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15 Jan 2003 : Column 764—continued
Jacqui Smith: I am pleased that the hon. Member for West Chelmsford (Mr. Burns), in moving the amendment, recognised that it is right and responsible to have in place a system for dispute resolution, because, of course, disputes can already exist between health and social services. In fact, it is sometimes precisely because of such disputes that people are delayed inappropriately in hospital. Through the Bill, we are trying to ensure
that the relative responsibilities of health and social services are clearly understood and that there is a process to ensure that individuals are not stuck in hospital, losing out because disputes cannot be sorted out.I am not quite clear whether the hon. Member for Eastbourne (Mr. Waterson) was suggesting that people should not try to settle disputes before they reach the panel. Of course, that is the obvious way to settle them. Many disputes are settled between the staff concerned in an individual case of discharge or by managers from health and social care. Disputes do not inevitably need to be discussed formally by a panel and the guidance will point out that, for reasons of time and resources, it is desirable to have a system under which two public bodies are encouraged to reach an amicable agreement rather than have constant recourse to the panel.
Senior health and social services managers want to resolve matters, wherever possible, before spending time on dispute mechanisms, but we need a body that can arbitrate to achieve a satisfactory resolution if informal attempts to resolve problems are unsuccessful. In England, we think that the right body for that is the strategic health authority. The hon. Member for West Chelmsford repeated some of his concerns about whether that will create a bias to the NHS. I do not believe that it will. It is a practical response to the situation and the system.
Strategic health authorities are, as the House would expect, strategic bodies. They do not have operational responsibility and they will not be running the acute hospital trusts that may be involved in a dispute. They have a performance management function one step removed from the day-to-day workings of the NHS. There is no equivalent strategic body for councils, so it makes sense for strategic authorities to be the bodies with responsibility for setting up the panels. They also have an interest in ensuring that acute trusts and PCTs meet their obligations, but not through rewarding the NHS at the expense of local authorities.
I hope that I can reassure Members that the intention is that the panel will be composed of a local authority and an NHS representative with an independent chair. I have confidence in the integrity of the people who will be appointed to that panel. Being charged with such a function, the panels will of course have to act properly and in accordance with the rules of natural justice . The regulations will ensure that panel members are not from the bodies that are in dispute, and that the chair is independent of both NHS and local authority. There is no reason to suppose, therefore, that the panel will look more favourably on the NHS than on local councils.
The regulations will also cover situations in which not all the bodies in dispute are located in the same strategic health authority. They will probably follow a simple rule, such as the rule that a dispute should be heard by the panel of the strategic health authority in whose area the hospital is situated.
Several Members have asked about the particular rights of individuals. Clause 6 does not affect an individual's right to complain to either the NHS or social services about the care he or she has received, using the normal complaints procedures already
established, or to take legal action in the courts. The panels are not being established to divert individuals from the complaints procedures—although when they or their families have information that may help to resolve a dispute, they may be involved.Perhaps I can give some reassurance, at least to my hon. Friend the Member for Hampstead and Highgate (Glenda Jackson), by describing some of the improved safeguards—especially those relating to advocacy, about which my hon. Friend was concerned. Individuals wanting to know whether they should receive fully funded continuing NHS care should be informed as part of the assessment process. As I said earlier, the single assessment process and all other guidance make it clear that that is the first question NHS and social services need to consider when assessing the ongoing needs of someone who, potentially, has a primary need for health care. If an individual wishes to dispute an NHS decision that he or she is not a case for fully funded NHS care, the decision should be made within two weeks, and the individual can remain in hospital while the continuing care panel considers the case.
If individuals wish to complain about the services offered by social services departments, that should be dealt with by the social services complaints system, which was established to enable individuals to make such representations. If they are not satisfied with the local authority's response, they can go to the local government ombudsman. If they are concerned about the whole care package and about whether it is safe for them to return home with that package, they should be able to raise that at an early stage with both NHS and social services representatives.
The current system requires all trusts to have patient advocacy liaison services to give exactly the kind of support demanded by my hon. Friend. People raising what will clearly be difficult issues may well need such support. The representatives I have mentioned may be able to change the package, or to reassure patients and their families about its adequacy. There may be further recourse to the complaints provision, which will depend on the nature of the concerns involved.
I hope I have reassured Members that our proposals are logical and sensible. I am not suggesting that the complaints procedure should be biased in favour of the health service; I am saying that the strategic health authority is the appropriate body to convene the complaints panel, which itself will be represented equally by the NHS and local authorities. It will also have an independent chair. Nothing about the panel will undermine what I agree is the important ability of individuals to raise concerns and complain when that is necessary.
