Health and Social Care Bill

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Mr. Burstow: I want to ask a couple of questions arising out of page 15 of the explanatory notes, to which my hon. Friend the Member for Isle of Wight referred this morning. It would be helpful if the Minister could provide some further clarification. Paragraph 69 talks specifically about access and states:

``Access will generally be limited to areas where patients are permitted access (including consulting or treating rooms) and to reasonable times agreed''.

My hon. Friend rightly identified a number of places where patients may not normally seek access. However, in discharging a patients forums responsibilities, they should properly have access to places such as the mortuary, kitchens, laundries and so on. It would be useful if the Minister could confirm that the explanatory notes are wrong and that it is the Government's intention to widen it in that way. If not, it would be unfortunate if the explanatory notes were taken to be the basis of what this clause is about.

I want to talk about the amendments standing in my name and that of my hon. Friend the Member for Isle of Wight. What we are seeking to do here, in the same way as the hon. Member for Runnymede and Weybridge (Mr. Hammond), is to turn this permissive power to make regulations into a duty on the Secretary of State to make regulations. We then want to go further and stipulate specifically in the Bill that the regulations should allow for unannounced visits. Unannounced visits are invaluable for getting a picture of how the NHS is performing, and when CHCs undertake such visits, they often uncover things that may not revealed if the trust is aware of the visit. It is important that the Government are clear and upfront that they intend and envisage that, in all but the most extraordinary of circumstances, it would it be possible, to undertake unannounced visits in the same way as CHCs do now.

Amendment No. 86 deals with the issue of reporting. It seeks to establish that, having undertaken such visits, patients forums should be reporting to the relevant trust after a period of 60 days. Also—this is important to establish the interconnections between the various bodies that are to replace CHCs—it deals with the fact that the forums should report to the overview and scrutiny committees, the ILAF and the health authority. All those organisations that have an interest in how the trust is performing should be in the picture in respect of what the patients forum has found.

Mr. Hammond: I understand what the hon. Gentleman is seeking to do. However, as he goes wider, is it not better simply to require publication of those reports, as our amendment proposes?

Mr. Burstow: Our amendment seeks to identify the specific bodies and to ensure that the channels of communication exist. As both our amendment and that of the hon. Gentleman are intended to establish the Governments' intentions, I should be happy to support his amendment if there were to be a Division. The key point is that we have greater clarity about reporting lines and that the material is put into the public domain so that scrutiny can be carried through. With that point, I hope that the Minister will be able to give some reassurances, especially about unannounced visits, because of the benefit that they can have for the oversight process.

Mr. Denham: We have made it clear that patients forums should be able to visit and to inspect any aspect of the care provided to patients. The clause provides the framework that enables us to meet that commitment. As the hon. Member for Runnymede and Weybridge acknowledged, we do not want the process to be adversarial or combative—it should be done responsibly and productively. The capacity to make unannounced and short-term visits must be an option available to the patients forum but, in the normal course of inspections, one would want a more structured approach.

There are key areas vital to patient safety and services that the patients forums should be able to inspect. Equally, there are areas of trust responsibility, such as accommodation provided to nursing staff, for which it is unnecessary to create a right of unannounced inspection by patients forums. However, by agreement with trust staff, patients forums might want to take an interest in that. We must draw a sensible line, but we have no intention of denying patients forums access to places under the right circumstances, when it is relevant to their work.

Mr. Hammond: Will the Minister give way?

Mr. Denham: I should like to make progress.

So that there is no misunderstanding, I want to be clear about the way in which access will need to be secured. We are dealing with different types of premises. It is relatively straightforward, legally, to make it clear through directions that access to NHS premises will be provided. However, it is not appropriate to legislate in the Bill about private premises such as GP premises, because it would raise European Court of Human Rights issues, among others. We intend to seek access to those places through terms-of-service changes for GPs and have notified the profession of that. We intend that access to private sector providers should be provided for within the contract that the commissioning NHS body enters into, as with access by the Commission for Health Improvement.

Mr. Hammond: The Minister will forgive me if I draw a stark contrast between what he said about access to private premises and the premises of private providers and the approach taken by the Minister of State, Department of Health, the hon. Member for Barrow and Furness (Mr. Hutton), in the consideration of the Care Standards Bill. Draconian powers in that legislation allow unannounced access by inspectors to private premises providing care to elderly residents, at any time of the day or night. Why is the Minister proposing a less onerous inspection system for the NHS than is imposed on private sector providers of care?

