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Dr. Evan Harris: I agree with what the hon. Member for Wakefield (Mr. Hinchliffe) said about the Minister's conduct. She has always been available to listen to the multiple objections to her proposals. It is just as well she is a listening Minister, because otherwise we would be even more frustrated.

I also agree with everything else that the hon. Gentleman said, and I shall not cover the same ground except to point out, as I think he would recognise, that we have discussed this before. During the passage of the Health and Social Care Act 2001, my hon. Friend the Member for North Devon (Nick Harvey) stood where I am now and moved a similar amendment or new clause before the Bill went to the House of Lords and the proposal ran out of time. I hope that we do not have to go as far this time and that the Minister will find a way to recognise that the proposal in new clause 5, which has also been tabled by the Liberal Democrats, is a compromise. Some people would have preferred community health councils to be reformed rather than abolished.

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New clause 2 would have an effect similar to a proposal that we debated in Committee which sought to reform community health councils to take account of what the Government describe as the new NHS. We wanted to ensure that they had the functions and membership that Ministers, in many cases correctly, thought would be necessary to interact with the new NHS. The Minister rebutted or objected to our suggestions even more firmly than we argued them. New clause 2 is an attempt to persuade the Government to reform community health councils.

The Liberal Democrat party, which moved a similar amendment in Committee, supports the thrust of new clause 2, but we are also willing to put our names to an amendment that would go further. The advantage of new clause 5 is that it creates a structure for patients forums to interact in. Its functional approach places the roles of co-ordination and advocacy—advocacy in terms of changes to the local health service, not as defined in other parts of the Bill—at the level of overview and scrutiny committees. That will be of mutual benefit to patients forums that want to ensure that they have adequate mechanisms and structures to feed in opinions to the overview and scrutiny committees. It will also be of significant benefit to local authority overview and scrutiny committees to have patients councils that broadly cover the same area. They will be a single, effective and empowering channel—I am surprised to use the word "empowering"; I usually try to avoid it—for the concerns of patients and the public to be brought to the attention of the overview and scrutiny committees.

I join the hon. Member for Wakefield in thanking the Association of Community Health Councils for England and Wales. I also thank London Health Link. Not only did they provide advice on how our amendments and new clauses should be framed, but they recognised that things have to change. The Minister should at least concede that we are no longer fighting the principle of whether there should be patients forums. To an extent, if one accepts new clause 5, one accepts the abolition of CHCs. Those bodies have shown a willingness to meet the Government more than half way, because all the other structures that the Government propose will be in place. The framework is sensible. It is in tune with what the Government sometimes claim they want for the local networks. It is possible for us to rally around the framework and improve it.

7 pm

I turn now to other new clauses and amendments in my name and those of my hon. Friends. New clause 7 seeks to insert in the Health and Social Care Act 2001 a duty to consult. That duty would fall not only on strategic health authorities, PCTs and trusts but on the Secretary of State, or rather on bodies that function at a higher level than strategic health authorities and to which the Secretary of State could delegate the duty. I am concerned about bodies such as the national strategic commissioning advisory group, or NSCAG, and the regional specialist commissioning groups, which have a significant input into health service policy. They make recommendations and proposals for changes to significant areas of care, such as heart and lung services at a national level and paediatric

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intensive care at a regional level. If we are to have a complete consultation system, the necessary mechanisms must be in place.

The Government feel that the new clause is not necessary because strategic health authorities have a duty to consult and some of those supra-strategic health authority bodies will be made up of strategic health authorities. One of those may act as the lead authority and will therefore have the duty, the time and the personnel to consult all the patients forums and relevant groups in the area. However, it is questionable whether those circumstances will always pertain. Certainly it is hard to see how there would be a lead authority for consultation on a decision made by NSCAG or even by a regional specialist group. The Minister should state clearly that there will be no gap in the procedure, or she should accept the new clause.

New clause 8 is important because it would close an existing loophole. Those of us who carefully followed the proceedings on this Bill and on the Health and Social Care Bill will know that the important power of referral to the Secretary of State is currently exercised by community health councils, which are to be abolished. That function has not been given to patients forums, so we must ask which body will have the power to refer to the Secretary of State significant issues such as the failure of consultation or concerns about decisions made following consultation.

We have been assured that the function will be performed by the overview and scrutiny committees, but it is unclear whether the committees have that power, and it is important that the position be made clear. New clause 8 would do so—there is no disagreement about that—but I hope that the Minister will advise us as to whether the power exists. If she wants to resist the new clause, it would be nice if that advice were made available in written form. One would have hoped for it to be available before we had to decide whether to press the new clause, but the Bill has other parliamentary stages to come.

I may be able to explain amendment (a) to Government amendment No. 33 in interventions when the Minister is speaking to amendment No. 33. It makes a concession, which we requested in Committee, that patients forums will have the power to refer to the overview and scrutiny committee anything that they feel needs to be considered. Our amendment seeks to make it clear that the overview and scrutiny committee would have a duty to respond to that referral.

The Government say that they are reluctant to impose duties on local councils—indeed, they say that it is their policy not to do so—but that will come as a surprise to councils throughout the country. On such an important issue, where responsibility for consideration, oversight and scrutiny of health service changes is, in a welcome move, being shifted to local authorities, overview and scrutiny committees should have a duty to respond to patients forums. They should not necessarily have to take on all their concerns, but they should at least have to consider the issues. I hope that the Minister will ensure that that occurs.

There are many other amendments in this group, but I hope that the Minister will allow me to intervene to clarify the purpose of some of the Government amendments. In conclusion, I am determined to support the proposals,

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on which I took the lead in Committee, to reform community health councils because they are a tried and tested model, so I shall support new clause 2.

I am, however, much more optimistic that new clause 5 will secure support from hon. Members on both sides of the House, including the Government. I hope that we will find a way to ensure that the best of the Government's proposals are combined with the best ideas of the community health councils and of hon. Members of all parties to form an effective organisation, an effective structure and, most importantly, an effective function. We must ensure that the NHS is subject to the scrutiny and input of patients and the public.

Stephen Hesford (Wirral, West): I was unable to serve on the Standing Committee as I was a member of another Committee, so I rise to make points that I would have made in Committee if I had been present.

I always listen with great care to my hon. Friend the Member for Wakefield (Mr. Hinchliffe), but I cannot support new clause 5, which is a compromise. Neither can I support new clause 2. I served on a community health council for four years in the early 1990s, and I was a vice-chair in Manchester, just around the corner from my hon. Friend. It is unfair in the extreme of the hon. Member for West Chelmsford (Mr. Burns) to chide the Minister about the fact that nothing can change. The fact that someone has served on a community health council does not prevent them from seeing it in its true light. As the hon. Gentleman said, community health councils were set up in 1974, and times have changed. If he will forgive me for saying so, new clause 2 is opportunistic and backward-looking. It does not deal with the fact that substantial reform is necessary, as many hon. Members have come to realise.

Mr. Burns: Absolutely: reform is necessary.

Stephen Hesford: Does the hon. Gentleman want to intervene?

Mr. Burns: The whole point of my argument is that reform is necessary. If the system does not seem to be working as well as it should, the Government should reform it, not abolish it.

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