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Ms Blears: I have already said that there will be staffing both for the PCT patients forums and to facilitate the co-ordination of other patients forums. I am certainly not in a position to say whether that would be one person or one and a half, two, three or four people, but the staffing support will be adequate to enable the forums to carry out their functions. That is the key part of the equation. It would be wrong to give bodies responsibilities without the resources to discharge them. No sensible Government would ever do that.

Mr. Tom Harris: Does my hon. Friend share my surprise that the Conservatives are demanding accurate figures for the funding of the new bodies, yet will not commit themselves to the shape of the NHS—or even to support it?

Ms Blears: My hon. Friend goes to the heart of the matter. Our proposals are evidence of our commitment both to reform the system—this measure is a major reform—but also to the investment that makes reform work. The Opposition are unwilling to provide extra funds for the national health service as a whole. They have a reactionary approach to the whole subject. They are not looking forward—they have no creativity or imagination—and that is very disappointing indeed.

My hon. Friend the Member for Ilford, North (Linda Perham) made an excellent contribution and I was grateful for her support for the detailed amendments that we propose. I am pleased that she feels we have made significant progress in establishing a strong, independent and community-led system of public and patient involvement. She expressed a willingness to move towards those principles—as we are trying to do; we are talking about functions rather than rigid structures to which people should conform. I am grateful to my hon. Friend for her contribution, and for the time and effort that she has put in to try to reach a position that reflects the views not only of hon. Members but of the many stakeholders in the public and patient involvement system.

6.45 pm

The hon. Member for Oxford, West and Abingdon (Dr. Harris) said that my hon. Friend the Member for Wakefield (Mr. Hinchliffe) and I were centimetres rather than inches apart. I am grateful for the hon. Gentleman's acknowledgement of the progress made by the amendments. He accepts that the decision to abolish CHCs has been taken both in this place and in the other place and that we should now move on to try to provide a robust system for future patient and public involvement.

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I am sorry that before my hon. Friend the Member for Wakefield left for Russia he did not write to the hon. Gentleman, but I have noted the hon. Gentleman's concerns and the fact that my hon. Friend welcomed our amendments.

Dr. Evan Harris: We shall make our own decision about the proposals—as will the hon. Member for Wakefield (Mr. Hinchliffe) when he reads the report of the proceedings—but as some of the amendments were not tabled before he left, he would not have fully known the Government's position. We do not know whether the entire letter was read out and we still do not know whether he thinks that more progress could be made. I am not trying to be awkward, but, in his absence, we cannot be persuaded that the concerns that we share with him have yet been met in their entirety.

Ms Blears: I do not have the Moscow telephone number of my hon. Friend the Member for Wakefield—if I did, I would pass it to the hon. Gentleman. I assure him that my hon. Friend was aware of the principles and intentions behind all our amendments.

The hon. Gentleman read out a briefing from ACHCEW when he expressed his concerns. I urge him to take into account the fact that there are other views. ACHCEW has provided some constructive contributions, but one of the main reasons why we want to broaden the system of patient and public involvement is to incorporate the views of a range of patients organisations, carers groups and people in the community who are not part of the existing CHC framework. In many cases, they have been denied the opportunity to get involved because once the CHC world was consulted, the health service judged that it had fulfilled its duty. I ask the hon. Gentleman not to think that the views of ACHCEW express those of all patients and the public on important and crucial issues.

Recently, I attended an event organised by a support group for patients with bowel cancer. During the past three months, it had involved almost 1,000 people in various events; they had come together to share their experiences and to talk to clinicians about how standards could be driven up. That would not happen in a traditional, CHC framework. It is crucial that we involve people more creatively and imaginatively, so I urge the hon. Gentleman to look beyond the world of CHCs in coming to a view on the issues.

Clive Efford (Eltham): My hon. Friend referred to the involvement of local people in the formulation of health policy and decisions. Will that inform the process for choosing members of the local forums?

Ms Blears: As I explained earlier, the members of the forums will be appointed by the Commission for Patient and Public Involvement in Health, part of whose remit will be to seek out people rather than simply waiting for them to make an application—as is sometimes the case, when we end up with a self-selected and fairly limited group. The commission will actually go out and find people who, in the past, had no say in the health service and will give them support, guidance and training to enable them to come forward. I very much hope that a much more representative group of people than ever before will be shaping decisions. Crucially, involvement will not be confined to the people in the organisation—

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they will be charged with finding out the views of the public. The members of the forum will not simply put their own view—they will have to ensure that they draw in the views of a wider section of the community.

The hon. Member for Oxford, West and Abingdon and other Members expressed some concern about the name "primary care trust patients forums" and asked whether we could come up with something snappier. I have had my fingers slightly burned in coming up with names for organisations. I hesitate to say that we should call PCT patients forums "local voices". Perhaps we shall not go back down that path. However, I hear what is being said to me and perhaps we can consider the matter.

