Health and Social Care Bill

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Mr. Denham: I beg to move amendment No. 190, in page 8, line 22, at end insert—

    '(da) in prescribed circumstances, to perform any prescribed function of the trust with respect to the provision of a service affording assistance to patients and their families;'.

The amendment provides for a specific element of power to be placed in the hands of patients, carers and representatives through patients forums. We believe that the patient advocacy and liaison services needs to be based in, and managed by, the trust and primary care trust. That is the way in which patients will be most effectively supported and assisted.

We recognise that such an arrangement might not work if the trust management were hostile. The amendment enables us to set up a system in which a patients forum that was concerned and able to show that a PAL service was consistently falling below acceptable levels of quality would be able to refer the matter to the Secretary of State, who could then specify that the PALS be withdrawn from the management of the trust or PCT, to be run in an alternative way. That would provide for the possibility of its being placed under the control of the patients forum. I regard that very much as a last resort and a long stop, and do not believe that it would be widely used. However, we have been convinced that it would be worth taking such a power as a protection against an advocacy and liaison service that was not allowed to operate effectively within the trust.

Mr. Hammond: The Minister has clarified what was in many of our minds—that is, what the Government had in mind when tabling the amendment. Will he explain a more general point that has troubled me? Why is it appropriate to establish patients forums through the Bill, with all the rigmarole that that entails, but not to establish the independent local advisory forum or the patient advocacy and liaison service in the same way?

From the remarks that the Minister made during the previous debate, it seems that the independent local advisory forum will be the key element in any strategic overview of service rearrangement. It might be argued that that is a more formidable and strategic function than the one performed by the patients forum. Why the asymmetry in the design of the arrangements?

Mr. Denham: With regard to PALS, as we discussed earlier, no comparable powers of functions of trusts are specified. With regard to patients forums and the advisory forums, the Secretary of State has the power, by directions, to do as the hon. Gentleman suggested. However, a patients forum established by direction of the Secretary of State to a trust would have too close a relationship to the trust to have the necessary independence of voice that people want from the system. We acknowledge in the Bill that the Secretary of State could have set up those bodies by direction.

A number of health authorities already adopt an advisory forum approach, which shapes their policy. I do not see that it needs to be independent in the same way, as it is an advisory body, a listening body, a sounding board and a body with which the health authority works in developing its strategic approach to the local health economy. The power that the Secretary of State has to establish it by direction will be sufficient. It is not playing the same role of representing the patient in relation to a specific organisation; that is a different function.

Mr. Hammond: I accept that distinction, but does the Minister accept that the ILAF is taking over what many people will see as one of the key functions of community health councils without the statutory backing in primary legislation that, for example, patients forums have? There is a suspicion that that amounts to a downgrading of that part of the CHC function?

Mr. Denham: I believe that, in practice, the advisory forums will be more effective, more powerful and more influential on the future development of strategy than CHCs have often been able to be, despite their statutory role. That is certainly our goal and it is how we intend to go about establishing them.

Mr. Burstow: In the briefing sent to hon. Members, we are told that these bodies will be combining the views and experiences of all patients' forums within the single health authority area. The briefing says that they are seen as the arena where patients can look across the health economy. Surely those functions are vital to securing the oversight of the whole system. Surely the bringing together of these matters should be footed firmly in the Bill and not be the subject of direction and discretion by the Secretary of State.

Mr. Denham: I do not believe that that is necessary. Given how clearly we have set out what we expect the organisation to do, the Secretary of State's powers of direction will be perfectly adequate.

Amendment agreed to.

Mr. Swayne: I beg to move amendment No. 249, in page 8, line 22, at end


    `( ) to belong to and cooperate with any body established by regulation to represent at national level the Patients' Forums created under subsection (1) above'.

The Chairman: With this we may discuss amendment No. 29, in

page 8, line 24, at end insert—

    `(f) to provide advice, and make reports and recommendations, about matters relating to those services, including patients' views on those services, to the Association of Patients' Forums, established under section (Association of Patients' Forums).'

New clause 3—Association of Patients' Forums—

    `.—(1) The Secretary of State shall establish an independent national body, known as the Association of Patients' Forums, with a duty to provide a national overview of the patient experience to the Secretary of State and National Health Service bodies, on a regional and national level.

    (2) The Secretary of State shall make regulations for the purposes of subsection (1) above.

    (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. Swayne: When I looked at the great pile of briefs in my in-tray this morning, I was gratified to see that it appears that a large number of those providing the briefs find themselves in support of the principle that lies behind our amendment. That was certainly my understanding having read the brief from the Consumers Association, the citizens advice bureaux, the Royal College of Nursing and ACHEW—I do not know who thinks up these acronyms. The Association of Community Health Councils for England and Wales takes a strong view of the principle to which amendment No. 249 gives expression. That association will be abolished as a consequence of the Bill. There will, therefore, be no provision for a national body in England and Wales to provide an overview of the patient forums we have been discussing. That is an important role and there should be an umbrella organisation to provide a whole range of functions, such as staff training, particularly of volunteers, promoting the exchange of best practice and the provision of performance standards and expert advice, whether that be human resources advice, research and publications or legal services.

One of the complaints that we have heard repeatedly is that the service provided by community health councils was patchy—the word ``patchy'' has been used—and that it was not always of a uniform standard. That was when there was an umbrella body specifically to provide community health councils with a measure of the support and the sharing of best practice that I have described. Consider how patchy the performance of forums is likely to be without the provision for that central umbrella organisation.

6.30 pm

It strikes me that, under the Bill as constituted, there is no provision to enable information about the NHS at a local level to be used to influence national policy, but an umbrella organisation for patients forums would provide that. People should be able to expect the same standard of representation from forums wherever they live. That would be fostered—and there would be a powerful engine for sharing best practice—if such an organisation were set up. On Second Reading, the Secretary of State implied that the Department of Health was considering the feasibility of forming such an organisation to act as an independent umbrella body. For all we know, that may even have been announced down at Fulham today, where I understand that further examination of such issues is strangely taking place. We believe that it is an important role, and the Royal College of Nursing believes that

    ``such a role is vital if patient forums are to operative effectively.''

What will be the relationship between patients forums and, for example, the Commission for Health Improvement inspectors? Will they work with patients forums as a matter of course? I digress slightly from the issue of an overarching body, but such a body would provide guidance to members. Nevertheless, it is a good question. Without a central body, who will be responsible for recruiting, appointing and training the servants of forums? What training will be given? How will they be funded? Will funding come via the health authority, the trusts or primary care trusts? Will the reports that they will inevitably publish be made public, and be a matter of public scrutiny? All those are issues that we would expect to be thrashed out by an umbrella body, thereby establishing best practice. If there is no provision for such a body, as is the case under the Bill, will the Minister say how such issues will be addressed?

Dr. Brand: Amendment No. 28 and new clause 3 try to achieve the same end. It is essential to have a national arena in which patients forums can share information, for two reasons. First, forums will be able to carry out their functions better at local level by networking nationally, and sharing experience and knowledge. After all, health authorities network and share experience and knowledge, as do trusts. It would be wrong to place the patients forums at a disadvantage. Secondly, it is important that the national strategic thinkers for this country's health system have access to a national body representing patients forums. The process would therefore work in two directions. That cannot be left to accident or whim; it must be established, if only to ensure that such an organisation is funded.

On a minor note, ACHCEW—a wonderful acronym—has been a fruitful source of Members of the other place with great knowledge of the national health service. I would hate the Government to be deprived of such expertise.

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