NHS Reform & Health Care Professions Bill

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Dr. Andrew Murrison (Westbury): I have two chief concerns. First, the make-up of forums is opaque. Secondly, public access to them is similarly opaque and the subject matter of regulations that we have yet to see.

The Local Government Association made a good point in its response to the consultation. It said:

    ''Membership . . . should reflect a representative sample of the local population to ensure that hard to reach groups are included''.

I agree with that, but we must also have people with the adequate skills so that the interests of users are adequately represented. How does the Minister propose that we tap in to the right skill mix so that those views are adequately represented and members are effective advocates? We can make the analogy with school governing bodies, to which it is difficult to recruit volunteers with the right skills mix to take responsibility for such things as health and safety and finance; matters for which many are not well equipped. I seek the assurance that the forums will be made up of people who are representative and have the right level of experience and skills mix.

Mr. Heald: Does my hon. Friend agree that the Under-Secretary might have proposed that those who are severely handicapped or who have the problems as set out in the briefing of the Royal National Institute for the Blind should serve on patients forums? It is a surprise that she has not proposed that. We have heard a great deal about having a wide variety of members, but someone with those problems might be a useful person on a forum when considering access to hospitals and how services could be provided for people who are visually impaired, or deaf and blind.

Dr. Murrison: My hon. Friend makes a good point. It is easy for us to say that we need to ensure that the forums are representative, but putting that into practice is extremely difficult. Of course, we must try, and to that extent I welcome the Under-Secretary's comments. However, I would emphasise that people must be adequately skilled to do the job that we are asking of them. Public access is important. As some of us will know from attending the public meetings of community health councils, the meetings are valuable and well attended. We should ensure that the patients forums act in a similar way.

Ms Blears: I am delighted that we are discussing important issues for patients and the public at large in terms of how the new system will work.

First, in relation to appointments to patients forums, the hon. Member for Wyre Forest referred to pages 5 and 11 of the response to the original document. I am pleased that he has the response document, because things have moved on apace in consultation. The hon. Member for Billericay may be reading from the original document rather than the response. I will deal with his points in a moment.

The criteria for appointments to patients forums will be set by the independent appointments commission, which will take on board the concerns expressed by the hon. Member for Westbury (Dr. Murrison) about people having the right skills and ability to do an important and complex job. When we consulted, people said clearly that they did not want a formal process that would exclude many people from a range of different communities. If an advertisement is not placed in The Times, or a traditional recruitment process is not employed, some may feel that they do not have the necessary skills to make an application. If the process were national, it might seem bureaucratic and remote from communities.

People said that they wanted the rigour of the independent appointments commission criteria, but thought that recruitment should be done at a local level by people in touch with local voluntary organisations—such as citizens advice bureaux—and with the whole network that makes up the fabric of many communities, many of whose activists are involved in a range of organisations.

The criteria will be set by the independent appointments commission but the recruitment will be carried out by the staff of local networks of the Commission for Public and Patient Involvement in Health. The independent statutory corporate body will do the recruiting and appointment at local level in local communities, which answers the point made by the hon. Member for Billericay about independence. That body will also be charged specifically with building local capacity in the community, in recognition of the fact that volunteers do not appear out of thin air.

We must bring volunteers through the system and gradually get them more involved, while giving them more skills to take on responsibilities. The local workers of the commission will be specifically charged with going out to the community and finding people who are interested in taking part. Those people may not be ready to take part from day one; they may need more support, education and training on specific issues, so their contribution is a real one. The local commission will be charged with doing that.

The way in which we propose to recruit patients forum members has the best of both worlds; the rigour of the independent appointments commission, and the local connection at a community level of the local networks of the Commission for Patient and Public Involvement in Health. In that way, many volunteers will apply.

4.15 pm

Although there is sometimes difficulty in finding volunteers for a range of public organisations, the Wirral community health council, which is obviously keeping in close contact with our debates, sent me an encouraging e-mail yesterday. It stated that when it set up its private health forum a couple of months ago, it received 64 requests for information and 32 applications for 12 places. It shortlisted and interviewed 18 people, and said that the response was much more than had been the case via the traditional processes. It said that it might be able to export a few spare people to help other areas. I am delighted that people are coming forward and want to take part in the new structures.

