Health and Social Care Bill

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Dr. Brand: Will the Minister admit that there may be a difficulty with an approach whereby a statutory body supports a trust and a vague ``Do it as you wish'' arrangement is made for the commissioning authority?

Mr. Denham: I do not agree. There is a difference between developing the most effective ways of having input into the strategic leadership role played by the health authority across the health economy as a whole and the focused function that is at the core of the patients forum work, which identifies the patient view and interests in relation to that organisation. Under that system, each element is designed for the job that we have asked it to undertake. There is no obvious reason why one should be specified fairly clearly, while a loser approach is taken to a different element at this stage in the development of the system.

Question put and agreed to.

Clause 9 ordered to stand part of the Bill.

Clause 10

Establishment of Patients' Forums

Dr. Brand: I beg to move amendment No. 46, in page 8, line 9, leave out `Secretary of State' and insert

    `local authorities specified in section 7(2)'.

The Chairman: With this it will be convenient to take the following amendments: No. 47, in page 8, leave out lines 10 to 12.

No. 48, in page 8, line 16, leave out `trust' and insert `trusts'.

No. 49, in page 8, line 18, leave out `trust' and insert

    `overview and scrutiny committee and relevant trusts'.

No. 50, in page 8, line 20, leave out `trust' and insert

    `overview and scrutiny committee and relevant trusts'.

No. 51, in page 8, line 25, leave out

    `A Patients' Forum for a'

and insert `In respect of'.

No. 52. in page 8, line 25, leave out `Trust' and insert `Trusts a Patients' Forum'.

No. 53, in page 8, line 33, after `Authority', insert

`and overview and scrutiny committee'.

No. 54, in page 8, line 35, after `Authority', insert

    `and overview and scrutiny committee'.

No. 55, in page 9, line 4, leave out `for' and insert `duties in respect of'.

No. 42, in clause 12, page 9, line 21, leave out `trust' and insert `trusts'.

No. 43, in page 9, line 21, leave out

`for which it is established'

and insert

    `it covers and the establishing local authority'.

No. 60, in clause 13, page 10, line 5, leave out `trust' and insert `trusts'.

Dr. Brand: I was grateful to have an opportunity to speak in the clause stand part debate on clause 9 because it was so relevant to clause 10. It is right that each trust should have a patients forum, but it also important that these patients forums do not become the tame possession of that trust. I hope that we are not seeing a statutory establishment of leagues of friends of particular hospitals, and particular trusts. My experience of lay involvement, and some of the criticisms of community health councils voiced earlier today, shows that the lay public are well disposed towards health providers as a rule, and there is a great risk of them going native—if one dare use that term.

Our amendment would result in the patients forums becoming a more cohesive power. While it is important that they have a link with the trust, it is equally important that they are required to work collectively. This could be within the health authority area, but we have chosen to go the route of the local authority area, which would match the arrangements that we have already established.

It is important that patients forums are seen to be representative of the public, rather than representative of the trust. For that reason, we suggest that the local authority, mirroring the arrangements that we discussed earlier, should be the umbrella body for these patients forums. This would increase the local accountability, rather than the direct trust influence.

Mr. Swayne: I have a question, which follows on from what the hon. Member for Isle of Wight has said. We are told that the membership for the patients forums is to be drawn from local patient and voluntary groups—he is right to point out the importance of the voluntary groups—of which the league of friends will be one. Half of them will be drawn from the respondents to the trusts' annual surveys. The explanatory notes go on to say that members of the public who will be appointed to the patients forums must have been treated, or still are being treated, by an NHS trust or by a PCT.

I suspect that a significant portion of those being treated by trusts are children or are elderly and infirm. It is most appropriate that those who care for these patients should be allowed to sit on the forums, because they will have a great insight into the problems of, and the services provided by, those trusts. The requirement that those serving on the forum must have been recently treated or still being treated, leaves out a whole category of people who would be very useful to the forum.

