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Dr. Liam Fox (Woodspring): I shall be relatively brief.
None of us expected quite such a rapid victory for common sense as we have been seeing in the Chamber today. I share my hon. Friends' disappointment that the Secretary of State could not attend this debate and eat humble pie himself. It seems that he finds that diet unpalatable, and that the Prime Minister's three-week humility does not apply to all his Cabinet Ministers.The Minister was scrambling round for a description of the Government's position as a consequence of their position on the Lords amendments, but I shall try to help him. Climbdown, U-turn and humiliation are all reasonable descriptions of his position today.
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As for the Minister's unmitigated drivel about the need to protect free nursing care, which is Conservative party policy, it really was a very poor excuse indeed. However, I am sure that he will have the gratitude of at least some of his Back Benchers for abandoning one of the most ridiculous and disastrous policies to emerge from the Department of Health in the past four years. We shall not divide the House, as we agree with the position that the Minister has taken on the Lords amendments. The effect of what the Government are saying today will be simply to return us to the status quo, which is where we wanted to be all along.
There would have been no need to have ridiculous and lengthy debates on the subject only to arrive back where we started, if only Ministers had been willing to listen to representations that were made the length and breadth of the country, by those of all party political persuasions and none, to the effect that this was a poor decision that was not in the interest of patients and only in the interests of those who wanted a lapdog rather than a watchdog for patients.
The Lords amendments will return us to the position that community health councils are currently in, acting as a one-stop shop for patients. The community health councils that were created by a Conservative Government in 1973 offer free labour to the NHS worth £8 million a year. Each year, community health councils assist about 30,000 people, yet they were kept in the dark about the Government's plans.
When Ministers were asked about consultation they did not accept that ACHCEW--the Association of Community Health Councils for England and Wales--or the CHCs themselves had any legitimate expectation of consultation on the proposal that CHCs should be abolished through primary legislation to be introduced in Parliament in due course. That arrogance was one of the main reasons why their Lordships were unwilling to accept the Government's plans. In addition, apparently the Government had no idea of what would happen to CHC staff or the records that were kept by CHC. All that made a poor situation overwhelmingly unsatisfactory. The overwhelming view on both sides of the House, which is held by everyone except those on the Government Front Bench, is that there should now be a reform rather than abolition.
Government Back Benchers who might have taken some short-term comfort from the Minister's words may not be so happy when they read the Department of Health press release that says that, should the Government be
re-elected, they propose to continue with the abolition of community health councils. It will therefore be increasingly clear up and down the country that those who have been helped by community health councils, those who assist community health councils and those who work for community health councils will know that a vote for the Conservatives will keep the community health councils and a vote for Labour will abolish them.
Mr. David Hinchliffe (Wakefield): I very much welcome the fact that the Government are going back to the drawing board on this issue. That will come as no surprise to anyone who has heard my previous comments on the Bill. On Second Reading, I said that the Bill
- "contains many positive measures, but also some that need to be given further thought . . . Of particular concern are the proposals in clauses 7 to 14, regarding scrutiny and complaints . . . I feel that there has not been adequate public consultation and discussion . . . I get the distinct impression that the proposals regarding CHCs and scrutiny were something of an afterthought."--[Official Report, 10 January 2001; Vol. 360, c. 1104-105.]
On Report, I moved the new clauses in respect of patients councils in order to create an umbrella body that would draw together the various forums, reflecting the role that CHCs have undertaken over many years and the advocacy service to which the Government have agreed. I said:
- "I make no bones about the fact that I am proposing a framework that needs to be examined in more detail."
- "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."--[Official Report, 14 February 2001; Vol. 363, c. 395-96.]
The Lords amendment does not reflect the importance of the patients forums, which will be front-line bodies that will play an important role. I understand the reservations of my right hon. Friend the Minister on that point and I also understand the difficulties involved in the continuity question. I welcome the Government's willingness to make further proposals in that area.
The hon. Member for Woodspring (Dr. Fox) said that we were back to the status quo, but he is wrong. He nodded a moment ago when I mentioned independent advocacy, which is a major step forward, and I am sure that he--and the Liberal Democrats, given their previous position--will support that reform.
Dr. Fox: If I may clarify the position, I meant that we are back to the status quo for the CHCs, and we welcome
the additional proposals. Will the hon. Gentleman return the favour by telling us whether he will campaign in the general election on his party's ticket to abolish CHCs?
Mr. Hinchliffe: I made my position clear on Second Reading, when I said that the CHCs' functions need to be radically reformed, and the hon. Gentleman is well aware of that. I was a member of my local CHC for many years, and its members know that I believe that we need to modernise that scrutiny function and reflect the marked change in the whole direction of the NHS that has taken place, rightly, under this Government.
I would welcome the assurance of my right hon. Friend the Minister on whether the advocacy arrangements proposed in the Bill will ensure, as the Health Committee suggested, that the advocacy function can be placed temporarily with CHCs, so that patients have a clear, independent voice. I would also welcome his comments on where the advocacy function will be placed, as the Bill stands, and on the current position of CHC members, who are hard-working volunteers and need some assurances about their future role.
I am also concerned about the position of the staff of CHCs and of the Association of Community Health Councils for England and Wales. Serious questions have been raised about their their job security and future role. Those people have done a good job in many respects and I would be grateful for my right hon. Friend's comments. I also wish to praise the work of Donna Covey at ACHCEW; she has attempted to work closely with the Government and other parties, in difficult circumstances, to reach some solution that will reflect the concerns of those who want a modernised system.
Patients also need some assurances about the interim period. Will they still have access to CHCs carrying out the functions that they now perform? Can my right hon. Friend confirm my hope that the advocacy function will be available, once the Bill takes effect, within CHCs to assist patients in a way that many of them are not now assisted?
Mr. Nick Harvey (North Devon): The Government's proposals started out as a curate's egg and ended up as a dog's breakfast. We have taken the view from the beginning that what the Government proposed had three essential flaws. The first was a lack of independence in the arrangements. The second was a lack of cohesion--we were concerned that the system would be so fragmented--and the third was that no national body was proposed that would provide a voice for patients at national level.
During the progress of the Bill, some of those issues have been addressed in part. For example, the patients forums were taken away from the trusts, which originally were to fund and establish them. The provisions for independent advocacy also increased the independence of the new arrangements. The Government conceded in the other place that there should be a national body to represent patients at national level.
Just as the Bill was leaving this House, an amendment tabled by the hon. Member for Wakefield (Mr. Hinchliffe) proposed the creation of patients councils. That would have gone some way towards addressing the point about cohesion. We believe that patients councils could have become very worthwhile bodies, especially given the
bigger health authority footprint that is now being talked about, and that they should have been responsible for the independent advocacy service.The House of Lords, when it considered the amendment, wanted to put patients councils on a firmer footing. Their Lordships wanted the councils to be clearly marked out as successor bodies to the community health councils. It is regrettable that the Government did not feel able to accept that, but they seem to have concluded that it would be better to go back to a blank sheet; and we do not intend to obstruct them in that.
We will have to return to this matter, both during the election campaign and after it. If we are going to start from a blank sheet of paper, I hope very much that any decision made by the House about future arrangements for patient representation will provide for a set-up that is strong, independent, coherent, properly funded and represented by a national body.
The Government will feel some embarrassment that they have had to withdraw their proposal at this stage of the Bill's progress. The proposal was always flawed, but I have every hope that, after the election, we will arrive at an arrangement that is in the best interests of patients.
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