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Mr. David Cameron (Witney): Many of my constituents, particularly those living around Chipping

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Norton, use Horton general. It will concern them greatly that if the hospital does not have the support of PCTs and patients in south Northamptonshire, it may not be as viable as it is today. It currently gives my constituents a very good service, often much better than that provided by the very strapped John Radcliffe hospital in Oxford.

Tony Baldry rose

Mr. Deputy Speaker (Sir Alan Haselhurst): Order. Before the hon. Gentleman follows that line too far, let me say that the debate seems to be straying somewhat from the main point of the amendment.

Tony Baldry: We are focusing on patients forums, Mr. Deputy Speaker. Important questions are who will be on those forums, and what geographical areas they will represent. People in south Northamptonshire need to know which forum to go to, and they can know that only if they know which is their PCT. As I have said, they need some stability. For instance, people living in Chipping Norton, in the constituency of my hon. Friend the Member for Witney (Mr. Cameron), need to know which PCT represents them.

One of the most important concerns of the forums, however, will be the viability and vitality of their local general hospitals. The only logical reason for the Northamptonshire strategic health authority to want to take patients away from the Cherwell Vale PCT is that it wants to refer them to hospitals in Northamptonshire—which will undermine the viability and vitality of Horton general.

At present, Oxfordshire has five primary care trusts; each one will, under the Government's proposals, have a patients forum. They came into being after considerable consultation between general practitioners, everyone involved in the national health service and all the stakeholders. Doubtless they had to have ministerial approval. It was agreed that there would be five of them. They have chief executives, boards and chairman—all the paraphernalia of a primary care trust. The Government are asking us to vote tonight for a patients forum for each of those PCTs.

Similarly, as soon as the primary care trusts took up their effective duties on 1 April, the chief executive of the Thames Valley strategic health authority tried to bludgeon the five to become three. Not surprisingly, the smallest of these, the North East Oxfordshire primary care trust, based in Bicester in my constituency, is somewhat concerned. The chairmen of at least two of the primary care trusts said:

That was written by the chairmen of the North East Oxfordshire and the Cherwell Vale primary care trusts.

It is irrelevant to my constituents whether they have patients forums or patients councils. They want stability; people working in the NHS want stability; GPs want stability. The Government have set boundaries for primary care trusts—let us keep to them, at least until 2005, for heaven's sake. At least let there be natural

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evolution. The Government should not set up primary care trusts on 1 April 2002 and seek to change the boundaries radically, without consulting anyone, by 10 April. What kind of precedent is that for patient or consumer involvement? Ministers talk about involving the wider community. If the national health service does not even have the courtesy to involve Members of Parliament, what hope is there of involving the wider community?

The Government will win the vote tonight because they will dragoon all their members into their Division Lobby, except for those who have been expelled to Siberia for the occasion. However, this debate is irrelevant if Ministers cannot accept and understand that, above all, the NHS needs some stability for the next two or three years so that everyone involved can understand what is happening. Simply rewriting the geographical boundaries will benefit no one. I hope that the Minister will intervene with the chief executives of the various strategic health authorities who seem to have nothing better to do than try to rewrite the boundaries of primary care trusts.

Dr. Murrison: In an earlier intervention on the Minister, I referred to a number of organisations that objected to the abolition of community health councils. I cited a number of charities, and the Minister responded with the name of an organisation which, unlike the ones to which I had referred, could hardly be said to be a household name.

I see from the list that someone has helpfully passed me that a number of establishment bodies have complained that to shut down CHCs would be a retrograde step. These include the British Medical Association and the General Medical Council. Interestingly, however, that view is also held by the Socialist Health Association, Health Action for Homeless People and the Co-operative party, while the Greater London Assembly has objected unanimously. There seems to be a pretty uniform view that the Government are about to make a retrograde move. It is a great shame that they have not listened.

The hon. Member for Wyre Forest (Dr. Taylor) said that he was heartened that the Government had been listening since the Bill's Committee stage. My impression throughout the Committee stage and subsequently is that the Government have been extremely recalcitrant with regard to all the helpful suggestions that have been offered to them. That is a great shame.

Brian McGinnis of Mencap said very tellingly that the CHC network has been a nuisance to the Government, but that that has been one of its strengths at times. He said that the new patchwork of half-baked ideas, designed for difference rather than effectiveness, lacks any real credibility.

Mr. Truswell: For some years, I was a member of a CHC. The crocodile tears that Conservative Members are splashing about are making me smile wryly. If the Conservative party is so wedded to the idea of CHCs' independence and critical role, why did a former Conservative Government remove from CHC observers to

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health bodies the right to participate in their proceedings? That right existed until a Conservative Government took it away. How does that square with all these crocodile tears?

Dr. Murrison: The hon. Gentleman's knowledge of history is greater than mine. The important thing is our commitment to the general concept of community health councils.

The CHCs offer a fairly seamless guide to people passing through the journey of the national health service. We must remember that people do not simply go to their GP and then suddenly go to hospital—it is a journey. One of our chief concerns is that the new proposals will cut across that. No longer will people have that seamless recourse to a knowledgeable and well respected body if they want to raise an issue of concern in the national health service.

There was a wider consultation on the future of community health councils in Wales, which subsequently opted to keep its CHCs. We could learn something from that.

I was interested to learn that Bath and District community health council, to which I pay tribute for all its hard work, cost £119,000 in the last financial year. Its chief officer thinks that patient advocacy and liaison services alone will cost about £750,000. There is a big difference. The Health Service Journal reckoned around the time of Second Reading that the new structures would come to about 10 times the current cost of community health councils. It is important to bear that in mind. Subsequent Government amendments could conceivably lead to greater costs.

Functions are far more important than institutions, however. I was interested to see the comments of my community health council on the recent revelation that the Royal United hospital in Bath will end the year with a deficit of £17 million, and that there is evidence of fiddled waiting lists. My CHC reacted in a timely and effective manner in contributing to that debate. I am left struggling to work out how the new bodies that the Government intend to replace CHCs would cope with the crisis facing the Royal United hospital in Bath.

I was pleased to read the agenda for the Bath and District community health council meeting of 14 May, held in Bath. It contains a raft of useful things that that body has done. It includes a review of the emergency unit and a "casualty watch" 2002, which took place earlier this week. It comments on detailed plans for the new emergency unit at the Royal United hospital and on transport into Bath for medical attention. That is a tribute to the many and varied things that my local community health council does, and its work is replicated across the country.

One of my concerns about the proposals is the impact that they are likely to have on staff. It seems to me that there is some confusion about who staff will work for and to whom they will be accountable. If I understood the Minister correctly, she suggested that the staff of PCT patients forums would be farmed out from the CPPIH, yet ACHCEW thinks that staff will answer to the PCTs. I would be grateful to the Minister if she could clarify that because, if ACHCEW and I are confused, I suspect that the general public will be as well. I am genuinely concerned that, if the staff who participate in the new

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bodies do not know to whom they are accountable and where they fit in the organisation, there is a real risk that they will become disheartened and dispirited.

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