The hon. Gentleman made an important point about the different configuration of different communities—urban communities, rural areas and places with small market towns, which will be different throughout the country. Therefore, there may be a need for PCT patients forums to come together so that we avoid duplication. I draw the hon. Gentleman's attention to regulations that will be made under clause 18(2). Paragraph (f) provides for regulations to be made which govern

There is legislative provision there to meet the flexibility that not only the hon. Gentleman but my hon. Friend the Member for Bedford (Mr. Hall) wants. My hon. Friend made a similar point.

Dr. Harris: Clearly there are not yet regulations to read. Is the hon. Lady saying that there will be regulations that will allow, for example, the five PCT patients forums in Oxfordshire to group together to form one unit in the county as a PCT patients forum, which will have the staff and carry out all the functions, or will there still have to be five duplicated and different forums, that will come together for occasional issues?

Ms Blears: Far be it from me to take a centralist approach and to impose that on local communities. The regulations will be the subject of consultation. I am sure that the hon. Gentleman will want to make his views and those of his community known in the consultation process.

Dr. Harris: Will the hon. Lady give way?

Ms Blears: No. I think that I have responded adequately to the hon. Gentleman.

The hon. Member for Wyre Forest (Dr. Taylor) welcomed the changes that the Government are putting forward. I am delighted that his faith in the political process has been slightly restored since consideration of the Bill in Committee. I can reassure him that the forums will not merely be talking shops. They will be taking action. The hon. Gentleman expressed some concern about the election of a patients forum member as a non-executive member of the trust, and whether the NHS Appointments Commission would have a power of veto over that appointment.

The patients forum will put forward the person it wants to be on the NHS trust. That person will have to meet the criteria set by the appointments committee and will have the same status as all other members of the trust. It is vital

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that that person is not seen as a second-class member of the trust board, and that there is parity of esteem and influence within the board to ensure that their issues are taken on board.

There is a precedent in that at present the NHS Appointments Commission appoints a person—he or she is usually from the education sector—to trust boards, but it is the education sector that nominates that person to go forward. I hope that that reassures the hon. Gentleman. I am delighted to have his support for the Government amendments.

The hon. Member for Banbury (Tony Baldry) expressed the view that people knew where to find community health councils. Some of my hon. Friends expressed concern about the proportion of people who knew that. Some polling was done in the past. I do not pray it in aid and say that CHCs were bad because people did not know about them. However, extremely few local people knew what CHCs did, where they were and how they could get in touch with them. Less than 10 per cent. knew that. There is not the view that CHCs are well known and representative bodies.

The hon. Gentleman said that there had been a great deal of change in the NHS. That is exactly why the system of patient and public involvement needs to change, too, so that it can align with the changes that have taken place. He talked about dramas at the hospital in his area with which the CHC has been involved. There will be dramas about hospital configurations, but that is a tiny part of the entire system of the NHS. We are trying to get to a system that involves people who have diabetes, cancer and kidney disease, young people and children—the entire range of services.

In the past, everything has been about a drama and a crisis as a result of a configuration. That is one important aspect, but it does not reflect the entire range of concerns that people have about how the health service works for them. I genuinely believe that our new system will draw in many more views and issues than simply the sharp point about reconfiguration.

The hon. Gentleman raised an important issue about how decisions that change the way in which primary care trusts operate would be subject to public consultation. The general duty on the NHS, under section 11 of the Health and Social Care Act 2001, is that the trusts must consult—every part of the NHS must consult—where there will be an effect on the operational services. If it is a purely administrative matter that does not affect the way in which services are delivered, that can go ahead. Where the issue affects any of the services to be provided to the hon. Gentleman and his constituents, it needs to be the subject of proper and detailed consultation. That is a strong power in our provisions.

The hon. Member for Westbury (Dr. Murrison) again raised the issue of the abolition of CHCs, which is unfortunately not the subject raised by the amendments. However, I welcomed his statement that functions are far more important than structures. That was real recognition. Perhaps he is keeping up a little faster than the hon. Member for West Chelmsford with a new approach. I am delighted about that.

The hon. Member for Westbury raised some concern about staffing. There will be staff employed by the Commission for Patient and Public Involvement in Health

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who work with PCT patients forums, supporting all of the forums in an area, commissioning and providing independent complaints and advocacy services and, crucially, promoting public involvement in the whole of the health service and those wider issues that determine health in local communities. The staff will be a key part of the system, but they will be grounded and rooted in PCT patients forums close to their communities. I can confirm that the commission will be appointing members of the patients forums.

I believe that we have had an extremely wide-ranging debate on these issues. I like to think that after going over this ground perhaps half a dozen times, I may even have persuaded Opposition Members that the NHS is changing dramatically. Therefore, public and patient involvement needs to change too. We have recognised the fact that to get change we must have investment. We must ensure that our services improve and that we give local people the tools to get on with the job. We must give them guidance, back-up, education, training and support. We have active, articulate citizens who are able to take their rightful place in being involved in the NHS. We are proposing real and radical change. Perhaps these changes are a little too radical for Opposition Members, but we are committed to real change, real reform and massive investment, which we had the courage to vote for and take forward. I commend the amendments to the House.

Question put, That this House disagrees with the Lords in the said amendment:—

The House divided: Ayes 303, Noes 179.

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