NHS Reform & Health Care Professions

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Dr. Harris: I am grateful to the Under-Secretary for allowing me to interrupt her flow. She argued that community health councils were currently too responsive and reactive. Why not make them less responsive and reactive by—to use the hon. Lady's words—bringing them on board for each primary care trust? Why cannot she give councils for the involvement of patients and the public at local level a place on the trust board, as she proposes for her own creation?

Ms Blears: I hope that, when the hon. Gentleman can appreciate the breadth and sweep of the provisions under clauses 15 to 20, he will see emerge a coherent system that will provide an influence on the inside that is balanced by a rigorous scrutiny position on the outside, too. Taken as a whole, that system will fulfil the need of patients and citizens for a stronger voice. I hope that I shall convince the hon. Gentleman during our debate that we shall not have a mish-mash or a jumble of provisions, which, with respect, his amendments would put in place, but a coherent system. At trust-based level, the patient advocacy and liaison services system and the patients forums will be on the spot. On the outside, the scrutiny will be done by the commission, the local workers of the commission, the independent complaints and advocacy service and the overview and scrutiny committees of local authorities. That provides a real balance to ensure rigour, strength, accountability and integration in the system.

Dr. Harris: The Under-Secretary will know that it is her proposals, at their various stages, which have been called a mish-mash. I did not attack her proposals. Before she defends her proposals, she must say why the existing structures cannot be reformed to provide exactly what she has described. Nothing in the amendments says that the PALS system should not exist, or that the overview and scrutiny committees should not exist. Before she talks about her coherent system, she has a duty to explain why the existing one cannot be made coherent through reform and legislative change.

Ms Blears: And I certainly will do that. If one takes out the PALS system, which is the on-the-spot advice, patients forums, which provide the monitoring and inspecting, and the right to refer contested decisions to Ministers, which is the overview and scrutiny part of

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the community health council's functions, one already has a denuded organisation. There comes a point at which, after one separates out the functions and makes them stronger and more integrated, what is left is an empty shell of an organisation. Therefore, one must have a new system that properly reflects a multi-layered organisation such as the NHS, and one must ensure that the voice of the patient is heard at every single access point to the health service. Taken as a whole, that is a coherent system.

I am afraid that the hon. Gentleman is suggesting that, as well as all the other things, we have some kind of additional body. That would really be a mish-mash system, and very difficult to understand.

Mr. Burns: Why does the Under-Secretary think that the Labour Chairman of the Select Committee on Health is not convinced by her arguments?

Ms Blears: When my hon. Friend the Member for Wakefield (Mr. Hinchliffe) was promoting patients councils during debates last year, he was promoting a different animal from that which is referred to as a council in the amendments. He was seeking to provide a body within the system that would draw together all the patients forums and ensure that all those views were brought together regularly, to engender within the health community a sense of the issues being raised at local level. That would ensure that patients forums were not isolated in each trust and unable to get their view across. Under the Government's proposals, the local parts of the Commission for Patient and Public Involvement in Health will provide exactly the function of the patients councils advocated by my hon. Friend the Member for Wakefield. They will be patients councils plus, because they will have a number of extra statutory powers. Therefore, we are building on the proposals of my hon. Friend the Member for Wakefield, rather than simply putting them in place.

Mr. Burns: Then why is the hon. Member for Wakefield changing his view in his opposition to what the Under-Secretary is seeking to do?

Ms Blears: I think that my hon. Friend the Member for Wakefield will be interested to look at the discussions in this Committee. The conclusions that he reaches are a matter for him. Some of the proposals genuinely build on the ideas that he advanced, but his ideas are very different from those in the amendments tabled today, which refer to turning patients forums into patients councils, which was not within his contemplation at all. He was talking about co-ordination, drawing together, learning the lessons and joining up the system, not replacing patients forums with patients councils, which serves to confuse the matter even more.

I shall now explain why the new system is necessary, and why we need patients' forums. The NHS is more complex and multi-layered, and different functions are needed in different parts of the system. Most people involved in community health councils would recognise that there was inconsistency across the piece. Some brilliant community health councils were doing

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fantastic work, but it would not necessarily be done the same way in Bristol, Bath, North Yorkshire and Cornwall. Performance was extremely patchy.