5.45 pm
Mr. Burns: I listened carefully to the Minister, and I appreciate that she is seeking to reassure the House, but I remain unreassured. I get the impression that she is talking about an idealised world, but things do not work out that way in the real world. We should improve the Bill now rather than repent when it is too late.
No one doubts that dispute panels are needed. Heaven knows, we will need them if the Bill becomes law. However, I am still worried about making them the responsibility of the strategic health authorities—in
other words, the NHS, which has half of the vested interest in the problem. Even if every panel reached a judgment of Solomon in 100 per cent. of cases, the suspicion would remain among individuals and social services departments, if they did not like the decision that was reached, that a fair decision was impossible because of the way the panel was set up.I do not believe that there is a major difference between us on this matter, but I do not understand why the Minister has not agreed to bring the local authorities in to work on an equal footing with the strategic health authorities on the panels, subject to the regulations to be issued by the Minister. No accusation that the Government had fixed the system—and made the NHS, through the strategic health authorities, the judge and jury in a dispute—would then have an iota of justification.
I should have thought that the Minister would welcome my advice. I am only trying to help to improve and enhance a rotten Bill. Despite my entreaties, it seems that the Minister is not going to budge. I am hurt about that, but it is an unfortunate fact. As a result, I intend to press the amendment to a Division. I invite my hon. Friends to join me in the Aye Lobby in an attempt to save the Minister from herself.
Question put, That the amendment be made:—
The House divided: Ayes 198, Noes 318.
AYES
Ainsworth, Peter (E Surrey)
Allan, Richard
Amess, David
Ancram, rh Michael
Arbuthnot, rh James
Atkinson, Peter (Hexham)
Bacon, Richard
Baker, Norman
Barker, Gregory
Baron, John (Billericay)
Barrett, John
Beggs, Roy (E Antrim)
Beith, rh A. J.
Bellingham, Henry
Bercow, John
Blunt, Crispin
Boswell, Tim
Bottomley, rh Virginia (SW Surrey)
Brady, Graham
Brake, Tom (Carshalton)
Brazier, Julian
Brooke, Mrs Annette L.
Browning, Mrs Angela
Bruce, Malcolm
Burnett, John
Burns, Simon
Burnside, David
Burstow, Paul
Burt, Alistair
Cable, Dr. Vincent
Calton, Mrs Patsy
Cameron, David
Campbell, Gregory (E Lond'y)
Carmichael, Alistair
Cash, William
Chapman, Sir Sydney (Chipping Barnet)
Chope, Christopher
Clarke, rh Kenneth (Rushcliffe)
Clifton-Brown, Geoffrey
Collins, Tim
Cormack, Sir Patrick
Cotter, Brian
Cran, James (Beverley)
Curry, rh David
Davey, Edward (Kingston)
Davies, Quentin (Grantham & Stamford)
Davis, rh David (Haltemprice & Howden)
Dodds, Nigel
Dorrell, rh Stephen
Doughty, Sue
Duncan Smith, rh Iain
Evans, Nigel
Fabricant, Michael
Fallon, Michael
Field, Mark (Cities of London & Westminster)
Flight, Howard
Flook, Adrian
Forth, rh Eric
Foster, Don (Bath)
Fox, Dr. Liam
Francois, Mark
Gale, Roger (N Thanet)
Garnier, Edward
George, Andrew (St. Ives)
Gibb, Nick (Bognor Regis)
Gidley, Sandra
Gillan, Mrs Cheryl
Gray, James (N Wilts)
Grayling, Chris
Green, Damian (Ashford)
Green, Matthew (Ludlow)
Grieve, Dominic
Gummer, rh John
Hammond, Philip
Hancock, Mike
Harris, Dr. Evan (Oxford W & Abingdon)
Harvey, Nick
Hawkins, Nick
Hayes, John (S Holland)
Heath, David
Heathcoat-Amory, rh David
Hendry, Charles
Hermon, Lady
Hoban, Mark (Fareham)
Hogg, rh Douglas
Holmes, Paul
Horam, John (Orpington)
Howard, rh Michael
Howarth, Gerald (Aldershot)
Hughes, Simon (Southwark N)
Hunter, Andrew
