Health and Social Care Bill

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Kali Mountford: I should like to clarify that at no point did I say that CHCs, or any other body, should simply take up populist campaigns. However, I felt that they were not responsive enough, and that they did not listen to the public. The service is, after all, aimed at the public.

Dr. Brand: I am not sure whether that is much of a clarification. Clearly, CHCs should listen to the public. In fact, they should take the lead in public consultation, but that is not the same as—to use the hon. Lady's term—responding. One listens, evaluates and then takes a position. That is the same as our role in Parliament. We do not respond to every pressure group that wants to keep a particular hospital or accident and emergency department open. Hopefully, we receive briefings on the underlying reasons for changing the configuration. We can then decide whether the change is sensible.

The proposals are a mixed bag. The PALS system is fine, and I think that all well run trusts already have such systems. They may not be called by the same name, but they have liaison officers, and have good relations between complaints officers in trusts and staff on wards, in accident and emergency and on reception desks. Such a system will give patients the right advice, but is appropriate only when patients or their carers agree with the process produced by the trust.

In 90 per cent. of cases, that will be the right way to handle such complaints and give support. However, a simple way to receive such support is essential when complaints cannot be resolved in-house. My hon. Friend the Member for Sutton and Cheam said that the Government recognised the problem in their response to the Select Committee on Health about complaints procedure. It seems sad that we are abolishing a route whereby we could handle specialist complaint procedure, without being specific about what we are putting in its place, and that we are doing so before the Government formally respond to the problem, as they should in the next few weeks.

Mr. Denham: We have had a good introduction to the important debate on this part of the Bill. I welcome the hon. Member for Woodspring to the Committee to lead for the Opposition. He is not usually far from any bandwagon, and he has not disappointed us this morning.

Although the debate has been important and will continue to be, I feel disappointed by it so far. There has been a tendency to seize on the issue as one on which the Government have been criticised, so people have piled in to do that rather than to tackle the fundamental and serious question of what form of scrutiny and patient representation is needed to build a patient-centred national health service. Much of the debate has been complacent and lacking urgency about what needs to be done. It has proceeded on the premise that the situation is are pretty much okay from patients' point of view, and that tweaking with a few bad spots here or there will adequately deal with the problem. I do not believe that that is the situation, and it is not the vision set out in the NHS plan. That is why the Government propose a more fundamental change.

The clause is about the abolition of community health councils. It is essential that Committee members understand that the conclusion that CHCs are being abolished as a consequence of the decision to create a better and more powerful system of scrutiny and patient representation. It is not and never has been a primary objective of the Government. We did not start with the idea of getting rid of CHCs and then wonder what to put in their place, but by asking what was needed, from first principles, to build an effective system fit for the 21st century. We must change how the NHS operates, as well as protecting and enhancing the interests of individual patients. The change will be a comprehensive overhaul of the involvement of patients and the public in the running of the NHS. In key areas—for example, the oversight and scrutiny committees and patients forums—we are providing the necessary powers in the Bill, but in others we do not need new legislation to make the proposals work. As hon. Members have done, it is important to put the clause in the context of all the changes that we are making.

There is a need to strengthen support for patients, carers and their families. In the front line of that are the patient advocacy and liaison services. When we consulted on the NHS plan last summer, people said time and again that they needed someone to help sort out situations that had gone wrong. They wanted someone on the spot who could tackle an individual problem as it arose. We might like to think that the system already provided such assistance. The hon. Member for Isle of Wight said that that was often the case in trusts, but the overwhelming message from our public consultation was that patients did not feel that way. Through leaflets, radio phone-in programmes and meetings that Ministers attended, we were repeatedly told that something was going wrong, and that there was a need for someone to whom people could turn.

The advocacy and liaison services will be essential to sort out problems on the spot. We believe that they should be part of the trust, should have direct access to the chief executive, should be able to facilitate the swift resolution of problems and identify patterns of problems that emerge within trusts so that management can deal with them. There have been concerns about the independence and effectiveness of PALS, and we are building some safeguards into the process, but I will come to them later.

