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Dr. Murrison: The hon. Member for Wirral, West (Stephen Hesford) inadvertently made a very good point in his intervention on my hon. Friend the Member for Hexham (Mr. Atkinson). He suggested that, in his constituency, if one asked a person in the street about their CHC, they would not know anything about it. In my constituency, people would know about their CHC.

Stephen Hesford: I said that we would get that answer if we were to walk outside now and speak to people in the street. I do not represent Cities of London and Westminster.

Dr. Murrison: I am grateful for that correction, but I think that the meaning was clear. In Westbury, people

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know all about their CHC. The point is that there are differences in practice throughout the country. There are good CHCs and some that are not quite so good, but the fact that they are good means that they are a good basis on which to build and reform. That is the thrust of the Opposition's argument about CHCs.

Bath and District CHC monitors health care services provided by two health authorities, two ambulance NHS trusts, two acute hospital trusts, a mental health partnership trust, two PCTs and a PCG. When my constituents are poorly, many of them—especially the vulnerable and elderly—end up dealing with local NHS services that are provided by two or more trusts. None the less, however many trusts they use, in their view, they are using the national health service in a fairly seamless fashion. My CHC centres its work on ensuring that patients receive the very best seamless provision of quality health services as they navigate their way around the multiple tiers of the national health service. Seamlessness is one of its strengths, but a strength that the Bill threatens.

The Association of Community Health Councils is, understandably, rather hurt and upset. Indeed, it is bewildered. It said:

CHCs are certainly watchdogs, but what we have been offered in their place is poodles, and lots of them: oodles of poodles, in confusing myriad PALS and patients forums. The proposals made by the hon. Member for Wakefield (Mr. Hinchliffe) in new clause 5 are interesting, but they are second best. They suggest that we should keep our poodles and merely have something that might turn out to be a watchdog.

That brings us to cost. Despite the advice of the Opposition, the Government have set their face against building on the CHC model. My CHC costs £118,664, but its chief officer estimates that it will cost £750,000 to provide PALS alone. Indeed, the current edition of the Health Service Journal suggests that it will cost 10 times the amount spent on CHCs to provide the new services outlined in the Bill.

Roy Carr-Hill, professor of medical and social statistics at York said of the new system:

We should ask not only about the source of the money and the opportunity costs involved, but where the Government suppose that the army of volunteers required for staffing will come from. Those of us who have been heavily involved in the voluntary sector know that it has become increasingly difficult to get people, especially those with the right skills, to commit themselves for nothing. If public enthusiasm for the Bill is anything to go by, it seems unlikely that folk will queue up to lend their services to PALS and patient forums.

I am sure that my CHC's plea for a more integrated approach is echoed throughout the country. Patients, who view the NHS as a whole, not in little bits, would

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thus have a one-stop shop for their anxieties and representations. Conservative Members believe that reforming CHCs, not abolishing them, is the way ahead. If that is beyond the Government, can we place a duty on trusts to ensure that their poodles in a geographical area at least talk or bark to one another? Surely there is scope for sharing financial and human resources, thus driving down the appalling costs that informed opinion has forecast for the proposals, and making the best use of finite voluntary effort.

Mr. Baron: The Bill would abolish CHCs in England without replacing them with any community-led overview of the local NHS. England would be the only part of the United Kingdom without CHCs or a similar body. The measure proposes a confusing array of new mechanisms, which would make it more difficult for people to understand the system, influence the local NHS or obtain independent help when they needed it.

The proposed new system is difficult to understand because it is so fragmented and complex. The Bill proposes overlapping and separate organisations, which may serve only to confuse patients and the public. Without clarification from the start, there is a danger that much energy will be diverted into sterile competition as different organisations jockey for position in their local communities. That would be a complete waste of resources and energy. Elizabeth Manero, the chair of London Health Link, warned that the proposed system would be "a charter for tokenism". She said that it was "fragmented" and did not comply with recommendations from the Bristol inquiry for fully independent bodies.

Individual patients forums would have a remit for considering only their trust's services, with no formal mechanism for coming together to provide an informed overview of the local NHS from the patients and the public's perspective. Patients forums would be run entirely by volunteers and have no paid staff. I imagine that they would seek support from a separate body of paid staff—the Commission for Patient and Public Involvement in Health—or that they may be forced to rely on help from the trust that they monitor. That would compromise their ability to be an effective and independent watchdog.

People who require independent help with problems with the NHS or complaints would have to approach other organisations, for example, the independent complaints advocacy service. Separate organisations make up ICAS, and it would therefore be more difficult to scrutinise and monitor complaints as they were processed. Staff of the Commission for Patient and Public Involvement in Health would be tied up in the bureaucratic exercise of tendering, monitoring and evaluating ICAS.

