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6.19 pm
Mrs. Marion Roe (Broxbourne): Like most community health councils, the four CHCs in Hertfordshire recognised that certain changes were necessary to improve public and
patient involvement in health care. They have been working closely with local NHS organisations to try to put into practice some of the proposals to put patients at the centre of the national health service. To that end, they are engaged in setting up shadow patients forums in each local NHS trust, bringing together complaints staff from each CHC to create an embryonic independent complaints advocacy service, and working closely with the county council and other local authorities on the overview and scrutiny functions.None the less, although the East Herts community health council, which covers my constituency, views the Bill's public and patient involvement proposals as an improvement on previous health measures, it has several serious anxieties, which I shall outline.
The proposal for a Commission for Patient and Public Involvement in Health, with local offices to support and integrate the work of patients forums, commission the independent complaints advocacy service and encourage the transmission of patient and public views to local authority overview and security committees, goes some way to answering the criticism that the proposed system will fragment the current arrangement whereby the CHCs act as a one-stop shop for all those functions. However, it means that the number of members, accountability and staffing of the commission are of the utmost importance.
The Bill makes none of those matters clear. The criteria for appointment to the commission, its size and to whom members are accountable are unclear.
Angela Watkinson (Upminster): What confidence does my hon. Friend have that anyone who is not a Labour supporter will be appointed to the new bodies?
Mrs. Roe: That is why such serious anxieties exist in my constituency. Nothing states from where members will be drawn. In view of the composition of other health authorities and bodies, people are worried about the balance of membership.
I received a copy of the latest document, "Involving Patients and the Public in Healthcare: Response to the Listening Exercise" this morning. Although it gives some idea of the proposed make-up of the commission by suggesting a system of nominations from the lay panels of the commission's local networks—a new proposal that is not in the Bill—and national patients organisations, the criteria for appointment, number of members and accountability remain unstated. The amount and source of the commission's funding is also unknown.
The composition, appointment and accountability of members of patients forums, which are proposed to take over the CHCs' role of reviewing and monitoring NHS services, arouse similar anxiety. Although the functions and responsibilities of patients forums are given in detail, including an extension of inspection rights to cover primary care—the CHCs have requested such rights for many years—the Bill is largely silent about their accountability, size, make-up and membership criteria.
It is suggested that the independent NHS Appointments Commission will make the appointments. However, that is a national body, whereas patients forums are essentially local organisations that need to reflect local interests.
The explanatory notes state that membership will be drawn from patients, carers and organisations in the voluntary sector that represent patients. Although the response to the listening exercise suggests that the criteria for membership
- "will need to be open and clear",
The way in which the proposed procedure in the response to the listening exercise will ensure fair and balanced representation, including that of disadvantaged members of society, deserves greater clarification. Given that there are likely to be 600 or 700 forums, attracting enough people to serve on them remains a challenge.
The Bill is silent about staffing, including the level of professional advice as well as administrative provision, its adequacy for the tasks assigned to the forums and funding details.
A further anxiety is that the public's right to have contentious matters, such as the closure or reconfiguration of NHS facilities and services, referred to the Secretary of State—the CHCs currently exercise that right on behalf of the public—will be obscured by its transfer to overview and scrutiny committees.
The proposed abolition of the CHCs means that the current position will be superseded. Although the response to the listening exercise states:
- "powers of referral will be no less than the current powers held by CHCs",
Another anxiety is the form that any transition will take, if the Bill is approved. The CHC members and staff have been in limbo for almost 18 months. Demoralisation and uncertainty has meant that many CHCs throughout the country have lost valuable members and staff. Replacement has become extremely difficult.
My local CHC has been fortunate in maintaining its momentum by trying to deal with patient and public involvement positively, with the encouragement of the local NHS trust and health authority. That encouragement should be undertaken nationally by the Government, especially the Department of Health, and regionally. The CHCs need formal and practical encouragement, including adequate resourcing, to move to any new system.
The proposals in the response to the listening exercise try to deal with that and should be welcomed as far as they go, but they are too late for many staff and members. The Government must ensure that the valuable experience, knowledge and expertise of CHC members and staff do not continue to haemorrhage to the detriment of the NHS, but are retained for its benefit and, more important, for that of all those who use its services.
