Health and Social Care Bill

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Mr. Burstow: The amendments in my name and in that of my hon. Friend the Member for Isle of Wight are intended to explore the extent to which regulation-making powers are needed and whether it would be more appropriate for the Secretary of State to have powers to issue guidance. The amendments seek to rejig the clause, so that matters that are set become matters that are dealt with solely through guidance. They include appointment of members, qualification, disqualification of membership. However, the Secretary of State should issue regulations on funding, the provision of information to a patients forum, pay and rations.

We tabled the amendments originally because we saw them fitting in with the group of amendments that my hon. Friend tabled earlier, which would have seen the establishment of patients forums as a duty of local authorities. It is in that context that the amendments fit best. They do not fit so well in a regime that sees them as separate entities. We strongly believe that patients forums should be established on a basis that enables them to look at patients' interests and to advocate those interests locally. The patient's experience of the NHS, which is not trust based, but follows a path of care through several trusts, can thus be better taken into account.

The amendments aim to separate the matters on which local authorities should be given guidance from those matters on which local authorities should be given clear regulations. We believe that they offer a much better way of putting patients forums on a firm footing.

Mr. Denham: It is probably best if I set out our intentions as succinctly as I can.

It is an interesting point whether we should have downgraded the regulations to guidance in some areas, but we have sought to reassure hon. Members as effectively as we can that the establishment of patients forums will be independent. Regulations, which can be discussed, seem to us to be the best way of doing that. Therefore, they would include the funding of patients forums and the provision of premises, other facilities and staff. I am not sure whether I want to draw the distinction that the hon. Member for Runnymede and Weybridge requested, but at least he will be reassured that those matters will be dealt with by regulation.

The issue of how patients forums will be funded and staffed will obviously be important. We have clearly said that patients forums will be managerially and financially independent of the trust or primary care trust to which they relate. The funds for patients forums will be provided by the regional office of the NHS Executive, as was the case with CHCs. As with the CHC, the patients forum, an unincorporated body, will need a host for its funds and accounts. That role could be taken on by the health authority, as happens with CHCs, but as I said earlier we are considering allowing local authorities to take on that role. There are strong arguments in favour of patients forums coming together locally to share support and expert staff. Similarly, the local authority could be the employer, as the health authority is the employer for CHC staff. More work needs to be done on exploring the options, but that is one possibility.

We intend that members of the patients forum will receive expenses to cover travel and subsistence and loss of earnings. That is in line with members of CHCs. Of course, the patient-nominated non-executive director will receive remuneration. It is right that we set out those matters in regulations. Regulations are needed at least to allow the NHS appointments commission to appoint members of the patients forum.

Mr. Burstow: The Minister has moved on from the point on which I had hoped to intervene. An issue that is raised from time to time is the historic basis of the original funding settlements for CHCs and the level of endowment of some CHCs compared to others. As a result, they are not all resourced on the same basis. What will be done to ensure equality of funding in the new system?

Mr. Denham: That is probably an issue that should be addressed once the Bill is enacted, but we shall certainly consider how best to provide funding across the health service. I certainly acknowledge the matter.

Mr. Hammond: I am grateful to the Minister for his explanation. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Mr. Denham: I beg to move amendment No. 199, in page 9, line 36, at end insert

    `or by a joint committee appointed with another Forum'.

The Chairman: With this it will be convenient to discuss Government amendments Nos. 200 to 202.

Mr. Denham: This is a provision that allows joint working across patient forums, which will be welcomed by the Committee.

Amendment agreed to.

Amendments made: No. 200, in page 9, line 37, leave out `of a Patients' Forum' and insert `or joint committee'.

No. 201, in page 9, line 38, at end insert `or Forums concerned'.

No. 202, in page 10, line 2, after second `Forum' insert

    `or a joint committee of two or more Forums'.