Mr. Denham: The system for NHS patients should not be any less effective than that for patients in the private sector, but the contractual relationships differ from those dealt with by the Care Standards Commission. I thought it important to set out the ways in which we intended to achieve the aims that we all share.

Two issues have arisen as matters for discussion. First, it is clear from the Bill that patients forums have a duty to make reports and recommendations to the trust to which they relate. That would include reporting on the findings of inspections and visits. I am not convinced that we need a requirement in the Bill to report formally and publicly every single visit, as that would be a bureaucratic imposition. However, we would expect the patients forums to be able to report in that way.

The hon. Member for Sutton and Cheam raised another question, which now escapes me. He may want to raise the matter again.

Mr. Hammond: I confess that the Minister's answer has not entirely satisfied me. Opposition Members seek to establish the extent and nature of the access that is granted and an assurance that, in practice, the reporting and publication of visit information will not be less satisfactory than is the case with community health councils. If the Minister can say that it is the Government's intention that any changes will mean greater access to premises and fewer restrictions, that will be of great reassurance to members of the Committee.

Mr. Denham: I am delighted to be of assistance. I can give that assurance.

Mr. Hammond: I am grateful to the Minister. We are concerned that that assurance is not reflected in the Bill. We shall think more about the matter and hopefully we can find a way in which to make sure that the hon. Gentleman's intention will be translated into the provisions. However, given what he has said, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 11 ordered to stand part of the Bill

Clause 12

Patients' Forums: Annual Reports

Mr. Burstow: I beg to move amendment No. 85, in page 9, line 21, after `established', insert

`, the overview and scrutiny committee, the ILAF, the Health Authority,'.

The Chairman: With this it will be convenient to take new clause 6—Independent Local Advisory Forums—

`.—(1) The Secretary of State shall make regulations requiring every Health Authority to set up a body known as an Independent Local Advisory Forum (ILAF), and making provision for such bodies, including the establishment of links with Patients' Forums.

(2) It is the duty of ILAFs to provide independent advice to the Health Authority in determining the health priorities for the area and will be made up of residents of the local area including representatives from the local Patients' Forums.

(3) Before making regulations for the purpose 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: We have probably trodden this path several times today, but I want to refer again to the non-statutory basis of the independent area consultation bodies that are being established by the Government, but which is not covered in the Bill. During our discussions on the abolition of CHCs and their replacement, I began to wonder if anyone had drawn lines on a chart to show the connections between the various bodies, and I thought that I would have another look at the NHS plan to see whether there was a chart to help me navigate my way through the system. There is not, nor is there a chart in the briefing notes that we were provided with in advance of the sitting.

I imagine that a chart does exist, but I have not found the right document. It would be useful to see such a chart that showed the lines of accountability for the new bodies, their lines of appointment, the lines of communication between the bodies, the lines of authority for the gathering of information and details about from whom it can be gathered. That would provide us with a better understanding of how the different entities will operate with each other. That is why I want to return to the matter of the local advisory forums.

Earlier, the Minister said that the Government wanted to assure themselves and the public of the independence of patients forums—and rightly so. He said that the best way in which to secure such independence would be to give them a clear statutory basis. However, for some reason a body that has within its title the word ``independent'' does not need to have a similar statutory basis. Simply to call a body independent does not make it independent, so I tabled the amendment to give the Government a further opportunity to consider including in the Bill a measure that would deal with that problem.

The matter about which I am concerned is not the same as that regarding PALS. The Minister rebutted the amendments that dealt with the patient advocacy and liaison services on the basis that they were specific, managed services within the NHS. My argument is not about a managed service, but about the accountability mechanism that the Government want to put in place. It should have a statutory basis—at least as clear as the one that CHCs have had until now. Not to outline that in the Bill will be a cause of constant concern. It will give rise to the possibility of a considerable divergence of practice from one health authority to another.

Moreover, as a result of the reconfiguration of health authorities in London, we shall have large health authorities in London and probably in other parts of the country, too. Those bodies may have to consider whether one independent advisory forum is necessarily the appropriate structure. I hope that the Minister will give some further thought to how a statutory basis for the bodies can be secured in the Bill, so that they can act genuinely independently of health authorities when giving their advice to the authorities about the priorities for the local health economy. Without that, the patients forums that are independently based in statute will perhaps not have enough confidence that they should have in a body to which they will be obliged to provide information. I hope that the Minister will not only give us some reassurances on this matter, but will say how a statutory base could be provided.

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Prepared 30 January 2001