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Mr. Wilkinson: As so often, my hon. Friend is right, and he makes his point succinctly and clearly. I suspect that there is a malign motive: CHCs, by and large, do their job so well that they show up the deficiencies of the NHS and reflect the foolishness of many public policy decisions taken by the Government.

Mr. Dawson rose--

Mr. Wilkinson: I shall now give way to the hon. Member for Lancaster and Wyre (Mr. Dawson); I accept that I ought to have given way to him earlier.

Mr. Dawson: Does the hon. Gentleman accept that CHCs are not powerful enough? They often end up making their point by shouting from the sidelines. Does he further accept that putting a representative from a patients forum on the board of every trust undermines all the pejorative remarks that he has made about the new system of representation?

Mr. Wilkinson: The hon. Gentleman makes an extremely wise point, with which I have considerable sympathy. If he studied new clause 2, he would see that we propose that there should be 12 months from the enactment of the Bill for the Secretary of State to consider appropriate reform of CHCs. The Secretary of State would have time to get it right. The Government bounced abolition of CHCs on an unwitting public, with no consultation or prior notice.

Under subsection 4 of the new clause, the Secretary of State would be bound to

It is therefore essential that he appoints individuals with qualifications, impartiality and commitment to public service, which are all attributes that would give confidence to local communities and those whom they would represent. Last but not least, Parliament itself

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would have to consider whether proposed reform was wise. We would have to judge it, with debate on a statutory instrument giving effect to the proposed reform.

To conclude, the hon. Member for Lancaster and Wyre suggested that the CHCs were not powerful enough. As I said, I am sympathetic to that view. However, the problem also lies with Whitehall and Secretaries of State who believe that they know best. The official objections lodged against proposed changes to the NHS--such as the closure of Harefield hospital, to which my local CHC, along with Brent and Harrow, have lodged official objections--should be taken seriously by the Secretary of State and acted upon through modifications of policy and changes to bring public policy into line with the wishes of local communities. Because the Government seek to impose their will, Soviet-style, on local communities, there is frustration and a feeling of impotence, which can be best addressed by the retention of CHCs and their intelligent reform, as proposed by new clause 2 and the Opposition's related amendments.

Dr. Stoate: We have now had CHCs for about 25 years. Listening to Opposition Members, one would think that everything in the garden was rosy and that there was no cause for concern whatever. Even on the admission of Opposition Members who have spoken, the service provided by CHCs is at best patchy. There are some excellent ones: the CHC serving Dartford and Gravesham is a good one, and I have an excellent relationship with it. I have been a doctor for a long time and, time and again, I hear of cases in which CHCs have failed patients or been unable to help them in the required way. I shall give some examples.

CHCs have no role in primary care. Opposition Members talk about CHCs as if they were wonderful. However, although the Tories were in power for 18 years, they never addressed the fact that CHCs have no role at all in primary care. My practice is immune to CHC interference, which is illogical. If everything was so wonderful, why is performance so patchy, why do CHCs have no role in primary care and why are they unable to investigate when primary care services fail or when premises are substandard and patients consequently get a bad deal? That is an illogical situation.

There is no consistent advocacy role across the country. Some CHCs, including my own, provide an advocacy service. Others, however, do not. There is no requirement for them to do so, so patients in some parts of the country have no access to advocacy. If CHCs were uniformly wonderful, surely that sort of thing would be provided by all CHCs? Given that the Opposition were in power so long and did not address those issues, one wonders what was their understanding of what was going on in the community and the health service.

Mr. Burstow: Does the hon. Gentleman accept that he is making a case for reform to drive up standards to the best standard? Has he considered new clause 7, which my hon. Friends and I tabled, which specifically extends the role of CHCs to cover primary care and deal with advocacy?

Dr. Stoate: The hon. Gentleman makes valid points, and I agree with some of them. However, the bottom line

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is that doing nothing is not an option. For far too long, CHCs have provided a complacent service in some parts of the country, which has not worked. We need radical reform; how that reform is carried out is a subject for debate, and which proposals we accept are a legitimate concern for the House.

Making the advocacy service uniform across the country is the right way forward. Patient advocacy and liaison services, which will provide a point of contact in every hospital, are the right way forward. If wards are dirty or showers are not working, there will be somebody on site who can call the management to account then and there. Recently, the House heard how the mortuary in Bedford hospital had rusty hinges on its doors. PALS could pick up and sort out that kind of thing, avoiding some of the tragedies that have occurred. We have to have that radical reform.

