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Mr. Patrick McLoughlin (West Derbyshire): On a point of order, Mr. Speaker. Would it be in order for the
Minister to tell us whether he is agreeing or disagreeing with the Lords amendment and, indeed, what he is talking about? We have one hour only.
Mr. Speaker: The Minister is in order at the moment.
Mr. Speaker: The Minister is drawing a fine line.
Mr. Denham: I have sought to set the context. The Lords amendments set out proposals and amended proposals for a system of patient representation and empowerment. I hope that it will be possible to set out the Government's intentions in this Bill in trying to reform the system of patient representation, how the Lords amendments would affect that and the reason for the position that we take on the Lords amendments. I am very much in your hands, Mr. Speaker, but I hope that that approach will be acceptable.
Mr. Speaker: In my experience amendments tend to be narrow and it is best to keep to the amendment before the House.
Mr. Denham: We set out radical reforms to the system of patient representation in the NHS plan. As the Bill progressed, the system was incorporated in many amendments. The Bill provided for patients forums, and we said that we wished to co-ordinate their work locally. We established a group to consider the representation of patients through a national patients body. It recommended that the body should be statutory, and such a provision was included in the Bill in the House of Lords. Government amendments and those tabled by others, such as my hon. Friend the Member for Wakefield (Mr. Hinchliffe), led to a radical and powerful Bill for patient representation. However, the amendments that were made in another place wreck the Government's approach, to which the House of Commons had made amendments.
The key amendment is technically and legally unworkable, and it would not provide the structural change based on independent patients forums or the important shift towards the direct representation of patients and carers that lie at the heart of the Government's proposals. The part of the Bill that we are considering is controversial, and I believe that, before the Lords amendments, the measure was a significant improvement on the original. It reflected much of the discussion that took place inside and outside Parliament. Many people, including many in community health councils, will be disappointed that the provisions will be withdrawn.
At this stage of a Parliament, progress on Bills depends on the rapid agreement of both Houses. Several Bills have already fallen because such agreement was unattainable. The most disgraceful example is the Tobacco Advertising Bill, which has fallen because of Conservative party--
Mr. Philip Hammond (Runnymede and Weybridge): On a point of order, Mr. Speaker. Is it pertinent for the Minister to mention a different Bill when we have only one hour to debate the measure?
Mr. Speaker: Regardless of the time available, all hon. Members, including Ministers, must keep to the amendment that we are considering. It is a narrow amendment.
Mr. Denham: I hoped to draw attention to the fact that other Bills had suffered the same fate as the part of the
measure that we are considering. We made significant efforts to find an agreed way forward in the light of the Lords amendments. However, given the time constraints imposed by an impending general election, it is clear that the Bill would be jeopardised unless we removed the clauses that related to patient representation.We are determined to empower patients more. However, we are also determined to lift the burden of nursing costs from elderly people and their families as soon as possible; indeed, from October. We shall give up the clauses because we are not prepared to put at risk free nursing care for the elderly. We are determined to fulfil our commitment to pensioners.
The amendments that we have tabled, alongside the Lords amendments, will remove the necessary clauses from the Bill. We agree with Lords amendments Nos. 7 and 8, which remove the clauses on patients forums and patients councils. We disagree with Lords amendments Nos. 14 and 4 to remove any link between independent advocacy and patients councils. Lords amendments Nos. 16 and 17, with which we agree, ensure that CHCs will continue. We must therefore disagree with Lords amendment No. 15, and thus remove the national patients body. We regret its loss and believe that the proposed wider role and membership, and the opportunity to include voluntary organisations that represent patients, would be a considerable step forward. However, we cannot have two national statutory bodies that both seek to represent patients and the public. We must therefore withdraw the proposals for the new body.
We must reconsider how to pick up the proposals from the feasibility study, that we established on national patient representation. It was carried out for the Department by a consortium of leading patients' organisations. We do not wish to lose sight of the vision that it set out in its report.
We oppose Lords amendment No. 6, which seeks to transform CHCs into patients councils and reduce patients forums to mere sub-committees of CHCs. As I said earlier, that does not offer the basis of a realistic or workable way forward. The clause is technically deficient. If it were left on the statute book, it would lead to future arrangements for patient representation being decided in the courts rather than in the House. Consequential to that position and the removal of patients forums and councils are our amendments Nos. 1, 2, 3, 5, 6, 7, 82 and 83, which remove clauses 14, 15 and 16, and further technical changes. The Government also disagree with Lords amendments Nos. 10, 11, 12 and 13, which would have amended the clauses relating to patients councils and forums.
It might be helpful if I summarise the effect of the Government's proposals on the relevant legislation and policy. Although the effect of the amendments would be to leave the legislation governing community health councils as it stands, the Bill will still introduce significant changes. Overview and scrutiny committees of democratically elected councils will scrutinise the NHS, a change that has been supported in both Houses and was unaffected and unchallenged by the Lords amendments. The change has broad support and we will want to ensure that it is implemented. Among other things, overview and scrutiny committees will be given the role of referring local service change proposals to the Secretary of State
and the independent reconfiguration committee when the committee does not think the proposals are in the interests of the local population.The Secretary of State will still have the responsibility introduced in this place to ensure the provision of an independent patient advocacy service, which also will be widely welcomed. The first patient advocacy and liaison services are now being established in trusts across the country, often involving former CHC staff.
My right hon. Friend the Secretary of State has recently set out our plans to have far fewer, but more strategic, health authorities. The move to 30 strategic health authorities has been widely welcomed.
Mr. Hammond: On a point of order, Mr. Speaker. Could the Minister be asked to clarify to which Lords amendments those specific points relate?
Mr. Speaker: We must allow the Minister to express himself as he wishes to express himself.
Mr. Denham: It might be useful to the House and for the benefit of Conservative Members--I have no intention of talking out this debate--if I set out as clearly as possible the legal and policy position that would pertain if the House were to follow the advice that I am giving on the Lords amendments that we wish to accept, the Lords amendments with which we disagree, and the Government's own amendments. I am briefly setting out that scenario.
I have made it clear--perhaps I need to repeat the points--that, although the legal position governing CHCs would remain as it is, there would be consequential changes to the Bill. Overview and scrutiny committees would take on the role that we have set out for them, and the Secretary of State will have a responsibility to provide independent patient advocacy services.
The move to 30 strategic health authorities is one of the matters that will govern change in the future. The change has been widely welcomed as part of our commitment to devolving power and resources to the front line. It would be ludicrous to assume that patient representation can be championed effectively by ever-more remote committees. What is needed is patient representation within every NHS organisation. We shall still seek to establish patients forums, which are an essential tool if patients are to challenge and change each part of the NHS. Although we would need further legislation to give them the statutory independence that we would like them to have, non-statutory forums can be established in the interim.
Change is therefore inevitable. We will have to return to those matters after the election and further legislation may be necessary. However, as we have said from the beginning, any change must be as seamless as is practical and make the best and most appropriate use of the skills and expertise that are already within the system.
Mr. Speaker: Before I call the next hon. Member, I must draw the House's attention to the fact that privilege is involved in Lords amendments Nos. 15 and 66. If the House agrees to either of those amendments, I shall ensure that the appropriate entry is made in the Journal.
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