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Dr. Fox: This is likely to be the most controversial of the debates today. The strength of feeling aroused must have come as a shock to the Government; it must have come as a lesson to them that, although they may be able to muzzle criticism inside the House, it is much more difficult for them to do so in the real world. We look forward to whatever climbdown from the proposals the Minister of State is going to make.
Under the Government's proposals, the current functions of community health councils will be divided up into patient advocacy and liaison services, patients forums and local authority scrutiny committees. During the debates in Standing Committee, the Government did nothing to dispel our fear that the replacement of CHCs with a fragmented system will mean that there will no longer be an overall body that can span many care providers to oversee the whole of a patient's experience. The example was used of a patient who, in a single episode of illness, had a problem with his GP, a problem with the ambulance service and a problem with the acute trust. Under the new system, to whom would such a patient complain about each of those bodies? Will the patient find the new system more difficult or easier than the current one?
Similarly, the separation of scrutiny and complaints procedures undermines the work of CHCs in understanding the broader patterns of health provision. The Government have tried to argue that bringing scrutiny closer to trusts will mean that there will be speedier action. However, the loss of an independent perspective may result in no action at all. Attempts to solve those problems will necessitate further quangos. The new clauses proposed by the hon. Member for Wakefield (Mr. Hinchliffe) would create even more confusion. The Government are creating a system in which patients will have to shop around for their rights.
I am sorry that no apology was offered in Committee for the way in which CHCs have been treated by the Government during the progress of this matter. The Government have still to apologise for the lack of consultation that has left their employees in the dark as to the future. In the House, the Prime Minister famously claimed to have consulted the CHCs, but they denied it and the right hon. Gentleman was forced to backtrack. As Richard Gordon QC told the Association of Community Health Councils for England and Wales:
- "in my opinion, the consultation process over the new NHS plan was . . . legally flawed."
- "We do not accept that the Association of Community Health Councils for England and Wales or CHCs had any legitimate expectation to be consulted in relation to the proposals that CHCs should be abolished in primary legislation to be introduced in parliament in due course."
Mr. Fabricant: My hon. Friend says that the Government saw no reason to expect the CHCs to wish to consult. I suspect that he will not be surprised to learn that I received a letter from the South East Staffordshire community health council that states
- "the Government has consistently refused to consult on this issue, and has still not produced substantive detail on our proposed replacements, even at Committee Stage."
Mr. Deputy Speaker: Order. I think perhaps the hon. Gentleman might not go on to say anything.
Dr. Fox: My hon. Friend the Member for Lichfield (Mr. Fabricant) is right--the House will not be shocked to learn that I am not surprised at the information that he imparts.
In Committee, the Government also failed to answer some of the questions on funding in respect of CHCs. Will the Minister tell us whether the Government continue to reject the claims of the association that, by 2004-05, the new bodies that are to replace CHCs will cost £114 million, compared with the current CHC budget of £23 million? If the Government reject those sums, will the Minister tell us how they expect hospitals to fund the additional bodies?
On Second Reading and in Committee, the Government argued that the presence of patient advocacy and liaison services in hospitals will lend more immediacy to the complaints of patients. However, to steer patients towards the complaints system where necessary is greatly different from the proactive advocacy role currently played by CHCs. Independence will undoubtedly be lost, not gained--to the detriment of patient care.
The Government have also tried to argue that patients forums will be able to remove PALS from the control of trusts. That just might prevent a gross distortion of the system, but it would do nothing to stop PALS employees from feeling beholden to trusts; they might take decisions different from those that they would have taken had they enjoyed full independence.
The Government have failed to explain how conflicts of interest on the part of councillors scrutinising care trusts will be dealt with. Such conflicts will arise when councillors are increasingly called on to scrutinise services for whose funding and provision their authority has joint responsibility. They will thus not be independent of the services that they scrutinise. Many such councillors will be of the same political persuasion as the non-executive directors, and even chairmen, of the local trusts. We do not need to go back over the ground about appointments to trusts under the Labour Government--of which Dame Rennie Fritchie gave such a damning indictment. An alternative scenario might pertain, in which such councillors were of a different political colour. What we would then see would not be cronyism but the use of the situation as a political football, in a way that does not occur at present. That cannot be to the advantage of patients.
The Government have been unable to confirm that the lone member of the patients forum appointed to a hospital trust board will be selected by the relevant patients forum.
Perhaps the Minister can offer us that assurance tonight. In a Labour party briefing, the Government have also tried to portray patients forums as mini-CHCs. This is the line that goes out: "Don't worry about it because the patients forums are really mini-CHCs". If that is so, why are the Government abolishing CHCs? That makes no sense whatever.In Committee, the Minister of State said:
- "It is our expectation, however, that patients forums will undertake specific or general monitoring activity. That is important as an allegation has been made--and repeated this morning--that the aim of the exercise has been to remove from the system of scrutiny in the NHS any organisation or body that could play that role. That is not the case. Patients forums will be able to carry out that role, as CHCs have in the past."--[Official Report, Standing Committee E, 30 January 2001; c. 235.]
Ministers have conspicuously avoided public discussion of these issues. The Association of Community Health Councils for England and Wales held a seminar on 4 December last year, but the Minister who was to respond wrote in advance that she would be unable to answer questions about the Government's proposals to abolish CHCs. In other words, the Minister with responsibility for the abolition of CHCs tells a conference of CHCs that she is unable to answer questions on that very issue.
The Department of Health arranged a meeting in Fulham on a day when the Standing Committee was discussing many of those issues. A junior Minister took the place of the Secretary of State, but there was no sign of the promised guidelines. That is not surprising, given the confusing signals coming from the Government.
As we noted in Committee, the Prime Minister's agent wrote to his local CHC in Durham to say that, on the anniversary,
- "Tony would certainly like to add his congratulations to the work the CHCs have done over the last 25 years and wishes them every success in the future."
- "We are concerned that the Government have announced the intention to abolish CHCs as a cynical attempt to silence any negative publicity . . . What better way to deflect attention away from any shortcomings than by silencing the only independent monitor that the public has for the NHS."
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