Jack, rh Michael
Jackson, Robert (Wantage)
Jenkin, Bernard
Johnson, Boris (Henley)
Keetch, Paul
Key, Robert (Salisbury)
Kirkbride, Miss Julie
Kirkwood, Sir Archy
Knight, rh Greg (E Yorkshire)
Laing, Mrs Eleanor
Lait, Mrs Jacqui
Lamb, Norman
Lansley, Andrew
Laws, David (Yeovil)
Leigh, Edward
Lewis, Dr. Julian (New Forest E)
Liddell-Grainger, Ian
Lidington, David
Lilley, rh Peter
Llwyd, Elfyn
Loughton, Tim
Luff, Peter (M-Worcs)
McIntosh, Miss Anne
Mackay, rh Andrew
Maclean, rh David
McLoughlin, Patrick
Malins, Humfrey
Maples, John
Marsden, Paul (Shrewsbury & Atcham)
Mates, Michael
Mawhinney, rh Sir Brian
May, Mrs Theresa
Mercer, Patrick
Moore, Michael
Moss, Malcolm
Murrison, Dr. Andrew
Norman, Archie
Oaten, Mark (Winchester)
O'Brien, Stephen (Eddisbury)
Öpik, Lembit
Osborne, George (Tatton)
Page, Richard
Paice, James
Paterson, Owen
Pickles, Eric
Portillo, rh Michael
Price, Adam (E Carmarthen & Dinefwr)
Prisk, Mark (Hertford)
Pugh, Dr. John
Redwood, rh John
Reid, Alan (Argyll & Bute)
Rendel, David
Robathan, Andrew
Robertson, Hugh (Faversham & M-Kent)
Robinson, Mrs Iris (Strangford)
Robinson, Peter (Belfast E)
Roe, Mrs Marion
Rosindell, Andrew
Ruffley, David
Russell, Bob (Colchester)
Sanders, Adrian
Sayeed, Jonathan
Selous, Andrew
Shephard, rh Mrs Gillian
Shepherd, Richard
Simmonds, Mark
Simpson, Keith (M-Norfolk)
Smyth, Rev. Martin (Belfast S)
Soames, Nicholas
Spelman, Mrs Caroline
Spicer, Sir Michael
Spink, Bob (Castle Point)
Spring, Richard
Steen, Anthony
Streeter, Gary
Stunell, Andrew
Swayne, Desmond
Swire, Hugo (E Devon)
Syms, Robert
Tapsell, Sir Peter
Taylor, Ian (Esher)
Taylor, John (Solihull)
Taylor, Matthew (Truro)
Taylor, Dr. Richard (Wyre F)
Thomas, Simon (Ceredigion)
Thurso, John
Tonge, Dr. Jenny
Tredinnick, David
Turner, Andrew (Isle of Wight)
Tyler, Paul (N Cornwall)
Tyrie, Andrew
Viggers, Peter
Walter, Robert
Waterson, Nigel
Watkinson, Angela
Webb, Steve (Northavon)
Whittingdale, John
Widdecombe, rh Miss Ann
Wiggin, Bill
Willetts, David
Williams, Hywel (Caernarfon)
Williams, Roger (Brecon)
Willis, Phil
Winterton, Sir Nicholas (Macclesfield)
Yeo, Tim (S Suffolk)
Young, rh Sir George
Younger-Ross, Richard
Tellers for the Ayes:
Mr. David Wilshire and
Mr. Laurence Robertson
NOES
Abbott, Ms Diane
Adams, Irene (Paisley N)
Ainsworth, Bob (Cov'try NE)
Allen, Graham
Anderson, Janet (Rossendale & Darwen)
Armstrong, rh Ms Hilary
Atherton, Ms Candy
Atkins, Charlotte
Austin, John
Bailey, Adrian
Baird, Vera
Banks, Tony
Barron, rh Kevin
Beard, Nigel
Beckett, rh Margaret
Begg, Miss Anne
Bell, Stuart
Benn, Hilary
Bennett, Andrew
Benton, Joe (Bootle)
Best, Harold
Blackman, Liz
Blears, Ms Hazel
Blizzard, Bob
Borrow, David
Bradley, rh Keith (Withington)
Bradley, Peter (The Wrekin)
Bradshaw, Ben
Brennan, Kevin
Brown, Russell (Dumfries)
Bryant, Chris
Buck, Ms Karen
Burgon, Colin
Burnham, Andy
Cairns, David
Campbell, Alan (Tynemouth)
Campbell, Mrs Anne (C'bridge)
Campbell, Ronnie (Blyth V)
Casale, Roger
Caton, Martin
Cawsey, Ian (Brigg)
Challen, Colin
Clapham, Michael
Clark, Mrs Helen (Peterborough)
Clarke, rh Tom (Coatbridge & Chryston)
Clelland, David
Clwyd, Ann (Cynon V)
Coaker, Vernon
Coffey, Ms Ann
Cohen, Harry
Coleman, Iain
Connarty, Michael
Cook, Frank (Stockton N)
Cook, rh Robin (Livingston)
Cooper, Yvette
Corston, Jean
Cousins, Jim
Cox, Tom (Tooting)
Cranston, hon. Ross
Crausby, David
Cruddas, Jon
Cryer, Ann (Keighley)
Cummings, John
Cunningham, Jim (Coventry S)
Cunningham, Tony (Workington)
Darling, rh Alistair
Davey, Valerie (Bristol W)
David, Wayne
Davidson, Ian
Davies, rh Denzil (Llanelli)
Davies, Geraint (Croydon C)
Dawson, Hilton
Dean, Mrs Janet
Dhanda, Parmjit
Dismore, Andrew
Dobbin, Jim (Heywood)
Donohoe, Brian H.
