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1 Apr 2003 : Column 894—continued
Sir Michael Spicer: We certainly try to use those meetings to do so. I have certainly attended a public meeting on the consultation process. The point that we are making is that people have no option. The outcome is a fait accompli, and people are told, "This is what we are going to do." I should have thought that the first point of consultation is to be given some figures, but we are given no figures, time scales or facts; nor are we given any options. I assure the Minister that I have personally attended one of those public meetings, and the process is pretty well pointless because the whole thing is tied up before people get there.
Mr. Lammy: I hear the sentiment with which the hon. Gentleman makes that suggestion, but there are clearly differences of opinion about the nature of the consultation. I hope that he will forgive me—I do not want to be facetious—but he says that the outcome is a fait accompli, which does not fit with a process that is still continuing. Something cannot have come to an end if it is still going on. This is about consultation and getting involved, and it is about doing so to the best effect, as hon. Members seek to do on behalf of their constituents across the country.
To facilitate health scrutiny, the Act places three key obligations on the NHS: to provide information to overview and scrutiny committees; to consult on the substantial variation and development of services; and to provide for senior NHS officials to attend meetings to explain their decisions. On top of that, the committees have a specific right to refer the proposals to the Secretary of State if they consider that public involvement has been inadequate or that the proposal is flawed. The arrangements exist. Although they exist at some distance from the consultation period, the arrangements are available if there are local remedies. That must be right in what is, after all, a national health service.
Public interest is highest when proposals are made to reconfigure services. That is why we have also set up the independent reconfiguration panel. The panel will tackle complex and sensitive contested reconfigurations, referring in particular to "Strengthening Accountability" and "Keeping the NHS local—a new direction of travel". It will consider how the process of involving and consulting patients and the public was carried out to ensure that involvement has been an inclusive process.
The panel—made up of key stakeholders, a third of whom will be patient representatives—will provide authoritative advice to the Secretary of State on any proposed NHS service reconfigurations or significant service change that he asks it to consider. I should like
to clarify at this point that it is for the Secretary of State to ask the panel to consider a case. Overview and scrutiny committees have a power to refer decisions to the Secretary of State, and he will then decide whether to seek further advice. Only those contested proposals in which it is clear that all other options have been exhausted are likely to be referred to the panel for detailed consideration. The panel is very much the final option.
Sir Michael Spicer: This is an interesting and helpful passage in the Minister's speech. As I understand it, he is saying that the Secretary of State can call a matter in if he does not think that all options have been assessed properly and consulted upon. The Secretary of State can take his own position, and this is a useful precursor to that process.
Mr. Lammy: The hon. Gentleman will have heard me set out the course that is available to hon. Members and their constituents in such circumstances. On personal involvement, I have also made it clear that I am advised that consultations are taking place, and the hon. Gentleman takes no issue with that. Let that consultation take its due course. Clearly, other hon. Members and their constituents who have taken an interest in the matter see a difference in what is occurring. It is accepted that there is a deficit in the community, and the Government are doing all that they can to assist with allocations not just in the hon. Gentleman's area but right across the country. Record allocations of above the rate of inflation have been made to PCTs to assist in that endeavour. We are also supporting local people.
I have set out—yes, partly in legalese—what is available should things go wrong. However, despite all that has been said about the services, the PCTs are seeking to retain and enhance them. Given the money going in and the consultation that is at its midway point, the hon. Gentleman's conclusions may be a little premature.
Sir Michael Spicer: The advice that the Minister is giving the House is extremely interesting. If all options have not been considered in the consultation, that would provide a case for the Secretary of State to call a matter in. The law that the Minister has set down is that all options have to be considered, and certainly at the final phase. Is he saying that, if all options were not considered, that would be a serious matter and cause for the Secretary of State to call a matter in?
Mr. Lammy: I have set those arrangements out very clearly. Things are moving on at a pace in the hon. Gentleman's area, and I encourage him to support the health community's endeavours. I know, from Hansard and other sources, that the hon. Gentleman is committed to Malvern hospital and his local community. He will know that it is possible to jump to conclusions and to raise fears before the results of a consultation are complete. I ask him to engage in the process, to support the Government and to work closely with my hon. Friend the Member for Worcester.
