|
Dr. Fox: It is fair to say, in summary of the arguments that have been advanced, that even the CHCs themselves would not claim to be universally excellent. They have more than willingly accepted that there are shortcomings in many areas. However, some of them are excellent, as the Minister mentioned in his remarks to the Committee. Logically, that is an argument for reform rather than abolition. Some CHCs work very well, which proves that they can work well and provides an argument for bringing them all up to that standard. The rationale adopted by the Government in clause 14 seems to be that any organisation is to be judged by its poorest exponent, and that that should trigger abolition. That would be a very harsh test to apply to any Government organisation, never mind Government personnel. It smacks of a conclusion reached before its justification has been properly considered.
The Government's handling of the matters that we have been discussing has been appalling. I am sorry that the Minister expressed no regret for that and did not apologise to the CHCs, which have been treated disgracefully, especially as they were not consulted about the contents of the plan and had to hear it, like everyone else, from the Prime Minister's lips. Staff who have given great service have been discarded in an unacceptable way. There is ample precedent for shadow authorities. It makes sense not to leave patients vulnerable until it is possible to be sure that a new system will work properly. There is a growing feeling, which has been reinforced today, that Ministers are making all the new systems up as they go along. For the reassurance of the public I want to press amendment No. 241 to a vote.
Question put, That the amendment be made:—
The Committee divided: Ayes 6, Noes 10.
Division No. 3]
AYES
Brand, Dr. Peter
Burns, Mr. Simon
Burstow, Mr. Paul
Fox, Dr. Liam
Swayne, Mr. Desmond
Young, Sir George
NOES
Bailey, Mr. Adrian
Bradshaw, Mr. Ben
Denham, Mr. John
Fitzsimons, Lorna
Foster, Mr. Michael Jabez
Hutton, Mr. John
Jamieson, Mr. David
Mountford, Kali
Naysmith, Dr. Doug
Stewart, Mr. Ian
Question accordingly negatived.
Question put, That the clause stand part of the Bill:—
The Committee divided: Ayes 10, Noes 6.
Division No. 4]
AYES
Bailey, Mr. Adrian
Bradshaw, Mr. Ben
Denham, Mr. John
Fitzsimmons, Lorna
Foster, Mr Michael Jabez
Hutton, Mr. John
Jamieson, Mr. David
Mountford, Kali
Naysmith, Dr. Doug
Stewart, Mr. Ian
NOES
Brand, Dr. Peter
Burns, Mr. Simon
Burstow, Mr. Paul
Fox, Dr. Liam
Swayne, Mr. Desmond
Young, Sir George
Question accordingly agreed to.
Clause 14 ordered to stand part of the Bill.
Clause 15
Power to abolish community health councils in wales
Question put, That the clause stand part of the Bill:—
The Committee divided: Ayes 10, Noes 6.
Division No. 5]
AYES
Bailey, Mr. Adrian
Bradshaw, Mr. Ben
Denham, Mr. John
Fitzsimons, Lorna
Foster, Mr. Michael Jabez
Hutton, Mr. John
Jamieson, Mr. David
Mountford, Kali
Naysmith, Dr. Doug
Stewart, Mr. Ian
NOES
Brand, Dr. Peter
Burns, Mr. Simon
Burstow, Mr. Paul
Fox, Dr. Liam
Swayne, Mr. Desmond
Young, Sir George
Question accordingly agreed to.
Clause 15 ordered to stand part of the Bill.
Clause 7
Functions of overview and scrutiny committees
Mr. Swayne: I beg to move amendment No. 245, in page 6, leave out lines 14 to 18 and insert
`any county, county borough, district or London Borough Council having responsibility for social services within its area'.
The Chairman: With this it will be convenient to take amendment No. 226, in clause 7, page 6, line 18, at end insert—
`(e) any district council.'.
Mr. Swayne: After that passionate debate on the principles underpinning the clauses that we shall discuss for the rest of the day, I feel that it is down to me to lower the temperature of the Committee, and to bring us back to our ``meat and two veg'' agenda of detailed scrutiny of clauses and amendments. Notwithstanding the modest arrangements that we might make at lunch, and perhaps at 7 pm, the clock beckons us until 10 pm. I am sure that my hon. Friends would want us to give detailed and thorough, if not exhaustive, scrutiny to the amendments, so that those who have gone to Fulham today to learn of the rest of the Government's health agenda will wish that they had remained to share our scrutiny this afternoon.
Amendment No. 245 would make the principle of clause 7 clear. The practical consequence of the clause is that
will have oversight and scrutiny functions. The principle underlying that is that the local authorities detailed in the Bill are those that currently have responsibility for providing social services. However, we think that it is better to put into the Bill the principle rather than the practical consequence. Reform of local government may change the arrangements, so it is better to state the underlying principle that caused the Government to choose those structures to have responsibility for oversight.
