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6.15 pm
Allocations to local authorities—probably the most obvious and direct comparison that we could make in this context—are determined on comparable formulae, which also need to take into account many different issues. As with those for health authorities and PCTs, and in order to preserve maximum flexibility in a rapidly changing area, the formulae used by the Department for Transport, Local Government and the Regions are not set out in primary legislation. Neither is the formula for allocations to NHS organisations. It has never been the policy of successive Governments to specify part or all of the detail of the formula or the issues that should be taken into account in determining allocations to NHS organisations, whether PCTs, trusts or health authorities. There are powerful and convincing arguments for not doing that.
To some extent, amendments Nos. 8 and 9 are contradictory. Amendment No. 9 wants health care needs to be the basis upon which allocations should be determined to NHS trusts and PCTs, but amendment No. 8 wants the Secretary of State to take into account the financial liabilities of those organisations as well. I do not want to make a meal of this, but the hon. Member for West Chelmsford is to some extent pointing in two different directions on this. Is it a question of need or of a range of financial circumstances? He cannot have it both ways.
One could play devil's advocate and raise the question of surpluses. If one is to take account of liabilities under the hon. Gentleman's formula, why should the Secretary of State not take surpluses into account as well? I think it best to make sure that the allocation formula to trusts is based on health care needs. Meeting the health care needs of local people should be the exclusive determinant. That is precisely how we are addressing those issues.
There is an argument, which the hon. Gentleman raised, about whether his health authority or trust is fairly funded compared with a range of others. Most Labour Members would find it difficult to see the fairness of the comparison between West Chelmsford and Sedgefield and other parts of the country that he was trying to identify. It is on the basis of equity and fairness that the NHS should be funded according to the health care needs of local people. So I cannot accept amendments Nos. 8 and 9.
We have had a fairly full debate about these issues. We have gone over territory which is very familiar to those of us who served on the Standing Committee that considered the Bill. Conservative Members have raised a perfectly reasonable set of concerns, but my response to them, and to new clause 1 in particular, is that they have not acknowledged the progress that has been made since the second tracker survey was published. They have not weighed up, as we are required to do, the balance between the necessary changes, the organisational upheaval that they would impose on the service and the benefits to patients and the wider national health service. It is a complicated balancing equation, but our responsibility in government is to act first and foremost in the interests of patients. That is precisely what we are doing and why I do not want the House to accept the new clause.
Dr. Murrison: I am concerned about the Minister's dismissal of the second tracker survey, which is only months old. The work may have been carried out in the latter part of 2000 but it was published some time after that. If the right hon. Gentleman is so dismissive about the survey such a short time after its publication, why did he support it in the first place?
Mr. Hutton: I am not dismissive of the tracker survey. We think that it is a very important piece of work. It has helped us to respond to the concerns and criticisms made at the time. That is why we have put into place a substantial programme of primary care trust development work right across the NHS. I am not dismissing the contribution that the tracker survey has made. I am simply disputing the use that Conservative Members are making of it for the purposes of this argument. That is a very different issue.
In relation to these provisions, as to others, the House has an important decision to make tonight. These reforms are important and I accept that they are radical. However, they are motivated by a clear, simple and transparent principle—to make sure that as much responsibility, power and authority in the national health service is devolved as close to the front line as possible. That will allow the innovation, enterprise and experience of NHS managers to be used to the fullest possible benefit of staff, patients and the public as a whole. That is why the Bill should be supported by the House and the new clause, which has been considered carefully, should be rejected.
Mr. Burns: I listened to the Minister with great care. As a humble Opposition Member, I should like to say how grateful I am that a crumb has fallen from the Government's table and that the Minister has seen the strength of the argument put by my hon. Friends and me in Committee, and that he has in effect accepted amendment No. 6—albeit by substituting it with Government amendment No. 23. I am delighted that he has seen common sense and accepted the wisdom of what we and—to be fair—the hon. Member for Oxford, West and Abingdon (Dr. Harris) were trying to do and has drafted an amendment of his own. We have to be grateful for small mercies and this is one of those occasions, so I thank the Minister for that.
The Minister said that amendment No. 8 was horribly technical and that he did not want to go into the minutiae of its detail in case he confused my hon. Friends and me and, indeed, himself. Unusually I shall take the Minister
at his word; I shall not press either amendment No. 6 or amendment No. 8 to a vote. I, too, am not qualified to argue on the minutiae of the amendment. Having listened to the Minister, I shall also not press amendments No. 9 and No. 7.I listened carefully to the Minister's remarks on new clause 1. Although the drafting of the provision might have been flawed and it might indeed have been improved, I am disappointed that the Minister is not minded to accept it. The new clause was a genuine attempt to try to help the Government, as I said earlier. If the House is to change a crucial system that relates to two pillars of the NHS—its funding and its seamless provision of care—one obviously wants to ensure that the service works smoothly during the changeover from one system to another.
From the evidence that my hon. Friends and I have provided, both in Committee and during today's debate, we believe that there could be problems. As many of us pointed out during the debates on the Bill, we are not alone in expressing such concerns: health professionals and respected professional bodies such as the BMA have all expressed concern. However, I accept that the Government have the whip hand.
We have made a genuine attempt to try to help them, but they feel that our help is unnecessary and that things will be all right on the night. The jury is out on that. As a responsible Member of the House I hope that I am wrong. No one wants the system to be fraught with problems and mistakes. No one wants a hiccup in the provision of health care for our constituents, so I hope that I am wrong.
