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Sir Nicholas Winterton (Macclesfield): As my hon. Friend knows, I have tremendous respect for the CHC in Macclesfield, which has been staffed by professionals, and to which many local people have given up a great deal of time. Is not the truth of the matter that the Government have been frightened of the success and efficiency of the CHCs and the way in which they have represented the best interests of patients?

Mr. O'Brien: Indeed it is. Given that there are more than 100 CHCs across the country, it is inevitable that the performance will be patchy, but we have excellent CHCs in Cheshire. There was no need for the Government to throw out excellence for the sake of dogma, or to try to put something in its place simply because they could rely on one or two examples that were not up to the excellent standard set by Cheshire.

Another reason why the Labour Government said they wanted to scrap CHCs was to bring in more local community representation in their replacements. The Government have ditched that provision in their recent legislative proposals and, worse, removed the mandatory requirement for local patients forums to monitor their local trusts. So far, the Government have made no resources available for this monitoring role. I have received a letter from the chief officer of Chester and Ellesmere Port CHC, Mr. Geoff Ryall-Harvey, who says:

"You will be aware that the scrutiny and monitoring function of CHCs should be taken over by Local Authority Overview and Scrutiny Committees. The Cheshire CHCs have worked very closely with Cheshire County Council and the County Council has developed an excellent proposal to set up their OSC structure. Unfortunately, the Department of Health has been extremely vague over the months about the detailed arrangements for the function of OSCs and, particularly, about what resources might be available. We have now been informed that the establishment and operation of an OSC is a power and not a duty."

So there is no obligation to replace the CHCs, which were already functioning very well.

Mr. Ryall-Harvey's letter continues:

"We are concerned that in the absence of new funding for OSCs they will simply not be established in many areas. In Cheshire, having regard to the County Council's"—

various priorities—

"it is likely to delay its progress in establishing an OSC until these difficulties are resolved."

He goes on to say that that is probably the case across the country. He continues:

"You will recall that OSCs were part of the package that the Government offered in order to get its legislation on the abolition of CHCs through the Commons and the Lords last year."

He is particularly tilting at the various Labour rebels who were determined to give this matter a bit of attention, but who were bought off. However, this provision at least became part of the package. He goes on:

"I would suggest that if parliamentarians had known that these particular measures for the replacement of CHCs were an option and not a duty then they would not have withdrawn their opposition. I also seem to recall that the Government gave an undertaking that CHCs would not be replaced until there were robust new structures in place to take on the various aspects of their role. Does this mean that CHCs will remain in those areas where the local Social Services Authority has not set up an OSC?"

He then asks

"whether it will be possible to make the Minister honour his earlier promises".

Of course, I exonerate the present Minister from having to live up to the promises made on this subject by the string of Ministers who have preceded him. Given that all this started with the Prime Minister having to correct an answer that he gave me at Prime Minister's Question Time, the precedent is not good, however.

Mr. George Osborne: My hon. Friend is making an excellent speech, and I am only sorry that the Prime Minister has not turned up to listen to it. Is my hon. Friend aware that many of my constituents have written to me to say that they are not sure who they will be able to complain to once the CHCs go? There is considerable confusion among the people I represent as to exactly what the Government have in mind to replace CHCs.

Mr. O'Brien: My hon. and neighbouring Friend makes an exceptionally important and valid point. Indeed, my constituents have expressed the same concern. Part of the problem is that it is not only potentially vulnerable patients, but the whole country that feels that it has been duped yet again by the Government on this issue.

My hon. Friend the Member for Woodspring (Dr. Fox) has said:

"The Government has utterly betrayed CHCs, those who work in and depend on them, and those who accepted at face value the Government's promises on what would replace them . . . The abolition of CHCs is not only unwelcome, but indefensible. The morale of GPs and other health professionals is known to be at an all time low. Removing an established, successful and independent method for patients to raise concerns is hardly likely to improve matters. Worse still, to do so out of spite, in order to silence a potential critic of Government policy, adds insult to injury. Patients' Forums will"—

of course, that is now "may", rather than "will"—

"be acting as monitors, and reporting back to Trusts. This does not constitute a direct relationship with the patient. And we know from the Government that PALS will not be a complaints service. Labour doesn't care about patients' rights. The NHS can be a bewildering institution, and it is absolutely vital that patients are able to navigate their way through the maze. Having to work out which of sixteen bodies they should turn to will be hugely unhelpful."

