NHS Reform & Health Care Professions

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Dr. Harris: I beg to move amendment No. 163, in page 20, line 3, leave out subsections (1) and (2) and insert—

    ''(1) The Community Health Councils established for districts in England under section 20 of the 1977 Act are reformed and are renamed Councils for the Involvement of Patients and Public (''Councils'') and the Community Health Councils Regulations 1996 are amended accordingly.

    (2) The Secretary of State shall, following consultation with the Association of Community Health Councils for England and Wales, Community Health Councils, patients' and carers' organisations and the wider community, make regulations in relation to Councils in England providing for—

    (a) the inclusion in Councils' annual reports of details of the arrangements maintained in that year for obtaining the views of patients, carers and the wider community in their localities;

    (b) the commissioning of, or delivery by, Councils of services under section 19A of the 1977 Act (independent advocacy services) within their areas;

    (c) the preparation of reports on the operation of the independent advocacy service to be compiled by Councils and provided to the Secretary of State, the Commission for Patient and Public Involvement in Health, the relevant overview and scrutiny committees, Strategic Health Authorities, NHS trusts, and other appropriate organisations;

    (d)(i) promotion by Councils of the involvement of members of the public in its area in consultations or, processes leading (or potentially leading) to decisions by those mentioned in section 19(3), or the formulation of policies by them, which would or might affect (whether directly or not) the health of those members of the public;

    (ii) co-operation with the Commission for Patient and Public Involvement in Health in carrying out this function;

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    (e) the provision of advice, reports and recommendations by Councils to strategic health authorities, Primary Care Trusts, NHS trusts, and overview and scrutiny committees;

    (f) the furnishing and publication by NHS trusts, Primary Care Trusts, Strategic Health Authorities and overview and scrutiny committees of comments on the reports, recommendations and representations of Councils referred to in paragraph (e) above and paragraph (h) below;

    (g) the discharge of any function of a council by a committee of the Council or a joint committee appointed with another Council;

    (h) representation by Councils of the views of members of the public in its area about matters affecting their health to persons and bodies which exercise functions in a Council's area (including in particular the overview and scrutiny committees and the joint overview and scrutiny committees mentioned in sections 7, 8 and 10 of the Health and Social Care Act 2001);

    (i) co-operation with The Commission for Patient and Public Involvement in Health in its duties.''

The Chairman: With this it will be convenient to take the following amendments: No. 171, in page 20, line 21, leave out ''(2)(c)'' and insert ''(2)(e)''.

No. 172, in page 20, line 22, leave out ''Patients' Forum'' and insert ''Council''.

No. 173, in page 20, line 24, leave out ''Patients' Forums'' and insert Councils''.

No. 174, in page 20, line 27, leave out subsection (5)'.

No. 175, in page 20, leave out line 39.

No. 176, in page 20, leave out lines 44 and 45.

No. 177, in clause 16, page 21, line 15, leave out ''Patients' Forums'' and insert ''Councils''.

No. 178, in clause 16, page 21, line 20, leave out ''Patients' Forum'' and insert ''Council''.

No. 179, in clause 16, page 21, line 22, leave out ''Forum's'' and insert ''Council's''.

No. 164, in clause 19, page 23, line 20, leave out subsection (1) and insert—

    ''(1) the Association of Community Health Councils for England and Wales established under paragraph 5 of Schedule 7 to the 1977 Act is reformed as a body corporate and is renamed the Commission for Patient and Public Involvement in Health; the NHS (Association of Community Health Councils) Regulations 1977 and the Community Health Council Regulations 1996 are amended accordingly.''

No. 165, in clause 19, page 23, line 23, after ''following'', insert ''additional''.

No. 182, in clause 19, page 23, line 32, leave out ''Patients' Forums'' and insert ''Councils''.

No. 167, in clause 19, page 23, leave out lines 36 and 37.

No. 183, in clause 19, page 23, line 36, leave out ''Patients' Forums'' and insert ''Councils''.

No. 184, in clause 19, page 23, line 41, leave out ''Patients' Forums'' and insert ''Councils''.

No. 169, in clause 19, page 23, line 45, leave out paragraph (g) and insert—

    ''(g) co-ordinate and support the activities of Patients' Councils in respect of their activities provided for at sections 15(2)(h)''.

No. 185, in clause 19 page 24, line 35, leave out ''Patients' Forum'' and insert ''Council''.

No. 154, in clause 20, page 25, line 21, leave out subsection (3).

