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James Purnell (Stalybridge and Hyde): Does the Minister agree that the real test of the system will be what patients and people who work in the NHS think of it once it is in place, which we shall not know for a while? Will she tell us the views of the Chairman of the Select Committee on Health, whom no hon. Member would accuse of being a stooge of the Government, about the reforms?
Ms Blears: Certainly, I will. The Chairman of the Health Committee, my hon. Friend the Member for Wakefield (Mr. Hinchliffe), expressed concerns during our previous consideration of these matters. He said:
- "We are inches apart, but those inches are extremely important."—[Official Report, 15 January 2002; Vol. 378, c. 207.]
In a letter to me, my hon. Friend said:
- "Unfortunately, as you are aware I have a long standing commitment . . . I felt it might be helpful to outline my views on the amendments you are bringing forward."
- "You will recall that I raised specific concerns about the fragmentation of the separate Patients Forums and the inability to ensure an overview of the local health economy. I felt very strongly that a unifying structure of lay people at the level of local health economy should be written in the Bill."
- "I therefore genuinely welcome the fact that your new amendment"—
- "places on the face of the Bill the requirement that all Patients Forums in an area should come together regularly to share ideas, views and experiences."
- "Obviously, I have not had the opportunity to consider fully the implications of your amendments, but I am satisfied that you have moved very significantly in the direction I and others felt necessary."
To summarise, every NHS trust and PCT will have a patient advocacy and liaison service, ensuring that concerns are dealt with before they become a serious problem, and a patients forum, ensuring that the local public have a vehicle to express their views about matters relating to health. The forum will also monitor and review services. Every PCT patients forum will have staff to commission or provide independent support to help individuals make a complaint.
Mr. Paul Truswell (Pudsey): Leeds has one community health council. Under the new structure, we will have seven patients forums, which will be responsible for undertaking the vast range of crucial functions that my hon. Friend sets out. Will they receive a commensurate increase in staff and support from the commission?
Ms Blears: My hon. Friend is right to raise the issue of resources, which has been mentioned in all my meetings with local people. I have acknowledged and put on the record that the new system will be more expensive and will need to receive greater resources. Public consultation does not come cheap. If we are serious about involving patients, the public and the community in shaping health services, then we have to do it properly. It cannot be a superficial sham.
There are bids for additional resources to enable us to have a rigorous, strong and independent system. I need to ensure that all the elements are properly resourced so that we do not involve patients and the public without providing the necessary back-up and support that they need to make the system work. We should be open and honest about that. Real involvement requires hard work by all organisations, including the NHS, and we need to ensure that the system works.
Mr. Patrick Hall (Bedford): Broadly speaking, the Government amendments are welcome. Will the new system allow agreement to take place at a local level to allow a PCT patients forum to act as the lead on behalf of other PCT patients forums in a geographical area, such as Bedfordshire or Leeds, which my hon. Friend the Member for Pudsey (Mr. Truswell) mentioned? That would avoid the expensive duplication which would defeat the object of the new system.
Ms Blears: My hon. Friend has made several welcome and thoughtful contributions on such matters before, and I know that he is conscious of the detail. Many lead arrangements are in place for PCTs to commission services, so the idea of having lead organisations is already well established within the NHS. I would not want to do anything to provide a rigid blueprint framework to determine how people must operate. For patient involvement to work well, people have to agree on the system and feel as though they own it at a local level. I want the proposed regulations that will set out guidance for organisations to be flexible enough to accommodate the arrangement that my hon. Friend outlines.
My hon. Friend is probably aware that a number of pilot patient forums exist which are beginning to test out some of the new models. One such model in Tyneside has brought together the various elements in the system. They are sharing resources because they obviously get better
value by bringing some activities together. However, that has to be based on local agreement. We do not want to impose a framework from the centre. What we are trying to achieve is in tune with shifting the balance of power. We will set the framework, but it is up to local people how they want to operate it. It is for them to decide how they get maximum input in driving up the standards of local health services. My hon. Friend makes an important point.Every PCT forum will have staff who will commission or provide independent support to help individuals make a complaint. They will work to empower the local population to express their views about health issues, and will provide the one-stop shop service by giving advice and information about public involvement, the complaints process and how people can participate.
Dr. Murrison: Will the Minister give way?
Ms Blears: I will just make a little progress.
Nationally, the Commission for Patient and Public Involvement in Health will set quality standards for the work of patients forums and the independent complaints and advocacy service. It will also performance manage them in relation to those standards. The commission will submit reports to the Secretary of State on how the whole public and patient involvement system is working and advise him about it. It will make reports as it sees fit to other national bodies such as Commission for Health Improvement, the National Care Standards Commission and the National Patient Safety Agency on issues that in its opinion give rise to concern about the safety or welfare of patients, and that have not been or are not being dealt with properly. It will review patient data in patients forums' annual reports and follow that up with reports as appropriate to the Secretary of State and others.
The overall effect of the changes that we are making today is to make the system simpler to understand, less bureaucratic and consequently more effective. As a result, it will be easier for patients and the public to navigate themselves around the system, and easier for them to get involved. We must not forget that what underpins all our patient and public involvement provisions is empowerment. All patients have the right to have their concerns addressed and to be properly supported in making complaints. All patients and all members of the public have the right to be supported in expressing their views about health issues, to be listened to and to have their views acted upon.
That will be undermined by adopting patients councils. Councils and what goes with them would have the effect of perpetuating what we most want to change about the existing system—the idea of an organisation that only represents the interests of patients and the public, without encouraging the wider population to get involved; an organisation that consequently has to take a decision about the relative importance of the many and varied views of members of the local population; in other words, an organisation that decides for people what is in their best interests.
I genuinely believe that local people can make those decisions, provided they are given support. The changes that we propose will, with the original provisions, create a system that is truly accessible to everyone, that is radical and far-reaching, and that will make a positive difference to the services the NHS provides and to patients' and the public's experience of the NHS.
Mr. Burns: The purpose of the debate is to enable the Government to persuade the House to disagree with the amendments made in another place that put patients councils on the face of the Bill, in defiance of the Government's wishes. A debate on this subject without the hon. Member for Wakefield (Mr. Hinchliffe)—the father of the amendments, which were rejected by this House—being present seems rather like a production of "Hamlet" without the gravediggers. It is extraordinary that the poor man has been banished to Siberia because of the debate. I suspect that the Government Whips Office had known for some time about the hon. Gentleman's diary engagements when—conveniently, from the Government's point of view—the debate was scheduled for a day on which he was many thousands of miles away. The Minister shakes her head, but if she consults her Whips Office, she might find that there is far more truth in what I have just said than she believes.
The Minister alluded to the long history of this subject, and we have trodden a long road to get to where we are today. The proposals emanate from a desire, expressed in the Health and Social Care Act 2001, to abolish community health councils. When that legislation was passing through Parliament, the Conservatives said that that decision was wrong and not in the interests of patients, local communities or the NHS. CHCs were clearly defined, easily understood and well recognised by local communities. They were transparent, independent and able to consider and ask the awkward questions, as both Conservative and Labour Governments discovered.
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