This precisely confirms the point made by my hon. Friend the Member for Tatton.

Ann Winterton (Congleton): Does my hon. Friend agree that it is essential that patients should have confidence in the national health service and in the services that are provided locally? Does he agree that the Government have kicked this issue into touch by getting rid of the one body that has been effective in putting forward the fears of patients, and, so far as we know, replacing it with absolutely nothing? Will this not be most damaging to the confidence of patients?

Mr. O'Brien: My hon. Friend is absolutely right. Not only do the replacements lack independence, but CHCs did good work on the casualty watch survey, monitoring the position on trolleys and beds. That was part of their tremendous added value. They were able to give patients, often vulnerable patients, the feeling that they could have confidence in the NHS but that was only because it was accountable through an independent body.

While I believe that the Government's decision to scrap CHCs has always been stubborn, spiteful and wrong-headed, we have to move to the present crisis as closure looms. With staff and volunteers managing casework and doing their best to secure an orderly transition, the Government are acting in a crass and totally incompetent manner, as predicted, and as predictable as the Government's shambles and incompetence on their tax credit system.

In politics, it is said that there are no rewards for saying, "I told you so" but perhaps the Minister, the media and vulnerable patients throughout the country, especially my constituents in Cheshire and those of my hon. Friends in other parts of Cheshire and Shropshire, will listen to Mrs. Jean French, chief officer of the Cheshire Central CHC. She wrote to me on 5 June and said:

"Dear Stephen


Whitehall Farce—Final Act


You've no doubt heard that, yet again, CHCs have been seriously disrupted, distressed and dismayed by a ministerial decision.


In the light of criticism of the gap between the closure of CHCs and the coming on-line of Patients' Forums, a decision has been taken not to concentrate resources on developing the new system but to waste money requiring CHCs to continue to fulfil their statutory duties for three months beyond the announced closure date.


This smacks of unbelievable incompetence.


Yet again, we were not informed in a proper manner. Staff had been told they would receive redundancy notices by the end of May in line with the closure of CHCs on 1 September. When these did not arrive by 31 May, we suspected a problem. We were then left speculating what was happening until yesterday, 4 June when it was announced that the new closure date would be 1 December.


As you would expect from any reasonably efficient organisation, CHCs, having been given 6 months notice of closure at the end of January 2003, embarked on a sensible, structured exit strategy. This is well underway now. Some staff have left for new jobs; files are being sorted through for shredding or archiving; contracts for equipment on lease have been given notice of termination; final monitoring projects have been written-up and submitted to Trusts for comment and action. We have a farewell event for members booked for mid-July. By ironic coincidence, our final Annual Report came back in first draft from the printer yesterday. Also yesterday, we held what should have been our final public meeting!


This process cannot now be reversed. We have reached the end of our monitoring and visit programme before the summer break for members. July and August were to have been spent clearing the office. The community drugs team is waiting for our premises to be vacated so they can have more office space for their expanding staff.


Three further months 'to continue the monitoring function' would be a farce. Some CHC Members are likely to resign in protest. Others will become members of local authority Health Scrutiny Committees—another of the mechanisms set up"

partly

"to replace CHCs. They believe this makes them ineligible for continued membership of the CHC. (The Minister has not addressed this point.) We have been told not to take on any more NHS complaints work after the end of May. This instruction has not been countermanded"

by the Department of Health.

"A national Independent Complaints Advocacy Service was promised from 1 September. Do we restart complaints work now? Will there be a new service in September? (The Minister has not addressed these points.)


I enclose a copy of the Minister's letter to CHC Staff. He says he has decided 'to make the position absolutely"—

can hon. Members believe this?—

"unassailable'." Whose position and 'unassailable' from whom? Is he trying to protect himself from criticism?"