Mr. Ian Stewart: Will my hon. Friend the Minister comment on the accountability of PALS and advocates?

Mr. Denham: PALS will be part of the trust, reporting to the chief executive and sorting out problems as they occur. We expect the new independent patients forums to scrutinise the work of PALS and to assure themselves that they are working for patients as they were designed to do. As a safeguard, we will provide powers in amendments today so that, if necessary, a patients forum can recommend that the PALS be taken out of a trust and run independently. I honestly do not believe that that is likely to happen on many occasions, but it is built into the Bill as a safeguard against the danger that a trust management would browbeat or neuter the work of PALS and stop them from being effective on behalf of patients.

PALS will help patients going through hospitals and primary care, so on occasions serious and formal complaints will need to be addressed. We are reviewing the complaints system. There will be new proposals, and Ministers have not yet received the evaluation of the existing complaints procedure, but we think that we need a more independent system. Although we do not have the exact shape of the new system, we are confident that patients will require independent advocacy—someone to hold their hand. We are confident about going ahead with the proposals because it is difficult to conceive a complaint system in which there is no need for independent advocacy on behalf of the patients.

As part of the pattern for provision, an independent patient advocacy will be commissioned in each area of the country. We accept that there is a critical issue—it is managerial, not legislative—about ensuring that the signposting to the PALS in each hospital or primary care trust leads directly to the advocacy service. As we have heard, that is often lacking in the current system, so that some people do not find their way to CHCs.

Mr. Burstow: The Minister said that the tasks of PALS would include discerning the patterns that complaints produce and reporting them to their chief executives. What powers and duties will be placed on PALS, should they come to the view that their chief executive and trust are not responding to their concerns? To whom to do they report, and will they be protected for doing so?

Mr. Denham: There is obviously extensive provision. The hon. Gentleman will know that the Government introduced legislation to protect individual members of staff, whatever their position—whether they are part of an advocacy and liaison service or in any part of the health service—who, having properly tried to raise their worries about how things were being managed, felt it necessary to become a whistleblower. That is a fundamental protection.

We shall certainly discuss it, but we shall need a good flow of information between the different parts of the system as they are being put together. I am not persuaded that we need to legislate for it, but it will be necessary for the patients forum and PALS to work closely together because the forum will be overseeing and scrutinising the work of PALS. A member of the trust board will have been elected from the patients forum. That person will be another friendly member of the trust board, although he or she will be there as a trust board member and not simply as a patients' representative.

Mr. Burstow: The Minister referred to the appointment of a patients forum member to the trust board. However, neither the explanatory notes or the briefing paper discuss the problems that a patients' representative will have given his duty as a corporate member of the trust board. How will those difficulties be overcome so that the patients' representative can act for the patients?

12.15 pm

Mr. Denham: A representative will be elected by the patients forum but, on balance, we believe that it will be better for him to be a full corporate board member. It guarantees patients a route through the system that does not exist now.

PALS and the independent advocacy service are the key organisations for the patient. Other elements in the system, such as the advisory forums for health authorities, are important in ensuring that patients and local communities have a voice. However, for individuals trying to find their way through the system, PALS and the independent advocacy service are the two critical elements. It is all about the experience of individuals.

We want to strengthen the patient's voice within the NHS. That is why we want to establish a patients forum for every trust and primary care trust. Subject to today's discussions, they will be statutory bodies independent of trusts. As I said, each forum will appoint one of its members to be a non-executive member of the local trust board. The patients forum will consider and comment on every aspect of trust care from the patients' perspective. They will also have the right to make inspections wherever NHS patients go—hospitals, doctors' surgeries, nursing homes and the private sector—and they will be able to make recommendations direct to the trust board, ensuring that patients' views are heard where it matters most.

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