I have two further anxieties. First, the Bill removes the requirement to consult about changes to functions and boundaries of key NHS organisations, such as strategic health authorities, PCTs and NHS trusts. Community health councils must currently be consulted on such changes. The Bill does not specify the organisation that will take on that function. That is worrying.

7.45 pm

Secondly, the new structures will be much more expensive than CHCs. It is proposed to abolish CHCs without any guarantee that sufficient funding will be made

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available to ensure that their replacements are properly resourced. Again, that is worrying. Community health councils should be given more time to reform. They have had faults in the past, but, overall, they have championed patients by monitoring the health care in their local communities. They should be given more time to reform and I therefore support new clause 2.

Mr. David Amess (Southend, West): I support new clauses 2 and 5. The hon. Member for Wyre Forest (Dr. Taylor) is not naive, but I have observed him on the Select Committee on Health, and he is a gentleman in every sense. He asked the Minister why CHCs should be abolished; perhaps I can help him. The Government dislike any criticism, and they are especially upset about criticism from Labour supporters. When Labour Members were in opposition, they loved CHCs because they were critical of the Conservative Government. Now we have a rotten Labour Government, and they cannot abide criticism from CHCs, especially from Labour activists.

The Under-Secretary who will reply to the debate has been a great champion of CHCs. The hon. Members for Wakefield (Mr. Hinchliffe) and for Bedford (Mr. Hall) also have an honourable record in consistently championing the cause of CHCs. However, there is no doubt that what we are being offered as a replacement will not do. The proposals are ill thought out and shambolic.

If CHCs continued to exist, they would champion the cause of one of my constituents, a lady, who was diagnosed with lung cancer eight weeks ago. The cancer is operable, but she has been waiting eight weeks for an operation. The cancer is pressing on the spine but nothing has been done because of delays. Southend community health council will take up the lady's cause. As her Member of Parliament, I am doing everything that I can. I have tried to talk to the bed manager, who was on holiday for a week. No one was in charge during that time. When we spoke to the person today, we were told that further time was needed to examine the matter. Southend community health council is disgusted by the fact that my constituent has had to wait eight weeks. Her family are distraught about the circumstances, and they will not forgive the Government unless something happens.

I have received a letter from Southend community health council, as my hon. Friend the Member for Hexham (Mr. Atkinson) said, which expresses its anxieties about the Government's plans. Community health councils are enthusiastic about changes that benefit patients and the public. They do not claim that there should be no change. They are certainly not arguing for the status quo.

CHCs have been an effective independent watchdog in the NHS for the past 27 years. In that time, Southend community health council has helped thousands of people. The hon. Member for Wirral, West (Stephen Hesford) said that people in his constituency had not heard of CHCs. I am surprised at that. In my area, and those of most other hon. Members, if people had not heard of CHCs before the current campaign, they jolly well have now. People probably took them for granted, but now they are clutching at this precious commodity, and saying that what is being offered in its place will not do.

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The new proposals threaten to eliminate the only effective, integrated independent watchdog that patients have, without putting forward an adequate replacement. The letter that I received from Southend community health council states:

It goes on to say that the proposals with which the Minister will probably try to seduce the House shortly are

The Government, when they were in opposition, never turned away from using any briefing from the British Medical Association. For 18 years, the BMA was the Labour party's watchdog. However, since 1997, we never hear the Government say a word of good about the BMA. All hon. Members will have received a briefing from the association, stating how disappointed it is with the proposals.

The Secretary of State for Health put his foot in it in a big way today. Those of us who witnessed what happened during the private notice question and heard not one "Hear hear" from the Government Benches saw his proposals go down like a lead balloon. Today, the Labour Government are privatising the national health service. There can be no doubt about that. It has taken a Labour Government to do so. A number of hon. Members who sit on the Select Committee on Health are present in the Chamber now. When the Secretary of State came before us last week to give evidence on the private health sector, not a word was mentioned about these extraordinary proposals when we questioned him.

The right hon. Member for Holborn and St. Pancras (Mr. Dobson) was obviously extremely upset about the proposals earlier, and I think that says it all. No doubt we shall hear from the Labour party in the weeks ahead about its plans to charge for all sorts of services that have traditionally been free under the national health service. It is not too late for the Government to admit that they are wrong about abolishing community health councils, to rethink their proposals, and to accept new clauses 2 and 5. If they did that, the hon. Member for Southend, West and the whole of the country would think far more of the Government than they do at the moment.

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