NHS Reform & Health Care Professions Bill

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Mr. Mike Hall (Weaver Vale): The hon. Gentleman could learn from him.

Dr. Harris: Indeed. The hon. Member for Wyre Forest speaks with great clarity, normally.

There is a question about whether the geographical membership of patients forums will reflect the geographical areas covered logically. There is also a question of whether the overview and scrutiny committees, which are geographical in their nature—by definition, and by their establishment—will have members on the patients forums to which they can relate clearly. I hope that those amendments are self-explanatory.

I now move to the three new clauses that are to be considered in this group of amendments, which are important. New clause 3 is complex and I suspect that, in terms of drafting, it needs to be read in relation to the Local Government Act 2000. I have looked at this carefully and, while there may be drafting errors, I hope that it was sufficiently clear for the Minister to understand its intention. That intention is to place a duty on overview and scrutiny committees to carry out the scrutiny of local health services. Under the Health and Social Care Act 2001, overview and scrutiny committees have the power to scrutinise, but not the duty. Therefore, some local authorities could choose advertently, or inadvertently—I seem to say that so often in relation to this Bill—not to exercise this power, leaving the local community with no powers of scrutiny for the NHS.

Paragraph 1 of schedule 7 to the NHS Act 1977 places community health councils under a duty to

    ''(a) represent the interests in the health service of the public in its district; and

    (b) to perform such other functions as may be conferred on it . . .''

The CHC Regulations 1996 expanded upon this duty. Regulation 17 places a duty—not just a power, but a duty—upon each CHC to:

    ''keep under review the operation of the health service in its district, to make recommendations for the improvement of that service and to advise any health authority upon such matters relating to the operation of the health service within its district as the Council thinks fit.''

The amendment, effectively, puts a similar duty on the overview and scrutiny committees. If the Minister cannot accept this new clause, I would be grateful if she reassured me that she has plans to provide this duty, because I have been told that it does not exist. Otherwise, I ask her to in some way seek to reassure me that the worries that prompted the amendment are unfounded.

Ms Blears indicated assent.

3.15 pm

Dr. Harris: I am pleased to see her nodding, which I accept in good faith. It gives me hope that I will be satisfied on the matter.

New clause 4 would amend the Health and Social Care Act 2001 to add an extra section, placing a duty on overview and scrutiny committees to refer matters of concern to the Secretary of State. Community health councils have the duty to refer to the Secretary of State a decision that has involved inadequate consultation or given rise to significant local unhappiness, thereby placing responsibility and accountability with him. In a previous debate, we heard how careful Ministers were to ensure that, where necessary, accountability lay with the Secretary of State, even if they were not keen that the performance of those duties should be expertly scrutinised.

The new clause, in conjunction with new clause 3, would ensure that the powers of overview and scrutiny committees were coupled with a duty to refer matters to the Secretary of State in circumstances prescribed by the regulations. I do not need to go into any more detail about the current powers of CHCs, but the new clause is intended to replicate those powers within the new structures.

New clause 5 would amend the Local Government Act 2000. Many long minutes, if not hours, were spent hunting down the sections that I wanted to amend, but I am pretty sure that the new clause is in the right ballpark in terms of accuracy. It would provide for overview and scrutiny committees or sub-committees to include at least one member of the relevant patients forum. That would be a way of feeding information from the work of forums into the work of the committees, providing a more integrated approach and greater co-operation between the two. OSCs will need first-hand knowledge of patients forum members to exercise their functions. At the moment, CHC members have the powers of referral, inspection and scrutiny and they must know what is going on. In the context of the new structure, it is important to link the two bodies more closely together; an effective way of doing so would be to ensure that OSCs have shared membership with the relevant patients forums.

There may be an argument for having a wider body within the new framework to represent patients forum views cited at overview and scrutiny committee level; it could be called a patients council. I suspect that, at a later stage, we might consider such arrangements. For the time being, we should ensure that OSCs have the powers and duties to scrutinise and refer, and that they have the expertise to call upon in terms of personnel to ensure that scrutiny is adequate and decisions to refer are appropriate.

I look forward to hearing the Under-Secretary's response to these important amendments and new clauses. We should take this opportunity to ensure that overview and scrutiny committees are workable.

Mr. Heald: The community health councils—which act as the local watchdog and independent voice—and the overview and scrutiny committees are interlinked. The role of the one, the CHC, is vital to the work of the other, the committee. I draw the Minister's attention to the emergency motion that was passed by Croydon council in December 2000. It said that

    ''this council is proud of the way Croydon CHC provides a strong independent voice for the people of Croydon on NHS matters . . . The involvement of an independent watchdog role is essential''.

There were numerous other articles in Croydon newspapers at that time, with headlines along the lines of , ''Health watchdogs play a crucial role''. The story ran again when the Government lost the previous provisions.

The amendments relate to one of the important interfaces if we are to have the changes; that between patients forums and overview and scrutiny committees. My party and I rather agree with the sentiments of the motion to which I referred. We are proud of community health councils and do not really see the need for the changes, but if they are to be made, patients forums will be the bodies with the first-hand knowledge of services. They must be in a position to refer matters to relevant overview and scrutiny committees. Amendment No. 217 is, therefore, right up our street.

The purpose of amendments Nos. 218 and 219 is to include overview and scrutiny committees in the list of bodies that will be obliged to make and publish comments on reports or recommendations made by patients forums. It is important that the overview and scrutiny committees use the powers that they are given. The hon. Member for Oxford, West and Abingdon (Dr. Harris) has raised concerns that giving a body a power is not the same thing as making it do the work.

Amendment No. 220 would ensure that the membership of patients forums contained representation from residents of the catchment areas and related to the relevant overview and scrutiny committees. That seems sensible to us. The new clauses would place a duty on overview and scrutiny committees to do their work. That might seem draconian, but I think that it is important that the work is done. This is a way of highlighting the importance that Parliament places on the duty that has been given to those committees.

Turning to new clause 4, regulation 18(5) of the community health council regulations places CHCs under a duty to refer inadequate consultations and contested decisions to the Secretary of State. In the course of carrying out the functions of representing the views of patients and their local communities in health services, CHCs sometimes disagree with plans being considered for those services. CHCs are relied on to provide the community perspective on plans, although they are always willing to look at other views. New clause 4 would provide a safeguard in the system, and we are tempted by it.

I am not entirely sure, from what the hon. Gentleman said, what the effect of new clause 5 would be, but I will be interested to hear the Minister's response.

Dr. Taylor: Amendment No. 219 is absolutely crucial. As we have heard, it would add the overview and scrutiny committees to the list of bodies that comment on the forums' reports. Given that they are the only democratically elected bodies concerned, they have every right to be asked to comment on the reports.

Amendment No. 220 would ensure that all overview and scrutiny committees relevant to a trust were represented. That is only a small part of my concern about membership. We strayed widely, as your co-chairman Miss Widdecombe said at the time, Mr. Hurst, on to clause 18 this morning. There are various other points that I would like to make. Can we return briefly to the topic under clause stand part?

The Chairman: I can confirm that the hon. Gentleman will have the opportunity to say more on that matter during the clause stand part debate.

Mr. Baron: I have two brief comments. I congratulate the Government on including, under clause 18(3), in the membership of a patients forum,

    ''at least one person who is a member or representative of a voluntary organisation''.

I believe, as perhaps do other hon. Members, that that is vital. The Government should do much more to empower the voluntary and community sector in their efforts in the community in general. Here is an example of how they can be involved in local decision making; in this case, for health care provision. That is a good move.

Will the Minister clarify a concern that I have, relating to clause 18? Under the new proposal—

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