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The hon. Member for West Chelmsford mentioned the fact that my community health council in Salford did some excellent work. I can also confirm that, for years, it has been trying to pilot new ways of working, which we are proposing to use to involve citizens and find groups who are never involved in public consultation. We want to involve the socially excluded and marginalised: homeless people, asylum seekers, travellers, young people, those who cannot turn up to a meeting on the second Tuesday of the month at the public library, but whose views are equally valid in shaping the health service. The most progressive community health councils carried out that sort of public involvement work and welcomed those ideas, so they have drawn in the views of the wider community.

Over the past six months, I have devoted much time to our listening exercise—talking to CHCs, councils for voluntary service, local authority groups and a range of voluntary groups in the NHS. We have had nine regional listening events and 1,000 people—

Mr. Burns: The Under-Secretary outlines the extensive consultation. How many members of CHCs told her that she was right to abolish them?

Ms Blears: There were 1,000 people at the consultation meetings, and we have received 1,000 letters, one of the biggest ever responses. Many CHCs welcomed the proposals.

As well as many patient organisations that have welcomed the proposals—

Mr. Burns: Come on.

The Chairman: Order.

Ms Blears: I received a personal letter written on behalf of Wirral community health council. The writer said that at the council's meeting on 15 November, it examined the Department's latest proposals—we had changed our proposals because we do listen and it was a proper exercise in consultation. The writer of the letter said that members of the CHC agreed that the new proposals offered a much more cohesive approach. They applauded the emphasis on co-ordination of the new structures at a local level by the Commission for Patient and Public Involvement in Health. They commended the inclusive nature of the consultation. They said that they themselves were piloting new ways of working, engaging local people in health decision making. They said that in November, they would be presenting to local MPs an evaluation of their pilot NHS comments hotline and that whilst the announcement in the NHS plan of the intended abolition meant an uncertain year for them, they had worked hard to embrace the spirit of reform heralded by the plan and had no doubt that the new proposals would ensure that that position was enhanced and strengthened. I am delighted that, after a year of

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consultation, Wirral community health council welcomed the proposals with such open arms; it is not alone.

Dr. Harris: Does the hon. Lady accept that she is a Minister for England, not just the Wirral? If she is going to increase support one body at a time, it will take several years before she can cover a county. How can she argue that the amendments are dealing with an empty shell when all the reformed CHCs' functions, including PCT representation on boards, are set out in amendment No. 163? Are those functions important?

Ms Blears: The functions are extremely important, which is why they belong to the patients forums inside each trust. Other bodies must carry out functions in a coherent system of patient and public involvement. We need a new system to create powers to follow patients wherever they go in the system. Patients forums can work together. In primary care trusts, a patients forum will allow us to study the premises of GPs, dentists and pharmacists. Where joint arrangements with local government exist, patients forums will also have the power to follow people in local authorities. In private sector arrangements, a condition of the contract will be that patients forums are allowed to monitor, inspect and ensure that the quality of services is up to the mark.

CHCs, no matter how good they are, would acknowledge that they are not fully representative of their communities. My constituency CHC is not because it is a static membership organisation that meets on the second Tuesday of the month. It tends to be self-selecting in the sort of people who can, or want to, take part. It is mainly politicians who enjoy going to meetings on the first Monday, the second Tuesday, the third Wednesday and the fourth Thursday of the month. Asking people in a voluntary sector setting to give that type of commitment is sometimes extremely difficult. We need to be more creative and more imaginative about the way that we seek to involve patients and the public in a range of public services, but particularly in the health service.

What I find very disappointing about the amendments that have been tabled by the Opposition today is the fact that they are designed to perpetuate the status quo. From the Conservatives I am not surprised but I am surprised that we see the Liberal Democrats in alliance with the forces of reaction. I am surprised that they do not want to be forward looking or progressive or to raise their sights and consider whether there might be better ways to involve the public and patients in our health service. Do they simply want to say that the status quo is good enough? [Hon. Members: Hear, hear.] Certainly that is not my view. I believe that we have a challenge and a duty to improve the way in which we involve the public and citizens in our public services.

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