition of CHCs and the establishment of structures for patient empowerment and greater public accountability. Reference has already been made, in this debate and earlier, to the manner in which the planned abolition of CHCs was announced last summer. That could and should have been handled much better.

There is one overriding reason for that: if the new proposals that replace CHCs are to work, it is essential to harness the skills, experience, knowledge and good will of as many as possible of the 700 staff and 5,000 volunteers who work for CHCs in England. I know that the Government are engaged in the process of talking to those people, and they now recognise that point. Making the system work is the overwhelming will of the majority of people in this country.

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As I said in the Adjournment debate on the future of CHCs on 28 November, a key question is whether the proposals for the new system of patient empowerment and community involvement provide the necessary mechanism to make things work and, more important, whether they do so better than CHCs. That question was behind early-day motion 1103, which was tabled in my name last October and was re-tabled as early-day motion 109 in the current Session. The hope was, having laid down the gauntlet last July, that the Government would work with others to fill the many gaps in their outline proposals. I welcome Ministers' willingness to engage in that process. They and their officials have worked hard with many people from CHCs, patients groups, voluntary organisations, research institutions and others to address those matters, and continue to do so. As a result, a fuller, clearer and more reassuring picture is in the making, but it is still far from complete.

That is the difficulty that we face. Today, we are debating the general principles of a Bill that deals with only part of the new structures. It includes, for the first time, a statutory duty on health authorities and trusts to consult on changes in service delivery, which is extremely good. It abolishes CHCs and sets up patients forums for every NHS and primary care trust. It places scrutiny of local NHS plans and the ability to refer contested proposals to the Secretary of State in the hands of local council scrutiny committees.

The only truly new body in the Government's proposals to appear in the Bill is the patients forum. Other bodies are not mentioned directly. I do not see how we can debate those matters effectively and answer the question that I have just posed unless we discuss patient advocacy and liaison services, independent local advisory forums and how the existing Commission for Health Improvement is to play a part.

In addition to the five bodies that I have just mentioned, Ministers have talked about health authorities commissioning citizens advice bureaux or other bodies--we have heard today that they could include local authorities, which is an interesting and welcome move--to perform the key role of offering independent advocacy services to handle patients' complaints. That is a welcome recognition of the fact that PALS are not suited to that task. However, that means that there will be another organisation, making a total of six, only two of which are included in the Bill and only one of which--the patients forum--is genuinely new. Several matters relating to the membership and powers of patients forums will be dealt with by regulation, so we might not get the detail until the Bill has completed its parliamentary stages.

In considering those aspects of the Bill, there is a strong need for a clear vision of the bigger picture. I do not mean that every detail should be included in the Bill and, of course, there should be flexibility. However, there is surely a need to demonstrate some detail, such as national standards for training, resourcing and sharing good practice. If that is not done, we could end up with a system that displays the patchiness of performance that has been cited, rightly, as a key weakness of CHCs.

I therefore urge the Under-Secretary to respond to our debate by addressing the need for sufficient detail, to enable us to scrutinise the whole picture, not just what is

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in the Bill. We must tease out the details of issues involving PALS, independent local advisory forums and the Commission for Health Improvement, and how everything fits together. We must consider how those are to be resourced, supported and integrated, both locally and nationally, to provide a coherent, workable and joined-up system. To do that, it would be helpful if draft regulations and guidance were made available when the Bill is considered in Committee. Will my hon. Friend the Minister give me an assurance that that will be done?

It is proposed that one patients forum will be set up for every trust, charged with a duty to monitor, review and inspect the provision of health services from the patient's perspective. It is a relief to have heard today that the forums will be funded by health authorities, not the trust to which they are attached. That gives them every chance to be independent, which they need to be. There is a radical proposal in the requirement for the forums to elect a representative to serve as a non-executive director on the trust's board. However, would there be a conflict of interest? To whom would the extra new non-executive director be accountable? Would it be the patients forum or the trust's board? After all, a trust's board is a corporate body that expects collective responsibilities and confidentialities to be respected. Would that compromise the independence of the forum?

Mrs. Caroline Spelman (Meriden): I know that there is a time constraint, but does the hon. Gentleman accept that there might be a conflict of interest if the patient has a complaint against the health authority that is funding the forum?

Mr. Hall: That needs to be worked out. The money has to come from somewhere, and it has to come from the public sector. After all, CHCs are funded through regional health authorities, and it is sometimes possible to trace policy back to the regions. Such issues should be examined thoroughly in Committee so that we can see the full picture. That is a perfectly fair point, although it is preferable to remove the patients forum from the direct management and financial responsibility of the trust to which it is attached. I hope that the hon. Lady agrees with that. I am not saying that a healthy tension between a non-executive director from the patients forum and the board on which he or she sat would not work. However, the status of that non-executive director needs to be clarified.

The proposal for local council overview and scrutiny committees is one of the best in the Bill. It is a welcome initiative that will confer a new and important role on local government. However, that role will only be as good as the information and advice that councillors receive. Councillors will need to be well informed to engage constructively in debate about the local health scene, and to decide whether to refer proposed service changes with which they do not agree to the Secretary of State. They will need easy access to independent, reliable sources of information as well as to the official views of the health authorities and trusts, which brings us back to the point about the integration of new structures.

What will happen in parts of the country such as Bedfordshire with two tiers of local government? What will happen to a trust covering a wide geographical area? For example, the Bedfordshire and Hertfordshire

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ambulance trust covers two county councils, one unitary district and 13 ordinary district councils. How is that trust to be held to account?

There is a great deal at stake in these matters. The transformation and modernisation of the NHS is an ambitious and desirable goal. I wish it well, and I would like to assist in that process. However, there remains much more to be done before the system that replaces community health councils can be seen to be credible and capable of bringing about the improvements for the patient and the community for which most of us are looking.


Mr. Deputy Speaker (Mr. Michael Lord): Order. I now have to announce the result of a Division deferred from a previous day.

On the motion "Electoral Commission", the Ayes were 486, the Noes 4, so the motion was agreed to.

[The Division Lists are published at the end of today's debates.]

Health and Social Care Bill

Question again proposed, That the amendment be made.

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