Health and Social Care Bill

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Mr. Burstow: What struck me as I read the NHS plan, the explanatory notes and the briefing paper is that the Government have managed to create a feeling of anti-synergy--the sum of the parts of this new structure will be worth less than the whole, and will reduce and diminish because they do not connect one with another. They do not enable the picture and patterns of individual complaints to be discerned. As a result, we will not benefit from synergy: we will lose synergy in this new system. CHCs may well have their flaws, but at least they integrate the various aspects of individual complaints and have an overview of the system as a whole. At their best, that is what they should and can do, and that is why we need reform.

Lorna Fitzsimons (Rochdale): The hon. Gentleman is worried about trusts ``getting away with it.'' Surely the easiest way for them to get away with it is under the current system, because patients have nowhere to go and do not go anywhere, so complaints do not get heard.

Mr. Burstow: The hon. Lady will have to excuse me, but we are debating the Government's proposal to abolish CHCs. We are discussing what the Government propose to put in their place and whether that will be better than the current system and better than instigating reform. Twenty years have been invested in CHCs: they have 20 years of experience. One of the arguments advanced for abolishing CHCs is that the variability of their performance depends on their individual members and officers. The Government's argument that a CHC's effectiveness is down to the performance of the individuals in it surely begs the question whether any new organisation would be any better. All the organisations will need to use human beings to carry out their tasks, and their performance will vary. Human beings are fallible, and that is particularly relevant, given the report that we shall hear about later.

Lorna Fitzsimons: Will the hon. Gentleman give way?

Mr. Burstow: I am happy to take an intervention, but I have barely started and do not want to delay the Committee unnecessarily.

Lorna Fitzsimons: Does the hon. Gentleman accept the main point made by my hon. Friend the Member for Colne Valley? CHCs, as currently constituted, do not deal with the problem caused when there is no one in situ--as with the patient advocacy and liaison services--and someone needs help there and then, especially if there is a problem with the consultant and a patient feels that he has not been properly understood and represented.

Mr. Burstow: The key words are ``as currently constituted''. I shall address that point later as I deal with the amendments. The theme of this debate about abolition is ``if it ain't broke don't fix it''. We believe that the Government have failed to carry the argument for abolition of the community health councils. They have failed to persuade patients and professional organisations of their case--certainly according to the evidence we have had from representations. On Second Reading, some Labour Members also expressed concerns and are yet to be persuaded. This area of concern is one of the reasons why the Liberal Democrats voted against the Bill.

The proposals for patient empowerment and the abolition of CHCs were important for us. Our central opposition to the clause is based on the fact that it will result in the fragmentation of the work currently undertaken by CHCs, which will be divided among a number of bodies that have no clear linkage and no co-ordination. Patients come into the NHS at different stages and follow different care pathways. It is crucial to test any new system of patient representation and advocacy to ensure that it is able to cut across the boundaries of the different agencies and providers of care that come into contact with patients. It has to be patient-centred, which is a key part of what we understand to be the Government's aim for the NHS as a whole. The fundamental weakness of the Government's plans is that they are provider-centred.

The structures are based around providers rather than around patients.

11.30 am

We learned from the briefing material provided by the Minister last week that the Government accept that some CHCs are doing ``a very good job.'' However, Ministers go on to say that CHCs are very dependent on the individual officers and members. Where is the evidence that the replacement system will be free of the failings that the Government have identified in the CHCs? Performance and overview committees, patients forums, the patient advocacy and liaison services and the independent local advisory forums will all depend on members and officers who are perhaps equally as fallible as those currently involved in CHCs. It is striking how easy it is to construe from the explanatory notes, the briefing paper and ministerial statements that these proposals have been developed on the hoof, and are being re-written time and again. Indeed, the role of PALS is being re-written almost daily.

We learn from the explanatory notes that the overview and scrutiny committees and the patients forums, which will constitute the successors to CHCs, are the core of these new arrangements. They will have the statutory backing that the Bill provides. At best, however, those two bodies will have no more power—possibly less—than the CHCs that they are intended to replace. I accept entirely that some of those powers may not have been exercised as hon. Members would have wished, but the powers in the National Health Service Act 1977 are there to be used. At worst, the two bodies will represent a dilution of those powers by splitting up the inspection and scrutiny functions.

The scrutiny role will be left without the insight and intelligence that inspection brings. Furthermore, separating handling of complaints from scrutiny denies the overview function the ability to identify common problems and trends thrown up by complaints. Under the Bill, there is no obligation on patients forums to work with local authorities in exercising their overview function, and some aspects are not covered by any legislation. We are told in the explanatory notes:

``The new arrangements are to be supplemented by two new non-statutory arrangements, Patient Advocacy and Liaison Services (PALS) and Independent Local Advisory Forums''.

However, the briefing notes that the Minister rightly circulated to the Committee state that the Government see the advisory forums as providing an arena for patients to have their say about the whole local health economy. That is an important role, but the advisory forums will gather the views and experiences of all patients in their areas. If that important role is as the Secretary of State and Ministers have said in their briefing paper, why is it not dealt with as a specific measure in the Bill? Why is there shortly to be a dramatic expansion in the areas that health authorities cover? Health authorities in London are being reconfigured, so these new advisory bodies will be very remote when it comes to dealing with and drawing together the everyday experiences of patients.

All the matters that these area advisory groups and the patient advocacy and liaison services cover are discretionary and at the behest of the Secretary of State. They are not covered in the Bill. As with the advisory forums, the powers are not covered in the statutory provisions that are before us. Their role, as mentioned by the hon. Member for Rochdale (Mrs. Lorna Fitzsimons), appears to be more akin to that of a customer care manager, or even a concierge. The explanatory notes talk specifically about them being

``Situated in or near main reception areas of hospitals and act as a welcoming point for patients and carers.''

I am sure that that is a valuable role, and that the descriptions given in the briefing notes show an important augmentation of the existing system to address concerns. However, what about accident and emergency departments, where people have experiences of poor service? What about on the wards themselves? I think the most revealing phrase of all in the briefing notes is the heading on page 5:

``Guiding the patient through the system''.

In my view, CHCs provide a readily identifiable independent one-stop service for patients. That is clearly not the opinion of everyone in the Committee, but it is the experience of many people, to judge by the evidence that I have seen. More could be done to ensure that people are aware of CHCs. We will have a confused and confusing set of arrangements in their place, so a guide will certainly be necessary.

I asked the hon. Member for Colne Valley about my concern that the Government are putting the cart before the horse, as they are reviewing the NHS complaints procedures, and the results have yet to be published. Before we have had the benefit of seeing the complaints procedures, we are designing an infrastructure around which they will operate. It would seem more sensible to design the complaints system and then to decide on the independent elements designed to work with it.

The issues of costs has been explored at some length. I hope that the Minister will be able to tell the Committee how much extra will be pumped into the system. More specifically, I hope that he will confirm that about one twentieth of patient care budgets will be diverted to pay for patients forums. That may not seem a large proportion of those budgets, but every penny for patient care should go to patient care, not be siphoned off to fund new bodies. If the Government are committed to making the changes work, new resources should be committed to make them work effectively.

As I said, for the theme for our deliberations, we should take the adage, ``If it ain't broke, don't fix it.'' I do not have a misty-eyed view about the perfection of CHCs, and other hon. Members have made similar points.

Dr. Brand: Does my hon. Friend agree that it is rather sad that awful CHCs have not been tackled using existing powers? The Secretary of State has enormous input into decisions about who serves on CHCs, as do local councils. I have been concerned about the poor performance of CHCs from Labour areas.

 

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Prepared 30 January 2001