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6.30 pm
I am also concerned that the remit of PCT patients forums is being widened to include issues that broadly affect health. I would be the first to admit that, in general, many things impact on health and that issues such as housing, transport and so on have a very definite impact on people's lives and, indeed, health, but I would caution the Government that, by widening the remit in that way, they are perhaps diluting the forums' focus on the NHS. Of course the resources will have to be increased if the remit is widened, and the Minister has said nothing about that so far.
The Minister talked about representatives from various interest groups that could conceivably have a view on health-related issues. I am confused about that notion because she appeared to suggest that representatives would not be the way ahead in the new order of things. I disagree with her on that point, but I would be grateful to her if she could clarify it. If she is referring to representatives, who will choose them? Will they be appointed? If so, who could dismiss them?
Mr. David Wilshire (Spelthorne): One of the great advantages of being an Opposition Whip rather than a Government Whip is that one is not quite tied to the same vows of silence. I am conscious of the fact that I have not heard all the debate, but I do not wish to go over any ground, other than to say that I note the time is 6.32 pm and it would be fair to say that the Government willingly agreed to our request to change the guillotine arrangements so that there would be a guillotine part way through our proceedings. I should like to put on record our appreciation for that.
A subsequent request for further time came not from Her Majesty's official Opposition but from the Liberal Democrats. [Hon. Members: "Where are they?"] They wanted an extra hour. The Government offered us two hours to discuss this business, and I am sure that you will notice, Mr. Deputy Speaker, that we have indeed said all we wish to say. We have had our opportunity to disagree. We do not like what is going on, and I doubt whether we will be satisfied by the Minister's reply. However, I must make the point that the Liberal Democrats demanded an extra hour, but none of them can even bother to be here to hear the Minister's response.
Mr. Heald: Does my hon. Friend agree that the effect of changing the guillotine arrangements in that way was that we were unable to debate three groups of amendments that would have been discussed earlier, as a result of the Liberal Democrats' activities? [Interruption.] I see that one Liberal Democrat Member is now arriving in his place.
Mr. Wilshire: That very Member—the hon. Member for Oxford, West and Abingdon (Dr. Harris)—is the one who demanded the extra time because he had so much to say, and so many of his hon. Friends wanted to say it, but I have made my point, and I do not wish to stray into the issues that were debated when I was not present in the
Chamber. However, I am most grateful to the Government for agreeing to our request, and I ask the House to note what else has happened.
Ms Blears: This has been an interesting and wide- ranging debate. It is fair to say that all hon. Members involved in it probably know far more about patient and public involvement than they could ever had anticipated when we first embarked on this journey almost two years ago, and I hope that we have all extended our knowledge and understanding during that period.
The hon. Member for West Chelmsford (Mr. Burns) said at the outset of his contribution that the decision to abolish CHCs was wrong, and he set out why he thought that was the case. I would simply remind him that the decision to abolish CHCs was approved in the other place by a majority of 27 and that Lords amendment No. 6 deals with patients councils, and therefore we are discussing the fact that the Government disagree with that amendment. The issue of whether to retain CHCs is in fact behind us.
The hon. Gentleman expressed a kind of nostalgia about CHCs and said that they had a power of veto over hospital closures. I need hardly remind him that that power of veto, or power of referral, has now been transferred to democratically elected local government, and I would hope that that very important step forward would command the support of the whole House. Such crucial local decisions should be taken not by non-elected bodies but by ones that are locally accountable and democratic. I am sure that overview and scrutiny committees will carry out their tasks in a very discerning and appropriate way in future. That is real progress.
The hon. Gentleman also expressed concern about whether the new system will be able to address issues such as the terrible events that occurred at Alder Hey hospital. Hon. Members have also mentioned the dreadful trauma caused by the events at Bristol. I should like to remind the House that Professor Kennedy made the absolutely crucial point during the Bristol inquiry that patients and the public need to be on the inside of the system of patient and public involvement, not on the outside reacting to events when things have already gone wrong.
People should be inside the system and able to shape and influence the decisions that are taken. It is crucial to this debate to say that patients councils would perpetuate the system whereby people are on the outside, observing. Patients forums are fundamentally different; they are about patients and the public being on the inside of the system and able to exercise real power and influence.
The Conservative party is going through what the hon. Member for West Chelmsford described as a fundamental review of its policies on health and everything else. Obviously, there has been huge change in the NHS recently, which is the very reason why the system of public and patient involvement needs to change as well. If the hon. Gentleman is undertaking a review, he needs to be a little more creative and imaginative in looking to the future, not back at what has gone on for the past 27 years with CHCs. The shape of the system will be very different in future, and its values will be different as well. I urge him to keep up with the pace of change in our system.
The hon. Gentleman raised the issue of funding. My hon. Friend the Member for Crewe and Nantwich (Mrs. Dunwoody) welcomed his commitment to extra
funding for the NHS. It is a great pity that the hon. Gentleman did not see fit to vote for it in the recent Budget debate. Nevertheless, I have acknowledged that more resources will be needed to ensure that the system works properly and that we do not get consultation and involvement on the cheap, so we will need to invest extra resources.The hon. Gentleman also raised the important issue of value for money. At long last, performance management of patient and public involvement will be part of the new system, so we will be able to find out what we get for our money. In future, the people whom we have asked to pay a little extra for the NHS—I am delighted to say that the vast majority of the community are happy to do that—will be able to see exactly where the money is spent, what they get for it and how well the system of patient and public involvement is working across the country, instead of having perhaps a bit of a hit-and-miss system.
Dr. Evan Harris: On taxpayers' money being spent on a locally accountable health service, there is a strong argument for local democratic accountability in running the health service. Will the Minister make an announcement on the funding available to resource the model that she now proposes? Many of us think that it will cost a lot of money. If that money comes from the same announced resources, it will be spread more thinly, simply because of the multitude of organisations that she now seeks to beef up as PCT patients forums.
Ms Blears: I have in fact put it on the record in this debate and in Committee that the system will be more expensive. I am not in a position to make an announcement about specific allocation decisions, because they will be made as we decide where it is appropriate to put the massive extra investment that Labour is making in the national health service. The announcement of those allocations will be made at the appropriate time. However, we value a robust, independent and vigorous system of patient involvement, and clearly its implementation will cost more than the existing system. That is evidence of our commitment to investment.
Mr. Burns: Although I accept the Minister's statement that she cannot tell us about funding allocations for the bodies, has her Department made any assessment of their probable costs and, if so, can she share those figures with us?
Ms Blears: I have already acknowledged that the proposed system will cost more. At present, CHCs receive about £23 million; we allocated an extra £10 million to fund the patient advocacy and liaison services. The staffing of the patients forums will require additional resources, but I am not in a position to go into further detail. We could make hugely ambitious proposals for public and patient involvement, but we need to be sensible when making decisions, because investment is crying out to be made in other parts of the health service. Getting the balance right will be fundamental as we go through the next few months.
Dr. Evan Harris: I recognise that the Minister is committed to putting more resources into the new system
than the old one, which included PALS. I also recognise the need to ensure that the money is well spent and that there is a crying need for it actually to be spent on services. However, if she cannot give us an undertaking about money, can she give us some indication of the possible staff numbers in PCT patients forums? We know about the staffing levels of CHCs—at least in our own areas—but if there were to be only 0.7 of a person per PCT forum that would significantly obstruct us in reaching agreement with her as regards the proposed structure.
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