I do not know whether I am wrong; equally, I am not convinced that the Government know that they are right—we shall see. I reiterate that I hope that we are wrong. I hope that the system is seamless and that our constituents do not experience disruption or problems. We have tried our best.
As the Government are not prepared to take the lifeline of help that we are responsibly offering them, I beg to ask leave to withdraw the motion.
Motion and clause, by leave, withdrawn.
New Clause 2
Community Health Councils: scheme for reform
'.—(1) The Secretary of State shall lay before Parliament within 12 months of the date of coming into force of this section regulations setting out a scheme for the reform of the Community Health Councils in England.
(2) The scheme set out by the Secretary of State in regulations under subsection (1) above shall extend to all parts of the health service (including the provision of Part II services under the 1977 Act).
(3) The Secretary of State may make regulations providing for access by members of a Community Health Council to premises from which services under Part II of the 1977 Act are provided.
(4) The scheme set out by the Secretary of State in regulations under subsection (1) shall provide for the proper representation of the population in the area served by a Community Health Council on that council.
(5) Regulations under subsection (1) may not be made unless a draft of the statutory instrument containing the regulations has been laid before, and approved by a resolution of, each House of Parliament.'.—[Mr. Burns.]
Brought up, and read the First time.
Mr. Burns: I beg to move, That the clause be read a Second time.
Mr. Deputy Speaker: With this it will be convenient to discuss the following: new clause 5—Establishment of Patients' Councils—
'(1) The Secretary of State shall, subject to subsection (2) below, establish a body to be known as a Patients' Council ("Councils") in England in each area for which an overview and scrutiny committee has been established under section 7 of the Health and Social Care Act 2001 (c.15); each council shall be appointed from among members of relevant Primary Care Trust Patients' Forums and NHS Trust Patients' Forums operating in that area and representatives from relevant community interest groups.
(2) Where it appears to the Secretary of State that there is a need to establish a Council for an area other than that represented by a local authority with overview and scrutiny functions, he shall, after local consultation, establish a Council for such other area as appears to him will meet the needs of the local community.
(3) The functions of a Council are to represent the interests in the health service of the public in its district and in particular to—
(a) facilitate the co-ordination of the activities of member Patients' Forums including by the provision of staff and services to Patients' Forums,
(b) provide or make arrangements for the provision of services under section 19A of the NHS Act 1977 (independent advocacy services) at the direction of the Commission for Patient and Public Involvement in Health,
(c) represent to persons and bodies which exercise functions in its area (including in particular the overview and scrutiny committees and the joint overview and scrutiny committees mentioned in sections 7, 8 and 10 of the Health and Social Care Act 2001) the views of members of the public in its area about matters affecting their health,
(d) advise the bodies mentioned in subsection (4) on involvement of the public in its area in consultations or processes leading (or potentially leading) to decisions by those bodies or the formulation of policies by them, which would or might affect (whether directly or not) the health of those members of the public, monitor the effectiveness of this involvement and co-operate with the Commission for Patient and Public Involvement in Health in carrying out this function.
(4) The bodies referred to in subsection (3)(d) are—
(a) health service bodies,
(b) other public bodies, and
(c) others providing services to the public or a section of the public.
(5) The Secretary of State shall, following consultation with the Association of Community Health Councils for England and Wales, Community Health Councils, patients' and carers' organisations and the wider community, by regulation make provision in relation to Councils as to—
(a) the Patients' Forums and other community interest groups from which members of the Council are to be appointed,
(b) any qualification or disqualification from membership,
(c) terms of appointment,
(d) the proceedings of a Council,
(e) the discharge of any functions of a Council by a committee of the Council or by a joint committee appointed with another Council,
(f) the circumstances in which Councils will co-operate with each other in the exercise of their functions and exercise functions jointly with one or more other Councils,
(h) the preparation and publication by a Council of annual accounts,
(i) the provision of information (including descriptions of information which are or are not to be provided) to a Council by an NHS Trust, a Primary Care Trust, a Strategic Health Authority, the Commission for Patient and Public Involvement in Health, the relevant local authorities or a person providing independent advocacy services (within the meaning given by section 19A of the NHS Act 1977),
(j) the provision of information by a Council to another person,
(k) the preparation and publication of reports by Councils,
(l) the furnishing and publication by NHS trusts, Primary Care Trusts, Strategic Health Authorities and Overview and Scrutiny Committees of comments on reports or recommendations of Councils, and
(m) the referral of matters of a prescribed description to any overview and scrutiny committee, the relevant Strategic Health Authority, the Commission for Patient and Public Involvement in Health or the Secretary of State.
(6) The regulations shall include provision applying or corresponding to any provision of Part 5A of the Local Government Act 1970 (c.70) (access to meetings and documents).
(7) In section 21(10) of the Local Government Act 2000 (membership of overview and scrutiny committees) after the words "who are not members of the authority" there shall be inserted ("and shall include a person appointed by the relevant Patients' Council").
(8) In paragraph 1 of Schedule 1 to the Health Authorities Act 1995 as amended by this Act after "(c) a prescribed number of officers of the Health Authority" there shall be inserted—
"(d) persons appointed by the relevant Patients' Councils.".'.
New clause 7—Duty of Secretary of State and Strategic Health Authorities to consult—
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