Mr. Denham: The hon. Member for Isle of Wight raises a number of issues. First, should the forum relate to the trust or cover a wider area? Secondly, will the forums become of the trust rather than relating to the trust—in other words, will they loose their independence? Thirdly, the relationship with the local authority was raised. The fourth issue, raised by the hon. Member for New Forest, West, is whether the broad proposal that we have set out for membership is right for the function of the patients forums.

The patients forums will be independent of the trusts to which they relate because the provisions of the Bill establish them as independent and statutory bodies, because they will be funded separately to the trusts and because they will have clear powers in relation to the trust. Their membership will be appointed by the independent appointments commission, rather than by the trust. They will be able to select a non-executive director of the trust and will have the powers to carry out visits and inspections, which we discussed earlier. They will have specific functions.

Under clause 9, we discussed the patients prospectus, but I omitted to say that we intend the patients forum to have the right to sign off the patients prospectus. The fears that were expressed about a glossy document saying how wonderfully the trust was doing will not be realised. The patients forum will need to agree that what the prospectus says about patients' views is correct. For all those reasons, the patients forum will be an independent structure.

The big question is whether the patients forum should relate directly to an individual trust or primary care trust or whether it should cover a wider area. There may be a simple philosophical difference between hon. Members on both sides of the Committee. The Government believe that the forum needs to relate to the particular organisation, its management structure, culture and ethos if it is to bring about change.

A patients forum that covered a wider area would have huge attractions in some ways, because not as many patients would be needed, it would not cost as much to run and so on. However, such a forum would be too remote from any individual organisation and its management structure to effect change on the patients' behalf. We may have to accept that there is a difference in view between hon. Members on different sides of the Committee.

6.15 pm

None the less, it will be interesting to explore the potential relationship with the local authority, which is where the hon. Member for Isle of Wight sought to locate the larger patients forum. There are attractions in the idea that a local authority could offer a base or secretariat that supported a number of patients forums in the area. That would enable each forum to be individually independent and established in law. They would relate to an individual primary care trust or NHS trust, but share a common base or secretariat in the local authority. However, there are practical models of administration and co-ordination that would provide what we want to achieve, while delivering co-ordination across the patients forums in an area.

I said that the NHS appointments commission would appoint the membership. We envisage that part of the membership will comprise people who are or have recently been patients of the trust, perhaps drawing on people who have taken part in the annual patients survey. Others will come from local voluntary and patients' organisations. We are clear—probably clearer than the explanatory notes as I recollect—that carers must also be represented in the membership. They will form an important part of the membership of patients forums.

Dr. Brand: I am slightly confused. I think that we are covering amendments Nos. 81 and 82 at the same time as the constitution of the membership of the forums. I am quite happy to address that issue during this debate, because those are clearly exploratory amendments.

The Government are being too prescriptive by saying that the membership must be made up of past patients. Health care is not only about ill people, but about the larger community--people who want to avoid becoming ill and the steps that one can take and that trusts ought to take to promote that. I hope that the Minister will look again at the explanatory notes and the Bill, and not be quite as prescriptive on the membership of the bodies, because it will be difficult to find good people to serve on them anyway.

I am all in favour of more public involvement, but it must be real, rather than token, public involvement. I would not want to see the same busybody appearing on all forums at all times. Those of us who serve on voluntary bodies tend to meet the same people wearing slightly different hats—until, of course, they arrive in Parliament, having polished the front door plate often enough. As regards membership, it would be helpful if people could serve on more than one forum. For example, they might serve on a trust forum as well as an advisory body.

I was encouraged that the Minister recognised the need to support patients forums that relate directly to one trust, and that there is great merit in allowing or, indeed, requiring those forums to work together. In that way, members of the forums may not only develop a feel for what happens within the trust—I agree with the Minister that that is essential—but appreciate how that relates to the wider picture and other people's experience. Given those circumstances, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

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