Health and Social Care Bill

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Mr. Hammond: I should like to return to the Minister's explanation to the Committee of the Government's reticence on the issue of NICE and beta interferon. Will he tell the Committee whether it is expected that the Government will be in a position to talk about the issue before the general election, or does he expect that they will only be in such a position after the general election?

Mr. Denham: The general election could be in May 2002. NICE has said that it wishes to reach a conclusion by this summer, so we may well be in a position to discuss that conclusion before the general election.

Mr. Swayne: I think that I might reassure my hon. Friend that this Government certainly will not have an opportunity to discuss those issues after the general election—that is for sure. The Minister's logic for excluding special health authorities has not been persuasive, but that is not a matter that we wish to pursue now, and I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Mr. Swayne: I beg to move amendment No. 247, in page 7, line 41, at end insert—

    `(2A) It is the duty of every body to which this section applies to publish annually (in such manner as it reasonably believes appropriate) a report on the arrangements it has made to discharge its duties under subsection (1) above'.

The Chairman: With this it will be convenient to take amendment No. 80, in page 8, line 8, at end add—

    `( ) Every body to which this section applies shall include in their annual report details of the arrangements maintained in that year for obtaining the views of patients, carers and the wider community.'.

5.39 pm

Sitting suspended for a Division in the House.

[GW1]I think all this procedure is right - log's a bit confused and so am I.[TMB2]Unable to find a note on this.

5.55 pm

On resuming—

Mr. Swayne: As I no doubt would have got round to saying, had you not interrupted me at such an opportune moment, Sir. David, amendment No. 247 places a duty on those bodies specified in clause 9 to produce an annual report to demonstrate how they have informed and consulted on the planning of the services that they make available, the development and consideration of proposals for any changes that they may have and any decisions that they have taken. It begs the question that if there is no annual report in which those bodies are required to demonstrate how they have met those provisions and consulted in that way, how else are they to be scrutinised, given the statutory responsibilities that are placed on them in the clause. I should be interested to hear how the Minister is planning to ensure that those functions are carried out. We believe that the best way would be to do it in an annual report and that that annual report should be available publicly for scrutiny. Not only will that be an effective tool for ensuring that the functions have been carried out, but we believe that it will be a powerful engine for generating best practice within the NHS by comparison between the different bodies concerned. We will be able to use those annual reports as an effective tool for measuring one against the other and generating a levelling-up across the board.

Mr. Denham: We will certainly see something akin to an annual report. Indeed, what we have proposed is that there should be a patient prospectus for all trusts, which should say how they have taken the views of patients into account. In fact, a prospectus will go further than that because, for the first time, people will be able to read not only what patients think of their local hospital but how the trust's management have taken patients' views on board to improve services. The prospectus will set out how trusts have gathered patients' views through the new trust level patient survey and show the results of the survey data. Patient surveys will contain core questions that will enable trusts to monitor progress in areas identified nationally for specific improvements in services such as primary care access, food and cleanliness. There will also be scope for additional questions to be included that reflect local circumstances. We will expect the patients forum, and the trust management, to identify the areas to be covered by the additional questions, and for the patients forum to then take the lead in developing those questions.

Mr. Hammond: Is this not just another example of doublespeak? Does not a prospectus, in the normal course of language, imply that people have a choice? People review prospectuses and decide where they want to go. Can the Minister back up his choice of the word ``prospectus'' with any prospect of real choice being introduced for patients?

Mr. Denham: The prospectus normally sets out what is on offer, and that is precisely what a trust prospectus will do. Of course, under the failed internal markets, health authority bureaucrats had to second guess the choice made by clinicians. Now that Conservatives are commissioned at local level by front-line clinicians, they are much more involved in shaping services. So ``prospectus'' is a totally appropriate word.

For the record, I will say a little more about what the patient prospectus will do. The patients survey will be included. Trusts will have to show what action they are taking to deal with shortfalls identified through the patients survey. We expect the trust to share the survey data with the patients forum. We expect them both to agree local standards for all the service improvements. The prospectus will contain information on a range of local NHS services and non-NHS open information such as voluntary organisation addresses and telephone numbers. It will act as a single vehicle for publishing local targets and standards, how they were measured, progress made against them and new priorities for the next year.

