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Dr. Richard Taylor (Wyre Forest): I am amazed and delighted that some of my first impressions of the Government are beginning to be proved wrong. As we sat through the tedious hours in Committee, I felt that the Government were a juggernaut that was not for turning. Today, however, we have evidence that the Government have taken notice of many of the concerns expressed about the abolition of CHCs.
The first concern was the loss of the one-stop shop, but that does seem to have been addressed. Just this week, I have had complaints from a man who would have had to go to at least two separate PCTs; now, he should be able
to go to a one-stop shop. I am also very pleased that the Minister has said that the forums will not be only talking shops, but will have opportunities to make changes.My second concern—the independence of patients forums—is more difficult to address. There was no doubt about the independence of CHCs, but I remain to be convinced about the independence of patients forums. The Prime Minister recently wrote that PCTS were
- "run by patients, doctors and nurses."
The non-executive directors are appointed by the NHS Appointments Commission. Several issues were raised at a recent public meeting of the Health Committee that called into question the independence of the commission. I do not wish to cast aspersions on individuals—the problem is the system that has been set up. For example, the chief executive of the commission was the chief executive of the previous similar body and the chairman has been well steeped in the functions of the NHS as a chairman of trusts. The first act of the commission was to appoint 28 strategic health authority chairs, 26 of whom already chaired, or were non-executive directors of, trusts or health authorities and had been appointed by the Secretary of State.
I am waiting to see what effect the appointment of patients forum members by the Commission for Patient and Public Involvement in Health will have. I am pleased to hear that it will be able to seek members from potentially disadvantaged groups, but I was puzzled to hear recently that patients forums will elect a member to sit on PCTs and the NHS Appointments Commission will have the power to vet—and, presumably, veto—those elections. I hope that the Minister will deny that.
I was encouraged to see that the amendments would open the door to patients forum membership for people from health-related voluntary groups. That was one of the strengths of CHCs. My fear about patients councils is that they would add an extra tier, so I fully approve of strengthening an existing tier instead. On balance, I will support the Government, because they have widened and strengthened the scope and functions of PCT patients forums. However, as other hon. Members have pointed out, we need a better name for the forums. That would be a help, but their independence will be largely in the hands of their members—if they are given enough freedom.
Tony Baldry (Banbury): Like almost everyone who has spoken in this debate, I am at something of a loss to explain why CHCs have been abolished. The hon. Member for Oxford, West and Abingdon (Dr. Harris) and I have both had experience of the Oxfordshire CHC. For many years it was led by John Power, the leader of the Labour group on Oxford city council. It was a constructive and critical CHC, irrespective of which party was in office. I still do not understand why it was felt necessary to abolish CHCs.
Mr. Heald: Does my hon. Friend think that the abolition might have had anything to do with "casualty watch", which showed how poor the situation was in accident and emergency departments?
Tony Baldry: I genuinely do not know, but we have never been given a coherent explanation for the abolition. If I was looking for bits of the machinery of government that caused concern, CHCs—especially the Oxfordshire CHC—would not have been high on my list. As Ministers and everybody else would have hoped, Oxfordshire CHC was an effective voice for patients and the community as a whole. It was critical and constructive, and it engaged in the debate.
The most important thing about community health councils, however, was that people could find them. We in the Westminster hothouse may sometimes forget how long it takes for our constituents to adapt to change—and the NHS has experienced an enormous amount of change recently. I suspect that if we asked people in the high streets of our constituencies "What do you know about primary care trusts?" we would find that few had caught up with the change, or would know who was involved in the trusts. Our Oxfordshire health authority has been replaced by five primary care trusts; I suspect that few of my constituents could name the trust currently covering their area.
Stephen Hesford (Wirral, West): Does the hon. Gentleman realise that community health councils were introduced in 1974, while PCTs have existed, broadly, since April this year? He is not really comparing like with like. My experience is the reverse of his: I found that even after nearly 30 years people did not know where their community health council was, and most of those I bumped into did not even know what community health councils were.
Tony Baldry: Perhaps the Oxfordshire CHC was a star, but I suspect that many people in Oxfordshire knew about it. We experienced a number of dramas over the years. There were concerns about the future of hospitals such as the John Radcliffe and the Horton general hospital in my constituency. When public meetings were needed, people were content for the CHC to organise them, knowing that it was objective and independent and would not be party political or partisan. CHCs dealt in the politics of the possible, carrying out effectively the job with which Parliament had entrusted them.
As I have said, a lot of change is taking place in the NHS and it is sometimes difficult for our constituents to keep up with it. For each primary care trust there will be a patients forum. I must tell the Minister that I do not think that my constituents, or indeed many other people, are desperately gripped by the debate about whether there should be a patients forum or a patients council. I will support those on my Front Bench because I think that the other place has made some good points, but I believe that what people out there really want is stability.
My postbag today contained a newsletter from the primary care network, whose line was simply "Give NHS managers space, time and freedom to deliver". Inside was an article by the hon. Member for Dartford (Dr. Stoate), in which he said that PCTs must be allowed space in which to establish their own priorities.
People do want stability. If there is to be a patients forum for each primary care trust, people must at least know what the trusts are. As I said earlier, Oxfordshire now has five PCTs, one of which—Cherwell Vale—is based in Banbury. When it was set up, with the agreement of all, it included a chunk of Northamptonshire. The reason was simple: as Banbury is a market town, a day's cart ride has historically been involved. That is how it came to be a market town.
For centuries, those in many villages and small towns in the constituency of my hon. Friend the Member for Daventry (Mr. Boswell) have considered Banbury to be their natural market focus. Consequently, general practices in south Northamptonshire have traditionally sent patients to Horton general hospital in my constituency. Indeed, 30 per cent. of the hospital's work comes from Northamptonshire.
6.15 pm
Mr. Tim Boswell (Daventry): Will my hon. Friend accept a declaration of interest? I have lived in my constituency, in the far south-west of Northamptonshire, for more than 30 years. Throughout that period I have not only used Horton general as my local hospital, but used a general practice in Banbury. I have crossed the border for primary as well as secondary services.
Tony Baldry: My hon. Friend—who has lived in, worked in and represented his constituency for many years—makes an effective point.
The primary care trusts that the forums will represent "went live" on 1 April 2001, but only began active life on 1 April this year with the demise of the Oxfordshire health authority. They were shadowing the authority for a year. As I have said, Cherwell Vale primary care trust stretches into Northamptonshire. Members can imagine my amazement on seeing a letter from the chief executive of the Northamptonshire strategic health authority. Incidentally, if few people know which PCT represents them, I suspect that almost no one—and this goes for many Members of Parliament—understands what strategic health authorities do.
One thing strategic health authorities clearly want to do is reorganise PCTs. On 10 April, less than a fortnight after Cherwell Vale went live, David Sissling, chief executive of the Northamptonshire strategic health authority, wrote to the chief executive of the Thames Valley health authority saying:
- "We recently discussed a possible adjustment to the boundaries of Cherwell Vale PCT and Daventry and South Northamptonshire PCTs. This would enable an alignment with the boundaries of Northamptonshire and Oxfordshire and of course the new health authorities.
I have discussed the proposal with a"—
- "limited number of colleagues including the Chief Executive of Daventry and South Northamptonshire PCT. On the basis of these discussions I can formally confirm our strong support for a reconfiguration."
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