No. 203, in page 10, line 4, at end insert—

`(ia) the inclusion of annual accounts of a Patients' Forum in those of a Health Authority;'.—[Mr. Denham.]

7.15 pm

Mr. Hammond: I beg to move amendment No. 257, in page 10, line 13, at end insert

    `represent the population in the area served by the NHS trust or Primary Care Trust for which it is established and'.

The Chairman: With this it will be convenient to discuss amendment No. 93, in page 10, leave out lines 14 to 24 and insert `will comprise—

    (a) at least 25 per cent. of members who are members or representatives of voluntary organisations operating in the district whose members or client group have an interest in the health service, and

    (b) at least 25 per cent. of members being persons living in the locality or district for whom services are being provided or may in the future be provided under the 1977 Act, and

    (c) at least 25 per cent. of members being persons who provide care for persons detailed in paragraph (b) above but who are not employed to do so by anybody in the exercise of their functions under any enactment.'.

Mr. Hammond: I suspect that this will be the last group of amendments that we need to debate today. I suspect that the hon. Member for Sutton and Cheam will want to speak to amendment No. 93. Amendment No. 250 seeks to add to the list of duties of representation a general requirement that the membership of the body should represent the community that it serves. That will not replace any of the requirements provided under subsection (3) on specific representation on the patients forum, but it seeks an overarching requirement that the membership of the body should be properly representative of the population served. It is evident what I mean by that, and I hope that it is the Minister's intention. It is merely a form of words that expresses the intention without providing specific additional requirements in the Bill. I hope that the Minister will be able to accept it.

Mr. Burstow: I hope that the Minister will be able to accept either amendment, because we want the Government to clarify how they intend through regulations to ensure the widest possible representation of the interests of the local population on patients forums.

The amendment perhaps falls foul of one of the traditional lines of defence in Committee—the overly prescriptive argument. Nevertheless, it serves as an expression of what we believe to be the appropriate way forward in terms of representation on such bodies.

Mr. Denham: We differ on this matter, and it is worth briefly rehearsing the Government's argument.

Mr. Swayne: No, it is not.

Mr. Denham: For some people, at any rate.

We intend that the patients forums should be representative of patients and of organisations that represent patients and carers. That is not, strictly speaking, the same as having people who are simply representative of the local community. A difference in philosophical outlook may be involved here, but we see the advisory forum as the place where the whole local community is represented. We are keen that patients forums should represent patients relating to the trust concerned and to the services that are being provided. The issue may divide the Committee, but that is the Government's view.

Mr. Hammond: I hear what the Minister says. We are still concerned that the bodies should represent the communities that they serve, but the amendment was intended merely to probe the Government's thinking and would add nothing specific to the Bill. I am happy to reflect on the Minister's remarks, and I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Amendment made: No. 204, in page 10, line 24, at end insert—

`(3A) The regulations may include provision applying, or corresponding to, any provision of Part VA of the Local Government Act 1972 (access to meetings and documents), with or without modifications.'.—[Mr. Denham.]

Dr. Brand: I beg to move amendment No. 30, in page 10, line 24, at end insert—

    `(3A) The regulations must make provision to ensure that the members and the staff of a Patients' Forum are not financially dependent on the health authorities or trusts for which it is established.'.

This is another attempt to make the Government reconsider having members of patients forums as executive members of trusts. I foresee that a great conflict of interest may arise. For example, it has been shown to be difficult for some directors of public health, who are also governed by their corporate duty as the director of a trust or a health authority, to be totally independent in their views. It would be nonsensical if two members of a patients forum were to attend a trust board on which one of them is a trust board member who has to take an opposite line from the representative participating non-voting member of the forum. That could be untangled by stipulating that no one should be paid by two masters, and that it would be wrong for someone who is paid by a trust to be a member of a patients forum.

If the Minister can assure me that he does not intend a non-executive member to be a member of a patients forum, but to be an appointment by the forum, my anxieties will be much assuaged.

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