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Under the regime that the right hon. Gentleman has in mind, it will be increasingly difficult to detect what is going on in the NHS, because he also intends to silence potential critics of this brave new world by abolishing the only independent voice of patients and communities in the health service--the CHCs.
In today's debate, with two exceptions--I acknowledge that the hon. Member for Lancaster and Wyre (Mr. Dawson) clearly set himself apart from this view--every speaker from every part of the House disagreed with the Government's intention. [Interruption.] I said that there were two exceptions. [Interruption.] If I had to go into battle with only two people behind me I would not have chosen the hon. Members for Lancaster and Wyre and for Brighton, Kemptown (Dr. Turner). No hon. Member has suggested that CHCs are perfect. They themselves recognise the scope for reform and improvement, but the Government's ham-fisted attempt to replace independent CHCs with employees of the bodies to be monitored and committees of party politically controlled local authorities in the name of improved scrutiny is clearly incredible.
We all know that many patients are already extremely wary of making complaints against doctors or hospitals. My hon. Friend the Member for Eddisbury (Mr. O'Brien) alluded to that point. How much more so will they be when the person handling the complaint is a direct employee of the hospital in question? Who can really believe that controversial service reconfigurations, as part of a Government strategy, will be reviewed objectively by party politically controlled councils?
Nowhere in the Government's plans is even a pretence of replacing the whistleblowing role of community health councils. All Members of Parliament receive Casualty Watch reports from councils. Who will count the people lying unattended on trolleys for hours, correlate the results and circulate them to Members of Parliament so that we can hold Ministers to account? The answer of course is no one. It is no part of the Government's plan to be held to account. We see that in their treatment of Parliament, in their manipulation of the news agenda, in the Department of Health's arbitrary discontinuation of the publication of the chief medical officer's report after 100 years and in the proposal in the Bill to abolish CHCs arbitrarily without any consultation.
Care trusts may well be a good way of delivering services--the Opposition have an open mind on them--but before the model has been tested or any proper evaluation has been made, the Government are instinctively reaching for powers of compulsion to impose them. Their response to the royal commission on long-term care of the elderly, albeit 18 months late, is welcome as far as it goes. It will provide some relief to some elderly people in long-term care, but it will fall far short of the promise--implied, at least, by the Prime Minister--to end the forced consumption of capital to pay for care. It will present real practical difficulties and create the perverse incentives to which hon. Members of all parties have alluded.
The loan scheme, while it has merit, may conceal but does not alter the fact that the prudent, thrifty elderly person who has saved all his or her life will still have to consume capital to pay for long-term care.
The Bill fails entirely to provide anything for those who are struggling to meet care bills, or to help people such as myself--the future generations of the elderly--to prepare themselves to meet the costs of their care without the trauma of consuming the capital in the family home.
My hon. Friend the Member for Woodspring (Dr. Fox) said that we are minded broadly to support the Government's proposals on local pharmaceutical services, as long as they are properly trialled and evaluated, although I was quite taken by the point made by the hon. Member for Dartford (Dr. Stoate). We will want to consider the issues carefully in Committee, should the Bill reach that stage.
Despite the fine aspirations of parts of the plan and the fact that some parts of the Bill are worthy, and despite the welcome for the measures, albeit limited, on long-term care costs, I will ask my colleagues to support our reasoned amendment. The Bill's underlying theme of centralising power to the Secretary of State and increasing the micro-management of the NHS from Whitehall is one that we oppose both in principle and for practical reasons.
That is unacceptable to Conservative Members, and from the tone of the debate today it is clearly unacceptable to most Government Members as well. The Bill is another missed opportunity to begin the process of genuine decentralisation and depoliticisation of the national health service that could yet ensure its survival and prosperity in the future.
Mr. Denham: What is striking about tonight's debate is the extent to which the Government have won the argument about the future of the national health service. Although there is a debate about community health councils, which I shall turn to in a moment, and long-term care costs, no right hon. or hon. Member on either side of the Chamber has challenged the core vision that the Government have set out in the NHS plan for the future of the national health service.
There has, of course, been silence from the Conservative party on their real agenda, which includes health insurance. Tonight there has been silence about the notorious list of hips, knees, cataracts and hernias in respect of which people would need private medical insurance, and there has been no fundamental challenge to the Government's vision.
The hon. Member for Woodspring (Dr. Fox) once said that his ambition was to be the least active Secretary of State for Health ever, or words to that effect. That is certainly his approach to the job of Opposition spokesman. Tonight he said not a word about what the Opposition would do. There were no ideas, no proposals and no policies. The hon. Gentleman is indeed Doctor Dolittle.