Doran, Frank
Dowd, Jim (Lewisham W)
Drew, David (Stroud)
Drown, Ms Julia
Dunwoody, Mrs Gwyneth
Eagle, Angela (Wallasey)
Eagle, Maria (L'pool Garston)
Edwards, Huw
Efford, Clive
Ellman, Mrs Louise
Ennis, Jeff (Barnsley E)
Etherington, Bill
Field, rh Frank (Birkenhead)
Fisher, Mark
Fitzpatrick, Jim
Fitzsimons, Mrs Lorna
Flint, Caroline
Flynn, Paul (Newport W)
Follett, Barbara
Foster, rh Derek
Foster, Michael (Worcester)
Foster, Michael Jabez (Hastings & Rye)
Francis, Dr. Hywel
Gapes, Mike (Ilford S)
Gardiner, Barry
George, rh Bruce (Walsall S)
Gerrard, Neil
Gibson, Dr. Ian
Gilroy, Linda
Godsiff, Roger
Goggins, Paul
Griffiths, Jane (Reading E)
Griffiths, Win (Bridgend)
Grogan, John
Hall, Mike (Weaver Vale)
Hall, Patrick (Bedford)
Hamilton, David (Midlothian)
Hanson, David
Harman, rh Ms Harriet
Harris, Tom (Glasgow Cathcart)
Healey, John
Henderson, Doug (Newcastle N)
Henderson, Ivan (Harwich)
Hendrick, Mark
Hepburn, Stephen
Heppell, John
Hesford, Stephen
Hill, Keith (Streatham)
Hodge, Margaret
Hoey, Kate (Vauxhall)
Hood, Jimmy (Clydesdale)
Hope, Phil (Corby)
Hopkins, Kelvin
Howarth, rh Alan (Newport E)
Howarth, George (Knowsley N & Sefton E)
Howells, Dr. Kim
Hughes, Beverley (Stretford & Urmston)
Hughes, Kevin (Doncaster N)
Humble, Mrs Joan
Hutton, rh John
Iddon, Dr. Brian
Irranca-Davies, Huw
Jackson, Glenda (Hampstead & Highgate)
Jackson, Helen (Hillsborough)
Jamieson, David
Jenkins, Brian
Johnson, Miss Melanie (Welwyn Hatfield)
Jones, Helen (Warrington N)
Jones, Jon Owen (Cardiff C)
Jones, Kevan (N Durham)
Jones, Lynne (Selly Oak)
Jones, Martyn (Clwyd S)
Joyce, Eric (Falkirk W)
Kaufman, rh Gerald
Keeble, Ms Sally
Keen, Alan (Feltham)
Keen, Ann (Brentford)
Kemp, Fraser
Kidney, David
Kilfoyle, Peter
King, Andy (Rugby)
King, Ms Oona (Bethnal Green & Bow)
Knight, Jim (S Dorset)
Ladyman, Dr. Stephen
Lammy, David
Laxton, Bob (Derby N)
Lazarowicz, Mark
Lepper, David
Leslie, Christopher
Levitt, Tom (High Peak)
Lewis, Ivan (Bury S)
Lewis, Terry (Worsley)
Liddell, rh Mrs Helen
Linton, Martin
Lloyd, Tony (Manchester C)
Love, Andrew
Lucas, Ian (Wrexham)
Luke, Iain (Dundee E)
Lyons, John (Strathkelvin)
McAvoy, Thomas
McCabe, Stephen
McCafferty, Chris
McDonagh, Siobhain
MacDonald, Calum
MacDougall, John
McFall, John
McGuire, Mrs Anne
McIsaac, Shona
McKechin, Ann
McKenna, Rosemary
McNamara, Kevin
McNulty, Tony
Mactaggart, Fiona
McWalter, Tony
Mahmood, Khalid
Mallaber, Judy
Mann, John (Bassetlaw)
Marris, Rob (Wolverh'ton SW)
Marsden, Gordon (Blackpool S)
Marshall, David (Glasgow Shettleston)
Marshall, Jim (Leicester S)
Martlew, Eric
Meacher, rh Michael
Meale, Alan (Mansfield)
Merron, Gillian
Michael, rh Alun
Milburn, rh Alan
Miliband, David
Miller, Andrew
