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The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears): Following the last contribution, I will try to bring us back down to earth, and closer to reality and to the clauses that we are discussing. I want to deal with new clause 2 and the consequential amendments and then new clause 5. Obviously, many of the same issues are involved in both new clauses.
I reject absolutely the idea that this is a vindictive or pernicious attempt to attack community health councils, as has been alleged by the hon. Member for West Chelmsford (Mr. Burns). He knows very well that, in Committee, I put on record on three or four occasions my personal tribute to the excellent work carried out by many community health councils up and down the land. That stems partly from my own experience, and also from my fairly detailed knowledge of the work that has been carried out over many years by staff in CHCs and, crucially, by volunteer members who have given of their time unstintingly to try to improve the health service.
That is not to say that realistic, down-to-earth, grounded people do not recognise the limitations of those organisations. Many such people want actively to embrace change and to consider new ways of working; they have the courage to examine new forms of organisation that can strengthen the patients voice.
Mr. Burns: Will the Minister tell the House how many members of community health councils in England wrote to the Department of Health, following the consultation process, saying that they wanted the CHCs to be abolished?
Ms Blears: I have already spoken in detail to the hon. Gentleman about Wirral CHC. He knows that extremely well.
Dr. Evan Harris: It was Wigan.
Ms Blears: It was not Wigan, it was Wirral. That CHC has welcomed the proposals. Many members of CHCs have been in touch with me, either in writing or in person. Many came to the nine regional listening events that were held up and down the country, and broadly welcomed many of the proposals. Yes, they had concerns, but they were willing—unlike some intransigent, inflexible Conservative Members—to embrace change and to consider new ways of working that could help to strengthen the voice of patients and the public in the system.
Our new system aims to be more accessible, accountable, independent, robust and effective. We are not starting from scratch. We have genuinely tried to build on the best of the existing work being done in public and patient involvement. That involves not only CHCs. We must not forget that a whole range of patient organisations has been involved in this work for many years. There is a tendency to think that public and patient involvement involves only CHCs. The process that we have undertaken over the past few months has enabled many organisations to get more involved and to see how they can make a more effective contribution in future.
The current system of CHCs has been in place for about 27 years. Inevitably, any change will encounter resistance and uncertainty, and people will cleave to what they know because they do not know what the new system will look like. I acknowledge that there has been a need for the Government to try to explain the changes. Certainly, over the past seven months, I have been out and about with other Ministers and officials from the Department, talking to people in local communities to ensure that we get our vision of a more effective, independent, integrated system across to them.
Only last Thursday, I spent three and a half hours meeting representatives of the Association of Community Health Councils for England and Wales. We agreed at the end of the meeting, as my hon. Friend the Member for Wakefield (Mr. Hinchliffe) said, that we were only inches apart in terms of the things that we wanted to do. We made many changes during the listening exercise and as a response to the listening document. We showed that we had not just listened; we had not just heard what people said, we had acted on it as well. This was not a sham process, an empty attempt at consultation. This was real, engaged activity. We were prepared to listen and to act.
There is broad consensus about the functions of the new system. The functions of the new commission have been broadly welcomed. There is also consensus about the need
to involve people who traditionally have not had a say in the health service—people in excluded and marginalised communities who have been ignored for many years when services have been shaped, developed and drawn up. There is a willingness in the field to draw in a wide range of individuals and groups, and to make sure that their voices are right at the centre of shaping services for patients.The consultation process has been an extremely good one, and that is not just my view. I draw to the attention of hon. Members a letter circulated by the Long-Term Medical Conditions Alliance. The alliance represents the Alzheimer's Association, the British Cardiac Patients Association, the National Schizophrenia Fellowship, all long-standing, respected patients' organisations. They welcome the new proposals, and state, quite realistically, that
- "bearing in mind the impossibility of accommodating everybody's wishes in their entirety, the key concerns raised during"
- "have been addressed in the latest set of proposals."
- "We believe that the proposals contained in the Bill will allow diversity to develop, and that any amendment involving yet more committees (such as the Patients' Councils"
- "would lead to the strangling of genuine citizen involvement and the promotion of bureaucracy at the expense of the voice of individual users of the NHS."
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Lynne Jones: I have read the LMCA letter, but those bodies represent people with long-term medical conditions who are regularly engaged with medical services. Patients forums are therefore much more likely to involve patients who take a long-term interest in them. Those with acute conditions go in and out of the system. With respect, the view of those organisations is not necessarily representative of patients as a whole.
Ms Blears: I would not say that that is the view of all patients, but it is extremely important, given which organisations are members of the alliance, and it shows that widespread support exists.
Dr. Harris: If we are trading organisations, the Minister may be aware of the view of the Patients Association, which has at least as much legitimacy in this respect as the LMCA:
- "The Government has been truly determined to get rid of an effective local voice for patients in the form of Community Health Councils . . . This amendment"—
- "offers a compromise and an opportunity for patients to have an independent and powerful say in what's happening to their health services locally."
We have heard the arguments about reform on various occasions. Over the past five years—the period highlighted by the hon. Member for West Chelmsford—the NHS has changed dramatically and it is about to change even more fundamentally still. Therefore, there is a need to put in place a new system of patient and public involvement that properly reflects all the different NHS levels and functions to ensure that, where there needs to be public involvement, it is sited in the most appropriate place in the service so that it can act as a key lever for driving up standards and change. No longer should patients be outside the system, able to react only after the event.
The hon. Member for Southend, West (Mr. Amess) has gone to his CHC to look after the interests of his constituent, who appears to be in a dire situation, but the CHC has to act after the event and from the outside. The new structures will put the PALS system inside that trust, so it will be on the spot to provide assistance to that constituent where it matters and when he or she needs it. The system will be a powerful force for ensuring that the trust, its consultants and the service that that constituent receives improve. Therefore, I genuinely believe that what we are introducing is much more appropriate for the changed NHS. We are putting patients and the public right at the heart of the system, which is where they need to be and where they can make the most difference.
I want to deal in detail with the concept of patients councils in new clause 5. As my hon. Friend the Member for Bedford (Mr. Hall) said, it is important that I set out how the commission would work so that people can visualise the way in which the system may be drawn together. All the concerns about fragmentation can be addressed. Many Members have mentioned the need to ensure that the system is integrated and that there is an overview of the whole health community. That is very important.
The concept of patients councils, which was introduced by previous legislation, has helped to inform the arrangements before us. Over the past year, we have developed our proposals in the light of those ideas and many others. This has not been a static process in which the Government have taken a fixed view. We have taken on board the views of many stakeholders in the system and the proposals have been much improved over the past year or so.
The system will take on board all the functions set out in new clause 5, but it will also allow for a more dynamic and much more influential arrangement that is fit for the purpose of empowering all the people whom we want to involve in the NHS. First, we all agree that there must be a mechanism to pull together the informed overview of the patient experience across a specified area. That overview is fundamental. We must ensure that we collect all the data from PALS, the patients forums, the trends and the themes that emerge from independent complaints and advocacy services so that we have in one place all the information we need to know what the NHS is like in a certain community or neighbourhood and what is causing concern regularly, not just as a one-off. Currently,
there is no one place in which all that intelligence can be held, but we shall be able to ensure that there is such a place in future.The commission will go out locally and engage hard-to-reach groups and people from marginalised communities. It will get not only the views of long-term and acute patients, but, perhaps, those of the homeless, people in the travelling community and people from black and ethnic minority groups—the voice out there that has never shaped the service before. The commission may use that data, that intelligence, those views and those concerns to ensure that reports are prepared not narrowly—
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