I can confirm to the hon. Member for Wyre Forest that we will set up a transitional advisory board to help us manage the transition. As a result of the listening exercise, I am conscious that people did not want a big bang. They did not want CHCs abolished before the new structures were up and running, so we will have a board that comprises representatives of CHC staff, CHC members, Unison, the Society of Community Health Council Staff and others. We are delighted that ACHCEW is involved, as are other patients' groups, such as the Long Term Medical Conditions Alliance. Patients have a real input to make, as do representatives from local government, because they are involved in scrutiny. A wide-ranging board will help us independently to manage the transition.

One of the problems that the board is specifically charged with considering is how to work out a way in which members of the current structures can find their way into and populate the new system. The board will consider whether it is practical to extend their terms of office. By amending the CHC regulations, we would be able to ensure that people whose terms of office were due to expire could stay on and be managed through the process. As hon. Members have seen from the post-implementation plan, it is proposed that CHCs disappear in April 2003 as part of the managed transition into the new structures.

Public access to information and advice on the proceedings of patients forums is vital. Clause 18(4) states that the regulations will apply or correspond to the provisions of the Local Government Act 1972, which covers access to meetings and documents. That is to try to ensure that patients forums are at least as open as CHCs have been. I hope that that reassures hon. Members on the issue.

Mr. Baron: I do not have the 1972 Act in front of me, which is a terrible admission. Access to public meetings is fine, but my experience suggests that if they are not advertised and widely known about, there is no point in having access as no one knows that they are taking place. May I have clarification on that point?

Ms Blears: The hon. Gentleman makes a good point, which is that the proceedings of all the bodies will need to be properly advertised. There is no intention that any of them operate in secret. I am not sure whether the provisions for local government on access to information provide for pre-advertisement, although I recollect that they do so, based on my time as a councillor. I remember having to put forward documents that would have been available for inspection before a meeting, which leads me to think that members of the public would need to be notified so that they could inspect them. I shall check, but I think that a statutory provision requires notice of meetings and of the documents to be considered. The provisions provide that the tiny proportion of private meetings need a good reason for not being open to the public. We want to ensure that that is followed as rigorously as possible.

It is of course essential that we advertise for members of patients forums, and not only in traditional ways. We could advertise in supermarkets, post offices and newsagents to try to bring the positions to the attention of a range of people who traditionally might not have been notified of them. We want to recruit our members actively.

The hon. Member for Billericay raised an issue about the voices represented and a lack of lay members above patient forum level. I directed him to the response to the listening document, which moves the debate on significantly. As regards clause 19 and the commission, there were concerns that the voices were not local and independent lay members. Everyone loved the functions, but was concerned about the structures. The response moves us on. It says that the local networks of the commission will have reference panels of local lay people to guide the work programme. There will be lay people involved at the level of patients forums. I do not like the word ''above'' because I do not see this as a hierarchy. . There will, however, be people at every level of the system. There will also be lay members on the national commission, which will be made up of people from patients' forums and local strategic partnerships to ensure that there is a lay voice at every level of the proceedings. That is important, and we must make sure that it happens.

Under clause 18(4), we can even modify the provisions of local government legislation. I think that that legislation provides for prior notice, but even if it does not, we certainly can. We would provide prior notice to enable the greatest number of people to know when and where meetings are and how they can get involved.

As I said, I hope that there will be more ways of consulting than just meetings. I recently talked to people in a rural area who told me that it was sometimes difficult to get to meetings. It was a farming community, and most of those to whom I talked were farmers. They really wanted to have a say in their health service. They said that they were all on e-mail and that we could use technology to have a consultation. That would mean that they did not have to travel 20 or 30 miles to take part in meetings. Using new technology to improve our consultations will be important.

I am not sure whether the hon. Member for North-East Hertfordshire was here when I spoke about funding this morning. I said that I did not want to isolate each individual part of the system and allocate a particular pocket of funding to it. We must see the whole system as coherent package of measures to strengthen patient and public involvement in the NHS. As I said, the system will be backed up by adequate resources. I recognise that good involvement requires the staff to service it. People must be helped to have a say, and I recognise that that will take resources. However, I do not want to pick off individual parts. We must fund the system as a whole, just as the system needs to operate as a whole. That is my intention.

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