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The commission will draw in all that experience across the local area. We all agree that patients do not fit conveniently or snugly into NHS or local government boundaries and that patients' experience often transcends various truststhey go from one to another. It is important that we are able to draw that experience together. We must ensure that patients forums and ICAS providers are sufficiently supported so that they can develop.
Patients forums in particular are new organisations and they will need to be properly staffed and facilitated to ensure that they can grow. Those organisations must work together to share their outcomes, plan joint work and identify trends and themes. Above all, the whole patient and public involvement system must be geared to hearing the voices of people, not a few representatives who purport to speak for the community. The community must find a way to express itself.
The public will want to know how they can gain access to every part of the public and patient involvement service, where they can get in touch with PALS, how to get in touch with patients forums, what the overview and scrutiny committees will do, what the Commission for Patient and Public Involvement can do for them and where, at every single point, they can get their needs, concerns and grievances addressed. It is absolutely crucial that all those organisations be led by the public and by patientslay members determining their priorities in the community.
All those provisions are dealt with in the Bill, so new clause 5 is unnecessary, not because the issues are unimportant, but because they are catered for and because such a patients council might prove inhibiting to other important features.
The Commission for Patient and Public Involvement in Health is the fundamental change to our proposals following the introduction of the Health and Social Care Act 2001. It will have core national functions and a range of local functions that have been universally recognised as being pivotal to the system's effective operation. The Bill says that the commission must operate at PCT level in local communities.
As is argued for the patients council, information sharing is critical to ensuring that the patient's journey is truly understood and captured. We shall use the regulation-making powers in clause 15(4) to require patients forums to work together. That will enable best practice to emerge and inform the commission about those areas in which there are stresses and strains and where further work is needed. A strength of CHCs was that they could see such trends emerging. We shall ensure that that strength is not lost in the new system.
We envisage the commission and patients forums forging partnerships across different boundaries. We do not want to tie those boundaries down to specific and restrictive areas, because they will work in many different ways. Many issues span different PCTs and the commission will need to work across those areas and with lay members in partnerships and to have the flexibility to do so.
We think that the concept of a patients council, as expressed in new clause 5, would inevitably result in a limiting of the remit of the public and patient involvement system. It would also require a service organisation to support that organisation. I am keen to maximise the use of our resources in carrying out the consultation work that local people want to happen, instead of in servicing committees, taking minutes and the other aspects of a bureaucratic organisation. There would need to be 150 patients councils established, which would mean another 150 bodies in what hon. Members have already called a complex and complicated system. I do not want us to be tied to servicing such organisations, although the functions of the patients councils are crucial to making the system work.
We have to ensure that the commission will respond to what patients forums tell it are the important issues in their community. We have the flexibility in the Bill to make secondary legislation that will set out the relationship between the commission and patients forums, to ensure that when forums highlight an issue the commission takes it on board. We can ensure that patients forum representativesthe lay membersset the work programme for the commission and ensure that community priorities are at the top of the agenda. We shall use regulation-making powers to require the commission to have specific regard to the recommendations of joint patients forums when planning programmes of work.
By using the two regulation-making powers already in the Bill, we will be able to set up all the functions of the patients councils, as set out in new clause 5, and we can do much more. We will not be rigid or tied to a specific structure. The commission will go out into communities and hear those different voices and draw in those socially excluded groups and marginalised communities. We will be able to move on. It is a matter of having the courage to consider new ways of working. We are all tempted to stick with what we know because it is comfortable and
Dr. Evan Harris: Nothing in new clause 5 prevents the Secretary of State from making regulations to fine-tune the functions of patients councils, but the Minister described the provision of staff who would enable patients to make their views known to the relevant organisations as creating a bureaucracy. However, when staff are provided to support other organisations, that is called providing appropriate support for effective mechanisms. Simply labelling something a bureaucracy when the Government do not like it is not worthy of the issues involved.
Ms Blears: I assure the hon. Gentleman that there will be staff. The staff of the commission will support the patients forums. The staff will also go out into the communities to find the volunteers mentioned by the hon. Member for Westbury (Dr. Murrison) and give them support, education, training and guidancewhich they have never had beforebefore they are placed on patients forums and other bodies. That will ensure that patients and the public are empowered to challenge professionals. The representatives will be really fit for the purpose of serving on those bodies and will be able to feel that they can make a significant difference and a real contribution.