Moffatt, Laura
Mole, Chris
Moonie, Dr. Lewis
Moran, Margaret
Morgan, Julie
Morley, Elliot
Morris, rh Estelle
Mountford, Kali
Mudie, George
Mullin, Chris
Munn, Ms Meg
Murphy, Denis (Wansbeck)
Murphy, Jim (Eastwood)
Murphy, rh Paul (Torfaen)
Naysmith, Dr. Doug
Norris, Dan (Wansdyke)
O'Brien, Bill (Normanton)
O'Brien, Mike (N Warks)
O'Hara, Edward
Organ, Diana
Osborne, Sandra (Ayr)
Owen, Albert
Palmer, Dr. Nick
Picking, Anne
Pickthall, Colin
Pike, Peter (Burnley)
Plaskitt, James
Pollard, Kerry
Pond, Chris (Gravesham)
Prentice, Ms Bridget (Lewisham E)
Prentice, Gordon (Pendle)
Primarolo, rh Dawn
Prosser, Gwyn
Purchase, Ken
Purnell, James
Quin, rh Joyce
Quinn, Lawrie
Rapson, Syd (Portsmouth N)
Reid, rh Dr. John (Hamilton N & Bellshill)
Robinson, Geoffrey (Coventry NW)
Rooney, Terry
Ross, Ernie (Dundee W)
Roy, Frank (Motherwell)
Ruane, Chris
Ruddock, Joan
Russell, Ms Christine (City of Chester)
Ryan, Joan (Enfield N)
Savidge, Malcolm
Sawford, Phil
Sedgemore, Brian
Shaw, Jonathan
Sheerman, Barry
Sheridan, Jim
Shipley, Ms Debra
Simon, Siôn (B'ham Erdington)
Singh, Marsha
Skinner, Dennis
Smith, Angela (Basildon)
Smith, rh Chris (Islington S & Finsbury)
Smith, Geraldine (Morecambe & Lunesdale)
Smith, Jacqui (Redditch)
Smith, John (Glamorgan)
Smith, Llew (Blaenau Gwent)
Soley, Clive
Southworth, Helen
Squire, Rachel
Starkey, Dr. Phyllis
Steinberg, Gerry
Stevenson, George
Stewart, David (Inverness E & Lochaber)
Stewart, Ian (Eccles)
Stinchcombe, Paul
Stoate, Dr. Howard
Strang, rh Dr. Gavin
Sutcliffe, Gerry
Tami, Mark (Alyn)
Taylor, rh Ann (Dewsbury)
Taylor, Dari (Stockton S)
Taylor, David (NW Leics)
Thomas, Gareth (Clwyd W)
Thomas, Gareth (Harrow W)
Timms, Stephen
Tipping, Paddy
Todd, Mark (S Derbyshire)
Touhig, Don (Islwyn)
Trickett, Jon
Truswell, Paul
Turner, Dennis (Wolverh'ton SE)
Turner, Dr. Desmond (Brighton Kemptown)
Twigg, Derek (Halton)
Twigg, Stephen (Enfield)
Tynan, Bill (Hamilton S)
Vaz, Keith (Leicester E)
Vis, Dr. Rudi
Walley, Ms Joan
Ward, Claire
Wareing, Robert N.
Watts, David
White, Brian
Whitehead, Dr. Alan
Wicks, Malcolm
Williams, rh Alan (Swansea W)
Williams, Betty (Conwy)
Wills, Michael
Winnick, David
Wood, Mike (Batley)
Woodward, Shaun
Worthington, Tony
Wright, Anthony D. (Gt Yarmouth)
Wright, David (Telford)
Wright, Tony (Cannock)
Wyatt, Derek
Tellers for the Noes:
Mr. Phil Woolas and
Mr. Nick Ainger
Question accordingly negatived.
It being after Six o'clock, Mr. Deputy Speaker proceeded to put forthwith the Questions necessary for the disposal of the business to be concluded at that hour, pursuant to Standing Order No. 9 and to Orders [29 October and 28 November 2002].
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