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11.22 pm

The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): I begin by congratulating the hon. Member for Eddisbury (Mr. O'Brien) on securing this debate. I know that this is an issue in which he has taken great interest; indeed, he has pursued it on several occasions. I am also grateful to him for giving me my first opportunity to come to the Dispatch Box. If one is to get over first night nerves, it is better to do so in the calm environment of an Adjournment debate than in the bear pit of Question Time. I was not quite so keen on his description of the reshuffle as botched, however; from my point of view it was astute and far-sighted. Nor was I too keen on his describing me as hapless, but I suppose that that fits with the description of me in the Daily Mirror as obscure.

The hon. Gentleman raised several issues of concern relating to community health councils in Cheshire that I shall try to deal with in the time available. If I do not manage to deal with them all, I will give him answers if he writes to me about them. Indeed, I shall certainly read the account of our debate to check whether I missed anything that I should have dealt with.

I should perhaps remind the House about what we are doing and why we are doing it. Several of those who intervened gave me the impression that they are perhaps not fully aware of the full range of methods that we are putting in place to involve patients. Because the national health service is publicly funded, in our view the public have the right to be involved and consulted about how services are delivered.

Through the new arrangements, the Government are moving the NHS into a new era of patient involvement whereby patients themselves are the watchdogs of the NHS. In future, involving the public will become the norm.

In the past, the community health councils have indeed been the principal NHS watchdog for nearly 30 years. Frankly, however, empowering the public to speak up for themselves or providing opportunities for them to do so was never part of the CHCs' remit. A CHC might have found mechanisms to do so in some areas, but not in others. It is also worth pointing out that CHCs never had an obligation to follow up complaints on behalf of patients. Again, they did it very well in some areas, and not so well or not at all in others.

Our programme of improvement addresses issues of influence, control and accountability for patients and the public across the NHS and beyond. We do not underestimate the task of ensuring that patients and the public have greater influence and control. Change will not happen overnight. Our aim is to put in place a programme that will stand the test of time. Neither do I underestimate—in response to what the hon. Member for Macclesfield (Sir Nicholas Winterton) said—the work that CHCs have done, nor the quality of the contribution made by some CHC teams, including the Cheshire team, in the past. We expect much of the expertise and knowledge of staff and members to be of benefit to the new system.

However, the programme of change aims to achieve a cultural shift in which patient and public involvement is real and meaningful, so it will have to be more than just passing on knowledge and experience. The new mechanisms for patient and public involvement will enable patients to be as involved as they want to be in decisions about their care and enable communities to be involved in their local health service in a way that they have hitherto been unable to do.

Mr. Osborne: The Minister is new to the job and the civil servants have not yet got their claws into him. Surely he does not believe the rubbish that he is reading out to us. Should he not take an early ministerial decision and restore CHCs, at least in Cheshire.

Dr. Ladyman: No, I should not take that decision, because I honestly believe that the new system leaves us with a range of mechanisms for involving the public and will, for the first time, allow them to stand up and have their say in a way that was not possible with CHCs.

If I explain the various steps that we are taking, perhaps Opposition Members will become more convinced. The key is to put the patient at the centre of everything that the NHS does. In that way, we are trying to deliver our modernisation programme as set out in the NHS plan and we also want to respond to the Bristol Royal Infirmary inquiry report, which recommended representation of patient interests "on the inside" of the NHS and at every level. That is exactly what we have put in place.

The new system for patient and public involvement system will be achieved through trust, community and national arrangements, which have already started. The Commission for Patient and Public Involvement in Health, in operation since 1 January, will represent the patients' voice nationally and establish its nine regional offices. It is the first ever national body representing patients. Local authority overview and scrutiny committees will be scrutinising the NHS, and they have had those powers since January 2003. That is also a new power and it has been long sought by local councils. Speaking as a former local councillor, I know that it is a power and a duty that local councils have wanted for a long time—and they will have it in the future.

The NHS will also carry out its new duty to involve and consult the public, which has been a legal requirement since January 2003. Patient advice and liaison services have been in place for some time now and exist in almost all trusts. Again, PALS are a new organisation. In Cheshire, for example, PALS are in place in many NHS trusts—the Cardiothoracic Centre, North Cheshire hospitals, the Cheshire and Wirral partnership, the Clatterbridge Centre for Oncology, the Countess of Chester, the Mersey Regional ambulance service, the Eastern Cheshire trust and others. In addition, primary care trusts in Halton, Birkenhead and Wallasey, Bebington and West Wirral, Cheshire West and Central Cheshire all have PALS in place.

In addition, we will have a new structured monitoring of the NHS by the Commission for Health Improvement and by patient environment and action teams. There will also soon be independent support for complainants from the independent complaint advocacy services. Pilots are running already in 60 per cent. of the country. A new national system is planned from September. That is new, and part of legislation.

A national helpline has been set up by the Commission for Patient and Public Involvement in Health, which will provide advice, information and signposting for the public about where to get independent complaint and advocacy services and other support. Again, that will be new. The local network providers, supporting patients' forums, will act as one-stop shops for patients and they will be in place from September and will also be established by the CPPIH. The new patients forums—one for each of the 571 trusts will be in place from December to monitor and review the NHS and do much more. In other words, more than 500 patient-centred bodies will be set up to replace the180 CHCs.

NHS trusts and primary care trusts will have patient advice and liaison services, providing on-the-spot help and information about health services. In addition, they tell people about the independent complaints advocacy services that are available. PALS are already up and running in all but a handful of trusts. Patients' forums will be set up for every NHS trust and PCT to influence the day-to-day operation of health services by the trust. The commission has committed to have those in place across the country by 1 December.

The Commission for Patient and Public Involvement in Health will establish, support and facilitate the co-ordination of patients' forums. The forums of PCTs will, in due course, when they have settled down in their role, have the responsibility to provide independent complaints advocacy services and commission them where appropriate. In each community, patients' forums will be a key resource for local people, helping and supporting community groups and promoting better public involvement.

Mr. Stephen O'Brien: The Minister has described the aspirations for what should come after CHCs, but that has been delayed. What really matters is the manner in which the whole issue has been handled, and all that people want to hear is an apology for all the distress and upset.

Dr. Ladyman: The hon. Gentleman should think about who we were responding to when we extended the life of CHCs by three months. Among many others, it was the Opposition, here and in the other place, who said that we should extend the life of the CHCs by three months. The Government's view was that we would have a structure in place by 1 September to replace the CHCs, but the Opposition said, "Do something extra for the transition. Try to take extra steps." So we put in place a belt and braces process and extended the CHCs for three months—

The motion having been made after Ten o'clock, and the debate having continued for half an hour, Madam Deputy Speaker adjourned the House without Question put, pursuant to the Standing Order.



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