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Mr. Peter Bottomley (Worthing, West): My hon. Friend has quoted the Prime Minister's agent wishing CHCs well in the future and cited the Prime Minister saying on the Floor of the House that there had been
consultation on their abolition. Has any Minister from Department of Health acknowledged on the Floor of the House that there has been no consultation? If no Minister has yet done so, will the Secretary of State do so now?
Dr. Fox: I very much look forward to Ministers being open about the fact that there was absolutely no consultation on the abolition of CHCs, either before it was announced in the national plan or subsequently. They have consulted only on what should replace CHCs. To suggest that proper consultation on abolition has taken place is to define the concept in a way that the rest of us would not understand from reading an English dictionary. That shows that the Government's interpretation of consultation is very far removed from that which anyone else would regard as meaningful.
Under new clause 10, tabled by the hon. Member for Wakefield, CHCs would not be retained, and we simply cannot accept the complex mechanism that he proposes as an alternative. What has been suggested in that new clause constitutes a tool for limiting the damage that the Government's proposals would cause, rather than an attempt to stop the damage being done in the first place. I am sorry that the hon. Gentleman has departed from his position, which involved a robust defence of CHCs; he is now trying to ameliorate the damage. That is a case of crusader turned collaborator, and it does the hon. Gentleman no justice.
Mr. Fabricant: Will my hon. Friend give way?
Dr. Fox: I will not. I hope my hon. Friend will forgive me.
We make a strong case in new clause 2 for reforming CHCs to make them more effective. For example, there could be more standardisation of CHC work, reform of the appointments systems and better resourcing. No one can deny that CHCs have done good work--for example, in the Harold Shipman and Rodney Ledward cases, in preparing and publishing "Casualty Watch" and in highlighting the many instances of poor performance in our hospitals. It should never be forgotten that CHCs represent the entire public, not just patients in the NHS. There is a growing feeling among politicians, CHCs and patient and medical bodies that Ministers are making up all the new systems as they go along. No doubt, they will make up a new version on the hoof during the debate.
Some CHCs do work well, and we all accept that. Ministers have said that some are excellent, and we also all accept that. Our logic suggests that we should bring the standard of the poorest up to the standard of the best. The Government's logic suggests that everyone should be judged by the standard of the poorest--then let them be abolished. I should love to see them try to apply that Mandelson test to Ministers.
The Opposition will accept nothing less than reform and retention of CHCs. If we are defeated on new clause 2 tonight, we shall carry the fight to the other place. The Government are running out of time as they come to a general election. We look forward to carrying into the general election our proposal to maintain and reform CHCs, whereas the Government want to abolish organisations run by many people who have not only done sterling public service in the past and helped many patients, but who support their own party. Government
Back Benchers should be warned that if they vote to abolish CHCs, they will inflict deep hurt on many people who may well have been willing to help them in the forthcoming general election. Given that the Government have treated CHCs with contempt by failing to consult, and given that they are now treating them with disdain, Labour Members may not receive that help in the future.
Mr. Paul Burstow (Sutton and Cheam): The Liberal Democrats want to make it clear that we stand on a ticket of reforming CHCs, not of abolishing them. I want to outline our views on the amendments that my hon. Friends and I have tabled. I want to make it clear that if a Division takes place on new clause 2, we will join the official Opposition in the Lobby to advocate the case for retaining CHCs and building on what is good about them, not throwing out the baby with the bath water as is proposed at the moment. We believe that an effective watchdog is needed, so we must look at the good practice that exists in CHCs, which Ministers acknowledged in Committee.
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The new arrangements will fragment the watchdog rule. They will shatter the complaints handling system and inspection and overview. They will scatter those matters around to a range of new bodies. The new system--which is being gradually revealed, piece by piece--is more centred on the interests and needs of care providers than on those of the patients who receive that care. The reality is that people's experience of the NHS is gained not on a piecemeal basis of what individual trusts provide, but on the care pathway that they take through the NHS, which includes visits to their GPs and the services provided by community NHS trusts and acute trusts. To end up with a system in which different patients forums deal with different aspects of patients experience misses the point of trying to create a patient-centred NHS. That is what the Government say in their NHS plan they want to do, but the new system will not deliver it in practice.
As the hon. Member for Woodspring (Dr. Fox) has said, the new arrangements will leave community interests out in the cold. We are specifically dealing with patients experience of the services provided, so it is essential that we do not lose the wider view of the interests of the local community being served by the local health care economy, the NHS and other care providers. The powers and other aspects of the proposals show, time and again, the confusion between customer care and advocacy on behalf of patients and the community and the effective oversight and scrutiny of the NHS.
Mr. Gordon Marsden (Blackpool, South): I think we would all applaud what the hon. Gentleman says about the needs of the community, but does he not accept that the role of the proposed patient advocacy and liaison service is an entirely new one, especially for patients in hospital, which is not currently addressed by CHCs?
