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House of Commons
Session 2000-01
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Standing Committee Debates
Health and Social Care Bill

Health and Social Care Bill

Standing Committee E

Tuesday 30 January 2001


[Sir David Madel in the Chair]

Health and Social Care Bill

Clause 7

Functions of Overview and Scrutiny Committees

4.30 pm

Mr. Paul Burstow (Sutton and Cheam): I beg to move amendment No. 44, in page 6, line 20, at end insert—

    `( ) as to the commissioning of independent advocacy services and requirements placed on any officer of a local NHS body or other specified body to assist the advocacy service in discharging its duties,'.

The Chairman: With this it will be convenient to take the following: Amendment No. 237 in clause 9, page 8, line 8, at end add—

    `(4) It is the duty of every body to which this section applies to commission independent advocacy services to support any formal complaints made against that body and to support patients' use and access to services provided by, or under arrangements made by, that body.'.

New clause 5—Patient Advocacy and Liaison Services—

    `.—(1) The Secretary of State shall make regulations requiring all NHS trusts and Primary Care trusts to set up services to be known as Patient Advocacy and Liaison Services (PALS) and making provision for such services, including the establishment of links with Patients' Forums.

    (2) It is the duty of each PALS to provide advocacy services to patients both in relation to everyday use of services provided by, or under arrangements made by, the relevant trust and in relation to complaints, including formal complaints, about the provision of such services.

    (3) Before making regulations for the purposes of subsection (1) above, the Secretary of State shall consult such bodies as represent the interests of persons likely to be affected by the regulations.'.

Mr. Burstow: Welcome to the Chair of this Standing Committee, Sir David. We are having very interesting deliberations. I want briefly to address this group of amendments, which deals with two related issues. The first is independent advocacy, which we spent some time discussing in the broader debate that we had this morning. We now come to the more specific details of how we are to secure that independent advocacy. The second is the further examination of the proposals for the patient advocacy and liaison services staff, which are not in the Bill but were referred to in the Government's explanatory notes.

Amendments Nos. 44 and 237 deal with the question of advocacy and would enshrine in the Bill the Government's commitment to providing the funds and the necessary regulations to ensure that independent advocacy services are established. They would also provide that whoever is responsible for funding those services--the pay and the rations--be it a local authority or a health authority or some other potential commissioner of these services, it is able to ensure that the advocacy service can operate effectively on behalf of patients. It should ensure that any NHS body it deals with understands that it should signpost patients to the advocacy service when that is appropriate, and should set out when that would be appropriate so that there is no doubt about that. It should also ensure that the various agencies within the trusts are willing and able to co-operate with the advocacy service.

New clause 5 also deals with the role of patient advocacy and liaison services. Even at this late stage, we should reconsider the name of these services, especially as the Government have not been persuaded of the merits of including in the Bill provisions governing the operation of this particular function within trusts. This morning we were told that many people in hospital who want to complain are not aware of the existence of community health councils. I fear that confusion will be sown by calling it an advocacy service, because, on any standard definition of that role, the post will not actually operate as an advocate. We are in danger of causing confusion. This is not merely a point of semantics. People will be confused when they consider the range of bodies that they are asked to deal with when they have problems with the NHS. We need to be careful about the language we use so that we minimise that confusion. I hope the Minister will comment on that, because we currently have two bodies that use the term advocacy in very different ways.

New clause 5 seeks clarity on the boundaries between PALS, the independent advocates and the patients forums. It would enable the Secretary of State to use regulation-making powers, and would at the very least allow further scrutiny, through secondary legislation, of the details of how PALS will be rolled out and operated on the ground. That is why we tabled these amendments. We do not want to diminish the value of such services within trusts—that has not been our argument—but this important role should have a statutory basis. That is what new clause 5 asks for, but if the Government cannot accept the amendments, I hope that they will be willing to table similar amendments.

How soon will the Government make proposals on advocacy services to guarantee that they are secured? How do they intend to secure the funding arrangements? Will there be new funds? Are funds already included in the comprehensive spending review, or will additional moneys be made available to fund the development of a comprehensive network of advocacy services? On the face of it, the comprehensive spending review does not contain the wherewithal to fund that significant expansion throughout the country.

I look forward to the Minister's response, and I hope that it will be positive.

The Minister of State, Department of Health (Mr. John Denham): I, too, welcome you to the Committee, Sir David. We have had some productive sittings, and I am sure that that will continue under your chairmanship.

It is an interesting group of amendments; they would be contradictory if we were to accept them all, but they allow us to explore the issues involved. The hon. Member for Sutton and Cheam (Mr. Burstow) asked whether PALS should be a statutory body. We envisage the service being one of the functions of trusts, and such functions—the specific services provided by trusts, such as running out-patients clinics or doing operations—are not provided for in primary legislation. It would therefore be rather odd to include PALS in the Bill. The hon. Gentleman will have noticed, however, that under later amendments we shall provide the means by which a failing PALS or one that had been neutered by management could be taken out of the trust. If those later amendments are accepted, we shall, in a roundabout way, have provided some protection of the advocacy and liaison service.

We disagree with the hon. Gentleman on independent advocacy to support patients through the formal complaints procedure. We have been persuaded by CHCs and others that that formal role needs to be separate from the advocacy and liaison service role. New clause 5 would seem to put PALS in charge, but we would not want that. Nor do I agree that the independent advocacy service should be provided by the local authority scrutiny committee, but where it should go is something for further discussion. There are two possible models of providing the independent advocacy service. It could either be commissioned by the health authority—the obvious choice—or by the local authority. In turn, the local authority could be either the commissioner of the service or a provider of the service, commissioning the service from itself.

At this stage, it is better to allow further discussion and even some local flexibility. Funds will clearly be needed. We may take a similar route to that taken for CHCs, which is to use the regional health authorities for that purpose. There are clear attractions in locating the advocacy service in a local authority, particularly if, as we suggest in the explanatory document, the authority were to provide the secretariat for the patients forum in the area. That would mean a concentration of staff; they would be working for the same service in the same location. It is better that the Bill is not too prescriptive. Discussions are continuing with the health service, the Local Government Association, CHCs and other patient groups. A clear line suggests itself, and we want to discuss it in more detail.

It has been a brief debate, but I hope that I have responded to the major points raised by the hon. Member for Sutton and Cheam.

Mr. Burstow: I am grateful to the Minister for having clarified one or two matters. In return, I shall clarify the thinking behind new clause 5. It is not intended to substitute powers for the provision of the independent advocacy service, and the Minister is right that it would be inconsistent for the other two amendments to be read alongside it.

The Bill should place a specific obligation on the Secretary of State to ensure that advocacy services are commissioned, even if we are not specific about the commissioner. Will the Minister suggest whether there would still be an opportunity for a legislative amendment if consultation on the matter were concluded before the conclusion of the passage of the Bill?

Although we may come back to these issues later, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Mr. Burstow: I beg to move amendment No. 45, in page 6, line 20, at end insert—

    `( ) as to the composition of the committee so as to include representatives of the voluntary sector and the Patients' Forum'.

The Chairman: With this it will be convenient to take the following amendments: No. 25, in page 6, line 33, at end insert—

    `(g) as to information which the committee shall make available to Patients' Forums.'.

No. 75, in page 6, line 33, at end insert—

    `(g) requiring the committee to liaise with the Patients' Forums on matters of concern raised by the Patients' Forums,

    (h) as to matters allowing the committee to set up local enquiries with the power to call for evidence,

    (i) as to matters allowing the committee to refer matters of concern to NICE, CHI, the Audit Commission and the Secretary of State.'.


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