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Dr. Harris: It is almost with a feeling of trepidation that I begin the debate on these important clauses. I note that my amendments have been signed by Conservative Members and I welcome that. Before the Minister tries to judge what I am about to say, patient and public involvement is not something that divides, or should need to divide, along party political lines. We should all be in the business of finding the best solution.

Resources do not play a huge part in the clauses. Many types of formula have been hit on to find the right approach, and the amendment constitutes one of them. I am happy for it to be described as a varied, amended or reformed status quo; that is what the Government intend for the NHS. The Minister has just said that it is not the intention to tear up or abolish the NHS and start again. On that basis, it is reasonable and appropriate that the Government consider amending the system before cancelling it out and imposing a new one.

A few things will be said at the beginning of the debate that will have been heard before, but bear restating. Those who support the amendments, which address the existing community health council structure, and those that address clause 19, which address the reform of the Association of Community Health Councils of England and Wales—here, we are talking about England—do not necessarily feel that every community health council is as good as another. In earlier debates, we would not have argued that every provider, or commissioner, was as good as another, even if they had all been given the same resources. However, that does not mean that we should abolish the lot. We should not abolish every provider or commissioner simply on the basis of varied performance; we should seek to ensure that they have the right powers, the right monitoring and the right support, both from the centre and from their own staff, to do the best possible job, at least to minimum standards.

Throughout this debate, which has now spanned two Parliaments, the Government have never set out clearly enough why the current system cannot be reformed and has to be abolished. That point has been made at length by Conservative Members, Liberal Democrat Members—including my hon. Friend the Member for North Devon (Nick Harvey)—and the former and current Chairmen of the Select Committee on Health.

Mr. Burns: Does the hon. Gentleman agree that the Government have never coherently, or even satisfactorily, explained the need to abolish CHCs and replace them with another structure?

Dr. Harris: Quite so. That is a useful and clear summary of my preamble.

One argument that the Government could deploy is that the performance of community health councils is patchy, as is that of the Association of Community Health Councils in its various functions. However, they have never commissioned a report to analyse the failings of individual CHCs and to find out whether they are failing as a result of their mere existence,

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rather than as a result of their under-resourcing, having the wrong personnel, their inappropriateness to their geographical function or the fact that they have been too easily bamboozled by the local health care players that they are there to monitor. It is incumbent on the Government to present such a case before going for wholesale abolition instead of considered reform.

I greet the Under-Secretary and apologise for not having done so earlier. I know that she is prepared to listen and to consider the issues, and she probably does not bring much with her in the way of set views; she is relatively new to her job, although she seems to have been here for a long time because she has made a big impact. However, I suspect that some of her more senior colleagues have an absolutist position and will not consider anything short of what they originally envisaged. If that is so, it is regrettable, and it should be made explicit. I fear that it will not be made explicit, but it will be made regrettable; if not here, in another place.

The second argument that the Government could use to justify the abolition of CHCs is that they do not have the right powers for the ''new'' NHS; the NHS that the Government have created and are in the process of structurally recreating through almost every piece of legislation. Indeed, that argument was more than hinted at by the Secretary of State on Second Reading, when he complained:

    ''The CHCs had no role in primary care; patients forums''—

the Government's preferred model—

    ''will have that role. The CHCs were refused the right to inspect GPs' premises; patients forums will have that right. The CHCs were partly appointed by the Secretary of State for Health; patients forums will all be appointed independently of both the Secretary of State and indeed the NHS. The CHCs had no formal rights of representation within NHS organisations; patients forums will elect, as of right, one of their members to sit on every trust board.''—[Official Report, 20 November 2001; Vol. 375, c. 203.]

The obvious response to that was given by the hon. Member for Wakefield (Mr. Hinchliffe), the Chairman of the Select Committee. He said:

    ''I accept that CHCs do not deal with primary care issues, but they could do, as the Secretary of State is aware. It would be easy for them to deal with those sectors that they have not been allowed to address. We need to modernise the CHC structure.''—[Official Report, 20 November 2001; Vol. 375, c. 214.]

I was surprised to hear him use the word ''modernise'', as I think that he has similar views to mine about its overuse in describing pointless reforms. I suppose that he was playing the game, as we all do sometimes.

In respect of all the powers that the Secretary of State described, the law could be changed to give them to CHCs. I hope that that is what the amendments would do. The Government have made an important point in saying that CHCs do not have the right powers to fit the shape of the NHS. The straightforward and simple solution to that is to make the necessary reforms to ensure that CHCs have those powers.

Apart from CHCs not having the right powers, I cannot think of any other good reason for the Government to abolish them, other than the patchy performance that is a function of their existence, rather

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than being something that can be ameliorated. The Government have not taken such an approach with other parts of the NHS.

