|NHS Reform & Health Care Professions Bill
Mr. Heald: On a point of order, Miss Widdecombe. I apologise that I have been called away from the Committee on an urgent matter. I apologise particularly to the Under-Secretary because I wanted to hear her winding-up speech, but I shall read it carefully in Hansard.
The Chairman: Thank you, Mr. Heald.
Dr. Harris: I shall give the Under-Secretary the opportunity to wind up, but I want to put on record my concern about the approach taken by Conservative Members.
Ms Blears: I shall do my utmost to cover all the points that have been raised by hon. Members. We have had a wide-ranging debate on the amendments, which raised a significant number of important issues.
Amendment No. 209 would make it mandatory for the Secretary of State to make regulations. It is not usual to oblige the Secretary of State to make regulations in any legislation. That would create uncertainty about the extent of the duty being imposed and might oblige him to make regulations in respect of every paragraph; he would not have the power to decide which were appropriate for regulations. I shall resist the amendment because it is not appropriate to have such a provision in the Bill. Nevertheless, it is important that the regulations cover many of the issues raised by hon. Members.
The hon. Member for Oxford, West and Abingdon asked whether all stakeholders would be consulted about the content of the regulations, how they would operate, which premises would be included, how visits would take place, who would have access and whether prior notice would be given. He also mentioned details about confidentiality. These are all extremely important matters. I can confirm that in drawing up the regulations, there will be widespread consultation with all the stakeholders in the system to ensure that we get the regulations absolutely right. These are matters of practicality, and the regulations need to balance the rights of patients forums and those of other people in the system. We want to ensure that we get that balance absolutely correct, and the content of the regulations will be much better if they are formed after consultation and debate. We intend to allow that.
That is the very reason why the draft regulations are not before the Committee; they have not been drafted and they are not ready. It is not a matter of the Government's withholding regulations from the Committee. My right hon. Friend the Minister of State actually said that he would share the regulations if they were prepared, but he confirmed that they were not prepared. The reason is that we want to conduct extensive consultation on the contents of those regulations.
At this point, it may help if I draw Members' attention to a document that I have placed on the Table today. It is a proposed implementation programme for all the patient and public involvement provisions. I am keen to share that with hon. Members, because it sets out a project plan that takes us all the way up to April 2003 and beyond.
I should like to give Members a sense of how the proposals will be implemented, when consultation will take place and when regulations will be drawn up. I appreciate that the document is complex, so I want Members to have a chance to look at it, perhaps before we debate some of the later clauses dealing with patient and public involvement. The heading of the document refers to a ''proposed implementation programme''. Obviously these matters will be subject to consultation with people in the field who are already involved in community health councils, patients forums, local authorities and a wide range of bodies, who I hope will play a real and substantive part in drawing up a coherent framework for patient and public involvement. I hope that the document will help hon. Members to see that this is not a hastily conceived plan, but a structured and managed programme for implementing patient and public involvement.
Dr. Harris: I am grateful for the information provided and I have no questions about it at this point. I want to take the Under-Secretary back to her original rejection of amendment No. 209, in which she said that accepting the amendment would make it mandatory for the Secretary of State to make regulations relating to the list of premises. It is appropriate that that is mandatory because, presumably, these are the premises where there should be some rights of inspection. I am not suggesting in this amendment that those would be full rights, because clearly the nature of the rights would have to be negotiated, for reasons that have been given by Conservative Members.
The implication that the Secretary of State might not then make regulations providing for the inspection of one of those areas implies that the Under-Secretary envisages circumstances in which there would be no inspection and entry rights for patients forums. That would be a diminution of the powers currently held by community health councils. The Under-Secretary should clarify whether that is the implication of her remarks.
Ms Blears: No, I do not envisage the circumstances that the hon. Gentleman has suggested. The provision is right to allow the Secretary of State to make regulations in relation to these matters. I do not think that that detracts from the power or strength of the provision, and the amendment is resisted on that basis.
I shall now discuss the ''prison clauses''. Obviously, we shall have a debate under clause 21 about the substantive nature of the partnership arrangements between the Prison Service and the national health service. It might help if I now deal with the powers of entry and the powers of patients forums in relation to the Prison Service.
The primary responsibility for the environment of care for prisoners rests with the Prison Service. There are already established mechanisms for independent inspection and scrutiny of prisons. These cover health care services for prisoners and are provided by Her Majesty's chief inspector of prisons, who conducts a regular programme of announced and unannounced inspections, covering the full range of prison activity, including health care provision. As part of their inspection, the chief inspector's teams carry out survey work to assess patient satisfaction with health services, and they have direct access to prisoners to assess their views. Other inspections in prisons are carried out by boards of visitors, comprising independent laypeople. They are in place at all prisons, and they provide an element of day-to-day independent oversight of all aspects of prison activity, including health care. Boards can raise concerns with the prison's governor and through their annual report to the Home Secretary.
Several hon. Members rose
Ms Blears: I am spoilt for choice.
Mr. Burns: On the question of boards of visitors, does the Minister think that a board's composition of members might suffer in the way that memberships of community health councils have?
Ms Blears: The Government are keen to involve people from the widest section of the community. That approach applies across Government: we want their involvement in boards of visitors, education services and regeneration projects, for example. When we talk of public involvement, we are committed to ensuring that we are not simply using words or offering an empty shell, but that individuals who offer a wide range of experience participate in such bodies.
Mr. Burns: Will the hon. Lady give way again?
Ms Blears: I want to make progress because I have many points to answer. I believe that I have dealt with the hon. Gentleman's point.
Dr. Harris: Will the hon. Lady give way to the mover of the amendment?
Ms Blears: Yes.
Dr. Harris: I am sure that boards of visitors do excellent work in their own way, as does Her Majesty's chief inspector of prisons in respect of detention centres for asylum seekers with medical problems and in the prison health care systemexcellent work, which is often ignored by the Home Secretary. However, it is certain that the boards of visitors do not have expertise in health care areas or reflect patient and public community involvement. If NHS provision is to be given to prisons, it is eminently reasonable to provide the same rights of access, entry and inspection for patients forums or, were they to remain, CHCs. That would all come under NHS care. The idea that one can have details of a patient's condition and of any complaint about a prison's governor wholly disregards the key separation, which the Prison Service recognises must exist, between the clinical confidentiality of a prisoner and other areas over which the governor has charge.
Ms Blears: I believe that I have outlined that the primary responsibility for the care environment in prisons lies with the Prison Service, and that independent inspection regimes exist in prisons. During the debate on clause 21 and partnership arrangements, hon. Members will appreciate the step-by-step incremental approach being taken to improve health care services in prisons. Many hon. Members acknowledged that those services had suffered from considerable deficiencies in the past. At present, independent inspection lies with Her Majesty's chief inspector of prisons and the boards of visitors.
Dr. Murrison: Will the hon. Lady give way?
Ms Blears: I have spent sufficient time on the clause and we shall have an opportunity to discuss more general matters of prison health care under clause 21.
Dr. Harris: On a point of order, Miss Widdecombe. Can you clarify something for the Committee? If there is not enough time under the guillotine to discuss clause 21, is not the ministerial assurance that we may discuss matters during the debate on that clause meaningless? It will all be dictated by the timetable.
The Chairman: Indeed, Dr. Harris, I can confirm that if the Committee has not reached clause 21 and debated it by 5 o'clock tonight there will be no debate.
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