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15 Jan 2003 : Column 760continued
Clause 6 deals with the appeals procedure. I think that seeking to delete it is the right way forward, but not because I believe that there should not be an appeals procedure. I believe that there should, because, given what the Government are doing with fines, there is an urgent need for it; I fear that, as a result of the breakdown of partnerships and working together, the arguing between the health service and social services over whether a fine will be paid will be so intense that an appeals procedure needs to be in place.
What I do not find attractive about the Government's proposal, as many of my right hon. and hon. Friends said in Committee, is that unfortunately the way in which they are going about it is to set up the procedure though the strategic health authorities, so that in effect the health service will be both judge and jury. That cannot be right, in the interests of fairness and justice.
What we have always argued, and what I remain committed to, is that there should be an appeals procedure, but that it should also include social service departments or local authorities on an equal footing with the health service, with an independent chairmanor chair, in the current politically correct language. The Bill would be greatly enhanced by that. Unfortunately, because of the lengthy discussions in Committee, it would not have been in order to re-table the amendment that we proposed in Committee, and regrettably this is the only way in which one can seek to persuade the Government to think again and adopt a more even-handed approach.
I am sure that the Minister will say that it would be nonsense to take the whole appeals procedure out of the Bill, and I would agree. But I should like to persuade her and the House that removing the clause from the Bill now would give the Government time to reflect further on our eminently sensible suggestions of an even-handed approach to an appeals procedure, so that they could reinstate in another place a clause that was more acceptable to my right hon. and hon. Friends and, I suspect, many social service departments, which see this as potentially a fix where justice will not be seen to be done.
For those reasons, I hope that the Government will accept the amendment, solely as a temporary measure while they reflect on introducing their own amendment. If they do not, my noble Friends in another place will be in a position to do so instead.
Mr. Burstow: We rehearsed a lot of these concerns and arguments in Committee before Christmas. The Liberal Democrats fundamentally share the Conservative position: the arrangements for setting up the dispute panels under strategic health authorities do not guarantee the independence of those panels. Indeed, I noticed that, in Committee, the Minister acknowledged the need to reconsider the independence issue. Simply keeping on saying that the chairmen should be independent does not make them independent. She said that she would consider how to secure such independence and
The notes that the Minister has circulated, which give a glimpse of what might be covered in the regulations under clause 6, raise a couple of issues, and I hope that she might be able to give us some further information on them. The first point relates to clause 6(2)(a) on the constitution of the panels. Paragraph 24 of the notes says:
Having said all that, we wish to support the Conservative proposal to delete clause 6 simply because that clause will not be effective in ensuring that dispute resolution is fair and free of the bias that will exist if such issues are vested in the NHS.
Glenda Jackson: I should like to make a brief contribution. I cannot support the argument to remove the clause that relates to appeals panels, nor do I share the somewhat cynical view, voiced by the hon. Members for West Chelmsford (Mr. Burns) and for Sutton and Cheam (Mr. Burstow), that strategic health authorities or primary care trusts are so single-minded and blinkered that they believe that they have to preserve their vested interests, if that is what they perceive their responsibilities to be, to the exclusion of all else. My experience of the individuals in my strategic health authority or, indeed, PCT is that they are more than aware that there has to be particularly close working with social services on such issues to ensure that the patient drives the reforms in the NHS.
I wish to ask my hon. Friend the Minister a question, and I hope that she can reassure me. It would be good if the chairmen of the panels were independent, but whomsoever serves on them, it is important that someone must speak for patients and carers. One of the
Mr. Waterson: I find myself agreeing with much of what the hon. Member for Hampstead and Highgate (Glenda Jackson) has just said. I hope that that will not cause too much damage to her socialist credentials. She is absolutely right. If nothing else, the Bill is consistent, and anyone with any optimism turning to a clause headed XDispute resolution" is going to be severely disappointed because all that the Bill is concerned about is arguments between two or more public authorities. The words Xpatient" and Xcarer" are simply missing again. This provision involves two faceless bureaucracies fighting it out in front of a panel. That disappointment is reflected in the comments of Age Concern, which states that
I want to raise a few points about the practicalities of the proposals, particularly in view of all the bureaucracy involved, and I endorse some of the points already made on that by the hon. Member for Sutton and Cheam (Mr. Burstow). The proceedings of this panel have the smell of something that could go on for a long time, with all the arguments going on between the public authorities, so there is no prospect of any quick decisions being taken. There is certainly nothing here for the patient or carer who says that what is being proposed for them for today, tomorrow or next week is inappropriate, and who wants someone else to appeal to. I do not believe that that kind of time scale is being envisaged, although if the Minister thinks otherwise, she will no doubt say so.
Amendments were also tabled in Committee at the behest of Age Concern and Help the Aged about having a fast-track complaints process for just this kind of situation, but, as is so often the case nowadays, they did not get debated due to time constraints. Age Concern also reflects concerns that have been expressed by at least two hon. Members in this debate when it asks whether