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Mr. Simon Thomas (Ceredigion): I thank the hon. Gentleman for explaining his proposals so carefully. Will he elucidate a little further on how they will affect CHCs in Wales? Wales is covered by new clause 10, but CHCs are to be retained in Wales--[Hon. Members: "You support that."] Indeed, I do, but surely it would be better for the Government to go back to the drawing board, forget about their current proposals and return to the House with fresh suggestions.

Mr. Hinchliffe: I support devolution and believe that if the Welsh wish to retain CHCs they should have that right. I look forward to a time when there is devolution in Yorkshire, and I no longer have to mix with some of the people that I meet here.

Dr. Lynne Jones (Birmingham, Selly Oak): Representatives from my local CHC told me today that they were concerned about how representatives on patients forums and patients councils might be appointed. Does my hon. Friend agree that great care will need to be taken to ensure that representatives are genuinely independent? That might be easier with trusts that have an on-going relationship with patients--such as mental health trusts--than acute trusts, where patients are often involved with the hospital only for a short time.

Mr. Hinchliffe: My hon. Friend will understand that I have not proposed to amend the Bill as it relates to the new NHS Appointments Commission, which was established after the publication of Rennie Fritchie's report. I accept that the issue needs to be considered carefully, and I make no bones about the fact that I am proposing a framework that needs to be examined in more detail.

New clause 10 is especially important. The Select Committee noticed--

Mr. Mark Todd (South Derbyshire): Will my hon. Friend give way?

Mr. Hinchliffe: No, I am sorry but I must conclude; I have given way several times.

The Select Committee picked up on patients concerns that when something has gone badly wrong in the NHS--fortunately, that does not happen very often--the experience has been worsened by the inability to get an appropriate response, help in complaining, and someone to rectify the damage. I hope that the advocacy services as proposed in new clause 10 would help to deal with that.

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My proposals will improve the system proposed in the Bill. Patients councils will be independent and comprehensive. They will bring together the various patients forums. They will cover primary care. Community health councils do not co that, which is a huge weakness. I am surprised that those who are defending the status quo do not recognise that. Moving to the idea of patients councils reflects the work that they will do better than does the term "community health council".

In my constituency--as in the constituencies of some of my hon. Friends, perhaps--there is a community health trust. I would bet that 99 per cent. of my constituents have not the least idea about the difference between the community health council and the trust. I hope that the name "patients council", which will reflect so much of the positive contributions of the CHCs, will have an impact.

Dr. Fox: Will the hon. Gentleman give way?

Mr. Hinchliffe: No.

I accept that the new clause and the amendments should be reconsidered in another place. However, I hope that we have a framework on which we can build. We must consider continuity between any change and the new system. I genuinely hope that some of those who have served so well on CHCs will make a major contribution within the new system. My proposals offer a framework for improving patient representation. I hope that the Government will accept them. If not, I intend to put the issue to the vote.

Mr. John Wilkinson (Ruislip-Northwood): The debate characterises all that is worst about the Government, and particularly their management of the national health service. Earlier, we had the disgraceful spectacle of the Prime Minister refusing to admit how many people had written to him in support of his proposals to abolish community health councils. He did not have the courage or the candour to recognise that it was only a handful of people, or none. We know that there have been numerous representations in favour of the retention of CHCs. They have been articulate and well argued. I have received no representations in favour of the proposal to abolish them, as announced in the NHS White Paper.

That was typical of the Government. There was a fanfare of political trumpets in favour of the proposals in the White Paper for increased resources for cardiac care and thoracic medicine, for example. However, in the small print it was seen that the CHCs were to be abolished. People realised that yet again they had been conned. They were unimpressed and, as a consequence, opposition to the proposals to abolish CHCs grew to the point where Parliament was lobbied by many people this afternoon. I am talking of individuals who have given many years of service, dedication and professional expertise to helping to resolve patients' complaints and representing the interests of their local communities through the health service.

The hon. Member for Sutton and Cheam (Mr. Burstow) was right to stress the importance of the representational role of local communities, which CHCs fulfil. It is the arrogant and soviet-style management of the NHS which is so abhorrent to many of our electors. There is the feeling that decisions are taken on high in Whitehall that

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have no relationship to the situation in particular community areas. CHCs fulfil a crucial lightning- conductor role in trying to dissipate the feeling of impotence, fury and frustration within many local communities against decisions that they believe to be entirely wrongheaded and against their interests.

Mr. Hilton Dawson (Lancaster and Wyre): Will the hon. Gentleman give way?

Mr. Wilkinson: No, I will not. I will amplify my point.

In the part of Middlesex that I represent, proposals have been imposed by the Government to move one of the best burns and plastic surgery units in the country from its present location at Mount Vernon hospital. To its credit, the CHC provided the impartial chairmanship of consultation meetings. It answered the questions and it sought to resolve the difficulties. Above all, it provided a mechanism, as it has for the proposed closure of Harefield hospital, for objections to be lodged with the Secretary of State, upon which he will have to make a decision. The crucial function of official objection is one which needs to be maintained. It gives the public at least some hope that they have an opportunity of redress against wrongheaded public policy.

8.15 pm

The hon. Member for Wakefield (Mr. Hinchliffe) gave me the impression, with all his bluster, that he had been bought off politically. New clauses 9 and 10 may be verbose but they are not clear. Patients councils, which he is advocating, seem to offer a bureaucracy which gullible people might believe to be a genuine alternative to an effective system provided by CHCs, in which the public already have great confidence.

Mr. Hinchliffe: Will the hon. Gentleman explain the difference between what I have proposed and existing CHCs that have sub-committees? The only difference, as I see it, is independent advocacy and the title.

Mr. Wilkinson: I leave that judgment to the Secretary of State. If he and his Department are impressed with the proposals of the hon. Gentleman and his numerous friends who have similarly been bought off, the right hon. Gentleman will show himself to be more amenable to rational argument than he has in most of his direction of the NHS. I shall applaud the event. I am sure that some Labour Members will, too. However, I do not believe that it will happen, any more than I believe that I shall see pigs airborne tonight.

We have heard about local government being a forum within which complaints can be addressed. Usually, local people fail to regard local authorities as impartial. Instead, they regard them as party political institutions. Local government is not genuinely objective. The joint responsibility that it has with the NHS in the social services sector gives it a vested interest that CHCs do not possess.

We have heard, too, about the patient advocacy service. If patients are to have confidence and feel that their complaints are properly addressed, NHS hospitals need a clear line of command. There should be one chief executive, to whom complaints should be addressed. He should address them properly, answer them and meet any

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failings in the service with the necessary changes, and, if necessary, alterations of style and method of service. However, this does not happen.

All too many hospitals have a shared boss. In the part of London that I represent, one section of Mount Vernon, a major hospital, has, in essence, a head who is the boss of three other hospitals. How will that give confidence to patients? How does it give staff the authority to know to whom they should refer? It is a recipe for chaos. That is why even a patients advocacy service in a hospital is not the right mechanism. One wants a clear line of command, and the man or woman in charge at the top to take full responsibility for everything that goes on in the institution.

Mr. John Hayes (South Holland and The Deepings): Does not the difference between existing practice and that advocated by Government Members as a replacement centre on the fact that the existing system is well tried and tested, well understood by many people and involves many good people who are already giving service? If it is working, why change it? If it ain't broke, why fix it? Is that not the difference between what my hon. Friend is proposing and what was proposed by Government Members?

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