Let us consider a few of the issues that have come up tonight. There have been protests from the hon. Member for Southend, West (Mr. Amess) and from the Opposition Front-Bench spokesmen about the idea of any system that enables us to identify parts of the health service that are failing to provide an adequate service to patients and about our willingness to say that we want to raise standards in those trusts. The hon. Member for Southend, West complained about his local trust being so identified and, as he put it, time and motion men being sent in. He will know that in August, Southend had one of the worst out-patient performances in the country in terms of long waiting times. As a result of the support given by the national patients action team, working with the hard-working staff of the trust, waiting times have decreased by 25 per cent. in a couple of months and have reduced further since. So there are measures to enable us to work with trusts that are not performing to the highest standards to produce improvements.
Mr. Amess: I cannot believe that the Minister of State is coming out with more claptrap. Will he tell the House, as a result of his time and motion man coming in, how many extra staff he sent to Southend hospital? I can tell him the answer now: absolutely none. He should be ashamed of what he has just said, as it is a further attack on the hard-working women and men of Southend hospital.
Mr. Denham: The point is that it did not take extra staff to bring about such a significant improvement in out-patient performance; it took support and the co-operation of the management and the organisation of the trust. The issue was never that the trust staff were not working hard enough. It was that the system was not sufficiently well organised and that something needed to be done.
I now turn to the most important issues that were raised tonight, starting with patient representation. For more than 50 years, the NHS has to far too great an extent made patients fit around the way in which the NHS is organised, to the frustration of patients and staff alike. We cannot modernise the NHS unless we put patients at the centre of everything that it does, organising services around their needs. We cannot do that unless patients themselves have a powerful voice. We have already done a lot. Most of the new primary care groups have patients forums or other systems for patient participation.
We have undertaken and published, for the first time ever, nationwide patient surveys. Last year's national plan was drawn up after the biggest consultation exercise in the history of the national health service.
This Bill goes much further. In our first health measure, we gave trusts a duty of quality--clinical governance. In this Bill, for the first time, every NHS trust and primary care trust will have a statutory duty to consult with and involve patients. Over and beyond that, the Bill underpins new structures to protect patients.
In the consultation on the NHS plan, we were told by patients time and again that, when they needed a problem sorted out, no one was there to do it. They did not know where to go to complain; they did not receive sufficient support in doing so. That is what patients told us.
We had to make a choice: to look at the system from scratch and design a system based on what patients said they wanted; or to try to tinker with what currently existed--but that is what the NHS has done too often. It has too often responded to a problem by saying, "Let's be radical, let's be bold and change everything, but at the end of the day, let's back off because we do not want to change what we already have." We did not do that; it would have been a mistake. We needed to take a fresh look at what patients said they needed.
First and foremost, patients want somebody to sort out a problem when it arises--poor communication; concerns about cleanliness; help with food and drink and going to the toilet; worries about discharge arrangements. They want to tackle the problem not by means of a complaint after the event, but when it actually happens. That is what the patient advocacy and liaison services will do. They are part of each trust, because they are needed in order to sort out problems when they first arise. The service is not a replacement for CHCs, as hon. Members have suggested. CHCs have never exercised such a role; it is a new element of patient representation.
Although that is important, however, patients want more. They want to know that they have a real voice. That is why each trust will have an independent, statutory patients forum--legally separate, financially independent and with real power. Forums will have the power--if they choose--to undertake exactly the type of campaigning activities undertaken by CHCs. If patients forums want to set up a casualty watch, they can do so. There is no question of that not happening under the new system.
Forums will have power to monitor the work of the PALS. Although we believe that the advocacy and liaison services should be part of the trust, if the patients forum is dissatisfied with the work of a particular service, it will be able to recommend that that service is taken out of the trust and run independently. There is a safeguard against the service being captured by the trust.
Forums will have the power to produce an annual report and to sign off the patients prospectus for each trust. They will have power to engage directly with the management of trusts in a way that no patient or representative organisation has previously been able to do. They will have power to elect a non-executive director of the trust itself. They will have power to go wherever NHS patients go--including the voluntary and private sector.
We recognise that, even with advocacy and liaison services dealing with day-to-day problems and even with patients' forums, sometimes things will still go wrong. As hon. Members on both sides of the House have pointed out, when things go wrong people want to know that there will be an effective complaints system, and that they will have an independent guide through the system. The existing system is under review and we shall receive the report soon. However, it is fair to say that we expect changes to the complaints system itself to make it more, rather than, less independent.
We want patients to have an independent guide--an independent advocate--through the complaints system. That will not be PALS, because, as hon. Members have observed, it is part of the trust itself; the service cannot play that role in the complaints system. An independent advocacy service will be commissioned for patients in each area. The Government think that that should be commissioned by the health authority, but it could be done from a range of local organisations. In the run-up to and during the debate, several people have suggested that it should not be the health authority--that is not seen as being sufficiently independent--and that perhaps the services should routinely be commissioned from the local authority. We want to consider those ideas in detail in Committee so as to determine their potential.