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Dr. Peter Brand (Isle of Wight): Is the hon. Lady suggesting that whatever replaces the CHC should be absolutely populist and always support popular campaigns to save a national health service provision, however suitable, modern and relevant it is to today's world? If she is saying that, she is treading an extremely dangerous line. Kali Mountford: I do not think that I came anywhere near saying such a thing. However, consultation with patients and the community is essential. If we change anything, the people for whom we are changing it—mainly the patients—must have confidence in what is happening. That brings me to my other point, which concerns my own experience. When an accident in surgery happened to me, I was alarmed to find that the process for dealing with my complaint about it was extremely difficult. I have been in hospital several times recently—it is unusual to have the experience of being a Member of Parliament on a ward—and people were approaching me all the time. I was alarmed to find that no one knew how to access the service of the CHCs, and that hardly anyone had heard of them. That is a major flaw in the present process. Regarding confidentiality, of course I would like to know what would happen to my own records. However, the CHC—inadvertently, I hope—gave information about me to another organisation, and even to another patient about whom information was then given to me. I have, therefore, experienced some terrible flaws in the CHCs and must deal with the problems that I have experienced personally and look at how the damage that is being done, to other patients and to myself, can be repaired. I have not felt well served, as a patient or as a representative of the community, by what has happened so far, and I have been lobbying since 1997 to change the structure of CHCs. Dr. Fox: Will the hon. Lady give way? Kali Mountford: I will do so when I have finished this point. Opposition Members are entitled to argue that reform could be an option, but experience tells me that whatever reform takes place, CHCs are too distant from patients and not closely enough tied to the places in which patients experience problems: that is, GPs' surgeries and hospitals.
11.15 amDr. Fox: The hon. Lady has mentioned the important subject of patient access and knowledge of where in the system to go for redress. Under the Bill, to whom should a patient complain after encountering a problem with a GP, the ambulance service and the acute trust during a single episode of illness? Kali Mountford: The hon. Gentleman will be surprised to learn that patients in hospital expect some service there. I have now represented several patients who have had unhappy experiences, and in all cases their first port of call was the place about which they were complaining. That may surprise some Opposition Members, but most people with a complaint about a service will go back to where they received it. Mr. Burstow: The hon. Lady is developing an important point about the operation of CHCs, and about how we could deal with some of the problems. However, the Government are reviewing NHS complaints procedures. Does she agree that it would be better to design the architecture for the new system once the new complaints procedures have been revealed? Kali Mountford: I completely understand the hon. Gentleman's point, but it does not detract from the main thrust of my argument, which is that people feel that CHCs have not always represented them well. Whatever new procedures are set up, my experience gives me no confidence that CHCs would be any better. Whatever the structure in which complaints are dealt with, access to the structure is important. I strongly believe that access needs to be where patients most expect it, which is where the service is provided. Dr. Brand rose—
Dr. Fox rose—
Kali Mountford: I have a choice; I shall take the hon. Member for Isle of Wight (Dr. Brand) first. Dr. Brand: The hon. Lady is developing an important line of argument. It is important for people to receive support while they are in hospital or during an episode of primary care. Of course, most hospital trusts and all primary care practices have internal complaints procedures and internal liaison procedures. However, although in an ideal world those would be enough, does the hon. Lady recognise that in the real world something outside that arrangement is needed to support the patient when, for example, a multiplicity of organisations is involved? She has described something that is essential, and I am sad that she has had such poor experience in her area. Perhaps the Sheffield councillors on CHCs who advise hospital trusts should have done a better job. The Chairman: Order. That was a long intervention. Kali Mountford: I take the hon. Gentleman's point, although patient advocacy can be dealt with separately within an organisation. I do not think that it is impossible, as the hon. Gentleman seemed to suggest, to make distinctions within an organisation between the people and services about whom complaints have been made and the person who deals with the complaint. Dr. Fox: I entirely sympathise with the point that the hon. Lady is trying to make about single-point access to a system. Nevertheless, does she accept that whereas a patient encountering a problem with primary care, the ambulance service and the acute trust can, in the current system, make a complaint at a single access point, namely the CHC, under the proposed system patients will have to make three separate complaints at different points of access? That will not empower the patient; it will fragment the process of complaint and redress. Kali Mountford: The hon. Gentleman seems to have missed my point completely. I find that patients are not doing anything at present. Once they have made an approach to one of the organisations—for example, a hospital's patient advocacy unit—I would expect them to be advised as to whether they need to make further approaches. At least they would have made the first approach. I find that patients are making no approach to get advice at all. Often, they just suffer in silence from the bad service that they have received. We should be able to use the information that is gathered. When I asked whether there was any information that would help me in my own case, whether there were other patients who had experienced something similar, and whether there was a case for a certain doctor to go back and be retrained in the technique that was used in my surgery, I was told that no such information was held. We need that sort of information. In my experience as a representative, a councillor, a Member of Parliament and member of the community and, above all, as a patient, the organisation is far too cumbersome, remote and distant from patients. It needs vital reform. If that means creating something completely new, I am all for it. Mr. Burstow: I shall start by picking up on some of the points raised by the hon. Member for Colne Valley (Kali Mountford). We should be debating the reform of CHCs, not their abolition. Some of the amendments provide hon. Members with an opportunity to allow that debate to proceed as an alternative to throwing the baby out with the bath water. I suspect that some of the hon. Lady's criticisms, drawn from her experience, will find an echo in all parts of the House. The performance of the complaints procedure could accurately be described as patchy. Equally, it has been acknowledged by the Government that the CHCs have done a very good job. I want to return to that point, and develop our view in asking some questions about how the matter will proceed. The hon. Lady made a case for reform—she used the word herself in her conclusion—not abolition. The clause contains a proposal to remove the structure and substitute a new set of structures. I want to analyse some of those new structures to see whether they will allow effective scrutiny of our health service. Will the Minister tell the Committee who, in the new set-up that the Bill will establish, will be responsible for undertaking such work as Casualty Watch? At the moment, CHCs, locally and perhaps regionally, take periodic snapshots of the performance of accident and emergency departments, recording the length of waits on trolleys, the age profile of the patients and the nature of the condition that they are waiting to have treated. That is invaluable, independently gathered information, which gives an insight into how that sector is performing. I hope that the Minister will tell us how such surveys will be conducted in future. Can he tell us why, at the end of last year, there were delays in finalising the funding settlement for CHCs at a national level? That appears to have delayed, if not put off altogether, the nationwide Casualty Watch, which usually takes place in January or February. The Minister of State, Department of Health (Mr. John Denham): I am worried that my response may be rather lengthy. Patients forums will be able to, and will, carry out activities such as Casualty Watch. I do not know why the nationwide Casualty Watch did not take place, but I have no reason to believe that it had anything to do with the funding of CHCs. Mr. Burstow: Perhaps we can return to that, but it is certainly my understanding that there were delays in finalising the funding settlement for the Association of Community Health Councils for England and Wales, which made it much more difficult for it to plan sensibly for a Casualty Watch exercise in the coming period. Dr. Fox: Does the hon. Gentleman share my suspicion that this measure is not about increased scrutiny, but about decreased scrutiny, as a body under the auspices of a trust is less likely to be willing to criticise that trust? Under the new arrangements, local government will provide the care, so will be less willing to criticise its own provision of care. Does not that undermine objective criticism of services?
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