Mr. Burstow: The hon. Gentleman is right to say that the role of PALS is entirely new, but it is a customer-care role, not a customer advocacy role. Indeed, the Bill contains no specific proposals about setting up independent advocacy services. New clause 10, tabled by the hon. Member for Wakefield (Mr. Hinchliffe), tries to
deal with that, and the hon. Gentleman has our support in that respect because proposals that establish genuine, independent advocacy services for patients are needed.
Dr. Fox: Does the hon. Gentleman accept that even if we accepted that PALS were good in itself, there would be nothing to stop that being introduced alongside CHCs, as an additional measure rather than as a substitute?
Mr. Burstow: I entirely agree. The proposals on PALS should be viewed completely outwith those on patient advocacy and the ability to scrutinise how the NHS works on behalf of local community and patients. PALS are separate matter, but the proposals, although useful, are more about customer service than about anything else. Although PALS are a good idea, we do not view them as part of the watchdog role that we need to retain and develop. Many outside the House, including many of those who lobbied hon. Members today, view PALS as poodles rather than effective watchdogs.
Dr. Brand: Does my hon. Friend agree that the real value of PALS is to encourage the internal resolution of complaints in trusts and that they will be very useful vehicles for doing just that, but that they cannot be a substitute for supporting people who have genuine problems with the care provided by trusts and who have lost faith in them?
Mr. Burstow: My hon. Friend is absolutely right. It is worth stating that the Government still have to produce the details of the complaints procedures. They are designing the systems to operate a new complaints procedure before we have seen them. They are putting the cart before the horse.
The overview role, which is to pass to local authorities, will be handicapped if we do not have the benefit of the insight provided by inspection and individual complaints. The independent local advisory forums that health authorities will set up are neither independent nor particularly local--and, not least, they lack statutory backing. As a result, they will be the creatures of the Secretary of State. I hope that they will be independent, but they will be very much at the beck and call of individual Secretaries of State in terms of the directions that will be used to set them up.
The Government have so far failed to make the case for abolition. The CHCs, as they stand, are underpowered and under-resourced. As has been said in this debate and in Committee, their performance is variable across the country. However, surely we should raise the standards of the poorest performers to match those of the best. We should examine what is good in the system and build on that instead of casting the whole system aside. The Government's reasons do not sustain the case for abolition; they are reasons for reform and for properly resourcing CHCs, not for getting rid of them.
If we are unable to persuade the Government tonight of the merits of new clauses 7 and 8, my colleagues will not accept the case for abolition when the Bill is considered in the other place. They will not vote for abolition and will want the Government to embrace the case for reform before they accept any attempt to take the Bill through the Lords. To that extent, we welcome the fact that Members in both Opposition parties support that approach.
The Government have failed to make their case. In Committee, several Labour Members told us that CHCs had not fulfilled their role as the bodies that deal with complaints in the NHS. Unfortunately, that is a bit of misconception. Although CHCs undertake complaints on behalf of complainants and help them navigate their way through the complaints system, there is no statutory duty on them to do such work. Despite the fact that no funds had been specifically earmarked for that purpose, CHCs saw a gap, recognised a need and undertook that responsibility and it is only because of that that they carry out the role at all. That is another reason for considering how we can ensure that they are properly equipped. We should pay tribute to the work that CHCs have carried out, for example, in the Alder Hey case. The work that they did in supporting parents should not be neglected when we consider the case for keeping them.
Our new clauses 7 and 8 show how CHCs could be reformed to become the delivery mechanisms for the proposals set out in the NHS plan. The new clauses address the need for independence and co-ordination. They are about stitching together the pieces in the NHS plan and in the scheme for consultation and the empowerment of patients. Quite rightly, they would extend the remit to primary care and they would locate the independent advocacy services in the new reformed CHCs. They would establish patients forums as sub-committees of CHCs and allow co-ordination, sharing and the following of patients care pathways to take place more effectively. They would also require the Secretary of State to consult on the detail.
I do not believe that the Government have demonstrated that their proposals, as they currently stand in their various pieces, will enhance the patients voice. New clause 9, which was tabled by the hon. Member for Wakefield, will not do that, either. It does not go far enough. Although I understand the intentions behind it, it fails to deal with the fragmentation of the proposals in the Bill and in the NHS plan. It would add an extra tier without being clear as to what that tier would do for the management of patient advocacy.
The Government have overlooked the wider community, but one of the questions that has been asked tonight and in Committee is how much their proposals will cost. When the Bill was in Committee, I tabled a written question to ascertain from the Government how much the proposals would cost and I received a reply from a Minister telling me that it would not be appropriate to provide that information because we were not at the right stage of the Bill's passage through the House. Does that mean that there can be no scrutiny of the Government's proposals for the abolition of CHCs and their replacement, or does it mean that scrutiny must occur once the Bill has become an Act and the details have been worked out in regulations? What on earth does it mean when a Minister tells the House in a written answer that it is inappropriate to provide the costings that should be the basis of examination, scrutiny and debate in this place?
The proposals in the Bill were unmodified in Committee and I suspect will remain unmodified after the Report stage. The arrangements are nothing more than a dog's breakfast. We need a decent watchdog on behalf of patients and the wider community, and unless we get that, we will not accept this part of the Bill.
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