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Lords amendment: No. 1.
Mr. Hutton: I beg to move, That this House agrees with the Lords in the said amendment.
Madam Deputy Speaker (Sylvia Heal): With this we may discuss Lords amendment No. 3.
Mr. Hutton: Members will recall that on Report I tried to deal with the concerns of those on both sides of the
House by tabling an amendment seeking to provide for consultation before name changes, boundary changes and mergers of strategic health authorities could take place.I am very grateful to Baroness Thomas of Walliswood for helpfully recommending in Committee in another place on 14 March that the Government could usefully reconsider the wording proposed for the new section 8(5) of the National Health Service Act 1977 Act contained in clause 1 of the Bill. My noble Friend Lord Hunt of Kings Heath promised at the time to look at the wording again, and I am pleased to say that on reflection we were able to bring a revised and shortened version of subsection (5) before their Lordships.
The wording as now drafted follows the precedent set for NHS trusts in section 5(2) of the National Health Service and Community Care Act 1990, as substituted by the Health Authorities Act 1995. The term "prescribed" is defined in section 128 of the 1977 Act as meaning prescribed in regulations made by my right hon. Friend the Secretary of State.
Let me make it clear that the previous version was not wrong. It would have achieved exactly the same in policy terms as this amendment. However, as we considered the issue further during the passage of the Bill, it became clear that what we wanted to do could be drafted more simply. We accordingly took the opportunity of making what I hope will be regarded on both sides as an improvement to the Bill. However, it does not change the substance.
Amendment No. 3 tidies up a minor drafting error in a definition in clause 5 to make it clear that for the purposes of this section
- "a section 28C dental practitioner"
- "in the area of the Primary Care Trust"
Mr. Oliver Heald (North-East Hertfordshire): Let me start by saying as I did on a previous occasion that it is welcome that the Minister has accepted that there should be consultation on the orders about the establishment, variation, the name or the abolition of a strategic health authority. In supporting our amendment on Report, some Labour Members, including the hon. Member for Leigh (Andy Burnham) said that it was necessary to have proper consultation.
We had a concern, however, about the wording, if the Minister should make such regulations as provided for in the previous amendment that the Minister put forward on Report. Earl Howe, speaking for the Opposition in the other place, made that point. It is good that the Government have responded to the points that we made in Committee and on Report and have come up with what is, without doubt, a neater form of wording. I entirely agree with the Minister that amendment No. 3 is purely technical. We welcome these amendments.
Lords amendment No. 3 agreed to.
Clause 14
Lords amendment: No. 5.
The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears): I beg to move, That the House agrees with the Lords in the said amendment.
Madam Deputy Speaker: With this we may take Lords amendment No. 30.
Ms Blears: Amendments Nos. 5 and 30 enable the Secretary of State for Health to delegate the appointment of the chair and members of the Commission for Health Improvement and the Commission for Patient and Public Involvement in Health to the NHS Appointments Commission. Indeed, we go further than this, demonstrating that we are committed to the independence of these bodies and distancing the appointments process from the Secretary of State.
The amendments enable the Secretary of State to delegate to the NHS Appointments Commission such of his functions as may be appropriate in relation to the tenure of office, terms of appointment, dismissal, and so on, of the chair and members. The details of how such arrangements with the Appointments Commission might work in practice are subject to negotiation with Sir William Wells and his team.
As I have said, similar arrangements have been made for the appointment of the chair and members of the Commission for Health Improvement—
It being one hour after the commencement of proceedings on consideration of Lords Amendments, Madam Deputy Speaker, pursuant to Order [this day], put forthwith the Question already proposed from the Chair.
Madam Deputy Speaker then proceeded to put forthwith the Questions necessary for the disposal of the business to be concluded at that hour.
Lords amendments Nos. 17 to 30 agreed to.
New Clause
Lords amendment: No. 6, before clause 16, to insert the following new clause—Establishment of Patients' Councils.
4.45 pm
Ms Blears: I beg to move, That this House disagrees with the Lords in the said amendment.
Madam Deputy Speaker: With this it will be convenient to take Lords amendments Nos. 7 to 16 and the Government motions to disagree thereto, and Government amendments (a) to (d), (o) to (q), (e) to (l), (r), (m) and (n) in lieu.
Ms Blears: I should like to express my sincere apologies to all hon. Members for the late tabling of some of these amendments, as that lateness may have caused hon. Members some concern. I have certainly done my best, by issuing covering memorandums and by writing directly to Opposition Members, to try to set out not just
the terms of the amendments, but their effect so as to try to minimise any awkwardness that may have been caused. The amendments have been tabled in a genuine attempt to try to engage the widest possible range of stakeholders in producing a proposal that I can put before the House this afternoon. I should like to express my genuine apologies for any difficulty that the amendments' late tabling may have caused.At last we are coming to the end of a rather tortuous journey to strengthen patient and public involvement in health. From the NHS plan, published in July 2000, to the Health and Social Care Act 2001, and now in the Bill, we have reached a position on patient and public involvement that is as good as it gets. I genuinely believe that we will have a robust, independent and vigorous system of public and patient involvement. I and my ministerial colleagues, as well as previous Ministers—and our officials, too—have been in discussion with many stakeholders during the last year and a half to ensure that we develop the best possible set of arrangements.
The points made during parliamentary scrutiny and arising from the involvement of stakeholders have been extremely constructive. Although we have not agreed with all of the views expressed, it is fair to say that they have all played their part in helping to fine-tune the system. Patients councils were one of the turning points in our preparations.
The amendments to provide for patients councils that the other place voted to include in the Bill are not welcomed by the Government, as patients councils are, in our view, flawed organisations for reasons we have rehearsed in the House and in the other place. One of the primary reasons why they are not welcome is that they would involve the introduction of 150 new bodies, adding an entirely new layer to the system of public and patient involvement.
The other fundamental reason why we oppose introducing patients councils is that they would involve a system in which a body purports to speak on behalf of the public. That is fundamentally opposed to the whole system that we have tried to establish, which enables the public to speak for themselves. That is a key difference in the kind of facilities that we want to put in place.
Dr. Evan Harris: I am still recovering from the last few sentences, but I want to ask the Minister whether she has worked out how many enhanced PCT patients forums her proposals will produce? Will not there be twice as many as there would be patients councils based on overview and scrutiny committee areas? Although the proposed forums will be in addition to PCT patients forums, does she accept the argument that increasing PCT patients forums is at least as bureaucratic and will result in smaller organisations than introducing a more limited number of larger, local authority patients councils, based on overview and scrutiny committees, or something of that sort?
Ms Blears: I understand the point that the hon. Gentleman seeks to make, but I do not accept it. We propose to enhance existing organisations, whereas patients councils would introduce a whole new layer of separate organisations in the system. I am keen to ensure
that we do not recreate a hierarchy of organisations that operate with increasing exclusivity and in which people see themselves as delegates of other people. The whole thrust of the patient and public involvement mechanisms is to enable people to express their own views and for them to have support in doing so, rather than having a delegate system whereby other people purport to speak for them. Hon. Members may have difficulty with that distinction—it may be complex—but it is crucial to the new approach in the new national health service that we have a system that is not about an exclusive delegate democracy but about liberating local people so that they can speak for themselves.
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