That is not me speaking but someone who is deeply affected by the Government's cack-handed attempts to try to manage their way out of a deeply embarrassing and needless problem. She goes on:

"Since the announcement of abolition in July 2000 which you will remember well, I have lost four members of staff, one of them a temporary replacement. I am lucky to have one member of staff still with me but there are CHCs with one or no members of staff. Also, I am lucky in having 20 loyal Members who have wanted to see the CHC through to the end but it is absurd for the Minister to pretend we can fulfil our statutory duties for a further 3 months. Remaining in existence would be mere tokenism in order for the Minister to save face.


Remaining in existence would also be a waste of public money. 700 staff will have to be paid for a further 3 months with more of them becoming entitled to redundancy payments during this time. (Staff who were taken on after the abolition announcement are now entitled to redundancy payments!!)"

The extra three months mean that public money has to be allocated, properly, but because of the Government's incompetence, the whole thing will cost taxpayers more. Mrs. French continues:

"The CHC budget for this year is shared with the new Commission for Patient & Public Involvement in Health. Money spent retaining CHCs as a token gesture would be money lost to the Commission for developing the new systems. This does not make sense."

She then mentions the appalling upheaval, disappointment and deep distress that have been caused. She says:

"We can have no trust in the competence of current decision-making in the Department of Health. The only reason can be that they see CHCs as too insignificant to care about. They are trading on the goodwill of caring volunteers. It is not acceptable.


The Minister has the power to change his mind . . . He has done it once. Dare he"—

the new Minister—

"be brave enough and sensible enough to do it again?"

She adds:

"Please, if you can . . . make use of this letter in any way to expose this government incompetence or to forward the cause of CHCs by arguing for a dignified and professional exit on 1 September— this year!"

That letter deserved a public airing, given this absolute outrage from the Government.

I replied to Jean French's letter, pointing out that the appalling way in which she had been dealt with was in stark contrast with Labour Ministers repeated claims of how much they value those who work in the NHS. Such comments lie ill in their mouths in the light of their actions in relation to CHCs.

At a stakeholders' meeting involving the Department of Health, the Association of Community Health Councils for England and Wales, CHCs and trade unions, Sharon Grant, the chairman of the Commission for Patient and Public Involvement in Health—the Government's supposed flagship replacement—did not turn up. Instead, the commission sent along someone who had been in her job for only eight days. What sort of commitment does that reveal on the part of a Government-created commission to deliver on the Government's promise to learn from the knowledge of CHCs' experienced staff? Despite what the Prime Minister said to me in November 2000, the commission has refused invitations from ACHCEW to discuss the transition. Now that they are being killed by this Government, CHCs want an effective transition, with a work programme that the commission must, in any case agree with the Department of Health. But no, this Government have ditched 28 years worth of the dedicated knowledge and experience of CHC staff without a care—just as they ditched 1,400 years of constitutional experience by trying to scrap the post of Lord Chancellor, botching the process in doing so. Even a trade union representative said today that he has never seen such a process handled this badly.

Things could have been different; there could have been negotiation and the process could have been orderly. The prolongation of the death of CHCs has led to more than the bitterness of 2000; now, there is real anger. What has it all been for? One need only read the miserable answers given by the former Under-Secretary of State for Health, the hon. Member for Tottenham to the Chairman of the Health Committee on 15 May. The hon. Gentleman admitted that patient advice and liaison services were at the front of the new system; however, they are not even independent. After ringing more than 100 areas in the past week in respect of PALs, ACHCEW found that just 51 have any form of telephone answering system. Of those, the telephone number given for independent complaints was—lo and behold—that for CHCs.

This is a travesty of decision making, and an illustration of the worst sort of administrative incompetence by this Government. My constituents, the people of Cheshire and those in the country as a whole will conclude that this Government's brutal, chaotic, stubborn and arrogant approach to the prolonged death of CHCs typifies all the reasons why the Government have breached the trust of the people; indeed, they care even less that they have done so. They should be giving a wholehearted apology, and agreeing to an inquiry in order to learn the lessons from this appalling administrative incompetence.

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