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Mr. Heald: Which body will run "casualty watch"?

Ms Blears: As I explain the full implications of the amendments, the hon. Gentleman will see that we propose—in amendment (r), I think—to introduce a new power, or rather a function—which could be a power or a duty—for the Commission for Patient and Public Involvement in Health to consider reports from patients forums and to assess emerging trends that may give rise to issues of national concern that should be taken up by patients forums generally. That would not be limited exclusively to "casualty watch". The forums might want to consider other issues that span the spectrum of their concerns; for example, they might want to undertake a review of a national service framework.

Our proposals are stronger than those envisaged by the hon. Gentleman; they are not simply limited to "casualty watch". It might be perfectly legitimate for patients forums to look into accident and emergency waiting times. They could report to the commission to ensure that we had a national overview. They might be even more creative and look into other issues.

Linda Perham (Ilford, North): As regards the point made by the hon. Member for Oxford, West and Abingdon (Dr. Harris), will my hon. Friend explain why the proposals in respect of the duties of patients councils and the patients forums of the primary care trusts would not create a hierarchy of PCTs?

Ms Blears: I am grateful to my hon. Friend for that question. She will be aware that I and my ministerial colleagues have expressed concern about the creation of a hierarchy of patients forums. I am keen to ensure that one forum is not seen as better than another. I want to try to ensure that the forums are able to attract local people of high calibre. I want patients forums for acute trusts and mental health trusts to be just as attractive as those for the PCTs. We want to ensure that the system is rooted in patients forums—that people see them as the driver in the system. There are genuine reasons for PCT patients forums to have a wider role, because PCTs do not merely provide primary care but also commission secondary services. Instead of seeing the system as a hierarchy—where one patients forum is better than another—I should prefer the PCT patients forums to be seen as having a broader remit. They should be seen not as reporting upwards in a hierarchy of organisations, but as having extended responsibilities.

Dr. Harris: I realise that the hon. Lady wants to make progress, and I shall be welcoming her proposals for other

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aspects of the measure, but this matter is important. One of the points that she made about patients councils is that she does not want people to feel that they are representing other people—or acting as delegates—and she wants people to feel free to speak out. I have not really understood that point. However, in order to create the super-patients forum—the PCT patients forum to which she referred—the amendments provide that at least one member of that forum should come from one of the other patients forums in the area. Does not that recreate what she considers a problem in the proposals for patients councils, although we would consider it a strength?

Ms Blears: When I go through the amendments, I shall explain the extended membership of the PCT patients forums. That is not about people representing others—it is a way of making connections and ensuring that people can share their ideas, knowledge and experience. It may help the hon. Gentleman if I explain that I said that the system should not involve people speaking on behalf of other people because there will be complex issues on which the public will hold a range of views. I do not want one organisation to weigh up that range of views and to come down firmly on one side and to promote only that point of view. Where there is a diverse range of views on a complex health service issue in a community, we need to have mechanisms that allow all of those views to be expressed, to be ventilated and to be weighed by those who are making decisions. Firm decisions should not be set in stone at an early stage before all the relevant views have been expressed. I appreciate that these matters are complex but I do not think that it is beyond our understanding to develop new ways of working.

We have said that much of the purpose of patients councils fits with our view of a strong and comprehensive public and patient involvement system. I think that the way forward is clear, and that is to try to ensure that the system that we have proposed builds on the strengths of patients councils but does not weaken the overall structure of embedding those powers in patients forums.

I shall explain the effects of amendments (a) to (d), (o) to (q), (e) to (l) and (r). The overall effect of what we are doing is to give to PCT patients forums the functions that we previously envisaged for the local offices of the Commission for Patient and Public Involvement in Health. I genuinely think that that makes for a stronger local connection.

The commission will appoint staff to support and work with every PCT forum in England. The staff of the forum will support the members of the PCT forum on a day-to-day basis. That will ensure that there is a robust process in place for the work priorities of the staff to be fully informed by the priorities of local people. There will be real accountability to those communities.

It will be the job of the forum to promote the involvement of the local community in local decision- making processes. In particular, it will be its job to go out and find out the views of those disadvantaged and marginalised groups that traditionally have not had a say in shaping the development of health services.

It will also be the job of the forum to promote the views of people in its area to local decision makers, and in particular to a local overview and scrutiny committee. I believe that this arrangement will root and ground the commission's staff in local neighbourhoods.

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In addition—this is where we have picked up some of the key strengths of the patients councils concept—the staff of the PCT forums will be able both to provide and to commission independent advocacy support. During various stages of the Bill's consideration many Members have talked about incorporating the duty to represent the views of local people, and the provision of independent complaint and advocacy support would make sense. We genuinely picked up on that idea.

It will also be the responsibility of PCT patients forums to act as a sort of one-stop shop for local people, by providing advice and information to them about how they can get involved locally, what consultations are taking place and how they can make a complaint. The forums will also be responsible locally for keeping an eye on the arrangements that other NHS bodies have in place to fulfil their duty to involve the public and to make arrangements to consult them about changes to services.

We have amended the composition of PCT patients forums. They will now include members of local community groups that represent the views of the public on issues that affect their health. For example, if a local environmental group was concerned with a particular issue that could affect the health of local people, it would be welcome to be involved. It is important to note that we are trying to expand the remit not only of the NHS in terms of the service that clinicians and the NHS has traditionally provided, but to try to make key links with the wider determinants of health—the environment, jobs, education and safe streets. All those things significantly influence health.

Dr. Harris: I stress that I welcome the fact that the Minister wants to include on one of these consultative bodies—which she wants to be PCT patients forums—people from other groups. However, she has just referred to them as representatives from other groups. I do not see a problem with that save that I wish they were to be democratically accountable. That is the only difference between us. However, she has talked earlier about rejecting the patients councils idea because she wants people to speak for themselves and not to feel that they are delegates of organisations. Has the hon. Lady sold the pass—I welcome it if she has—by recognising that it is reasonable for that representation to take place?

Ms Blears: No, I have not sold the pass on this one. What I have said is that there are organisations and groups out there who will want to feed people's views into the patients forum who will then put those views forward to other people. That is a perfectly legitimate position to be in.

By placing all these responsibilities with the PCT patients forum, we have shifted the power base of the new system for patient and public involvement to local communities. To do that, we will remove the middle layer of our original proposals: local offices of the national commission. We recognise, however, that there needs to be a way for forums to come together across an agreed area, which is a key concern raised by many Members. We have strengthened the provisions in the Bill to say that forums must work together in prescribed circumstances. Those circumstances will be set out in regulation, and I hope that that will meet the concerns of many Members about the integration.

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Helen Jones (Warrington, North): I welcome what my hon. Friend is saying about the representation of community groups. Will she assure me, however, that the regulations will ensure that, in places such as Warrington, deprived areas get representation on these bodies, as well as the better-off areas? Will she assure me that there will not be a repeat of what we have seen in the Warrington PCT, on which my constituency has hardly any representatives?

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