It is equally important that we make sure that patients feel as if they are at the centre of the NHS. Although it is important that patients get a good deal, it is also important that they feel they are getting a good deal. In too many parts of the country, they do not feel that. The Government's proposals on patients forums go a long way towards dealing with that. However, there is clearly a problem.

Some patients and some people in the community feel that patients forums might be too close to the health authority, the trust or the local authority. The umbrella organisation--the patients council--suggested by my hon. Friend the Member for Wakefield (Mr. Hinchliffe) is surely the way forward. That could give a sense of overriding impartiality and independence, and would encompass all the reforms under one umbrella.

When I discussed the idea with members of my CHC earlier today, they were reassured by the proposal and think that it would go a long way towards addressing their legitimate concerns. I do not want to belittle CHCs. They have done a marvellous job, they are a well-intentioned group and they include some excellent people, but the service is not uniform. For far too long, patients have been sold short because they have not received the uniform, guaranteed level of service that they have a right to expect in the 21st century.

Opposition Members tell us that everything in the garden is rosy, when clearly it is not. They failed to address the problems for 18 years. [Interruption.] I do not mean the Liberal Democrats; I am referring to the previous Government. I believe that the Liberal Democrats have honourable intentions on the matter and I do not dismiss what they say. I do not believe that they have the right ideas, but I do not belittle what they do.

Mr. Gordon Marsden: Does my hon. Friend agree that it is the height of hypocrisy for the Conservatives to complain about postcode rationing, as they do so often in their rhetoric, when they are prepared to continue the system of community health councils which leads to that?

Dr. Stoate: My hon. Friend makes an excellent point. Effectively, there is postcode rationing through CHCs. There are excellent ones in some parts of the country, and others that are unacceptably poor. My hon. Friend the Member for Wakefield and I are asking the Government to consider how we could get the best of all worlds--

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a truly uniform service under the umbrella of patients councils, which will ensure that patients get a good deal, wherever they live.

Mr. Fabricant: I have been listening to the hon. Gentleman's rant, but he clearly has not read new clause 2. The Opposition recognise that everything in the garden is not rosy, despite what the hon. Gentleman says. That is why we propose in new clause 2 that there should be reform. He proposes throwing the baby out with the bath water.

Dr. Stoate: The hon. Gentleman has not been listening. That is precisely what I suggest we should not do. His party was in government for 18 years, and has finally come round to the idea that there ought to be reform. That is laughable. The Conservatives had a long time in which to do something, yet they did nothing. We are proposing radical reform and, more important, reform that brings benefits to patients, uniformity of service, an advocacy role and the guaranteed impartiality of the umbrella suggested by my hon. Friend the Member for Wakefield, which I hope Ministers will accept.

8.30 pm

Mr. Stephen O'Brien (Eddisbury): Let us start at the beginning and not lose sight of how the issue arose; perhaps then it would be proper to ask about the motivation behind the Government's summary decision to scrap community health councils.

There was a consultation exercise on the NHS, which was not well responded to. It is rumoured--we do not have the findings--that the few respondents who referred to CHCs generally did not know much about them. Let us consider why that might be. Although they were not originally expected to deal with complaints, CHCs have grown to be the body in which patients have confidence and which they trust to deal with their complaints, because CHCs are seen to be independent.

One of the reasons for the success of CHCs is that patients, who are often vulnerable at this stage, or their relatives, have been able to engage with them in trust, because CHCs have tended not to trumpet what they do. With their knowledge, expertise and volunteer spirit, CHCs have sought to resolve problems, and only when a resolution was not possible, after exhaustive efforts, were formal procedures initiated to take a complaint forward and ensure that it was properly resolved in accordance with the patient's rights.

It is not right to think that because CHCs are not generally known, they should be abolished. Surely a Government using the rhetoric--but not the substance--of meritocracy would look at the worth of CHCs, not seek to abolish them because they were not known.

I was more hopeful about what the Chairman of the Select Committee, the hon. Member for Wakefield (Mr. Hinchliffe), would say, and I eagerly awaited his comments. I found his speech disappointing and not as dispassionate as I had hoped. It brought to mind Churchill's remark when he was told that there was a new hon. Member in the House called Mr. Bossom. He said, "Oh dear, poor man. Neither one thing, nor the other." That was very much my reaction to the speech of the Chairman of the Health Committee. It is not possible to argue for independence and at the same time to trumpet

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the potential benefits of structures whose purpose is to expose the difficulties of the very institutions of which they are part.

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