NHS Reform & Health Care Professions Bill

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The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears): And come out again!

Mr. Heald: There are security reasons why one might worry about that, especially as appointment details for patients forums are not well known. The Home Office might have concerns about some individuals being allowed, as a right, to enter prisons.

On costs, which I mentioned earlier, it is clear from paragraph 191 of the statement on financial effects that there is currently no budget. Can the hon. Lady give us some good news on that and, as a baseline at least, assure us that patients forums will have the £23 million that CHCs have?


10.45 am

The Chairman: Order.

Mr. Heald: I was offering the Under-Secretary an opportunity to intervene and say yes. I hope that she will cover that point when she replies.

I had three further points to make, but I will reduce them to one. I have been speaking for some time, and it is always good to curtail one's remarks.

Mr. Burns: No, my hon. Friend is doing very well.

Mr. Heald: My hon. Friend says that I am doing very well, but I will curtail the points that I was going to make.

It will be the role of the Commission for Health Improvement to enter and inspect premises. I understand that guidelines suggest that it should get round to each hospital once every four years or so; the Under-Secretary may confirm that. Will patients forums be allowed to go into premises whenever they wish, or will regulations introduce some regime to limit the number of occasions or provide for the adoption of a bureaucratic system to give early warnings about their visits?

That has been a vexed subject with bodies such as Ofsted. Questions have always been asked about whether the notice period that it gives is a good idea. Some people say that it should undertake on-the-spot inspection: just turn up, go in and see what is going on. Others say that it is a good idea to give some notice so that all the staff are present and everyone in the enterprise is visible. What is the Minister's view about the patients forums' visits? Will they have a straight power of entry and inspection, as the police have in certain circumstances, or will that power be circumscribed by early warning systems and a bureaucratic system?

Dr. Harris rose—

The Chairman: Order. Before I call the hon. Gentleman, may I tell the Committee that I have listened to the debate with interest and considerable restraint? It has gone far wide of the subject of the amendments. Indeed, it has gone round the equator and back on the subject of clause stand part, also touching on matters that should properly be debated under clause 18. I therefore give the Committee notice now that I will not allow a clause stand part debate on this clause. Hon. Members may wish to bear that in mind during the remainder of the debate on the amendments. I shall also take into account the wide-ranging nature of this discussion when we come to discuss clause 18.

Dr. Harris: I am grateful to you, Miss Widdecombe, for giving me a second bite at the amendments. I entirely agree with your diagnosis of the debate that we have had and am more than happy to forgo a clause stand part debate.

I want to comment on some points that have been made on the amendments before the Under-Secretary replies, if she will indulge me. I am delighted that my three amendments have stimulated the Conservatives to make such lengthy contributions, but I am conscious that we are running out of time and I want to deal with the issue that the hon. Members for North-East Hertfordshire and for Hexham raised about the appropriateness of including certain people in inspection teams.

I first have some questions that relate to the definition of premises in clause 13(2)(c)(ii), which I ask as formally as I can. A discussion on the amendments—I refer especially to amendment No. 211—is not the best place for this, but as there will be no clause stand part debate will the Under-Secretary say whether that definition covers premises abroad and whether the Commission for Health Improvement go into premises abroad under contract to the NHS? By extension, is that the correct definition for the inspection rights of patients forums under the clause, and would patients forums have the right, if their budgets allowed, to examine provision abroad?

Secondly, may I ask why special health authorities are not included in the list in paragraphs (a) to (e) in clause 16? If I am right, high security mental health trusts, for example, function as special health authorities, but are not covered, even with the Government amendments in the next group.

Thirdly, confidentiality is important and was raised by the hon. Member for Westbury (Dr. Murrison) and mentioned by the hon. Member for Wyre Forest (Dr. Taylor). There is nothing new concerning confidentiality that does not already exist for community health councils. We want ''Casualty Watch'' and we realise that when watching ''casualty'' we are watching casualties, who have a right not only to confidentiality, but to privacy and that is not available in corridors, regardless of whether the beds have wheels. There are issues concerning privacy and confidentiality and I am sure that the Under-Secretary accepts that she must reflect on whether new issues arise and whether she is satisfied with the current arrangements for community health councils.

Finally, I want to respond to the point about alleged unsuitability of some people to take part in patients forums. The hon. Member for Hexham made a controversial statement, which may have been inadvertent. It does not help to shout down such comments or to use words such as ''racism''. Nevertheless, some of the assumptions made must be challenged and I shall do so. The hon. Member for North-East Hertfordshire said something along the lines of, ''if there are good people in the travelling community'', the implication being that there are no good people in the travelling community. When he said ''good'', I think he meant that we should add value to the process.

Mr. Heald: Will the hon. Gentleman give way?

Dr. Harris: In a moment, because I want to ensure that the hon. Gentleman understands what I am saying. His assumption is dangerous and is the same as the assumption that there is an automatic risk to owners of premises from people in the travelling communities, whether defined as gypsies or otherwise.

Mr. Heald: Will the hon. Gentleman give way?

Dr. Harris: I will give way because it is important to do so and I am inviting the hon. Gentleman to clarify his comments. Making his point in the way that he did—it may be valid and I do not challenge his right to do so, nor am I accusing him of racism--emphasises the fact that there will be providers in the health service who share or make judgments about the travelling community and gypsies that are inappropriate, prejudiced and unreasonable. For that reason, the inspection regime must ensure that it covers any concerns that people may have that they are being excluded and subjected to prejudice. There may be racism in the health service--I am not saying that that is the hon. Gentleman's view--which is why it is important to go out and find people in those communities who can say whether the health service is responsive to their needs. Another example is that of asylum seekers, who are also a vulnerable group of patients.

I do not believe that community health councils need to be abolished to provide inclusiveness. Oxfordshire community health council has done a darn sight more to protect the health care of asylum seekers than any Government legislation, which is repressive in this area--

Mr. Atkinson: Will the hon. Gentleman give way?

Dr. Harris: In a moment.

Government legislation denies detained asylum seekers access to decent health care. It is not necessary to abolish CHCs, but the Government are right to identify what needs to be done.

Mr. Heald: I could have said, ''If we could find a good member of the accountancy profession'' or any other body. What I meant by good was someone who could make a valuable contribution to a patients forum. I hope that the hon. Gentleman agrees that there is concern--I am angry about the abolition of CHCs--that good members of CHCs who have given years of service may be turfed off and unable to continue doing their useful work. That was the context of my comment.

Dr. Harris: I note that and I may like a chance to respond, but I want to give way to the hon. Member for Hexham.

Mr. Atkinson: The hon. Gentleman is mixing up two issues. I have no problem with members of patients forums talking to gypsies, the travelling community or asylum seekers to find out about their health needs and I hope they would do that. However, it manifestly defies common sense that members of a group that is itinerant by nature should serve on a forum. That is not an attack on them because they are travelling people; it is simply that they would not have the knowledge of the community, area or, indeed, the medical institutions necessary to be members of a forum.

Dr. Harris: But members of that group have knowledge of their own experience and that of people in their community. We are discussing not premises and geography, but the delivery of health care to individuals. The hon. Gentleman misunderstands the reason for inclusiveness, which is to ensure that when inspections and overviews take place, decisions are made for all sections of the community, and not just for those that are established. It is a difficult area. The idea that people who are established in the community might be ''turfed off'' a forum by ''itinerants'' is dubious. That line could be used by other people whose views are inappropriate and who might not want travelling people to take their place. I am sure that that is far from the hon. Gentleman's view, but his position worries me, because it could be seen to share some interpretations with people who feel that the health service is for the white middle class.

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