However, the emphasis is on an evolving document that may change in shape over time. For those reasons, we do not regard the amendment as necessary, but I hope that the Government have made their intentions clear.

6 pm

Mr. Swayne: The hon. Gentleman has told us about a prospectus, for which there may be some justification—there is certainly some justification for the provision of telephone numbers—but it is a very different document and it raises the question of whether, when there is only one item available, a prospectus is required. Patients by and large will not have the choice to consume those services or not. They are patients rather than consumers. It is not as though they can take the option often enough to go elsewhere.

``Prospectus'' is not the appropriate term. We are looking not for a glossy, promotional publication, but for a means of scrutinising whether the health authorities or the PCTs have met the requirements of the clause on public evolution. We are looking for an annual report that will scrutinise and be able to measure their performance. The Minister has told us about a prospectus in which they would seek to give an account of their performance in the most advantageous manner, as one would expect with any prospectus. It is not the same document, but the hour is late and we are not going to press the matter. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Question proposed, That the clause stand part of the Bill.

Dr. Brand: On a point of order, Sir David. It would have been helpful if you had indicated at the beginning of the debate on the clause whether there was to be a stand part debate on the clause. I certainly would have wanted to make some points on that.

The Chairman: If the hon. Gentleman wishes to address the matter, it is still open.

Dr. Brand: I am very grateful.

The clause is interesting. It clearly requires all bodies involved in the national health service to consult. That involves commissioning as well as delivery units. I have a specific question for the Minister: will the bodies that can be set up under clause 4, the public-private partnerships, be caught by the clause?

I am particularly interested in the fact that clause 10 is quite specific about what form the public consultation will take. We will get to that later, but I ask the Minister to be a little more specific about what actions he expects from health authorities in discharging their duties in relation to clause 9. Has he given some thought as to how the competing—often, it will be competing—patient and consumer involvement with the consultation will work out in practice?

There is no doubt in my mind that trusts are extremely good at public consultation where the subject is particularly emotive. I also know that health authorities sometimes find it difficult to persuade the public to support a particular course of action that cuts against the interest of an individual trust. It is laudable that each trust shall have a patients forum, but I am concerned that we are not setting up a mechanism that allows us to balance the special pleading that will take place on behalf of clinicians within trusts with the public health requirements of a broader population, which will be the strategic responsibility of the commissioning health authority.

Mr. Denham: Let me concentrate on the specific point raised by the hon. Gentleman. The clause places a general duty on NHS bodies, which needs to be backed up by guidance. In that sense, it is akin to the general duty on quality that was introduced under the previous Act. None the less, it provides the responsibilities under which clinical governance is developed in the NHS.

I had the opportunity earlier to illustrate some of the ways in which a trust might involve patients by seeking their views and reporting on them. Health authorities will need to take a similar flexible approach. Clearly, one of the ways in which they can address such a duty is through the consultation that they will be expected to undertake with the local advisory forum. As was said earlier, we have been non-prescriptive at local advisory forum level. Health authorities throughout the country have already put their toe in the water. For example, Somerset has an advisory forum that brings together health panels in each PCG area. It has a total membership of about 36 people from the localities to discuss the broad direction of the local health economy. Sunderland went a stage further: it has a pool of 350 people on which it calls with a citizens jury-type approach. I understand that the Norfolk health authority's citizens panel comprises about 4,000 people. That illustrates the wide variety of different consultative methods that have been developed by health authorities throughout the country.

I do not believe that one particular model is self-evidently better than the others. We want health authorities, with the support of the Department, to draw on best practice that is already being developed in the country. That may be the way in which the health authority fulfils its obligations under the clause. Everyone accepts that good consultation means flushing out different and difficult points of view. Clearly, a duty to consult is not the same as a duty to take the majority opinion in a straw poll. Health authorities will remain accountable for their decisions, but we shall be helping them to develop consultative structures that enable all the issues to be identified effectively to influence their approach.

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