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Ms Blears: My hon. Friend makes an extremely important point. She has made a significant contribution over recent weeks, expressing her concern about what has happened in her local PCT. For that reason, we propose that members of patients forums should be appointed by the Commission for Patient and Public Involvement in Health rather than by the Appointments Commission. We want to ensure not only that people respond to an advertisement but that we seek out people from communities who, traditionally, have not put themselves forward. That is easier said than done. In many cases, people will need encouragement, support, training, advice and back-up to come forward and feel that they can be part of the patients forum. That is a very different and much more proactive approach—not simply issuing an advertisement, waiting for people to apply and allowing a very self-selecting group to come forward to be part of our public involvement, but going out to deprived, marginalised, excluded communities that, traditionally, have not been part of running our services and making those decisions. My hon. Friend makes a key point about the way in which these mechanisms will operate differently in the future.

We are also amending the provisions that apply to both primary care trust and NHS trust patients forums. We are making it explicit in the Bill that patients forums will not only have a role in monitoring and reviewing the services that a trust provides but that they will also be able to identify gaps in service provision and make reports and recommendations about those to trusts. Trusts will have to publish forum recommendations in their annual patients prospectus, together with the action that they will take as a result, further ensuring that forums have real influence.

What was said to me, at many of the events that I attended with local people, was that all the structures in the world could be as perfect as we could make them, but unless there was real evidence that the decision makers in the health service took notice of what local people said and acted on it, they would quickly fall into disrepute, and rightly so. Therefore, making sure that a patients forum's recommendations are published in the prospectus and acted on by the trust will be a key mechanism in saying to local people, "It was worth while coming forward to get involved in your patients forum, because something has happened as a result of your activity. It was not simply a talking shop; action has been taken."

Many local people have also said to me that, although they do not expect 100 per cent. of things to be changed, they do expect significant changes to take place.

Mr. Burns: Was the Minister dismissing the valuable work done by community health councils by suggesting that they were just talking shops?

Ms Blears: The hon. Gentleman knows well that, in various discussions of these matters, on Second Reading

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and in Committee, I have put on record three, four, five or half a dozen times my tribute to many community health councils that have done an excellent job in representing people. The hon. Gentleman also knows—and many members of his party have agreed with me—that their performance has, in some cases, been patchy and inconsistent, and that people's ability to get involved has varied dramatically up and down the country. He knows fine well that the situation is more complex than he seeks to portray it, and that standards have varied dramatically.

We have also made explicit the breadth of the powers for forums to be able to refer matters. Concerns have been expressed, but the forums will be able to refer matters not just to overview and scrutiny committees, as previous amendments to the Bill provided for, but to the commission and, indeed, to any other person or body that the forums deem appropriate. They will be able to make their representations and concerns public.

We have transferred some of the functions envisaged for the Commission for Patient and Public Involvement in Health that would have been carried out by its local offices to the PCT patients forums. We have also strengthened the functions that the commission will carry out at a national level. On top of its job of setting and monitoring quality standards for all patients forums and providers of independent complaints advocacy, it will also be able to make recommendations to them about how they can improve their performance. The commission will have a performance management role, and that is key to ensuring consistency right across the country and high quality in the activities of complaints services and patients forums. We are dealing with the key issue of inconsistency.

Laura Moffatt (Crawley): Does my hon. Friend agree that the proposals are genuinely about going out and involving people in decision making in the NHS? As a nurse, I very much welcome the fact that people will be involved. Does she also agree that some of the opposition to the proposals is merely about maintaining a cosy and comfortable atmosphere for the NHS watchdog? Implementing the proposals will not be easy—no one ever said that it would be—but it must be worth trying to involve people who were not previously involved in the NHS.

Ms Blears: I thank my hon. Friend for that contribution. She is right. Change and new ways of working are never easy. One of the most difficult things has been to try to get people to visualise what a new system might look like. When something exists, people can see, touch and feel it. It is hard to get people to understand something that is not yet in place. One of the problems is that people feel that the proposed system will be complex but, once the provisions are established, people will get used to working with them. They will see that that they are integrated at the right stages of the NHS. However, I do not pretend that the system will be revolutionised overnight; it is a matter of building on our proposals over the next few years.

The right for the commission to have a performance management role will ensure that the public, wherever they are, and the NHS can be assured of consistently high standards in the patients forums and from the providers of independent complaints and advocacy services.

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We have listened to parliamentarians and to stakeholders and, in particular, to the Association of Community Health Councils for England and Wales and to community health councils, which were on our transition advisory board and helped us with transition to the new system. They have referred to the often-cited need for a "casualty watch" exercise. As I said earlier, rather than limiting the activities to "casualty watch" per se, the commission should have the right to undertake national reviews of patient experience data on issues that appear to it to be of national concern. That might include the waits in accident and emergency departments or a wider range of issues.

Dr. Murrison: The Minister says that the Government have listened to interested bodies about the future of community health councils. However, I have a list of about 20 organisations that are very much against the abolition of the CHCs. The bodies that have written to voice their concerns include the Manic Depression Fellowship, Mencap, the National Association of Citizens Advice Bureaux and the National Council for Voluntary Organisations. I could go on. How much has she listened to outside organisations?

Ms Blears: The hon. Gentleman will be aware from previous debates that all sides of the argument have prayed in aid other organisations to support their case. However, I draw his attention to the view of the Long-term Medical Conditions Alliance, which has 115 patients organisations in its membership. On 8 April, it wrote to Members of the other place when the Bill was being considered there and said:

It consulted one of its groups that held an event in the local community and it reported that members were

It went on to say:

The hon. Gentleman is correct—there is a range of views on these issues—but the Long-term Medical Conditions Alliance expressed the view, on behalf of its members, that it wanted to be able to get on with the new issues at stake. We have listened, and I hope that the hon. Gentleman will accept that.

Dr. Evan Harris: I accept the Minister's point that there are different views. However, she will be aware that in January this year the Long-term Medical Conditions Alliance welcomed the local network of the Commission for Patient and Public Involvement in Health, which she has just announced an interest in abolishing. It also welcomed the separation of advocacy services from commissioning, for which there is an argument, but from which she is announcing a retreat. She should accept that certain organisations, even those that were among her initial supporters, will not welcome her proposals.

Ms Blears: The hon. Gentleman has been following the development of these issues closely and with great

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interest, and he will be aware that a wide range of organisations welcomed the functions of the commission in taking a proactive role to draw in views from communities that traditionally have not been represented and in promoting the involvement of local people. Certainly, the Long-term Medical Conditions Alliance, together with a wide range of organisations, welcomes the functions of the commission. Those functions remain very much at the forefront of our proposals but will be exercised by the PCT patients forum, and thus in a way that is more connected to local communities. We are not doing away with the functions of the commission, but embedding and grounding them much more in local structures. I hope that the hon. Gentleman is reassured by that.

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