We know that the function will not necessarily be easy to perform. It is somewhat analogous to the suggestions that have been made over recent years with respect to fluoride, whereby the Government has suggested that local authorities might consult their electorates and, as a consequence, bring about greater use of fluoride in the water. The problem is, of course, that local authority boundaries are not coterminous with water authority boundaries, so there is an immediate problem of how that exercise in seeking electoral consent will give practical effect to the policy.
There is a somewhat similar problem here, in that health authority boundaries, PCTs and trusts are not coterminous with the local authority scrutiny that will be provided. That problem is significant. I draw attention to the paper that the Government have provided within the last few days, entitled ``Patient Representation in the New NHS. Part One: A new voice for patients''. On page 6, the Government acknowledge:
``In many places, scrutiny committees from more than one authority will need to work together to ensure an efficient scrutiny process. Subject to Parliament, regulations will be made setting out how OSCs can pool or share powers or cooperate together to do this.''
I look forward to hearing the Minister spell out precisely how he envisages that that will take place.
``They will also set out how district councils may participate.''
That will be a very interesting discussion, to which we look forward, because I am sure that all members of the Committee will have received the correspondence from Epping Forest district council. It is obviously enthusiastic about taking up its responsibilities with regard to scrutiny—responsibilities that it believes that the Bill, as currently structured, denies it.
The council makes an interesting point. It says in its letter:
``It is not reasonable or realistic to expect the County Council to carry out a thorough scrutiny process when some 26 plus health service organisations are involved. This includes 2 Health Authorities, 16 Primary Care Groups/Trusts and at least 8 acute or specialist provider Trusts and ignores totally those Health Trusts which provide cross border services to a large part of our population.''
The council is speaking there of its own particular circumstances in Epping Forest, but I doubt very much that other district councils find themselves in a wholly different position.
I look forward with interest to the case that the Liberal Democrats will make for their amendment because, although I have some sympathy with it, I have reservations about expecting district councils to discharge the functions—[Interruption.]—The hon. Member for Sutton and Cheam murmurs from a sedentary position but, from my experience of my own district council, I wonder whether it is equipped to carry out that function. It is already struggling, given the resources that it has, to discharge its existing duties. How much additional resource will it be provided with if it is to discharge new oversight and scrutiny functions?
I would not go so far as to say that we are in danger of a surfeit of scrutiny, but there is a possibility that, by fragmenting the arrangements that were previously undertaken by community health councils and expecting the oversight to be taken up by any number of local authorities at different levels, we are creating the danger of fragmentation and we may weaken the authority with which local authorities can scrutinise the NHS by expecting scrutiny to occur at many levels.
We expect the Government to justify their stance but we are, by and large, comfortable with the notion of scrutiny at the level at which social services responsibility is exercised. Those councils are already under a statutory obligation to co-operate, under the Health Act 1999. We are confident that that is probably the right level, although we can foresee problems.
Mr. Burstow: I shall start by trying to square the circle that the hon. Member for New Forest, West has attempted to draw with respect to amendment No. 226. Our aim in tabling the amendment was to add to subsection (2) the category of district councils. The rest of the clause deals with order-making and regulation-making powers that will dictate how each tier of government is to discharge its function. To enable the Minister to keep his promise to set out the way in which district councils may participate, it seemed sensible to us that the Bill should provide for them to participate in the first place. The Minister could then, in regulations, specify how they were to do so. In view of that, it might be argued that amendment No. 245 is more prescriptive and inflexible. Simply making the necessary addition to the list of bodies that can be involved in the scrutiny process allows for greater flexibility.
I pray in aid the parliamentary briefing from the Democratic Health Network, which has drawn attention to the fact that district councils have an important contribution to make. They have a role in environmental health and they have housing responsibility, not just as strategic planners but often as providers. Those issues are part of a health improvement agenda and a health inequalities reduction agenda. It is slightly puzzling—perhaps the Minister will provide clarification on this—that the remit of the oversight and scrutiny committees seems to be focused very much on the provision of services by trusts, whereas it might also have included the wider questions of health inequalities and health improvement. Will it be possible for those matters to be dealt with in the regulations?
We consider that there is a case for participation by districts in what is proposed. Perhaps it would be better for them to be organised jointly with their county authorities, but on some occasions specific reconfiguration issues might have more of an impact on one local authority and population than any other, so that locally based scrutiny of the proposals by the district council in question would be by far the most appropriate exercise of the powers under the clause.
12.45 pm
|
