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Mr. Burstow: These amendments are about representation and how we ensure that the overview and scrutiny committees are not made up only of local councillors, important though their contribution to the scrutiny process will be. As with other local committees, the scrutiny committee will deliberate on the interests and expertise of others. In the context of the amendments, I am thinking of the role of the voluntary sector in our communities, and also the scrutiny role of those serving on patients forums—or, as we would prefer, a patients forum for each locality. We need to establish firm links between the role of the overview and scrutiny committees and the role of patients forums, so that we can avoid issues falling between stools. An overlap of membership would go some way towards addressing that concern. The amendments deal with the type of information that will be available to patients forums. We want to establish clearly in the Bill obligations on the exchange of information between the overview and scrutiny committees and patients forums. I am sure that the Minister will tell us that that will happen anyway, but we have been told by Labour Members that the CHCs have not performed as well as they might, despite the fact that the regulations that establish them are detailed. All that I ask is for a reference point in the Bill, to make the fact that communication should take place between the two bodies clear and indisputable. The bodies are important to the establishment of the Government's framework for the new overview and complaint systems in the NHS. Mr. Desmond Swayne (New Forest, West): I add my congratulations to you, Sir David, on taking the Chair. It is always a tremendous pleasure to address the Chair, especially when you occupy it. I understand the rationale behind the amendments tabled by the hon. Member for Sutton and Cheam. I share his anxiety about creating an interlinking network between the patient advocacy and liaison services and the scrutiny function. That is important, especially as those who participate in the PALS will have had experience of complaint handling, and will have powers of inspection. An avenue for the passage of information should be opened up. My concern is about the nature of the membership of the overview and scrutiny committees. I have always regarded such committees as an opportunity to redress a perceived—and, I think, real—lack of democratic accountability in the health service. It is therefore proper that the members of those committees should be elected councillors. By introducing co-opted members as full members of such committees, would we weaken that principle? That is my only concern with the amendment.
4.45 pmMr. Denham: The first two amendments seek to prescribe, through the Bill and through regulations, the relationship between the patient forums and the overview and scrutiny committees, in a way that goes beyond what is desirable or necessary. We understand the need for patients forums and scrutiny committees to work together. Although that is desirable, the bodies have different roles, and they must exist separately. The amendments would go too far in trying to merge their functions, at least at the edges. Patients forums are about bringing patients' views into the NHS, for every trust. The scrutiny committees are about scrutinising the way in which the NHS is developing and delivering its services locally. There will, in practice, be plenty of scope for co-operation between the two bodies. Under the local government legislation enacted last year, scrutiny committees already have the power to co-opt and involve people who are not elected councillors as members of the committee. I agree with the hon. Member for New Forest, West (Mr. Swayne) that that should be under the control and in the gift of the democratically elected councillors. It should not be set out in regulation by central Government that scrutiny committees should co-opt a certain number of such people under certain circumstances. It is better for that to remain the prerogative of the committees. Similarly, it will be useful for pertinent information to flow and be shared between patients forums and scrutiny committees, not least to enable them to understand each other's perspective on local issues. However, it is overly bureaucratic to set out in regulations exactly what information should be passed around. There is nothing in our proposals that prevents scrutiny committees and patients forums from sharing relevant information. I hope the hon. Member for Sutton and Cheam accepts that we are not trying to block the co-operation that he seeks, but that there is a difference between us over whether such co-operation should be prescribed by the legislation. Amendment No. 75 raises different issues. The scrutiny committees would be able to refer matters to the Commission for Health Improvement, to the National Institute for Clinical Excellence, or to the Audit Commission. The Commission for Health Improvement will often be the most appropriate body to which to refer issues that are raised in the course of scrutiny, because of its powers to investigate the management, the provision and the quality of local health services. Under existing legislation, the CHI can accept referrals from any individual or body, so the provision is already there for scrutiny committees to make such referrals. A committee would not have to limit itself. It could make its concerns known to the Secretary of State, or to regional offices of the health service. I have more difficulty with the idea of scrutiny committees establishing local inquiries. The hon. Member for Sutton and Cheam did not say a great deal about that in his opening remarks, and I may have misinterpreted him, but we could be in great danger if we were to have a plethora of bodies that were all able to set up independent inquiries into the same incident or series of events. Normally, inquiries in the health service are set up under health service legislation. They may be less formal, and be set up by the organisation itself—the health authority or the regional office on behalf of the Secretary of State. More formally, they may be set up under, for example, section 84 of the 1977 Act, which is the legislation under which the Bristol inquiry was established. Under exceptional circumstances, powers under the Tribunals of Inquiry (Evidence) Act 1921 may be used, as in the case of the inquiry into Harold Shipman. The CHI may also set up an independent inquiry. We do not need to add another formal system for establishing inquiries into that field of provision. Clearly, in the broader sense of the word, scrutiny committees will inquire into various issues. They will be able to call in chief executives, ask about the accident and emergency departments or the provision of maternity services or whatever issue they choose to scrutinise. They will hold inquiries, rather like Select Committees. However, that is not the same as looking into a formal clinical incident, such as happened in Bristol. Mr. Burstow: I am grateful to the Minister for commenting on that point. Certainly the intention behind the amendment is not to set up a second-guessing exercise around such important inquiries, but perhaps to consider issues of reconfiguration and performance. The Minister said that the Bill should not be too prescriptive about the provision of information. Does he accept that the Bill already contains considerable powers to stipulate what information can and cannot be provided by NHS bodies? Why cannot the Secretary of State stipulate what information should be exchanged between patients forums and overview and scrutiny committees? Mr. Denham: The provisions on information are to ensure that the legislation reflects the safeguards that are provided in the wider operation of scrutiny committees in looking into local government services. They do not govern the flow of information from one body to another. I suspect that we are at one in wanting to see a useful flow of information between the two bodies. That would be eased considerably if we were to combine the secretariat and support for these functions within, say, a local authority. Mr. Burstow: We welcome the proposition in the briefing notes that local authorities should provide the secretariat. Local authorities may well provide the glue in the new system that pulls it all together. If so, that will be very welcome. However, it would be strange if there were Chinese walls between the different institutions when it came to information exchange. We want to ensure that that does not happen. The Minister usefully referred to the danger of a plethora of bodies undertaking inquiries. I share that concern, and may come back to that point. I welcome the fact that the Minister is seeking plenty of opportunities for co-operation between these bodies. Therefore, I beg to ask leave to withdraw the amendment. Amendment, by leave, withdrawn. Mr. Swayne: I beg to move amendment No. 243, in page 6, line 20, at end insert—
Amendment No. 243 need not detain us long because all it does is to add an item about which regulations may be made concerning the scrutiny committees. It strikes me as an obvious that co-operation between the health service and providers of personal social services should be included. I cannot imagine any circumstances in which a scrutiny committee would not consider that issue. There is a long history of institutional barriers between the NHS and the providers of personal social services, although much progress has been made in recent years in breaking down those barriers and moving forward to a better agenda. The creation of this new scrutiny function provides yet another institutional opportunity by which to pursue that agenda. As we are here to help, I thought we should place it in the Bill.
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| ©Parliamentary copyright 2001 | Prepared 30 January 2001 |