6.15 pm

I will briefly go through the amendments to remind myself of their details and to help the Committee. Although in your wisdom, Miss Widdecombe, you have selected the amendments for discussion under clause 15, many of them apply to other clauses because they are consequential. With your permission, we will have to discuss some of the issues in the other clauses when dealing with those amendments. They must also be read with amendments that would have deleted whole clauses. They were not selectable because such matters should be dealt with under a clause stand part vote and not through discussion of an amendment. I hope that Committee members recognise that some of their amendments would be in this group were they selectable.

Amendment No. 163 would delete subsections (1) and (2) of clause 15 and substitute new subsections that would, in effect, rename community health councils. I think that that is worth doing, and I will explain why. I will also set out what would be their powers, and the powers of the Secretary of State to make regulations about them.

On the name, perhaps the Government feel that anything redolent of the old NHS needs to have its name changed and that ''community health council'' does not impart the idea of the need for patient involvement that they want. Those who tabled the amendment therefore thought it reasonable to rename community health councils as ''councils for the involvement of patients and public'', which can be abbreviated to CIPAP. Any other combination of those words does not lend itself to that abbreviation, but for the ease of the Committee, we refer to them as ''councils'' in the other amendments. The Minister and Committee members will notice that many of the proposals refer to patients forums as ''councils'', meaning these bodies.

The new subsection (2) that amendment No. 163 proposes sets out the councils' functions. Amendment No. 171 would change ''(2)(c)'' in clause 15, page 20, line 21 to ''(2)(e)'' because of necessary renumbering. Because of the pressure of time, it is not now appropriate to go through the functions in detail, but I will draw out a couple of them, to help the Committee.

The proposed new subsection (2)(b) discusses

    ''the commissioning of, or delivery by, Councils of services under section 19A of the 1977 Act (independent advocacy services)''.

There is an argument that the reformed community health councils—that is, these councils for the involvement of patients and public—should continue to attempt to deliver such independent advocacy. It was, however, often noted in the consultation that Ministers do not feel that such bodies should have a monopoly on the delivery of independent advocacy services.

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Now is not the time to argue about that. I have some sympathy with the view that diversity can be helpful and that, as we commission all sorts of things in the national health service, it is reasonable to commission independent advocacy services.

That is why the clause is drafted in terms of the commissioning or delivery of independent advocacy services by councils. We could argue that separation is needed because the councils are later asked to make a report on the quality of the independent advocacy services. It may be appropriate to ensure separation within the new councils or separate delivery from the commission.

The Under-Secretary will see that many proposals for the powers of the councils are familiar to her. They are the sorts of powers that she wants her patients forums to have; many community health councils still have them.

Some of the amendments would replace patients forums with the new councils. Clause 19 contains an important provision to give internal symmetry to the proposals by renaming the Association of Community Health Councils for England and Wales the Commission for Patient and Public Involvement in Health, which is a creature of the Government. It recognises that the existing structures can be reformed in the way favoured by the Government for the new NHS. Clearly, some functions will be common to the renamed association and the Government's creature; a separate non-amended body, the Commission for Patient and Public Involvement.

One of the reasons why we want to remove clause 19(2)(g) from the Bill is that the Government envisage the national body as having the ability to get to the nitty gritty of local decision making through overview and scrutiny committees. That function is inappropriate for a national body and therein lies the problem with the Government's proposals. The patients forums simply will not have the facility to engage properly with the overview and scrutiny committees and to influence the committees' statutory powers of calling in. The Government suggest in clause 19(2)(g) that a national body can have that power, but it is surely too centralised and unwieldy. It seems reasonable to ensure that built into this arrangement is the ability of the Government's patients forums to allow councils to liaise at local level. Whatever decision is taken on this group of amendments, clause 19(2)(g) will require further thought.

Time is pressing and there will not be time for me to go into the detail of all the amendments in this group, but I hope that I have given the flavour of our overall approach. I accept responsibility for and absolve other hon. Members who tabled the amendments if they are not complete. I fear that the proposal to abolish clause 20 is not included, but we shall have a chance to deal with that later and it may be inappropriate to try to abolish it now. Some matters are not covered, but we can only do what we can do. Help has been provided by the Association of Community Health Councils for England and Wales, which is busy at the moment with

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its statutory functions. I hope that the Minister will not simply rely on the fact that there may be drafting errors in the amendment and that he will address the substantive proposal.

In summary, I believe--I hope that other Committee members agree--that our approach is rational. The Government must demonstrate why it is inappropriate and why they must abolish community health councils without first trying to reform them.

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