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Mr. Tom Harris (Glasgow, Cathcart): The Conservative party has been curiously reticent about revealing any details of its health policy. Can we now assume that the reinstatement of community health councils will be a centrepiece of its health policy if and when it ever gets round to telling us what it is?
Mr. Burns: The hon. Gentleman rightly said that, in health as in other areas, we are in the middle of a review, which any Opposition party is perfectly entitled to undertake. Indeed, the hon. Gentleman's party undertook them on at least four occasions between 1979 and 1997. In due course, I shall give him my view of the abolition of CHCs and the way forward, but he must be patient.
As I was saying, CHCs were a one-stop shop that performed a vital and valuable service for the local community in dealing with patients' problems and general health provision. They also made controversial decisions about the provision of health care, whether closing down a ward in a hospital or the hospital itself, as they had a power of veto and could formally object to the Secretary of State; Ministers could then look at decisions that CHCs considered were not in the public interest. Many people say that some CHCs did not work as well as others and that the provision of the service was patchy. If a system provides an invaluable service in principle, but has certain flaws, those flaws should be identified so that improvements can be made; we should strengthen the system, rather than destroying it altogether. The Minister was a distinguished chair of Salford CHC in the 1990s and I suspect that she was fully supportive of the role of CHCs and thought that they did a tremendous job in looking after the interests of the local community and individuals. I wonder how many of the Government
proposals that we are considering today are motivated by a desire to remove a thorn in their side: they do not like criticism, especially if it comes from an independent source and gains credence among members of the public. The Government motion and amendments are a mistake. Personally, I would have preferred a strengthening and improvement of the CHC system to deal with perceived weaknesses, rather than the wholesale removal and replacement of the system.The initial replacement was to my mind—and presumably to the Government's, as they have now backtracked dramatically—a ridiculous miasma of proposals, which included things like patient advocacy and liaison services and other bodies. The system would have been fragmented, and there was little confidence that it would be independent. To be fair to the Government, they have bowed to sustained criticism of their proposals and have taken a different direction.
Laura Moffatt: The hon. Gentleman and his party often talk about reform and how crucial it is to the NHS. Yet, in one of the most important parts of the NHS—the watchdog organisation—they propose little or no reform. How then can the hon. Gentleman pretend that his party's view reflects that of the general public?
5.30 pm
Mr. Burns: I know that the hon. Lady was trying desperately in her earlier intervention to impress her Whip; of course, this is the season of the run-up to reshuffles. Unfortunately, she has not been listening. I said that my preferred choice was to pick up the weaknesses in the CHC system and legislate to improve, enhance and strengthen it to make it more effective where perceived weaknesses existed, instead of abolishing it wholesale. As the hon. Lady will notice if she reads tomorrow's Hansard, that is the view that I expressed. I am afraid that her intervention bore little relation to what I was saying.
Let me return to the point that I was making before I ill-advisedly gave way. The Government have had to alter their position on the patients forums proposals in tabling their amendments. The battle on CHCs is over and they are not going to change their mind about them. Another place decided on the patients council option instead of seeking to restore the community health councils. As a realist, I accept that we must now move forward because of those actions. As the hon. Member for Wakefield made clear in speaking to his amendments in this place and in expressing his views in the Select Committee on Health and other arenas, the patients councils are for a number of reasons preferable to the Government's broad proposal.
Patients councils not only offer a range of features that were present in community health councils, but represent a move forward in terms of adjusting to some of the concerns that have been expressed. I believe for a number of reasons that they are more attractive than what the Government are offering, as they are an attempt to oversee the health service from the perspective of the patients and to consider a wider spectrum of activity than would a body based solely on specific trusts.
I accept that we will move away from some of those areas as a result of the Government's amendments, but I believe that patients councils will be able to monitor the
complete patient journey between trusts. They can also play an advocacy role over a sustained period. In relation to Alder Hey, patients benefited from the work of CHCs in that regard. Campaigning work such as "casualty watch" and other work that is still done by community health councils would be within the remit of patients councils, which could continue working in line with developments in the past 27 years by acting as a watchdog and advocate for patients.It is also important to consider that patients councils would not be working in isolation within their trusts and that there would be greater interrelation between the trusts and on the progress of patient issues. The restoration of the one-stop shop and the removal of the maze brought into the system by the patients forums are also important, as the patients councils would be more easily understood by patients and members of the public in local communities. That is a preferable way forward.
Regardless of what the Minister says and of some of the amendments that have been tabled, the Government are proposing to introduce complex organisational bodies. In the early days, they will also be seen to be complex by patients and local communities. Whether that perception will disappear if they survive the legislation remains to be seen. With patients councils, as with CHCs, people would have a greater understanding of where they needed to go if they had individual health problems or problems with the provision of service in their area. The councils would, however, have to be properly financed.
The Government's statistics show that the funding of CHCs costs between £20 million and £30 million. I understand from the projections relating to the Government's proposals that the funding of the patients forum system will be considerably more—given their complexity and the sheer numbers involved—than the funding required for CHCs. I listened with interest when the Minister said earlier that she was determined that the forums would be properly resourced to ensure their success. That commitment is a slightly diluted version of one that would ensure proper funding to provide the resources necessary to operate effectively. I should be grateful if the Minister would return to the question of funding and give the House an assurance on that issue.
Mrs. Gwyneth Dunwoody (Crewe and Nantwich): Is the hon. Gentleman suggesting that, unlike other members of his party, he would be happy to see an expansion in the amount of money available for the NHS budget and for this particular service? If so, it is a welcome conversion.
Mr. Burns: I am grateful to the formidable hon. Lady. I will be cautious in crossing swords with her; I do not wish to make the mistake made by many of her own Ministers.
What I meant was that, in the context of CHCs versus patients forums, it is extraordinary that, in making a commitment fully to fund the forums, the Government are prepared to spend so much extra money when we already have a system in place that works.
Mr. Burns: If the hon. Lady will wait, I will tell her that I do not criticise extra money for the health service.
What concerns me about the extra money that has been made available is that there are no systems in place to ensure that it will achieve what it is meant to achieve—the improved, enhanced provision of health care. It worries me that, if we do not have structures in the health service to ensure that we get value for money and enhanced patient care, that money will be frittered away and the patients of this country will become even more disillusioned and discontented.
Mrs. Joan Humble (Blackpool, North and Fleetwood): Will the hon. Gentleman give way?
So that we do not continue to talk about money, which is slightly off the subject, I shall conclude by saying that the Government's proposals are ham-fisted, and that they will not work as the Minister suggests. The proposal for reformed and improved CHCs was the best way forward, but that is not to be. The proposals of the hon. Member for Wakefield for patients councils that were incorporated into the Bill in another place represent the better way forward. I question the motives behind the Government's proposals, because they are a way of trying to stifle any criticism and proper inquiry into problems in the health service in local communities. For that reason, I ask my right hon. and hon. Friends to join me in opposing the Government's proposals to reverse the decisions made in another place.
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