One of the aims of patients councils will be to make real links with local government. Some of the biggest determinants of good health are the issues that local government is responsible for, such as education, housing, transport and the environment. The commission will not be confined to an NHS model but will be able to make crucial links with local government, which have been championed by my hon. Friend the Member for Wakefield on many occasions. I am a little disappointed that my hon. Friend is not able to trust the Government's undertaking to put these measures into law through the use of the regulation-making powers. I have put our intention to ensure that those functions are carried out on the record and I am disappointed that my hon. Friend will not accept that.
Amendment No. 73, supported by the hon. Member for Hexham (Mr. Atkinson), deals with the rights of patients forums to inspect various properties. The matter was raised in Committee and I said that I would consider it. It is not our intention to hand to patients forums a set of draconian powers. We have said that patients forums should be able to inspect everywhere a patient goes, but that does not mean a right of access to private living accommodation. There will be appropriate limitations and restrictions in the regulations that we intend to enact. It will be necessary to spell out the circumstances in which patients forums can inspect various properties, and we will have to be conscious of the right to privacy under the human rights legislation. I therefore reject the amendment, but I hope that the hon. Gentleman will accept my reassurance.
Amendments Nos. 38 and 70 relate to the accounts and funding arrangements for patients forums. Independence for patients forums was a key issue in Committee and it is our intention to reinforce their independence through
I turn to the relationship of patients forums with the rest of the proposed system. Patients forums will be powerful and influential bodies, but we recognise that there will be times when the forums might feel that a significant issue from the patient's perspective has not been properly taken account of by the trusts that they monitor. In such circumstances, the forums might want to alert the overview and scrutiny committees, which will have the legal powers to scrutinise the NHS on that issue. Local OSCs will provide the democratic element, through democratically elected members, and we think it right that forums should refer issues of concern that have not been satisfactorily addressed to the OSC. The amendment has been widely welcomed by ACHCEW and patients' organisations, and I hope that hon. Members will also welcome it.
The democratic rights of local government must be a matter for its determination. We do not want to add to the Bill a requirement for OSCs to respond to referrals from the patients forum, because it is properly a matter for local government to decide what to do with those referrals in the course of the programme of scrutiny. However, it would be good practice to respond and we shall put in guidance our view on how OSCs should perform their functions. We would like to see a close relationship between OSCs and the patients forums. The OSCs should indicate, when they get a referral, what they intend to dowhether they will note the matter or look into it further. Government amendment No. 33 will join up the system between patients forums and OSCs, and I hope that it will be welcomed. Consequential amendments provide the necessary definitions and, on that basis, I would ask the hon. Member for Oxford, West and Abingdon to reconsider his amendment.
In Committee, the important matter of the right of overview and scrutiny committees to refer contested reconfigurations to the Secretary of State was raised. At the moment, the way in which community health councils deal with the matter is, as I said in Committee, tortuous, in that they rely on referrals to regulations. These are important matters, and I want the new powers for overview and scrutiny committees to refer contested reconfigurations to the Secretary of State to be no less rigorous than those that community health councils enjoyed.
I also want to clarify the situation about referrals on process and on merit. In relation to new clause 8, I would like to be able to consider further the details that are proposed. The drafting proposed by the new clause may not be sufficient to achieve the objective, and I would want to consider the proposals further.
Finally, new clause 7 seeks to amend section 11 of the Health and Social Care Act, which provides a duty on the NHS to make arrangements to involve and consult the public on decisions that it takes about the provision and delivery of services. It is not necessary to include the Secretary of State in the list of bodies to whom section 11 of the Act applies. The Secretary of State himself delegates all functions in relation to health servicesto health authorities, to NHS trusts or to PCTs.
A full list of potential providers of health services is already included in the Health and Social Care Act. Paragraph 34(a) of schedule 8 to the Bill extends the provision to strategic health authorities. On that basis, I would resist the new clause. There is sufficient definition of the bodies that are required to consult under section 11 to fulfil all the scenarios that have been put before us. The hon. Member for Oxford, West and Abingdon is going down the road of hypothetical situations and the Bill will be sufficiently robust to meet his concerns.