Mr. Foster: I am conscious that we are running out of time, so I thank my hon. Friend for giving way. Does he
think that constituents, interest groups and communities have options for the future of Pershore and Malvern hospitals which they think are suitable? Will he urge them to make those options public and to include them in the consultation process while it is still ongoing, so that they can be duly considered and any recourse to the Secretary of State becomes a long stop that is not appropriate to this particular consultation?
Mr. Lammy: Absolutely. I say unequivocally that people should be involved in the process and support what is, at the end of the day, devolution in the NHS. It cannot be right that the buck stops with Whitehall. As a Minister, I am a moderniser in that respect. I want decisions to be made locally, not here. I certainly support my hon. Friend in that endeavour.
Mr. Luff: I am trespassing on the hon. Gentleman's generosity, and I am grateful to him for giving way. I agree with much of what he is saying now, so we are ending on a note of consensus, which is marvellous. How can my constituents engage with one service at Malvern, the pulmonary rehabilitation service, about which the document says:
- "This is being reviewed separately within the PCT"?
Mr. Lammy: As I have indicated, where there is a substantial change under section 11, there is a duty to consult through overview and scrutiny. I advise the hon. Gentleman to return to his community with "Strengthening Accountability", which includes my preface, and to take the matter up with them. The thrust of my remarks has been that these decisions must be made locally.
Sir Michael Spicer: The Minister has been extremely generous and rather charming in the last parts of his speech, so I feel bad about pressing him on another point.
The Minister was pressed by the hon. Member for Worcester to say that we should all become deeply engaged in this process of consultation, and we are. Our problem, which I suspect the Minister and the Secretary of State may share, is that we have not been given alternatives with which we can engage. We have been offered just one option, so we can only say yes or no. If the Minister is suggesting that we should be offered alternatives through the consultation process, will he please let that be known to the PCT? That would be an important step forward, and it would certainly solve many of our problems.
Secondly, will the Minister make it clear that if those options do not exist or are not presented during the consultation, that will be cause for the Secretary of State to call the matter in?
Mr. Lammy: The hon. Member has been here for some time, and is seeking to draw me into the detail of
the process, but as a new and diligent Minister, it is important that I am not drawn into that detail. The consultation is under way and the hon. Gentleman, as I have encouraged him to do, should be in close contact with his PCT—I know that he is. What I have said about the process is on the record in Hansard and is available in the Department's documents on patient and public involvement in health.Finally, as the Minister responsible for patient and public involvement in health, I want to say that we are spending more funds on this issue than ever before in the history of the NHS. Whether it is patient advice and liaison services in our local hospitals, the patients forums that will be at the heart of our local communities, or section 11 of the 2001 Act, which makes provision for overview and scrutiny committees, we are spending more funds because we believe in democratic accountability and want it to be at the heart of our NHS. I repeat that I am proud that the Government have moved in that direction. It would be wrong for me to undermine that democratic and local decision making from the Dispatch Box.
Finally, I mentioned the Government's document "Keeping the NHS local," which states that hospital services need to change if we are to continue to meet patients' needs and improve access to local services. Biggest is not always best—we recognise that patients
want more, not fewer, local services. Our approach is based on three core principles that all health organisations embarking on service change must now follow. The first principle is about developing options with people, not for them, building on the new legal framework for patient and public involvement in health, which I have set out. The second is about exploiting the opportunities for service redesign and developing new ways of working to keep services local, sometimes keeping people in their homes rather than in a residential care setting. The third is about taking a whole systems view, with different health and social care organisations in a locality working together in a mutually supportive way.I expect the PCT to take account of the various forms of guidance available, and I hope that the hon. Member for West Worcestershire is ultimately reassured that a decision will be made in the right manner in the coming months. I recommend that the hon. Gentleman continue to press his views and concerns with the PCT, as well as with the strategic health authority, to ensure that proper scrutiny is undertaken, and that massive investment in health care in south Worcestershire under the Government brings about real changes in people's experience of the NHS.
- Adjourned accordingly at twenty-eight minutes past Seven o'clock.
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