As my hon. Friend the Member for Woodspring (Dr. Fox) said, the Bill does nothing to solve the genuine problems of the NHS. Replacing the CHCs with a plethora of alternative bodies with far less independence does not constitute progress.
6.28 pm
Mr. Frank Field (Birkenhead): I want to make a general point and a specific point, and I shall be as brief as possible. Today, we are debating the last of our nationalised industries, and many hon. Members wish to catch your eye, Madam Deputy Speaker. During my time in the House, the abolition of our nationalised industries has often been cheered by Members of at least one party. However, it is noticeable that when we debate the national health service, almost no Member criticises it. It is the one part of our post-war settlement that is held in such regard by the public that politicians reform it at huge personal and political risk. The fine picture painted by my right hon. Friend the Secretary of State at the end of his speech will be endorsed by the House and the entire country.
It is noticeable that the hon. Member for Macclesfield (Mr. Winterton) is in his seat for the debate. It is probably fair to say that he was one of the first Members to enter the Lobby when the House denationalised most of the nationalised industries, but there was no stronger champion of the NHS than he during the Tory Governments of the late 1970s and the 1980s and 1990s. In that way, he has accurately reflected the view in the country.
When the Secretary of State painted that broad canvas depicting his vision of the NHS at the end of a 10-year period, and spoke about how he hoped for the support necessary to turn that nationalised industry from a producers co-op into a consumer industry, it was noticeable how limited his first steps were in that direction. We need only think about how we behave as consumers in every other activity of our lives, and contrast that with how we have to behave as consumers in the NHS, to realise the lengths to which we must go to ensure that our last and only respected nationalised industry is successfully reformed. That is my general point.
My specific point relates to part 2 of the Bill. The ideas that I put before the House, and to which I may return in Committee and certainly on Report, relate to the regulation of the medical professions. I make a plea to the House to stand back and look at what we have been doing on regulation for the past 20 years. We have been denationalising ourselves and handing our functions to quangos outside the House, which are hardly responsible to the House. They lay an annual report before the House, but we all know that that is not accountability to the House. We have not recognised that the process of regulation should apply to an equally urgent issue on the Government's agenda—the modernisation of the House of Commons.
One of the problems that we face when we debate modernisation of the House is that some people have a hidden agenda, and view modernisation of the House of Commons as a means of defeating the Government. Of course, the Government must be sensitive to the views in this place, but if we are to hold the Government accountable at election times, Governments must, generally speaking, get their measures through, otherwise they will say, "We would have liked to do all that, but the rebels on the Back Benches prevented us from doing so."
Our role is not to take back the regulatory powers that we have given—the four huge ones to the public utilities now in the private sector, or to the Financial Services Authority or the Food Standards Agency. However, we should at least make those bodies responsible to the House
of Commons or to both Houses through a joint Select Committee, which would have the time and some of the expertise not to perform the function of regulation, but to hold the regulators accountable to Parliament and thus to the people.The Council for the Regulation of Health Care Professionals, which has a co-ordinating function, should have been established by the part of the Bill dealing with quality. If we, as consumers, are concerned about the professional standards of the growing medical profession that will affect us and our constituents, we should see it as part of the regulatory function and also part of our function to support those professions as they try to push up the quality of care and the standards to which they conduct their proceedings in the NHS and, as has been argued, in the private sector.
Those are not simply my ideas—they have been developed with Sir Donald Irvine who, as is well known, is the radical president of the General Medical Council. I hope that we may return to the idea on another occasion and not only debate more fully the effective reform of the NHS, but take the reform of Parliament out of the cul de sac where it has been for so long and give it a new track down which it could go towards success.
The first of my two points, then, is that the views expressed by my right hon. Friend the Secretary of State in his concluding remarks are shared by the entire House. Our job soon will be to improve the Bill so that it will achieve the objectives that he set before us and the country. Secondly, I have made a plea for us to link, in Committee and on Report, the raising of standards of care and professional standards of conduct in the health service to the reform of Parliament.
Perhaps with this measure we will cease to denationalise ourselves and hand our functions to quangos, and welcome the existence of new quangos but make them accountable to us. In that way, the new Council for the Regulation of Health Care Professionals will be able to carry out its functions more effectively, and many more Back Benchers will find a useful role in the House of Commons.
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